{"reporting_entity_name":"Molina-Healthcare-of-SouthCarolina","reporting_entity_type":"health insurance issuer","last_updated_on":"2026-10-28","version":"2.0.0","provider_references":[{"provider_group_id":237949,"network_name":["SC Network"],"provider_groups":[{"npi":[1396129201],"tin":{"type":"ein","value":"474491361","business_name":null}}]}],"in_network":[{"negotiation_arrangement":"ffs","name":"Ambulatory Surgical Care - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0490","description":"Ambulatory Surgical Care","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Ambulatory Surgical Care - Other","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0499","description":"Ambulatory Surgical Care","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"CT Scan - Body Scan","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0352","description":"CT Scan","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":618.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"CT Scan - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0350","description":"CT Scan","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":618.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"CT Scan - Head Scan","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0351","description":"CT Scan","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":618.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"CT Scan - Other CT Scans","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0359","description":"CT Scan","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":618.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Cardiology - Cardiac Cath Lab","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0481","description":"Cardiology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2500.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Cardiology - Echocardiology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0483","description":"Cardiology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2500.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Cardiology - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0480","description":"Cardiology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2500.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Cardiology - Stress Test","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0482","description":"Cardiology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2500.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Clinic - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0510","description":"Clinic","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Emergency Room - EMTALA Emergency Medical Screening Services","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0451","description":"Emergency Room","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":3800.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Emergency Room - ER Beyond EMTALA Screening","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0452","description":"Emergency Room","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":3800.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Emergency Room - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0450","description":"Emergency Room","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":3800.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Emergency Room - Other Emergency Room","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0459","description":"Emergency Room","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":3800.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Emergency Room - Urgent Care","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0456","description":"Emergency Room","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":250.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":325.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":3800.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]},{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Extra-Corporeal Shock Wave Therapy - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0790","description":"Extra-Corporeal Shock Wave Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Gastrointestinal Services - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0750","description":"Gastro-Intestinal (GI) Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Gastrointestinal Services - Reserved","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0759","description":"Gastrointestinal Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Bacteriology & Microbiology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0306","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Chemistry","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0301","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0300","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Hematology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0305","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Immunology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0302","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Nonroutine Dialysis","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0304","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Other Laboratory","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0309","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Renal Patient (Home)","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0303","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Laboratory - Urology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0307","description":"Laboratory","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Lithotripsy - Reserved","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0799","description":"Lithotripsy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRI - Other MRT","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0619","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0610","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - MRA - Head and Neck","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0615","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - MRA - Lower Extremities","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0616","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - MRA - Other","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0618","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - MRI - Brain/ Brain stem","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0611","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - MRI - Other","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0614","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - Reserved","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0613","description":"Magnetic Resonance Technology(MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT - Reserved","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0617","description":"Magnetic Resonance Technology(MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"MRT- MRI - Spinal Cord/Spine","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0612","description":"Magnetic Resonance Technology (MRT)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":924.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Medical/Surgical Supplies and Devices - Intraocular Lens","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0276","description":"Med/Surg Supplies &Devices (also see 062x, extension of 027x","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Medical/Surgical Supplies and Devices - Other Implants","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0278","description":"Med/Surg Supplies &Devices (also see 062x, extension of 027x","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Medical/Surgical Supplies and Devices - Pacemaker","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0275","description":"Med/Surg Supplies &Devices (also see 062x, extension of 027x","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Medical/Surgical Supplies and Devices - Prosthetic/Orthotic","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0274","description":"Med/Surg Supplies &Devices (also see 062x, extension of 027x","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - Evaluation or Reevaluation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0434","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0430","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - Group Rate","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0433","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - Hourly Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0432","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - Other Occupational Therapy","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0439","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Occupational Therapy - Visit Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0431","description":"Occupational Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Operating Room Services - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0360","description":"Operating Room Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Operating Room Services - Kidney Transplant","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0367","description":"Operating Room Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Operating Room Services - Minor Surgery","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0361","description":"Operating Room Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Operating Room Services - Other Operating Room Services","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0369","description":"Operating Room Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Other Diagnostic Services - Pap Smear","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0923","description":"Other Diagnostic Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Other Diagnostic Services - Pregnancy Test","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0925","description":"Other Diagnostic Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":2000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Other Imaging Services - Diagnostic Mammography","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0401","description":"Other Imaging Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":270.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Other Imaging Services - Screening Mammography","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0403","description":"Other Imaging Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":270.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Other Imaging Services - Ultrasound","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0402","description":"Other Imaging Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":372.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - Evaluation or Reevaluation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0424","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0420","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - Group Rate","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0423","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - Hourly Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0422","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - Other Physical Therapy","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0429","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Physical Therapy - Visit Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0421","description":"Physical Therapy","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Private (Deluxe)  - Rehabilitation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0148","description":"Room & Board - Deluxe Private","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":1650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Private (Deluxe) - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0144","description":"Room & Board - Deluxe Private","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Respiratory Services - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0410","description":"Respiratory Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Respiratory Services - Hyperbaric Oxygen Therapy","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0413","description":"Respiratory Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Respiratory Services - Inhalation Services","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0412","description":"Respiratory Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Respiratory Services - Other Respiratory Services","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0419","description":"Respiratory Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Private - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0110","description":"Room & Board - Private (One Bed)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Private - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0114","description":"Room & Board - Private (One Bed)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Private - Rehabilitation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0118","description":"Room & Board - Private (One Bed)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":1650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Semiprivate - 2 Beds - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0124","description":"Room & Board - Semi-private (Two Beds)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Semiprivate - 2 Beds - Rehabilitation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0128","description":"Room & Board - Semi-private (Two Beds)","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":1650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Ward - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0154","description":"Room & Board - Ward","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Room & Board - Ward - Rehabilitation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0158","description":"Room & Board - Ward","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":1650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Semiprivate - 3 & 4 Beds - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0134","description":"Room & Board - Three and Four Beds","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":2400.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Semiprivate - 3 & 4 Beds - Rehabilitation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0138","description":"Room & Board - Three and Four Beds","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"per diem","negotiated_rate":1650.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - Evaluation or Reevaluation","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0444","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - General","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0440","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - Group Rate","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0443","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - Hourly Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0442","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - Other Speech-Language Pathology","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0449","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Speech-Language Pathology - Visit Charge","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0441","description":"Speech Therapy - Language Pathology","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":225.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Level I","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0681","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Level II","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0682","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Level III","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0683","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Level IV","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0684","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Not Used","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0680","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Trauma Response - Other trauma response","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0689","description":"Trauma Response","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"inpatient","negotiated_type":"negotiated","negotiated_rate":0.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Treatment or Observation Room - Observation Hours","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0762","description":"Specialty Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]},{"negotiation_arrangement":"ffs","name":"Treatment or Observation Room - Other specialty services","billing_code_type":"REV","billing_code_type_version":"2022","billing_code":"0769","description":"Specialty Services","negotiated_rates":[{"provider_references":[237949],"negotiated_prices":[{"setting":"outpatient","negotiated_type":"negotiated","negotiated_rate":5000.0,"expiration_date":"9999-12-31","billing_class":"institutional","service_code":["11"]}]}]}]}