Version: 2.1

Payer

Analysis Date: 2025-08-28 13:56:55

In this analysis, we pull 30 samples from Core Rates for United, Aetna, and Cigna where multiple rates are posted for a J-code.

Takeaways:

United: there is a negligible difference between the multiple rates
Aetna: max() appears to be the best choice relative to ASP. median() generally looks close to ASP.
Cigna: there's more variability, but the single no-modifier rate is generally the best choice; there can be some wonkiness where they are using "derived" negotiated type where both median/max are too high and would not be selected based on ASP bounds

United

Sample 1/90

Payer: 643 | Provider: 6310 | Code: J1205

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $40.38

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
7016ED70C132B653A24312887E195CEB	$181.03	negotiated	$40.38		ffs
AD530F94BC3A39D2A757533BA8BC8C68	$190.79	negotiated	$40.38		ffs

Sample 2/90

Payer: 643 | Provider: 6310 | Code: J0850

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $1809.44

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B50720EF36F31CC0D94F2F3A01676606	$4043.42	negotiated	$1809.44		ffs
D0249D3F304A165E4C5C8A6460F7FAF5	$4261.31	negotiated	$1809.44		ffs

Sample 3/90

Payer: 643 | Provider: 6310 | Code: J0593

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $86.94

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
FAA13B5333D1B016A0A4F48DC06D992D	$231.10	negotiated	$86.94		ffs
20FC6C0A511506FC6188F730EDEC8D63	$243.55	negotiated	$86.94		ffs

Sample 4/90

Payer: 643 | Provider: 6310 | Code: J2010

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $5.61

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
294980A563FCCD47D75C853305A792D4	$37.05	negotiated	$5.61		ffs
277C84EE7767FCC585507E4C6791C655	$39.04	negotiated	$5.61		ffs

Sample 5/90

Payer: 643 | Provider: 6310 | Code: J1212

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $742.89

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
DB276303004C46CE5BFEC737E55DD333	$1886.92	negotiated	$742.89		ffs
BC225B4AD417F95FDBECFB23F754FEDC	$1988.60	negotiated	$742.89		ffs

Sample 6/90

Payer: 643 | Provider: 6310 | Code: J0153

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $0.46

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
6FB23E8D5D41CD9A2AE33B6376FAF6DD	$1.89	negotiated	$0.46		ffs
A053BB5D3E0965DFC254F76F653547F8	$2.00	negotiated	$0.46		ffs

Sample 7/90

Payer: 643 | Provider: 6310 | Code: J1670

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $577.05

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
5396C6E85DEBFCB857BAC68359036AF9	$1619.80	negotiated	$577.05		ffs
D2EB6757FF2060DC2F08955F606E3D83	$1707.09	negotiated	$577.05		ffs

Sample 8/90

Payer: 643 | Provider: 6310 | Code: J1451

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $6.70

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
EAA1E5CC12A39EFD159D8E174933A037	$26.59	negotiated	$6.70		ffs
28021AB158FD6B3F92EC15070C7861EE	$28.03	negotiated	$6.70		ffs

Sample 9/90

Payer: 643 | Provider: 6310 | Code: J9245

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $108.03

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
095DE97B9380969DCB45BF2B136FC71D	$1579.33	negotiated	$108.03		ffs
E09F52CC47E14E857039C4890E166DB6	$1664.45	negotiated	$108.03		ffs

Sample 10/90

Payer: 643 | Provider: 6310 | Code: J1201

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $16.40

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
4D67B2ABA3B7144E7CFE54070849BB45	$93.61	negotiated	$16.40		ffs
34216B230D1AF084F901DB93861D1975	$98.65	negotiated	$16.40		ffs

Sample 11/90

Payer: 643 | Provider: 6310 | Code: J3396

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $11.55

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
42E0211CE96C83ED12B38B0E9FA40D7B	$33.65	negotiated	$11.55		ffs
F16616284FE28201AB0AD445D61C2455	$35.46	negotiated	$11.55		ffs

Sample 12/90

Payer: 643 | Provider: 6310 | Code: J2405

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $0.09

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
464BF1988C47D89E3344643CF5BB08D6	$0.28	negotiated	$0.09		ffs
2F7CC73C695841B96CD42AF561C001F7	$0.30	negotiated	$0.09		ffs

Sample 13/90

Payer: 643 | Provider: 6310 | Code: J0121

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $4.01

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
CD47F72DBCB8881A32FE02028FB154B2	$10.03	negotiated	$4.01		ffs
A0988212F1127282135BD7E41CD9E0AF	$10.57	negotiated	$4.01		ffs

Sample 14/90

Payer: 643 | Provider: 6310 | Code: J9269

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $348.62

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C04C1F7817084DD897E1450E722A045B	$819.73	negotiated	$348.62		ffs
9381682D550992EFF3E243572021C664	$863.91	negotiated	$348.62		ffs

Sample 15/90

Payer: 643 | Provider: 6310 | Code: J8600

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $12.00

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D4452218D2B06C54CE2502CDEBB9A613	$39.07	negotiated	$12.00		ffs
CEDFBE41A8978D08437B27A808A35482	$41.19	negotiated	$12.00		ffs

Sample 16/90

Payer: 643 | Provider: 6310 | Code: J3485

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $1.51

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
A876F3048FF88D379EB7557EC2874F0F	$4.58	negotiated	$1.51		ffs
706EBFEDACC27C9457CE2F83817A8C2F	$4.82	negotiated	$1.51		ffs

Sample 17/90

Payer: 643 | Provider: 6310 | Code: J0597

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $75.86

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
4B78E47F826225C02A4AEA0BDBB08A5F	$155.32	negotiated	$75.86		ffs
C81522B73748D46F9B5EF8860F134E52	$163.68	negotiated	$75.86		ffs

Sample 18/90

Payer: 643 | Provider: 6310 | Code: J1290

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $579.99

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B3F77E372220560F1F6C13284FCAFDEB	$1503.27	negotiated	$579.99		ffs
C1A66A4B8392B546556E7CD3A376FDCE	$1584.27	negotiated	$579.99		ffs

Sample 19/90

Payer: 643 | Provider: 6310 | Code: J3370

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $1.95

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
3901B515455EE2909B1939D486AED434	$9.01	negotiated	$1.95		ffs
4122F315912529BC72EA5D9790CDE8B7	$9.49	negotiated	$1.95		ffs

Sample 20/90

Payer: 643 | Provider: 6310 | Code: J0490

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $56.01

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C8F7A1A095DF86CC331099B90BCFAA79	$137.83	negotiated	$56.01		ffs
4510333FA8CE77FA2F29DC2B6FAAD69C	$145.26	negotiated	$56.01		ffs

Sample 21/90

Payer: 643 | Provider: 6310 | Code: J1575

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $18.39

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
E69764BAEE8998A622F90D39E5A4A0AE	$42.83	negotiated	$18.39		ffs
A947CEE285FA6A0B853210C4C9B5EE2A	$45.13	negotiated	$18.39		ffs

Sample 22/90

Payer: 643 | Provider: 6310 | Code: J2597

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $3.89

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
595CB9B92B11097531C9BAB407BDD51F	$34.24	negotiated	$3.89		ffs
C36E2DF6D0E6EA5BF2222777A7151C00	$36.08	negotiated	$3.89		ffs

Sample 23/90

Payer: 643 | Provider: 6310 | Code: J9306

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $16.89

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
7A1F44C4C50A1F278AA07192F527B442	$38.29	negotiated	$16.89		ffs
D00BD3B92BB90C67157B08D57AFDDA8C	$40.35	negotiated	$16.89		ffs

Sample 24/90

Payer: 643 | Provider: 6310 | Code: J1569

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $47.80

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
503C16D64237A4934EA81F82FEDCEE90	$120.41	negotiated	$47.80		ffs
78028F84307E1621CE10D917D537EAE5	$126.90	negotiated	$47.80		ffs

Sample 25/90

Payer: 643 | Provider: 6310 | Code: J8515

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $14.57

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
09BD315BFD666FD5A6DD3AD4226BFAFE	$53.95	negotiated	$14.57		ffs
25378146DA41149B69B65FE1B8030268	$56.86	negotiated	$14.57		ffs

Sample 26/90

Payer: 643 | Provider: 6310 | Code: J2786

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $10.57

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
722B563833654671EC186594B2ABFC5B	$29.64	negotiated	$10.57		ffs
0558175501C70027DD06BBE5139CFC00	$31.24	negotiated	$10.57		ffs

Sample 27/90

Payer: 643 | Provider: 6310 | Code: J7502

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $2.07

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
081024F58ED0B3F4105ABB459E8E15C9	$7.81	negotiated	$2.07		ffs
94665C627D0965E8E814198D0CE43C8E	$8.22	negotiated	$2.07		ffs

Sample 28/90

Payer: 643 | Provider: 6310 | Code: J0583

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $0.17

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D6F00C7770C3FAB16425162D7ABA4189	$1.89	negotiated	$0.17		ffs
65C598C8E3A5092A7F628E4C7E798189	$2.00	negotiated	$0.17		ffs

Sample 29/90

Payer: 643 | Provider: 6310 | Code: J0690

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $0.83

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
2C0A3E6893FBD3CE5A13FBC5505485CE	$2.49	negotiated	$0.83		ffs
0A0095507B341227A8D0F749055BDEA0	$2.62	negotiated	$0.83		ffs

Sample 30/90

Payer: 643 | Provider: 6310 | Code: J0888

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $1.41

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
FAE5142853A39CD3CF99D420F9036CC6	$5.60	negotiated	$1.41		ffs
CF37C9E95605F28CC6289E24DF2A2102	$5.90	negotiated	$1.41		ffs

Aetna

Sample 31/90

Payer: 7 | Provider: 886 | Code: J1806

Results:

Number of rate records: 15
Unique negotiated rates: 5
ASP Payment Limit: $0.42

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
00BD41A89872DA147794FCF1F93C2E8C	$0.08	negotiated	$0.42	56	ffs
25AF74BFE196342AA54DA8933F1BA083	$0.08	negotiated	$0.42	56	ffs
A23AED1D560739B3AEB5B1D4E1E7E513	$0.08	negotiated	$0.42	56	ffs
046719449E1F43AD9BBADA284CF15627	$0.12	negotiated	$0.42	55	ffs
F38B161BAB0DA8493168CB903A8954EB	$0.12	negotiated	$0.42	55	ffs
1BD7BAF2474DE0CF74F93F3343BE5C53	$0.12	negotiated	$0.42	55	ffs
F8E9550A8311747719445E6BEEBAF775	$0.16	negotiated	$0.42	53	ffs
7399D157330950D06F85BB8CE9323FEE	$0.16	negotiated	$0.42	53	ffs
78EBF9D8E3C96529F71E4F5BB5EA7F9C	$0.16	negotiated	$0.42	53	ffs
974538C368BB59F4027591005870217A	$0.41	negotiated	$0.42	52	ffs
386D4E314692FCA756C7554E0E136ADF	$0.41	negotiated	$0.42	52	ffs
12E4A85765BE4F95C608F8ABFA448379	$0.41	negotiated	$0.42	52	ffs
5ED42D58B509644A7EC0E1E63F0F5B8C	$0.82	negotiated	$0.42		ffs
E6D78645B27F8D754C43FEFC5C6B8B9E	$0.82	negotiated	$0.42		ffs
DBF7B7DD56AD1C0D6DC0B23D98451838	$0.82	negotiated	$0.42		ffs

Sample 32/90

Payer: 7 | Provider: 2744 | Code: J9297

Results:

Number of rate records: 15
Unique negotiated rates: 5
ASP Payment Limit: $1.21

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
3914366B987D0A5C6FA20EC0448D208E	$0.26	negotiated	$1.21	56	ffs
90DF780751E5BC4D0FC749FD970176A4	$0.26	negotiated	$1.21	56	ffs
73C120357E07CFFFD8C9C2D7B3F1194A	$0.26	negotiated	$1.21	56	ffs
05EBD2D856C3650A345093087C54BF2A	$0.39	negotiated	$1.21	55	ffs
EA6C56AADFE599E42B584290C879E4EB	$0.39	negotiated	$1.21	55	ffs
7E1C77447B6A2E3A87696F9830C37528	$0.39	negotiated	$1.21	55	ffs
E0984E98E314B69059C3B6E31DD335C3	$0.52	negotiated	$1.21	53	ffs
70F633222EDBDAB92AC2108618A6E1CD	$0.52	negotiated	$1.21	53	ffs
E66E205B5AEF3C9F3F34E5E12764D5AD	$0.52	negotiated	$1.21	53	ffs
A4377D7BF3CF270DE43196CA93E0D9FC	$1.31	negotiated	$1.21	52	ffs
21411341280704A7D027ED8E174754B1	$1.31	negotiated	$1.21	52	ffs
F217828444C06DFAA2FDA283A8D30CE4	$1.31	negotiated	$1.21	52	ffs
CBAA4A93D84A8C3ADC582180F6642DDF	$2.61	negotiated	$1.21		ffs
B0CBDE8DEA965361134285984A860F27	$2.61	negotiated	$1.21		ffs
3F70B5445D4328B19E4318FE26A398E9	$2.61	negotiated	$1.21		ffs

Sample 33/90

Payer: 7 | Provider: 355 | Code: J0457

Results:

Number of rate records: 15
Unique negotiated rates: 5
ASP Payment Limit: $2.67

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
33CB71373DBB7957772C1E8FEFDFD23F	$0.83	negotiated	$2.67	56	ffs
CB0C8832A2D864E93E67627080E306C9	$0.83	negotiated	$2.67	56	ffs
B58A4ACF368B1003D39ED8CFC7FE41CD	$0.83	negotiated	$2.67	56	ffs
B23160E7889E451299E6F14CA04983BA	$1.24	negotiated	$2.67	55	ffs
F50BDE5313C1EE007B09D50B62116B9C	$1.24	negotiated	$2.67	55	ffs
A4D09B33611868CD15BE9158867A4CC3	$1.24	negotiated	$2.67	55	ffs
49FE3841BAB5B3357424129FE62CBEC2	$1.65	negotiated	$2.67	53	ffs
3065F78C74AFBC53E6DC97158E9E553C	$1.65	negotiated	$2.67	53	ffs
9968E12DAF7831D1AC6375397F046D31	$1.65	negotiated	$2.67	53	ffs
5BA6B7561FB3E9E27E60907D3D9CC6DA	$4.13	negotiated	$2.67	52	ffs
4B368A7D9EEF005F3C3907A354C8882C	$4.13	negotiated	$2.67	52	ffs
0AF9425902CC67A93AAC69F7913249F9	$4.13	negotiated	$2.67	52	ffs
AD4C1A71AA4C9F2614294AADE4A05EBB	$8.26	negotiated	$2.67		ffs
B4440239E322BB1823CF7D200F7E00BA	$8.26	negotiated	$2.67		ffs
5217564AFE9588D018B3E24C385660CA	$8.26	negotiated	$2.67		ffs

Sample 34/90

Payer: 7 | Provider: 160 | Code: J3247

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $17.84

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
05D9AC7E1206888942F1F9C9B49ACE96	$2.51	negotiated	$17.84	56	ffs
E1242AB69E111AE682196658DA4DC742	$2.51	negotiated	$17.84	56	ffs
E1A364E5D91F09FFD4C90652DF83BAE4	$3.77	negotiated	$17.84	55	ffs
AECDC9BC1116E9BB7ACD5451D3DBA8E6	$3.77	negotiated	$17.84	55	ffs
873418AB8D2B19D7A3B23823E034A6E1	$5.03	negotiated	$17.84	53	ffs
DE51D96F812125469357E2B96A29525E	$5.03	negotiated	$17.84	53	ffs
51EDCF806515CA94C5C6300D153487E9	$12.57	negotiated	$17.84	52	ffs
DC3DD60C7359EC00ACB8A8FDDBC4EA1A	$12.57	negotiated	$17.84	52	ffs
8E03CBDD9D786445FCEFD7175FADD8A7	$25.14	negotiated	$17.84		ffs
42CC46475548B1D928DD579694AC249A	$25.14	negotiated	$17.84		ffs

Sample 35/90

Payer: 7 | Provider: 2630 | Code: J9071

Results:

Number of rate records: 6
Unique negotiated rates: 6
ASP Payment Limit: $0.78

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
DB5BFE91CDA6ACE6FC8B52D0379D0D42	$0.15	negotiated	$0.78	56	ffs
412BBB1120CD7CA486124106C995BB64	$0.22	negotiated	$0.78	55	ffs
C3D791F7627DF024B36C7AD4630DEBB6	$0.30	negotiated	$0.78	53	ffs
5154437F643A322C9F106CAF44AB450F	$0.74	negotiated	$0.78	52	ffs
03252099743FC2FC2A50BDD27351613A	$1.48	negotiated	$0.78		ffs
55A07005B8E21DFBF814E396F8A55785	$1.59	negotiated	$0.78		ffs

Sample 36/90

Payer: 7 | Provider: 8630 | Code: J9353

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $50.45

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C151A3425B2F18CB1DB749DD6F1864F9	$29.94	negotiated	$50.45	56	ffs
92715C7FECD1A7A3BF9ECD462D1F190E	$44.91	negotiated	$50.45	55	ffs
3F319EE23B2E4D245A9CA891F32D10B0	$59.89	negotiated	$50.45	53	ffs
62163313D6583FF691A3619AD2B93EC2	$149.72	negotiated	$50.45	52	ffs
DA6F4D2673F7B6CEA4AE1A83C1BDEA2D	$299.43	negotiated	$50.45		ffs

Sample 37/90

Payer: 7 | Provider: 6396 | Code: J2501

Results:

Number of rate records: 3
Unique negotiated rates: 3
ASP Payment Limit: $0.67

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
43383E4B96698583B6092127A7DAD33B	$0.16	negotiated	$0.67	56	ffs
D9579BFC78D6268B1CC0D0E39A14EF18	$0.24	negotiated	$0.67	55	ffs
1D15E8C01594AFEE7F4C5838D59B951D	$1.62	negotiated	$0.67		ffs

Sample 38/90

Payer: 7 | Provider: 597 | Code: J2010

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $5.61

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
7022036FE3A9FE173CBC879C37702388	$0.75	negotiated	$5.61	56	ffs
38B9A97C5C843D5D72D7A7683E54A907	$1.12	negotiated	$5.61	55	ffs
AF5791682F11180A30B735EFB4F029EE	$1.50	negotiated	$5.61	53	ffs
5AD8667786963576869E20008EABF8F7	$3.74	negotiated	$5.61	52	ffs
EC0CF06C53F6EF8319C3C1740707AE86	$7.49	negotiated	$5.61		ffs

Sample 39/90

Payer: 7 | Provider: 4325 | Code: J7193

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $1.33

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B80D6ABE5A5BB1D52C62EBEF356F230C	$0.14	negotiated	$1.33	56	ffs
C734C4BCA0D9A6674EB984504887001D	$0.21	negotiated	$1.33	55	ffs
494446B560925AA017EA0798FED62DF0	$0.28	negotiated	$1.33	53	ffs
152F127B97853FE2609AB08765BFF558	$0.69	negotiated	$1.33	52	ffs
D1004F4C791E27AFC984F7E57A8DD131	$1.38	negotiated	$1.33		ffs

Sample 40/90

Payer: 7 | Provider: 1034 | Code: J2840

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: None

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C6089E53B19A6A8E971EA2532338D56A	$73.42	negotiated	None	56	ffs
2876C2A3764D8580F11AEEAC016D6EB1	$110.13	negotiated	None	55	ffs
E308D3A023CB51600FCC9BF62752D798	$146.84	negotiated	None	53	ffs
4440AAA794720D1C2C128957B4F2A813	$367.10	negotiated	None	52	ffs
3811AAA7E0392D1C4DD7CC9B96F769C8	$734.20	negotiated	None		ffs

Sample 41/90

Payer: 7 | Provider: 9933 | Code: J7190

Results:

Number of rate records: 20
Unique negotiated rates: 9
ASP Payment Limit: $1.13

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
F4CA09B6D81A2EE87EF85812B58A82E3	$0.18	negotiated	$1.13	56	ffs
EF85FE861A9A950F790BEC24486B4E2D	$0.18	negotiated	$1.13	56	ffs
7A4D78DDAAEE73333525F8EB9822A5A7	$0.24	negotiated	$1.13	56	ffs
002BCE406B1D704D1AB2157A55B10DD5	$0.24	negotiated	$1.13	56	ffs
4F0E77C600F8A8C1490BE393F0C29A09	$0.27	negotiated	$1.13	55	ffs
7E3F6A7C9EB18049759E32E50946F9F6	$0.27	negotiated	$1.13	55	ffs
8D33FFCA4D8FB83BC94B6BEFAD35766A	$0.36	negotiated	$1.13	55	ffs
0538728623C7E4BFD7463AA830BDAD8C	$0.36	negotiated	$1.13	53	ffs
2D0E4AB7CD6DBF67519E06AD609A1C95	$0.36	negotiated	$1.13	53	ffs
9151B232D8A8F770CCC0EB8F3B8E7011	$0.36	negotiated	$1.13	55	ffs
243FE2553454C397F69EC660AB137A1E	$0.48	negotiated	$1.13	53	ffs
EE744F42D20B218DFE369892B06F891F	$0.48	negotiated	$1.13	53	ffs
9A1C1A32142F9CB4CEBCB203DBAC754A	$0.90	negotiated	$1.13	52	ffs
5B9084DF2FEB5043CB8AB5EB90F05BF9	$0.90	negotiated	$1.13	52	ffs
11870FFFDB56645A1DED3D6D8FF2AC37	$1.19	negotiated	$1.13	52	ffs
FBB172FFA46A48147EA9D50153BC711C	$1.19	negotiated	$1.13	52	ffs
6D48978D092DB8153630F61A8FB5B65E	$1.79	negotiated	$1.13		ffs
911393FFEF0657BA0A2FFDBF1E9BC762	$1.79	negotiated	$1.13		ffs
29F496A1384C4A711D69FDDCD157A7E2	$2.39	negotiated	$1.13		ffs
4A2FB872C6AFC2428C15D4D254226756	$2.39	negotiated	$1.13		ffs

Sample 42/90

Payer: 7 | Provider: 1944 | Code: J1720

Results:

Number of rate records: 1
Unique negotiated rates: 1
ASP Payment Limit: $21.20

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
381CF2B6F00C798A70DD9C944ABADC3D	$20.57	negotiated	$21.20		ffs

Sample 43/90

Payer: 7 | Provider: 760 | Code: J3230

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $27.07

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B44923AD4FB7B07AC8B5B514F47F6AE2	$7.84	negotiated	$27.07	56	ffs
8F8DCA06F21621C62E6A34C2CC0D0358	$11.76	negotiated	$27.07	55	ffs
9E1A013501F00ED7096A1DFD4FA15175	$15.68	negotiated	$27.07	53	ffs
7A0113CE8335973E6329B2A34C9EEFAB	$39.20	negotiated	$27.07	52	ffs
F1F12DBEBF4B7BF344A09624604C7AF3	$78.41	negotiated	$27.07		ffs

Sample 44/90

Payer: 7 | Provider: 10479 | Code: J0893

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $0.78

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
5555FB434A038999199659AE63E384DF	$0.08	negotiated	$0.78	56	ffs
BCB19186CD8AA11CAC09844A7EA36D72	$0.08	negotiated	$0.78	56	ffs
3CE801E5B5C5221A7432597B8B4A5174	$0.12	negotiated	$0.78	55	ffs
F3996F16E9657D8D30DBAD9E261B06B2	$0.12	negotiated	$0.78	55	ffs
8CEA8826FCA2280A3C42F515E4903394	$0.16	negotiated	$0.78	53	ffs
7F466A63BDEAE78718E25CF79E4A7CD9	$0.16	negotiated	$0.78	53	ffs
AF7B672F0583BFE2A7F76AFC82DF5650	$0.39	negotiated	$0.78	52	ffs
76AB67021D31A62D1FBFE21727F35B69	$0.39	negotiated	$0.78	52	ffs
EF44CA5A24FFD18D8CEF6DBD7EAF4F7F	$0.78	negotiated	$0.78		ffs
E893D3765BF7CE6CBD3253A41A1D50BE	$0.78	negotiated	$0.78		ffs

Sample 45/90

Payer: 7 | Provider: 1863 | Code: J7504

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $5013.11

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
59CAA6375D86D6ACB6DEF8BA1DC86761	$437.63	negotiated	$5013.11	56	ffs
BE1FB5915A6122C3AA42ABA930D02D4C	$437.63	negotiated	$5013.11	56	ffs
B76B1609E951D60841016644E0E4EFAE	$656.44	negotiated	$5013.11	55	ffs
6E333309660295A277710F73DF24B3F7	$656.44	negotiated	$5013.11	55	ffs
B515E0798D2422EB319A8F74F5B21373	$875.26	negotiated	$5013.11	53	ffs
63357969B4673422F15CCF04E58DE8F3	$875.26	negotiated	$5013.11	53	ffs
DFC1B3238803FD7E577CBC767F1E5AB4	$2188.15	negotiated	$5013.11	52	ffs
2F1606BF56C1FDCA7D88DD55BFDF8FF6	$2188.15	negotiated	$5013.11	52	ffs
9BFEAF2140A4EDD3F00FC3872227E36F	$4376.29	negotiated	$5013.11		ffs
D7816C0D185064435B75FEF3335AACA3	$4376.29	negotiated	$5013.11		ffs

Sample 46/90

Payer: 7 | Provider: 2463 | Code: J1748

Results:

Number of rate records: 15
Unique negotiated rates: 5
ASP Payment Limit: $261.23

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
6BC5763771C1ECF911BB3041A9E064FB	$25.71	negotiated	$261.23	56	ffs
621EA0DCD524680C307E142A6DD52A5E	$25.71	negotiated	$261.23	56	ffs
9F8E7875EC0F736BBC05CFC027480DC2	$25.71	negotiated	$261.23	56	ffs
85F62FADCEEAE97127EF2C12EE08BD2D	$38.57	negotiated	$261.23	55	ffs
A561CCACF1512C5C4E5DA49EEC181D10	$38.57	negotiated	$261.23	55	ffs
2BE2058EEE827E040EBD6FFE73EE8FE7	$38.57	negotiated	$261.23	55	ffs
870DB35292877C8A705AD14657B74F5C	$51.43	negotiated	$261.23	53	ffs
2BF17F5434352DE6BD5C8323694029E5	$51.43	negotiated	$261.23	53	ffs
7A21E4F697DDDE935B8CAF2068ED3628	$51.43	negotiated	$261.23	53	ffs
9BB98DCFE26467AF406CB6F2DA340FB7	$128.57	negotiated	$261.23	52	ffs
C59F26F20EDD5A8869A0FD09362BF6C6	$128.57	negotiated	$261.23	52	ffs
A3D61E01AF564A4EB5464580C782A08F	$128.57	negotiated	$261.23	52	ffs
AD81775FD6C591421C14B4932F295BF8	$257.14	negotiated	$261.23		ffs
AC989683A5E841412301651CEE3F4CE1	$257.14	negotiated	$261.23		ffs
2F5A22C442CB8898669EFF76E1B16051	$257.14	negotiated	$261.23		ffs

Sample 47/90

Payer: 7 | Provider: 1260 | Code: J9203

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $236.62

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
9570946E6FBCD98A970076834DC60855	$56.65	negotiated	$236.62	56	ffs
A03EA6C78B37CDDC524A121874936FAE	$56.65	negotiated	$236.62	56	ffs
B2B83B95554C02A57EDA013362D3BA6E	$84.97	negotiated	$236.62	55	ffs
5464C803C92552ED56B11E5519DB39C9	$84.97	negotiated	$236.62	55	ffs
0753794ABB0EE07D591E69E497CBA124	$113.30	negotiated	$236.62	53	ffs
AD858C0244A8A2B139B60B1EA34CFEE2	$113.30	negotiated	$236.62	53	ffs
8D25392A981AFB632CE11967B880C35C	$283.24	negotiated	$236.62	52	ffs
CFBF22841093DFA55A3FAD55C89F3CA3	$283.24	negotiated	$236.62	52	ffs
6D20A830DBE3A1789063A0E6200200E2	$566.48	negotiated	$236.62		ffs
DC644CA974F76101A87A5916087F620C	$566.48	negotiated	$236.62		ffs

Sample 48/90

Payer: 7 | Provider: 5983 | Code: J9049

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $1.55

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
46E3785CEBBC2769A450A981FFC1952A	$0.17	negotiated	$1.55	56	ffs
B8E8625B1506F1C94B8206C2BA50345E	$0.25	negotiated	$1.55	55	ffs
D893D8C5876CF0F6888EE85F83089D65	$0.33	negotiated	$1.55	53	ffs
F0027BA12A6D468B5A050CB8AEDF52AB	$0.83	negotiated	$1.55	52	ffs
988A8F9DA5B392597B391387AA0EB0D1	$1.66	negotiated	$1.55		ffs

Sample 49/90

Payer: 7 | Provider: 881 | Code: J1212

Results:

Number of rate records: 110
Unique negotiated rates: 5
ASP Payment Limit: $742.89

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D49D184391A6470A51145E49A99E6CC4	$142.94	negotiated	$742.89	56	ffs
3434F3CE01079C0F2C3385D551347329	$142.94	negotiated	$742.89	56	ffs
75E7A4C40169A3A7907FD33D84A6DC4B	$142.94	negotiated	$742.89	56	ffs
1FE041720CA0099FAAD176EFB7F997B8	$142.94	negotiated	$742.89	56	ffs
004740DF779A2CC786B66EA35D65297A	$142.94	negotiated	$742.89	56	ffs
C64DBFFCB47D9452A510C5A3786A9F0F	$142.94	negotiated	$742.89	56	ffs
33D70C1AB3F4868252E7A87A8E1479CE	$142.94	negotiated	$742.89	56	ffs
51098BEA3AFEF8ED1A5115019E3EBC19	$142.94	negotiated	$742.89	56	ffs
5466E3A5AE5A6D3E0A54849F3BE35F9F	$142.94	negotiated	$742.89	56	ffs
FCA0A3B2C9885F7A564C0F984D47536E	$142.94	negotiated	$742.89	56	ffs
6D36D70501C55F43B3AF25E3F1C455DE	$142.94	negotiated	$742.89	56	ffs
173BB8D5549C633C9D90D049590B6CD1	$142.94	negotiated	$742.89	56	ffs
57D291277C329D9EDC9C1E0B988B5AD0	$142.94	negotiated	$742.89	56	ffs
DBE2E0861D80A8D255E5416580AF934B	$142.94	negotiated	$742.89	56	ffs
04EA54BCFB020C61AF79655F9F8CE538	$142.94	negotiated	$742.89	56	ffs
C86404191E2A71760CFB1459671A98AF	$142.94	negotiated	$742.89	56	ffs
DF78B43E26CAE4306D52BB615B953F28	$142.94	negotiated	$742.89	56	ffs
F59C35C7CE70F0BF01742CDFF5C8AB00	$142.94	negotiated	$742.89	56	ffs
FCA1F5DA0F2AAF248F86BA1AF2CC2652	$142.94	negotiated	$742.89	56	ffs
80BC1CB3BBE9FB961598237BEDFB1B94	$142.94	negotiated	$742.89	56	ffs
BF50D724AAFE93A1DE642164572B18B8	$142.94	negotiated	$742.89	56	ffs
AB0472E46AA3B0E9B6479C5F13A1721C	$142.94	negotiated	$742.89	56	ffs
246F25B3F6FBBE9FA63FE09DC077B3E3	$214.42	negotiated	$742.89	55	ffs
E0920243FA48ADEACC226B553A5D27A3	$214.42	negotiated	$742.89	55	ffs
591C1E29C690BBEC8E71C721C6F1109D	$214.42	negotiated	$742.89	55	ffs
12815CF40565CD782F566B7D3D6ABC88	$214.42	negotiated	$742.89	55	ffs
A329121415943CEE8D2E75887E390BDE	$214.42	negotiated	$742.89	55	ffs
9695519B1B5ED5B032F7E91944D8936E	$214.42	negotiated	$742.89	55	ffs
FADF64BE1333D849D05BDB959ED94E46	$214.42	negotiated	$742.89	55	ffs
0F3D81FFD7D5CE1E9320C8043027FBE9	$214.42	negotiated	$742.89	55	ffs
16AB3813A073D2247857A14FB7D954CD	$214.42	negotiated	$742.89	55	ffs
4EAC77670FEF2C953800CAE2DF35086D	$214.42	negotiated	$742.89	55	ffs
F94EBEC008211F385DD09E18292F7524	$214.42	negotiated	$742.89	55	ffs
82163CACF8D2355095664DFDBC1EC8C5	$214.42	negotiated	$742.89	55	ffs
C129982454454CB647A6359E1F21603B	$214.42	negotiated	$742.89	55	ffs
6173D602431D44C2A551C8026C24A388	$214.42	negotiated	$742.89	55	ffs
B4EC41D3660BC234A53502822E08D93B	$214.42	negotiated	$742.89	55	ffs
8C9994F520ED82CA357ECB18201FBB3C	$214.42	negotiated	$742.89	55	ffs
CA6264119AE9ACD20B53CF562AA59DEF	$214.42	negotiated	$742.89	55	ffs
50A3AD2CF5022D4A44C7EFB942EB23E4	$214.42	negotiated	$742.89	55	ffs
6E46FEE9931ED179B9476CAA021C3676	$214.42	negotiated	$742.89	55	ffs
D932CB91312647D0E1B97611F4117A38	$214.42	negotiated	$742.89	55	ffs
EA46860841AA89CB8D58EEDFB568870A	$214.42	negotiated	$742.89	55	ffs
4CA3F4133187616687FD0940597CF06F	$214.42	negotiated	$742.89	55	ffs
A5503E8809FFFFAEFFBBF9D5E46866FA	$285.89	negotiated	$742.89	53	ffs
35FFA9D0BDAE5AE29273592B0797D867	$285.89	negotiated	$742.89	53	ffs
649A9EA81C5AC39BCE8CB52A3484E062	$285.89	negotiated	$742.89	53	ffs
F30DA4D91A192726FF6BEA562B09B2B7	$285.89	negotiated	$742.89	53	ffs
268A719FABF29BEEF8A0250527B8A541	$285.89	negotiated	$742.89	53	ffs
268A860248E23946D2C6D05710C25862	$285.89	negotiated	$742.89	53	ffs
A2C383768BF12A624F9A070DBD896EBB	$285.89	negotiated	$742.89	53	ffs
5D537523EEB1B608C38E97359F59CABD	$285.89	negotiated	$742.89	53	ffs
8BEA622FFC861A5552CEA7883BD41F73	$285.89	negotiated	$742.89	53	ffs
8E7F00A235B8E2BFFB2F7DB9620071A6	$285.89	negotiated	$742.89	53	ffs
B0DFDF97366787296262C77A8FD76808	$285.89	negotiated	$742.89	53	ffs
9D4376C39C9E1CEC124098C2C014088E	$285.89	negotiated	$742.89	53	ffs
14E2B8EF97CA2EF062C752449BC145F0	$285.89	negotiated	$742.89	53	ffs
E46B5CA3F25C7667495A7E0D1EB1F0B5	$285.89	negotiated	$742.89	53	ffs
C49A2004E33AEA1F2FF2E4728B744F65	$285.89	negotiated	$742.89	53	ffs
B4EC33C9ADDB26044EC4A7DA2D34E436	$285.89	negotiated	$742.89	53	ffs
B23C0A9C6F6AF2078263E848B6D22CA1	$285.89	negotiated	$742.89	53	ffs
F91E3E660EA29A994CB9CA26EB4170B7	$285.89	negotiated	$742.89	53	ffs
5703107FA4F1606537484B93892E5A54	$285.89	negotiated	$742.89	53	ffs
AA2752393FC129EA6E7B1A7BA637B047	$285.89	negotiated	$742.89	53	ffs
A8269CE6769750B117E585483C68B3FF	$285.89	negotiated	$742.89	53	ffs
E85B291298751FBB3D15F3FD3E7CDC77	$285.89	negotiated	$742.89	53	ffs
88D6E356098245DB0A488DCCFBABB57C	$714.72	negotiated	$742.89	52	ffs
630A5ECF41A836B563CAD33010CDF9C5	$714.72	negotiated	$742.89	52	ffs
946EFCD91AC603E218CC7DC1BE186CD2	$714.72	negotiated	$742.89	52	ffs
1B86B697E5BC8ACD84532533A902A715	$714.72	negotiated	$742.89	52	ffs
C69ADEB416329BC0825CA3D482B543B6	$714.72	negotiated	$742.89	52	ffs
A71918A90C2C88C95AD2A45C10BF73E8	$714.72	negotiated	$742.89	52	ffs
4EBE2AC73EE9441CF1F505E5B900BE45	$714.72	negotiated	$742.89	52	ffs
E45C188C78BF1FA7E9C4E40A2A04E295	$714.72	negotiated	$742.89	52	ffs
C13672D6321608A94F5BC450D01A85AB	$714.72	negotiated	$742.89	52	ffs
0B8E4C578A6E8D81110F5F6FFC7841CB	$714.72	negotiated	$742.89	52	ffs
DEB228018B4A5B7F6996F4F4C792EC34	$714.72	negotiated	$742.89	52	ffs
173D90E266EDC30A5CE3D5BDE55937E6	$714.72	negotiated	$742.89	52	ffs
76A4AEEF28BE66A390245482CA8751E1	$714.72	negotiated	$742.89	52	ffs
9E5D503059D8DB730AF5D5AE83131857	$714.72	negotiated	$742.89	52	ffs
9D53BAB6A32B0982EFD2008D08821B39	$714.72	negotiated	$742.89	52	ffs
D7574BD3BDCE0B048FBD940A25B0E98E	$714.72	negotiated	$742.89	52	ffs
44E8F72B7BFB08D658B1FA57BB4D8370	$714.72	negotiated	$742.89	52	ffs
6F7CE7C88AA59A2C01050D64F656DA95	$714.72	negotiated	$742.89	52	ffs
7DCFB375C0A4470BACE9966486BA4B1D	$714.72	negotiated	$742.89	52	ffs
25E8518ED2F8F83E82650B2F3BDB58B7	$714.72	negotiated	$742.89	52	ffs
BC4EAABB41E238C75FCF8DA6272F1963	$714.72	negotiated	$742.89	52	ffs
BB136F27456EA4A1BCF26B68CA1E5DFE	$714.72	negotiated	$742.89	52	ffs
E673EA306E45B5B41D989851BCBAB916	$1429.44	negotiated	$742.89		ffs
1F5D5A754D064F92E0488A5A791C47BD	$1429.44	negotiated	$742.89		ffs
EA1B7584AC4CBB742EC8EC1B40DB68DA	$1429.44	negotiated	$742.89		ffs
222ED40FCF46522B1387850C8A24206A	$1429.44	negotiated	$742.89		ffs
200B933F06A85AAB6BD479198091BA06	$1429.44	negotiated	$742.89		ffs
81FB6F80A2C418CC409F8A94381DC051	$1429.44	negotiated	$742.89		ffs
47678CD71039873EEEC6E2444918C744	$1429.44	negotiated	$742.89		ffs
2966C7712F716DA90605A3CE691CFF6D	$1429.44	negotiated	$742.89		ffs
9452D9C85FF672E680793415F71846B8	$1429.44	negotiated	$742.89		ffs
0CEE35B9D007EE9728481D49D7F132CA	$1429.44	negotiated	$742.89		ffs
A95D7688A890F774DCE48BD58E2B5213	$1429.44	negotiated	$742.89		ffs
C928CF81DCD688915A7A4C7243C2B1A2	$1429.44	negotiated	$742.89		ffs
7D44442B0F3E0C50BFB3E88AD09C70CD	$1429.44	negotiated	$742.89		ffs
0DDDD6D189BF32C32F5AA5FB9F1BBAB0	$1429.44	negotiated	$742.89		ffs
1CFEE4CC16F73383D7BC0D897213414D	$1429.44	negotiated	$742.89		ffs
1E0F4038D0E7865E03585B24C6C66D4B	$1429.44	negotiated	$742.89		ffs
76769724E7955C54F5794D0FFFD3DD4E	$1429.44	negotiated	$742.89		ffs
7D0540E6354F0ECAF4A37E9694892FD9	$1429.44	negotiated	$742.89		ffs
AF161A6AB7EC87CFFE012E31BEF8916C	$1429.44	negotiated	$742.89		ffs
49B283A334349463117C881397E67367	$1429.44	negotiated	$742.89		ffs
C1A96B7BF87DA61F580EC51DDECED90A	$1429.44	negotiated	$742.89		ffs
5CFE884623F6087EEA635A439BB9E8ED	$1429.44	negotiated	$742.89		ffs

Sample 50/90

Payer: 7 | Provider: 1317 | Code: J2545

Results:

Number of rate records: 12
Unique negotiated rates: 6
ASP Payment Limit: $82.37

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D77C55253A1B789A8004B2358B837710	$9.55	negotiated	$82.37	56	ffs
9BEA05C55329EB4FA66E0AE25264A1F7	$9.55	negotiated	$82.37	56	ffs
A81A80FE3452F81E0C2099449980E6B2	$14.33	negotiated	$82.37	55	ffs
A0E441D316C09694CFEC00195EDB83C3	$14.33	negotiated	$82.37	55	ffs
963B3EC188C08C467129AD6BE8460226	$19.11	negotiated	$82.37	53	ffs
047355079B290B0562EE80BB311CD575	$19.11	negotiated	$82.37	53	ffs
3A12E244AE873CB57726740ABD8D593A	$47.77	negotiated	$82.37	52	ffs
76052625CB71F42579389F098785F744	$47.77	negotiated	$82.37	52	ffs
5177105C0FBD83379AD266D421331FF1	$84.30	negotiated	$82.37		ffs
1A88D5DAFF8F2DDBBDA169B5BA43790E	$84.30	negotiated	$82.37		ffs
B2FBDEC5A7531217D232B3502F6C30F2	$95.55	negotiated	$82.37		ffs
D58606B811F5556715956B2F1A7E4F5A	$95.55	negotiated	$82.37		ffs

Sample 51/90

Payer: 7 | Provider: 4256 | Code: J2760

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $436.51

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
FE723DAC40F0D756DCE4CCDAACB957A0	$44.93	negotiated	$436.51	56	ffs
05EF341F8C1AA746A1F54D09AE527492	$44.93	negotiated	$436.51	56	ffs
1B230AB0D14AE737B4A9240F2FE9B413	$67.40	negotiated	$436.51	55	ffs
AFB522DEBDB7FB129C1CF545E97259FD	$67.40	negotiated	$436.51	55	ffs
85CE295FB4387B6F2F11DB792EFE6BEF	$89.86	negotiated	$436.51	53	ffs
F84602AD181593DAD887E3104DC9E4E5	$89.86	negotiated	$436.51	53	ffs
CBD4F03A4A6AB141C1F8A21E67759103	$224.65	negotiated	$436.51	52	ffs
3DD263A0B080A190476B355D6AF705D4	$224.65	negotiated	$436.51	52	ffs
570ED22A2225F4042A5A52DB454CD94A	$449.30	negotiated	$436.51		ffs
A462677C8681D5B8EE8D8B12D993EF22	$449.30	negotiated	$436.51		ffs

Sample 52/90

Payer: 7 | Provider: 2867 | Code: J2650

Results:

Number of rate records: 15
Unique negotiated rates: 5
ASP Payment Limit: $0.52

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
4765E5A9E50F13BA2652C6E3FE86AD81	$0.04	negotiated	$0.52	56	ffs
864F7805FA496FFD1C18C66F8DF3E957	$0.04	negotiated	$0.52	56	ffs
1A7CDE526165E47A4BE07EA8A7BF104F	$0.04	negotiated	$0.52	56	ffs
84CFCEE00E52CF2E152D09D71750243A	$0.06	negotiated	$0.52	55	ffs
96D227E7BD8EE1E06F2596F3A6966F58	$0.06	negotiated	$0.52	55	ffs
4D1E2BFBE8127467D465D08F601A0A06	$0.06	negotiated	$0.52	55	ffs
ED6C7F94A59DEC871CB6682A247CDC64	$0.08	negotiated	$0.52	53	ffs
EB9BD1056D83E25E03C68FDA377DAA52	$0.08	negotiated	$0.52	53	ffs
75D9209356DFD196B8D89B4F08042983	$0.08	negotiated	$0.52	53	ffs
FA87CDDB1F16BF7D15F887E42092B0E5	$0.20	negotiated	$0.52	52	ffs
D5B85EE61DA2DC8F05903816F9E17B73	$0.20	negotiated	$0.52	52	ffs
2D4CA3A3042E090FAF6576EEEAC17F11	$0.20	negotiated	$0.52	52	ffs
91DE14382EC89BECD465E7D3922438FE	$0.40	negotiated	$0.52		ffs
2D906F6B23531A5136571BA2503BBFD8	$0.40	negotiated	$0.52		ffs
7E693B7C3A4FDAD5F369A5740BD39B5B	$0.40	negotiated	$0.52		ffs

Sample 53/90

Payer: 7 | Provider: 6438 | Code: J9052

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $0.05

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
52CDDFBA80155593CA7F72ADE2812562	$44.19	negotiated	$0.05	56	ffs
FFA41C0E69209D109AD86335089E4CB6	$66.29	negotiated	$0.05	55	ffs
3E76C61CB8138B443CCC2BA597696FF3	$88.38	negotiated	$0.05	53	ffs
C899150D8565B456441C703D808E2668	$220.96	negotiated	$0.05	52	ffs
07EEDC7A0F86847E97F3805B6740519E	$441.92	negotiated	$0.05		ffs

Sample 54/90

Payer: 7 | Provider: 1325 | Code: J0218

Results:

Number of rate records: 20
Unique negotiated rates: 5
ASP Payment Limit: $393.82

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
2CF6AD8F4FB0D6A835C1C23FBA1806D3	$115.90	negotiated	$393.82	56	ffs
891B97C3573E737708FEB253CA2CF81B	$115.90	negotiated	$393.82	56	ffs
7F0FDE7A7271086D11F5835D18DEA5BC	$115.90	negotiated	$393.82	56	ffs
9DE3C1B6327C83AEDA938ADC71CFB9FA	$115.90	negotiated	$393.82	56	ffs
8FBCB5A6AC5E91D78A32ADF6CAA8DAC2	$173.85	negotiated	$393.82	55	ffs
71B34441CC49A0AD3BA9E98391C1895D	$173.85	negotiated	$393.82	55	ffs
03F61BF4324E1C89AA6BA832BCB8BEDF	$173.85	negotiated	$393.82	55	ffs
6B23DDA6473D1ED1B09B37EFC8A20650	$173.85	negotiated	$393.82	55	ffs
500825A8A294B10F595E85062AA316D3	$231.79	negotiated	$393.82	53	ffs
52576FDFE7C249C52FF7BECE26873FBD	$231.79	negotiated	$393.82	53	ffs
7157FAEC7227F00A11987D6720234306	$231.79	negotiated	$393.82	53	ffs
E76B14276044B26404FC5F81AF0A68D9	$231.79	negotiated	$393.82	53	ffs
7B9C321F4852AE62F556061AA1B89B9C	$579.49	negotiated	$393.82	52	ffs
F8F1055847FB44D1755C0DE3979A261A	$579.49	negotiated	$393.82	52	ffs
A2C6C63A88936A09200D2F91C986D94B	$579.49	negotiated	$393.82	52	ffs
FAB6B12E27C7C5057C9D851DB61E97B6	$579.49	negotiated	$393.82	52	ffs
4E87115F20632FABDCB0110590DEB6BF	$1158.97	negotiated	$393.82		ffs
6B9632FD0FDEA27723B0B997DF326477	$1158.97	negotiated	$393.82		ffs
CD55D92B62D585D7C70F7F307C1C3D3E	$1158.97	negotiated	$393.82		ffs
B6FAE4CADCCC43261B26B77E771466CC	$1158.97	negotiated	$393.82		ffs

Sample 55/90

Payer: 7 | Provider: 6181 | Code: J2183

Results:

Number of rate records: 10
Unique negotiated rates: 5
ASP Payment Limit: $1.62

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
F6E45B375DEDCEF591A41A92FBB5263C	$0.32	negotiated	$1.62	56	ffs
A44C9BCFF8A663628DE2AC1D7DA179F9	$0.32	negotiated	$1.62	56	ffs
26A34AF7741EE3A4063EFA41B9B04BC3	$0.48	negotiated	$1.62	55	ffs
CC431D8CB8BB47EE8B97BD3E679806A2	$0.48	negotiated	$1.62	55	ffs
26FE7F3AA9E63719135E3546AA3F84CC	$0.64	negotiated	$1.62	53	ffs
774D75703F3798ABBC4B2B329AE2CB4F	$0.64	negotiated	$1.62	53	ffs
42E094642B10AEAD57D4DB232898AA42	$1.60	negotiated	$1.62	52	ffs
E2A7307C7C7DA913A9604EA52E369EC4	$1.60	negotiated	$1.62	52	ffs
6EB03B7EB1B54CF674AF615193F8A67B	$3.20	negotiated	$1.62		ffs
DF2788775D85EFCE4C58B5D51A1EC3FC	$3.20	negotiated	$1.62		ffs

Sample 56/90

Payer: 7 | Provider: 3768 | Code: J0715

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $5.24

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
71AE564AC6441B2E8B0CF1CB2FCF8149	$0.57	fee schedule	$5.24	56	ffs
F467B4AAD82B3860964ACB7F61BABECD	$0.86	fee schedule	$5.24	55	ffs
C5F4CC9CFEF4C06537DE5CC42CB6AE55	$1.14	fee schedule	$5.24	53	ffs
81C60504588D4038B2C73427C42F0EBC	$2.85	fee schedule	$5.24	52	ffs
0BA2B6239E25D430A77149AA026A6BC6	$5.70	fee schedule	$5.24		ffs

Sample 57/90

Payer: 7 | Provider: 760 | Code: J0687

Results:

Number of rate records: 5
Unique negotiated rates: 5
ASP Payment Limit: $1.00

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
887B544919AE4A042AB92CD1AAF707B2	$0.26	negotiated	$1.00	56	ffs
FA4E7423675A11F6BEDF099C3E5772EE	$0.39	negotiated	$1.00	55	ffs
B6B889CB16278A2F616FA080239D6AF9	$0.52	negotiated	$1.00	53	ffs
108C7323F902A912C64757B3085AB526	$1.31	negotiated	$1.00	52	ffs
4CBF65E3E21D2C023C949807AFAF59F0	$2.62	negotiated	$1.00		ffs

Sample 58/90

Payer: 7 | Provider: 4283 | Code: J7613

Results:

Number of rate records: 2
Unique negotiated rates: 1
ASP Payment Limit: $0.07

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
8D9ABC252E17DC402543B7DC97904781	$0.12	negotiated	$0.07		ffs
9B7C0FF13DE2F95F53C4D534E1462712	$0.12	negotiated	$0.07		ffs

Sample 59/90

Payer: 7 | Provider: 5759 | Code: J9172

Results:

Number of rate records: 40
Unique negotiated rates: 5
ASP Payment Limit: $49.08

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D20F5CC623FEFF74CD2D8CB06F218141	$11.44	negotiated	$49.08	56	ffs
FF4527A7B38453660DDA84CC9E0036EB	$11.44	negotiated	$49.08	56	ffs
EE570D2B58A32A74BA2508857C6701CD	$11.44	negotiated	$49.08	56	ffs
8D4EAB81B44F7E51BDAEEFC29E3E9655	$11.44	negotiated	$49.08	56	ffs
6319AA5EBC04A5AC062C6BA3F21727DB	$11.44	negotiated	$49.08	56	ffs
9AEB04C4841DC8846B6FE108D7A21D33	$11.44	negotiated	$49.08	56	ffs
9F5C33489A4C83DB044C1709888EE9F6	$11.44	negotiated	$49.08	56	ffs
DE44D7E5A91FB73AE80EC1C7FB5F5F6C	$11.44	negotiated	$49.08	56	ffs
072DC1DF418ED8CEE85A0FF6BA74EB86	$17.15	negotiated	$49.08	55	ffs
0E78460988092D7DF89BE20961C2A4D1	$17.15	negotiated	$49.08	55	ffs
8E630F23166984B50ADF4A9717FEA763	$17.15	negotiated	$49.08	55	ffs
F3DCAA4F8DD63D792FE15DEC2F6A74CF	$17.15	negotiated	$49.08	55	ffs
A06016CD54D60F1D81267FF7017C8F4B	$17.15	negotiated	$49.08	55	ffs
3A251B22EEE6DC84BB4C610998256D75	$17.15	negotiated	$49.08	55	ffs
9785780B28797FDFC83E76191064AA77	$17.15	negotiated	$49.08	55	ffs
A9692BCCCA27E45ADF211B3278C44428	$17.15	negotiated	$49.08	55	ffs
F2C7C568D65D9F27E2EC0973E96B7250	$22.87	negotiated	$49.08	53	ffs
CCDBD3306A3CD1F1AAA52F3536E1075E	$22.87	negotiated	$49.08	53	ffs
48359D904649400F77C3887D63C5CD7F	$22.87	negotiated	$49.08	53	ffs
085EA3F851C452721A89633E83B69054	$22.87	negotiated	$49.08	53	ffs
7FD7C40DD69FED28EFD2F5937A040E86	$22.87	negotiated	$49.08	53	ffs
5A08EDA73B047399F5E294090567B20E	$22.87	negotiated	$49.08	53	ffs
E6141D238647D5F1075B975180A1BE02	$22.87	negotiated	$49.08	53	ffs
3F3AF7D4817C13F688BE25391489D9E5	$22.87	negotiated	$49.08	53	ffs
2906B08989BC5AA1A2506527058D4083	$57.18	negotiated	$49.08	52	ffs
D36C2DD2FCC6D5284462A846835D9B21	$57.18	negotiated	$49.08	52	ffs
635958FBCC1AF391660F7E44BBFE4908	$57.18	negotiated	$49.08	52	ffs
D9E835A97D4EFBF532E3296D654FFA16	$57.18	negotiated	$49.08	52	ffs
4FEE1E69E23400C5881BB0F147A8D84F	$57.18	negotiated	$49.08	52	ffs
C8699669B31ADCC85AFE94F2DB9A61D3	$57.18	negotiated	$49.08	52	ffs
630C890292C9BE277CD0DBBB3E71B8E5	$57.18	negotiated	$49.08	52	ffs
8C6925F6241B2147E5913343059EB29F	$57.18	negotiated	$49.08	52	ffs
43551E7451356372C839C8DC464AD79B	$114.37	negotiated	$49.08		ffs
0AFC1DE145370DD53B28C6B5E65B8A2D	$114.37	negotiated	$49.08		ffs
F3693789BEAEA3B4CEC2FADE31AD2C7C	$114.37	negotiated	$49.08		ffs
C93E01A73CBC7C630EC1E1C2A0AB4812	$114.37	negotiated	$49.08		ffs
965D862C4A8410DC52F22D6042110BDA	$114.37	negotiated	$49.08		ffs
84D088BC6B014FB8BF974B474A28846A	$114.37	negotiated	$49.08		ffs
482764B1DC5AEC701967C7FFBEDC3A57	$114.37	negotiated	$49.08		ffs
A07F888DD0C3132AB93E0EC6F79A3B6F	$114.37	negotiated	$49.08		ffs

Sample 60/90

Payer: 7 | Provider: 1325 | Code: J2997

Results:

Number of rate records: 20
Unique negotiated rates: 5
ASP Payment Limit: $94.15

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
F6D1E71DA01C1B1440FFD525E45FCDCE	$27.80	negotiated	$94.15	56	ffs
0316A5649D7E4533B1260BE182D371EB	$27.80	negotiated	$94.15	56	ffs
133AEB56BE374E6DF4AADAD8F2060156	$27.80	negotiated	$94.15	56	ffs
E541153921CFD7B9A41022EC2C5EA2BC	$27.80	negotiated	$94.15	56	ffs
4F14FE367FFE67D27ABBBD5D874393DF	$41.71	negotiated	$94.15	55	ffs
73E9693E8B3AA08762428D25C766F900	$41.71	negotiated	$94.15	55	ffs
C8262FA25E49887D05466AED17E9E87A	$41.71	negotiated	$94.15	55	ffs
2C5C1145F0BDA961DB0E1125212F9C12	$41.71	negotiated	$94.15	55	ffs
A88FEA38CF7BC70E60973B7505D3FC95	$55.61	negotiated	$94.15	53	ffs
CF5477A87F0CB7EA21859B305AA1AC70	$55.61	negotiated	$94.15	53	ffs
449874F4B4CB58E2470B9811700BE5D6	$55.61	negotiated	$94.15	53	ffs
30D5821A250EDCD7972517D1ED59408D	$55.61	negotiated	$94.15	53	ffs
F4AAFFFA844C2620D2DA766F4B4074A7	$139.02	negotiated	$94.15	52	ffs
17CFEFF595E4A86F5BA73308E30EB4B9	$139.02	negotiated	$94.15	52	ffs
7E0651942C1BFB59B31ED15CB36F273E	$139.02	negotiated	$94.15	52	ffs
39A6C88F8B56C52C026E9B00EB9BD016	$139.02	negotiated	$94.15	52	ffs
8FB3AEEC0CA043FE1CDEB4EB0F8B509B	$278.04	negotiated	$94.15		ffs
C683681C7D8DD10603F5E0E523FDD6A3	$278.04	negotiated	$94.15		ffs
53672BF96FCA2720539CD91071D8EA2C	$278.04	negotiated	$94.15		ffs
879260CBB77D73E7485A3DBC3610F00F	$278.04	negotiated	$94.15		ffs

Cigna

Sample 61/90

Payer: 76 | Provider: 22853 | Code: J2724

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $15.03

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
77234AA772E09EBC0DD8C9009DFA6DB9	$8.50	derived	$15.03	AS	ffs
18B0E0E22F7D3527072172BB0798ED6F	$12.75	derived	$15.03	56	ffs
97ADF7F2F4ED52AC03B44C3BD7DBBF5B	$12.75	derived	$15.03	55	ffs
64D745CAF46F67A166A9D72C109180F8	$17.00	derived	$15.03	53	ffs
2B84F872C5DC550246D21488D4F923EA	$42.50	derived	$15.03	QK	ffs
AA65138B36A8102C2F8BA93E6526CFBF	$42.50	derived	$15.03	QY	ffs
2ECFFB589DE82749D6E7EC7DD908DDFA	$42.50	derived	$15.03	QX	ffs
717FBEA2320C7FDC4F8E718BB2ED7E91	$53.13	derived	$15.03	62	ffs
F04780AEE25FE6043B09E105D9F23E2D	$59.50	derived	$15.03	54	ffs
8CA2DA6F4729F231CCEFD75EA18806A0	$68.00	derived	$15.03	52	ffs
C9896AB7594AF9FF1738965BE98DDA91	$68.00	derived	$15.03	FX	ffs
F6442C7ABD62C81F51DF4B987546FDDA	$72.25	derived	$15.03	CQ	ffs
A37E4AB52EF778F828F89220DD013C6D	$72.25	derived	$15.03	CO	ffs
573B604502248F63195BCCB6425F1CF1	$76.50	derived	$15.03	FY	ffs
806D22EAE5DBFA8DF4FFE7BC1B1D3065	$85.00	derived	$15.03		ffs
115A0126D6C5BDD311485E8842F7D96D	$102.00	derived	$15.03	22, 23	ffs

Sample 62/90

Payer: 76 | Provider: 2649 | Code: J1746

Results:

Number of rate records: 4
Unique negotiated rates: 2
ASP Payment Limit: $79.39

Detailed Rates:

ID	Rate	Type	ASP Limit	Arrangement
6DB6A7EC852540C7D1578BD5F3536302	$76.95	fee schedule	$79.39	ffs
4E3DAF0A28351AF074CCB94160ABCDB6	$76.95	fee schedule	$79.39	ffs
AD374E3D4EAD956C2DC9E817033ECB29	$179.26	fee schedule	$79.39	ffs
03BDD120D2D075A7CE86392D553A0A62	$179.26	fee schedule	$79.39	ffs

Sample 63/90

Payer: 76 | Provider: 426 | Code: J8515

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 63: 'min'

Sample 64/90

Payer: 76 | Provider: 4876 | Code: J9296

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 64: 'min'

Sample 65/90

Payer: 76 | Provider: 67767 | Code: J2760

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $436.51

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
D768CEF1BD411F96BF2774441D38268D	$49.98	derived	$436.51	AS	ffs
9C02F9297EF7A05A3033190230D3F30A	$74.97	derived	$436.51	55	ffs
44923DC63CB40465CA79039F8EA10601	$74.97	derived	$436.51	56	ffs
C167FD60136B3F8816053918E1A3A9D7	$99.95	derived	$436.51	53	ffs
EA37E7C16823923370A08B74A8C2BBA9	$249.89	derived	$436.51	QK	ffs
68C786B00973FF9168C77BC6632B1840	$249.89	derived	$436.51	QY	ffs
F92758D5BBD316B2A7AF8DDDBEFF6D4D	$249.89	derived	$436.51	QX	ffs
0CF5AFD2DA1ECE4BAE80563DBAA7DD74	$312.36	derived	$436.51	62	ffs
DEFF6C8B2E5C558F224734FC6EC91FCB	$349.84	derived	$436.51	54	ffs
1CF579830D7A5C65D50246382632734C	$399.82	derived	$436.51	FX	ffs
F06E6DFDE2E2BBAA73BC541EDE4E9B40	$399.82	derived	$436.51	52	ffs
D5C7D6AE6ED9D42E6DBC6C5F8646A26F	$424.80	derived	$436.51	CQ	ffs
BA8BFB49BA63F6087CBF8FB7B72BE955	$424.80	derived	$436.51	CO	ffs
A24FA3C297E4112E91508DD6F026E1DF	$449.79	derived	$436.51	FY	ffs
1BD92229EEF61C5151D42A57F2912D81	$499.77	derived	$436.51		ffs
94F26CFB461248B7F33AFF3181D5F362	$599.72	derived	$436.51	22, 23	ffs

Sample 66/90

Payer: 76 | Provider: 1617 | Code: J9056

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $28.06

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
04B49B433B4D4A2EF47AABC7BD71F911	$3.34	derived	$28.06	AS	ffs
4C2453F29365D6E006FB21FA4058C7E7	$5.01	derived	$28.06	56	ffs
D8A2170AE3BD1D007881D071E2A9D473	$5.01	derived	$28.06	55	ffs
6C36B152B15B6DEA36C9935BB9DAA6F0	$6.68	derived	$28.06	53	ffs
E2C2BC3590829F98990F1EB2C8DEEF9E	$16.70	derived	$28.06	QY	ffs
7A69F1D44A2F28FD993A5128E3C65237	$16.70	derived	$28.06	QX	ffs
EBDF87D0DBABE578148D7A879361BDBC	$16.70	derived	$28.06	QK	ffs
C6A8DCECA187CD47CFF13BCB6EF3F87B	$20.87	derived	$28.06	62	ffs
DDC5AE480EC0BFF697719B78933036B8	$23.37	derived	$28.06	54	ffs
AF456F35110F788EC7F3DEB4A9ABAFB1	$26.71	derived	$28.06	52	ffs
B662CEFF7411DED07B857CAB540F9808	$26.71	derived	$28.06	FX	ffs
EBD2B970AE024A0818302B73CF1039EF	$28.38	derived	$28.06	CQ	ffs
568C09DB04E50F7967586215C6415974	$28.38	derived	$28.06	CO	ffs
4BADB2A568DA6B041D609B6D3D7A0D92	$30.05	derived	$28.06	FY	ffs
5BD92696A2AA544AA44D4208FB981DFA	$33.39	derived	$28.06		ffs
DFF4C32AAEA9F6E8B452DE18ED31B1F8	$40.07	derived	$28.06	22, 23	ffs

Sample 67/90

Payer: 76 | Provider: 3312 | Code: J2675

Results:

Number of rate records: 32
Unique negotiated rates: 11
ASP Payment Limit: $0.63

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
39BD20173535CCDAE3940DE9FC612777	$8.50	derived	$0.63	AS	ffs
92E0B6A06B0FC3E74F5E8036D7F23885	$8.50	derived	$0.63	AS	ffs
7B0537837CCF57B0FD3BD8DA1CFBD119	$12.75	derived	$0.63	56	ffs
8346B61F8DFE7A925F1A6CE24B8D875C	$12.75	derived	$0.63	56	ffs
B6777F549F578B2213BD4E79A99CFBE7	$12.75	derived	$0.63	55	ffs
240579E1B1ECFAF9E0F708560B13743F	$12.75	derived	$0.63	55	ffs
63161CC81E2E88183A0405BEF3F1B97A	$17.00	derived	$0.63	53	ffs
EA846D5FB8D2D28FBD849F5EFE5F8AB2	$17.00	derived	$0.63	53	ffs
95360EAE21095C43ABD0187732A1290B	$42.50	derived	$0.63	QK	ffs
DF4C8D481C4BD5BC6EF521013460A225	$42.50	derived	$0.63	QX	ffs
AD5338E5EFFA2E26280B13861088E784	$42.50	derived	$0.63	QY	ffs
6DC1396F7B5CF36BF3F28996F4F4FD79	$42.50	derived	$0.63	QK	ffs
1C113B240D571533DC5E8FA887C05CE0	$42.50	derived	$0.63	QX	ffs
C431BD61F2F3BD2EDFDE13F015EBA317	$42.50	derived	$0.63	QY	ffs
E0AAABB3EA571FCA6F43EBD882183F57	$53.13	derived	$0.63	62	ffs
EAFE66CFDBF0AC096C54A047FD497824	$53.13	derived	$0.63	62	ffs
75990DCBA126730AA307A4C032921773	$59.50	derived	$0.63	54	ffs
5A4E4749A903B66BFBFE68EF2394011B	$59.50	derived	$0.63	54	ffs
12C3D70E5A4988FFB8119B9D66AD0370	$68.00	derived	$0.63	FX	ffs
8850AF37BD7422C4F1F1C77DEDBD1A21	$68.00	derived	$0.63	FX	ffs
75B0D14B106344679F6726317FAFA767	$68.00	derived	$0.63	52	ffs
264F0E3C5189FA1E2A48D171E54ED657	$68.00	derived	$0.63	52	ffs
BBB78038DC5D8EF6BECB667834361294	$72.25	derived	$0.63	CQ	ffs
9EFDED4C2FBEB8070A8ACF2242A05A8B	$72.25	derived	$0.63	CO	ffs
0801EF002CD3308E2A34EA0B69128717	$72.25	derived	$0.63	CQ	ffs
08561EBBFCADC7CD1D8A0119A6100690	$72.25	derived	$0.63	CO	ffs
76C8EA515085D11DD4CDE972F3C67293	$76.50	derived	$0.63	FY	ffs
1C6D2EC9001872A8F66B26AC1F11DE57	$76.50	derived	$0.63	FY	ffs
035B9B0A12009BAF3B783EA97D0F83A4	$85.00	derived	$0.63		ffs
4169C18EA314A921EF93D7B054583F4B	$85.00	derived	$0.63		ffs
E2B99BE1D65327E64F561C0E4D360FB5	$102.00	derived	$0.63	22, 23	ffs
ED429EDFA105B98133D3B400CD3FA552	$102.00	derived	$0.63	22, 23	ffs

Sample 68/90

Payer: 76 | Provider: 1841 | Code: J1738

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 68: 'min'

Sample 69/90

Payer: 76 | Provider: 4876 | Code: J8600

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 69: 'min'

Sample 70/90

Payer: 76 | Provider: 3300 | Code: J1595

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $67.64

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
F54568029ADEDD7AC3C962CF263B43CD	$8.50	derived	$67.64	AS	ffs
A6297BEC2BA3F1B7B6B7DB23117A2A3E	$12.75	derived	$67.64	55	ffs
575D6FC96B1198C04538D0B045DC2CDC	$12.75	derived	$67.64	56	ffs
1D2EB089F483F4C35EDA8CAC220F12BD	$17.00	derived	$67.64	53	ffs
DF46B090DE2A7D6D66C17E41D9462518	$42.50	derived	$67.64	QK	ffs
E9DB8614CDA819F45FCE3870AAFA45C8	$42.50	derived	$67.64	QX	ffs
B8906B3818306A7511CF587430B628AB	$42.50	derived	$67.64	QY	ffs
0459132DFD3124CA6E2301AC1CEC7D10	$53.13	derived	$67.64	62	ffs
0C9FEF4DE18A01E9A0391626576E3F78	$59.50	derived	$67.64	54	ffs
EFCD8D6A3C9377172D8A36A9AC7D418A	$68.00	derived	$67.64	52	ffs
C5DCF71D071B620441593F82FD254BBB	$68.00	derived	$67.64	FX	ffs
99F0A844222007BC94D5072F9F025CA4	$72.25	derived	$67.64	CQ	ffs
3AF3D41103763D76C15B7A910CDD8FA0	$72.25	derived	$67.64	CO	ffs
F3295A5C44BBD66819ADE1A5620A2562	$76.50	derived	$67.64	FY	ffs
2676B9AA2C45F2864F67024D3F6CB828	$85.00	derived	$67.64		ffs
E47872AF84D992538C1104A7410DA036	$102.00	derived	$67.64	22, 23	ffs

Sample 71/90

Payer: 76 | Provider: 646 | Code: J1551

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 71: 'min'

Sample 72/90

Payer: 76 | Provider: 3315 | Code: J2274

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $10.79

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
578F9E116295B17A7E8999A3E582BF08	$8.50	derived	$10.79	AS	ffs
C99351BF1199C4E1296F48104A52BA77	$12.75	derived	$10.79	55	ffs
7AEABAAB00AC1D187D1CAC14B67B2745	$12.75	derived	$10.79	56	ffs
CA3062975FBBC801366E2D12F4063C2C	$17.00	derived	$10.79	53	ffs
8F96E44027894B3BE524F60794DA77BE	$42.50	derived	$10.79	QK	ffs
BE3A8BFFFCD39EBB0B670D6A47084FF1	$42.50	derived	$10.79	QX	ffs
CB24FA6F2B302A82ADF6DE47F2501AE5	$42.50	derived	$10.79	QY	ffs
B210E2ACE89745200C015AD70DDE24EE	$53.13	derived	$10.79	62	ffs
3E1CE025103D0E01EC6FED8B707F625C	$59.50	derived	$10.79	54	ffs
6DFBD7AC8138E22AB6437B76AAA176BD	$68.00	derived	$10.79	FX	ffs
B5A975C5A4A59B509E554A5CB143F7B7	$68.00	derived	$10.79	52	ffs
675866308B5ACD64394D36ABB47AC7D2	$72.25	derived	$10.79	CO	ffs
D9E1F26514AC45D2C9F7BE43A31E9230	$72.25	derived	$10.79	CQ	ffs
121FAEB7431111709E4871AF88857CA7	$76.50	derived	$10.79	FY	ffs
4B658D20BC7C12E8726EE56405BC035F	$85.00	derived	$10.79		ffs
752FB4AE9DD410C48E44973720A515B1	$102.00	derived	$10.79	22, 23	ffs

Sample 73/90

Payer: 76 | Provider: 3224 | Code: J7197

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $4.09

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C134BD821F1E51D49F28B8D2E02360DA	$8.50	derived	$4.09	AS	ffs
D011DF08B331A5FBB7BD0512C21568A5	$12.75	derived	$4.09	55	ffs
3B21BD4BF953D95DE08D7A400AFDEB4D	$12.75	derived	$4.09	56	ffs
9C06AFED0D2E9451A621B62818139C38	$17.00	derived	$4.09	53	ffs
F83B8314188A3AE097F25CC126A2CEE6	$42.50	derived	$4.09	QX	ffs
F576B8D9C668BD3432BF847C3B50AF81	$42.50	derived	$4.09	QY	ffs
158285DED83336135E461A3563320F9E	$42.50	derived	$4.09	QK	ffs
16B0B8D3D62D5541B86AB1C5ED09F3C4	$53.13	derived	$4.09	62	ffs
72176646C205007C1A00AD05038321A1	$59.50	derived	$4.09	54	ffs
EF41CE3EE2CDB83FF54444EDCB685D5C	$68.00	derived	$4.09	52	ffs
F6E9AAB70D64B8E9F11B4D52A33785B1	$68.00	derived	$4.09	FX	ffs
FACD2C72C26BD24E99164AD6F9E0FB2B	$72.25	derived	$4.09	CQ	ffs
CBC313F482BBAC9D223274B9BA197551	$72.25	derived	$4.09	CO	ffs
EEE1DDDFDF6F4EB0D8C042EFA47132C1	$76.50	derived	$4.09	FY	ffs
BB18318C3649FDE16A666C91C9B18CE3	$85.00	derived	$4.09		ffs
920639CCE2B73BB5E9E3B934B04EB5AC	$102.00	derived	$4.09	22, 23	ffs

Sample 74/90

Payer: 76 | Provider: 1626 | Code: J7212

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $2.40

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
DB418A2AA167E8F115E13FFAC5512723	$0.27	derived	$2.40	AS	ffs
A18701EB11AC710AC3E87A8D30934764	$0.41	derived	$2.40	55	ffs
B8314E9557474625B7EB0711CAE23DC8	$0.41	derived	$2.40	56	ffs
27A78C250D8E738E7AF873E75349E139	$0.54	derived	$2.40	53	ffs
A56C4E11B2400BBFA398EA5F49ED7545	$1.36	derived	$2.40	QK	ffs
A0A4A72B4D1F04DB9BCC29EED79B50C6	$1.36	derived	$2.40	QX	ffs
3D76BD12E0B46C8734A66BFE22141637	$1.36	derived	$2.40	QY	ffs
150B4198CCAF7AEC9ECAAA6643C4E427	$1.69	derived	$2.40	62	ffs
4B16AD66B787FB2E638B44E02EE6F930	$1.90	derived	$2.40	54	ffs
8D7665F16A6C75E4AD8F9A1DD0CD9EF4	$2.17	derived	$2.40	52	ffs
5377B4F011888AAF5DA94E857F63841B	$2.17	derived	$2.40	FX	ffs
3036F3F7367ABE24F7D7E5D9CF86F53B	$2.30	derived	$2.40	CO	ffs
5FB93C0AE4E382ABAA8CCC71CC48E953	$2.30	derived	$2.40	CQ	ffs
F36AA276526BB8D7A2A9C4E9EA71531F	$2.44	derived	$2.40	FY	ffs
F05E148783BCF16F974305074F0E3E81	$2.71	derived	$2.40		ffs
4E9904CCB557A88F7C5DD80E49D3F9FC	$3.25	derived	$2.40	22, 23	ffs

Sample 75/90

Payer: 76 | Provider: 658 | Code: J7682

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 75: 'min'

Sample 76/90

Payer: 76 | Provider: 8620 | Code: J0899

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 76: 'min'

Sample 77/90

Payer: 76 | Provider: 658 | Code: J0282

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 77: 'min'

Sample 78/90

Payer: 76 | Provider: 1626 | Code: J1571

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $71.66

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B24DFA482F1E182E563E1713B06330BF	$9.08	derived	$71.66	AS	ffs
4CD542A88E0BC38530033497FA63BF9C	$13.62	derived	$71.66	56	ffs
4C6A1DECAB87353A0FFEA5FCF2B06A96	$13.62	derived	$71.66	55	ffs
23823833F9020B01CA0634DFE984646C	$18.15	derived	$71.66	53	ffs
9C48D1D5FB241F1D7A9FD11B7D2850CD	$45.39	derived	$71.66	QK	ffs
A5AD51BD3D356B4C2ACE0C02DA4E9259	$45.39	derived	$71.66	QX	ffs
5746C83E218D1599384A96E5808A20F4	$45.39	derived	$71.66	QY	ffs
D8E27829B4A4F23428F8EBD77A509B46	$56.73	derived	$71.66	62	ffs
A50EDE754B8CB74EEDAE99C0D429D66A	$63.54	derived	$71.66	54	ffs
A6950DD1E78C97BB87F976FA1BB34B6F	$72.62	derived	$71.66	FX	ffs
D4790397081C2B00659A5F1425437C0D	$72.62	derived	$71.66	52	ffs
F4D60A66FE5A7503A379E01BC80C19D1	$77.15	derived	$71.66	CO	ffs
EB1A8F0C896A977CF64EF763C927739F	$77.15	derived	$71.66	CQ	ffs
6AA35CAC99954482B30499034A5CD377	$81.69	derived	$71.66	FY	ffs
10BFF1492D76D68F2EB55A755AA9F2FF	$90.77	derived	$71.66		ffs
E09E8E58A3FCB6A445E372B1D7B42FFD	$108.92	derived	$71.66	22, 23	ffs

Sample 79/90

Payer: 76 | Provider: 1776 | Code: J3300

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 79: 'min'

Sample 80/90

Payer: 76 | Provider: 29363 | Code: J7336

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $3.38

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C90C57AB6B5683C9A8ABF4DFC95108A7	$8.50	derived	$3.38	AS	ffs
802EF66067E223E96B31D45E5BA27595	$12.75	derived	$3.38	56	ffs
E45A9D357BD7B7C3117266890CE1CE50	$12.75	derived	$3.38	55	ffs
DE05AA668136F4CF5FA85DA180B05CAF	$17.00	derived	$3.38	53	ffs
B6D838DC2BFC8D0961BF041A878342BC	$42.50	derived	$3.38	QX	ffs
8DE326C3D087EC3C6F87BB52F92E8A66	$42.50	derived	$3.38	QK	ffs
693F74E0860BEF395C4BA850F9AB1553	$42.50	derived	$3.38	QY	ffs
37BC8A6C53020EA019C8918AAE586F72	$53.13	derived	$3.38	62	ffs
0F44A6862A705E2DBDACFE0850123436	$59.50	derived	$3.38	54	ffs
A9E9F3FA5AE3C5131CAF5AF69433B683	$68.00	derived	$3.38	FX	ffs
F229C9403CBCCD38C93BED3695AAA6DC	$68.00	derived	$3.38	52	ffs
9BC243E5AD5DFFC0D77EACCE5CFE2082	$72.25	derived	$3.38	CO	ffs
5A563C7E0F5BA567F4455E510B3FC33B	$72.25	derived	$3.38	CQ	ffs
559217FB2B6D40392AE62973705AD3C0	$76.50	derived	$3.38	FY	ffs
5E7F95392D6E0211DD581E7E73E1BDF3	$85.00	derived	$3.38		ffs
2A598FD1636B6F3F72A4D08ED0E6493D	$102.00	derived	$3.38	22, 23	ffs

Sample 81/90

Payer: 76 | Provider: 23595 | Code: J7311

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $339.76

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
C4ACE07C811C8AD3A0ADA3E38855C3D2	$466.52	fee schedule	$339.76		ffs
43A35EE98DC6EA201F97603A643064EC	$483.18	fee schedule	$339.76		ffs

Sample 82/90

Payer: 76 | Provider: 3315 | Code: J3285

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $55.48

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
17D5871C506A309DFC8B6892D510B287	$8.50	derived	$55.48	AS	ffs
F681D89EC2DC23206B13CB0F0AB845A0	$12.75	derived	$55.48	56	ffs
CBCD2D3425EBD8D0BBF787A15FBE40F5	$12.75	derived	$55.48	55	ffs
ACEE4F233181C507619D0ECE4FA88EEE	$17.00	derived	$55.48	53	ffs
6AA5FE663716FC7B91ECC9BE2F66886D	$42.50	derived	$55.48	QX	ffs
9FB278793DA05533FF28CD2E5D24835C	$42.50	derived	$55.48	QY	ffs
2CB85958A132692D72C513968EA45666	$42.50	derived	$55.48	QK	ffs
6E5430409DCC5CE82DDC348BAE42FDA0	$53.13	derived	$55.48	62	ffs
763A7367A9CF25DEA579DFD7DEBBC77B	$59.50	derived	$55.48	54	ffs
17932193C1E3161C40255C87B5C2EDF5	$68.00	derived	$55.48	52	ffs
74AAC97A7798F1003B385A33DF6CFBFA	$68.00	derived	$55.48	FX	ffs
B2172E4EEC6F8654C4C74F5D834E8E6D	$72.25	derived	$55.48	CO	ffs
392CCC836A32BAB2F40C7033AE75718F	$72.25	derived	$55.48	CQ	ffs
3A95ED3CB3E458E1F6029946AA80B8A4	$76.50	derived	$55.48	FY	ffs
11D9D1F86FBD2317F872427E4619E656	$85.00	derived	$55.48		ffs
956BE6C96CD9727E40E984C204EBCB7F	$102.00	derived	$55.48	22, 23	ffs

Sample 83/90

Payer: 76 | Provider: 5445 | Code: J1457

Results:

Number of rate records: 0
Unique negotiated rates: 0
ASP Payment Limit: None

Error processing sample 83: 'min'

Sample 84/90

Payer: 76 | Provider: 1626 | Code: J0834

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $28.02

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
44E6E663B3C0749B18EAE965ECFC2C6B	$8.50	derived	$28.02	AS	ffs
0DA853F81B6A5271880F820B6D693A0D	$12.75	derived	$28.02	56	ffs
9979F2609317C0090801FFE12974A7AF	$12.75	derived	$28.02	55	ffs
A18D9650A128708B9FA7A79CBA1E2D1D	$17.00	derived	$28.02	53	ffs
DA7673722E05EE322E71E544E0DA35E2	$42.50	derived	$28.02	QK	ffs
5E37BF8C0DDB58146BE9B75D5FD8E1E6	$42.50	derived	$28.02	QX	ffs
C12FB11E57C27AD387AEE29A78D3ECBD	$42.50	derived	$28.02	QY	ffs
DD1D7D61CC9AE271A2B258422A32DBDB	$53.13	derived	$28.02	62	ffs
277F99F87460DC2DE0D5FF40E62BD10C	$59.50	derived	$28.02	54	ffs
3EE124DF372379ADB20257719CA40A1A	$68.00	derived	$28.02	FX	ffs
67F9715FE956CF44E78A450D9C0DB931	$68.00	derived	$28.02	52	ffs
28E8CF3D3085C43152210BCE9A4E4693	$72.25	derived	$28.02	CQ	ffs
747466E5E890F4EED45F8683E3804BF9	$72.25	derived	$28.02	CO	ffs
1ED5F51E347B0CFCE90867082EFF2D60	$76.50	derived	$28.02	FY	ffs
40AACABA72DFC8A0EA4BAE036B41A3B3	$85.00	derived	$28.02		ffs
9FDB62CDFFB75890B85FD567D0E79816	$102.00	derived	$28.02	22, 23	ffs

Sample 85/90

Payer: 76 | Provider: 3224 | Code: J2469

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $0.45

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
B65F349EEADF9CA2087CE65D9E24C24C	$8.50	derived	$0.45	AS	ffs
208A96E316765435BE4F796F45F9E23D	$12.75	derived	$0.45	55	ffs
895BAFD6C449FA4BD2DC65FE8181CE00	$12.75	derived	$0.45	56	ffs
8ECF9E424D1C0CFC83C9E6C498D6FAD8	$17.00	derived	$0.45	53	ffs
CA8C530122D625943199BDDE77EB2468	$42.50	derived	$0.45	QX	ffs
E974E5E3C0404F27B697A9A0E540AEBF	$42.50	derived	$0.45	QK	ffs
B1A7CB5AE5A0343C5C654ED1805B85FB	$42.50	derived	$0.45	QY	ffs
A0B38E95C81A021855C2C802018C558D	$53.13	derived	$0.45	62	ffs
75696CFE2AEA6CD3F31AB08511016B3B	$59.50	derived	$0.45	54	ffs
665530CEDED509FE5538037EA7874BF6	$68.00	derived	$0.45	FX	ffs
2E77909D6E154F49C6F936BB6C2CA492	$68.00	derived	$0.45	52	ffs
798871EE23F8978305343DCEE6B6D84E	$72.25	derived	$0.45	CO	ffs
6638D872C01BFF527FE6733427D4924C	$72.25	derived	$0.45	CQ	ffs
3C0A216C4B1B00415C7690CE52462863	$76.50	derived	$0.45	FY	ffs
47B721A65C37CEFC3A8C0C845E2C611A	$85.00	derived	$0.45		ffs
C33A19C543519B4F7E883BE4027C381F	$102.00	derived	$0.45	22, 23	ffs

Sample 86/90

Payer: 76 | Provider: 67767 | Code: J9313

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $23.39

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
FFD6F304AB2EF8F06ACB2E6BD98A2350	$2.25	derived	$23.39	AS	ffs
6CAE9EB67C8E11BC6787CE1874583ECC	$3.38	derived	$23.39	56	ffs
BF2A2E20324939B9014FD90213296A7F	$3.38	derived	$23.39	55	ffs
863E5737130FE48713BE36AA9BCEBF4F	$4.50	derived	$23.39	53	ffs
28399485C83914007FB9FF742CFED3BC	$11.26	derived	$23.39	QY	ffs
8E29217866EBEAA8F2FFA74C91AD1250	$11.26	derived	$23.39	QK	ffs
142EDA9F2B4136D895DD49FB1963414B	$11.26	derived	$23.39	QX	ffs
2B423910F2FF8F8A15F60C062CC2A6A9	$14.07	derived	$23.39	62	ffs
FBE82A36B21D1404D903E322F7366B44	$15.76	derived	$23.39	54	ffs
589A4046230439668938561F6B3DE316	$18.01	derived	$23.39	52	ffs
5A07F49F146804885D40DB9B6D1EA85E	$18.01	derived	$23.39	FX	ffs
82C6F316CC90D49A3987FC925B58480D	$19.13	derived	$23.39	CQ	ffs
0CBDA13F752FE8B952E7748A0A2E5F64	$19.13	derived	$23.39	CO	ffs
085265797718BA454E76EE0916D4572D	$20.26	derived	$23.39	FY	ffs
1B4D3E87B93FA5A91D747BD705446961	$22.51	derived	$23.39		ffs
33610FA7BC1F581105AE7556AAF443DA	$27.01	derived	$23.39	22, 23	ffs

Sample 87/90

Payer: 76 | Provider: 80298 | Code: J3262

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $5.79

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
511E3E04F099575EE6EFCF55CCF1587C	$8.50	derived	$5.79	AS	ffs
D9710B48EB773C05A5FDDF45C480E100	$12.75	derived	$5.79	55	ffs
26A38E064585B31DC5A83FC4EA737BBF	$12.75	derived	$5.79	56	ffs
80BCFBE04906D73206CE9F081FA15E3A	$17.00	derived	$5.79	53	ffs
2E0F09EE68EA6DEEB9F66152DE55AA06	$42.50	derived	$5.79	QK	ffs
62288F23E9E9C0A154C831172A1C2645	$42.50	derived	$5.79	QX	ffs
97BB1DC1B939A0FF552200A7D0E8BDF7	$42.50	derived	$5.79	QY	ffs
587D90EAF4B5626663ADE16749DE1925	$53.13	derived	$5.79	62	ffs
2959F6EA1022EBD7CABEFA0762F40997	$59.50	derived	$5.79	54	ffs
6303A829851CD566DC0C0A08A1C5A28C	$68.00	derived	$5.79	52	ffs
E83C8DEF3D3716006C8E914D1A316816	$68.00	derived	$5.79	FX	ffs
C739045C80818B14E89B2406F0CCC756	$72.25	derived	$5.79	CO	ffs
B4D354B559A421E2C62B54E6F195599A	$72.25	derived	$5.79	CQ	ffs
1322EB9DF3AA3A5187357CF2C29A6765	$76.50	derived	$5.79	FY	ffs
B15F7AFADBB8A4706B79CCB0DBE4BE2E	$85.00	derived	$5.79		ffs
6E5F10777C8E59B9E02D563BFB6F229B	$102.00	derived	$5.79	22, 23	ffs

Sample 88/90

Payer: 76 | Provider: 80298 | Code: J2300

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $3.51

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
7BEBF9EFA25BA9EF79E8C25E6A16526C	$8.50	derived	$3.51	AS	ffs
502E86278EECAF958F7B16A4D15AE6C2	$12.75	derived	$3.51	56	ffs
047ACD7A9D28C1E11AF1AEE0D09BFC3D	$12.75	derived	$3.51	55	ffs
9CB581FE4EF45F39BC210DC8F340E587	$17.00	derived	$3.51	53	ffs
C69A29EEDEF95EC209E1BA8FB3786B65	$42.50	derived	$3.51	QX	ffs
012D76D554DA7DEE964EA333E9844301	$42.50	derived	$3.51	QK	ffs
47058747E85D3FBCF2F33F9659DC48E1	$42.50	derived	$3.51	QY	ffs
57664AD77EF9073C2FF680399722A0E5	$53.13	derived	$3.51	62	ffs
EE66FCDE68891653F706A186EAB577C4	$59.50	derived	$3.51	54	ffs
36958EA99C78811CD0C1FF9249CED5AF	$68.00	derived	$3.51	FX	ffs
820359051C229298A76A53DD07D5BA1A	$68.00	derived	$3.51	52	ffs
8271A9955FD1781B642EC2B978A07F1B	$72.25	derived	$3.51	CQ	ffs
B401C6CF6E47D64B90DF83E9EF88A9FA	$72.25	derived	$3.51	CO	ffs
3AFD9309722D7EE45EF94597BD7D3FB1	$76.50	derived	$3.51	FY	ffs
72F4DEB16779A4246A32ADE34148B9B3	$85.00	derived	$3.51		ffs
67FAAEAC138ADC3EF933A0AB5602DC1A	$102.00	derived	$3.51	22, 23	ffs

Sample 89/90

Payer: 76 | Provider: 3281 | Code: J2150

Results:

Number of rate records: 16
Unique negotiated rates: 11
ASP Payment Limit: $2.24

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
E006C5F6672BE65121209A730505FAC0	$8.50	derived	$2.24	AS	ffs
B0314BD1364F0FD9CF9AB0C18FE26495	$12.75	derived	$2.24	55	ffs
BD1ABC44CB1C6F209203CE0573E06DC3	$12.75	derived	$2.24	56	ffs
E5A70871649284835A656B4C7ABECD4E	$17.00	derived	$2.24	53	ffs
C0D39DDDDA51E2644B882535C320DCFC	$42.50	derived	$2.24	QY	ffs
888D22C253CE60359C1DBFE435F3FD31	$42.50	derived	$2.24	QK	ffs
C388E861D53DD84164784937394A5EEA	$42.50	derived	$2.24	QX	ffs
6AF3B2EC85232B985AA9AFF9B22D7974	$53.13	derived	$2.24	62	ffs
276FBF0E7E0E250057D53ABA2496F158	$59.50	derived	$2.24	54	ffs
DE56EC163A770D0CFB45E406D2E4ED7E	$68.00	derived	$2.24	FX	ffs
5B6706B22AD4AF725D3436C03DDB1F18	$68.00	derived	$2.24	52	ffs
F83A9A76C57C6E1ED0AC7BAF15A0AFA2	$72.25	derived	$2.24	CO	ffs
030F6DB2B9FC5EA0A0EF05842DDB9962	$72.25	derived	$2.24	CQ	ffs
753AA9ABCE06AE41F28260D6497E08C5	$76.50	derived	$2.24	FY	ffs
6E8DA491838502B6E8E99257E093E2CB	$85.00	derived	$2.24		ffs
22E67CF6D7B28AABF5C3B6560EE5D2CD	$102.00	derived	$2.24	22, 23	ffs

Sample 90/90

Payer: 76 | Provider: 28053 | Code: J9228

Results:

Number of rate records: 2
Unique negotiated rates: 2
ASP Payment Limit: $183.41

Detailed Rates:

ID	Rate	Type	ASP Limit	Modifier	Arrangement
E95287C46E1659E09B383F4C3DD5E3B1	$231.04	fee schedule	$183.41		ffs
E22A9D859CA4A78F9F22138B510D90D4	$301.74	fee schedule	$183.41		ffs

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