{ "reporting_entity_name": "Centene Management Company LLC", "reporting_entity_type": "Third Party Administrator", "version": "2.0.0", "last_updated_on": "2026-06-29", "out_of_network": [{ "name": "Under Proprietary Laboratory Analyses", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "0449U", "description": "Under Proprietary Laboratory Analyses", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 944.25, "providers": [{ "billed_charge": 11852.56, "npi": [1598314437] } ] } ] } ] }, { "name": "RESIDENTIAL TREATMENT-PSYCHI", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1001", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260605527" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 170687.98, "providers": [{ "billed_charge": 78320.00, "npi": [1962968529] } ] } ] }, { "tin": { "type": "ein", "value": "941496052" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 968.96, "providers": [{ "billed_charge": 6056.00, "npi": [1154426807] } ] } ] }, { "tin": { "type": "ein", "value": "992524107" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 113305.71, "providers": [{ "billed_charge": 320000.00, "npi": [1467265439] } ] } ] }, { "tin": { "type": "ein", "value": "208838214" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 444794.00, "providers": [{ "billed_charge": 91100.00, "npi": [1053934984] } ] } ] }, { "tin": { "type": "ein", "value": "834603742" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 93432.27, "providers": [{ "billed_charge": 48950.00, "npi": [1477204691] } ] } ] } ] }, { "name": "RESIDENTIAL TREATMENT - CHEM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1002", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823334211" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4056.50, "providers": [{ "billed_charge": 5795.00, "npi": [1518713643] } ] } ] }, { "tin": { "type": "ein", "value": "920261002" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9736.43, "providers": [{ "billed_charge": 29600.00, "npi": [1326760596] } ] } ] }, { "tin": { "type": "ein", "value": "883742034" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2609.08, "providers": [{ "billed_charge": 13000.00, "npi": [1700560695] } ] } ] } ] }, { "name": "TOBACCO NON-USER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1036F", "description": "CURRENT TOBACCO NON-USER (CAD, CAP, COPD, PV) (DM) (IBD)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810889110" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1421.02, "providers": [{ "billed_charge": 0.00, "npi": [1437516887] } ] } ] }, { "tin": { "type": "ein", "value": "621816823" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2421.33, "providers": [{ "billed_charge": 0.00, "npi": [1912979964] } ] } ] }, { "tin": { "type": "ein", "value": "362657618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 930.30, "providers": [{ "billed_charge": 0.00, "npi": [1801833983] } ] } ] }, { "tin": { "type": "ein", "value": "593214635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1266.51, "providers": [{ "billed_charge": 0.00, "npi": [1225034234] } ] } ] }, { "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 91.40, "providers": [{ "billed_charge": 0.01, "npi": [1811122880] } ] }, { "allowed_amount": 2128.93, "providers": [{ "billed_charge": 0.15, "npi": [1811122880] } ] } ] } ] }, { "name": "AMNT PAIN NOTED NONE PRSNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1126F", "description": "PAIN SEVERITY QUANTIFIED; NO PAIN PRESENT (COA) (ONC)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 254.11, "providers": [{ "billed_charge": 0.02, "npi": [1811122880] } ] } ] } ] }, { "name": "MED LIST DOCD IN RCRD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1159F", "description": "MEDICATION LIST DOCUMENTED IN MEDICAL RECORD (COA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "204923281" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.76, "providers": [{ "billed_charge": 0.00, "npi": [1003985102] } ] } ] }, { "tin": { "type": "ein", "value": "770460802" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 432.36, "providers": [{ "billed_charge": 0.00, "npi": [1588721500] } ] } ] }, { "tin": { "type": "ein", "value": "620864163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2518.65, "providers": [{ "billed_charge": 0.00, "npi": [1487604609] } ] } ] } ] }, { "name": "RVW MEDS BY RX/DR IN RCRD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1160F", "description": "REVIEW OF ALL MEDICATIONS BY A PRESCRIBING PRACTITIONER OR CLINICAL PHARMACIST (SUCH AS, PRESCRIPTIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "593110868" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 227.76, "providers": [{ "billed_charge": 0.00, "npi": [1568693554] } ] } ] }, { "tin": { "type": "ein", "value": "953942828" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 121.41, "providers": [{ "billed_charge": 0.01, "npi": [1720232465] } ] } ] } ] }, { "name": "PSTAY/WARD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "154", "description": "ROOM AND BOARD - WARD -PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883269656" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1275.00, "providers": [{ "billed_charge": 5500.00, "npi": [1730929803] } ] } ] }, { "tin": { "type": "ein", "value": "465716785" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 103058.72, "providers": [{ "billed_charge": 26000.00, "npi": [1063185809] } ] } ] } ] }, { "name": "PHARMACY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "250", "description": "PHARMACY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 134531.69, "providers": [{ "billed_charge": 1473.65, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "921385442" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 129754.79, "providers": [{ "billed_charge": 30.60, "npi": [1649051475] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1804405.64, "providers": [{ "billed_charge": 33715.08, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 20795.00, "providers": [{ "billed_charge": 4835.00, "npi": [1487771812] } ] }, { "allowed_amount": 28264.00, "providers": [{ "billed_charge": 535.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 156218.28, "providers": [{ "billed_charge": 332.38, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2634.33, "providers": [{ "billed_charge": 15.00, "npi": [1821074196] } ] } ] }, { "tin": { "type": "ein", "value": "205253134" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 27756.34, "providers": [{ "billed_charge": 129.14, "npi": [1417965559] } ] } ] }, { "tin": { "type": "ein", "value": "942916102" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 129057.00, "providers": [{ "billed_charge": 645.00, "npi": [1265423917] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3394058.95, "providers": [{ "billed_charge": 29886.48, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "883475837" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 15611.68, "providers": [{ "billed_charge": 28.13, "npi": [1104548478] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 425178.00, "providers": [{ "billed_charge": 15562.76, "npi": [1609217157] } ] } ] }, { "tin": { "type": "ein", "value": "876000525" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 167778.57, "providers": [{ "billed_charge": 1478.00, "npi": [1588656870] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5824644.00, "providers": [{ "billed_charge": 10949.40, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 117626.66, "providers": [{ "billed_charge": 94.47, "npi": [1801821376] } ] }, { "allowed_amount": 32956.36, "providers": [{ "billed_charge": 224.00, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 139200.00, "providers": [{ "billed_charge": 5806.50, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "203688688" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 251.76, "providers": [{ "billed_charge": 0.00, "npi": [1811045594] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2152232.20, "providers": [{ "billed_charge": 3080.08, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 805387.23, "providers": [{ "billed_charge": 5353.23, "npi": [1285621839] } ] }, { "allowed_amount": 16905.56, "providers": [{ "billed_charge": 0.00, "npi": [1285621839] } ] } ] }, { "tin": { "type": "ein", "value": "473932987" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 50444.66, "providers": [{ "billed_charge": 33.68, "npi": [1679043814] } ] } ] } ] }, { "name": "DRUGS/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "259", "description": "PHARMACY - OTHER PHARMACY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 10231.89, "providers": [{ "billed_charge": 38.30, "npi": [1306938071] } ] }, { "allowed_amount": 38860.20, "providers": [{ "billed_charge": 0.00, "npi": [1306938071] } ] } ] } ] }, { "name": "IV THERAPY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "260", "description": "IV THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2954.00, "providers": [{ "billed_charge": 505.00, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 166860.20, "providers": [{ "billed_charge": 2659.00, "npi": [1689772592] } ] } ] }, { "tin": { "type": "ein", "value": "390964813" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 34424.89, "providers": [{ "billed_charge": 3602.00, "npi": [1619079597] } ] } ] }, { "tin": { "type": "ein", "value": "910565889" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 173802.20, "providers": [{ "billed_charge": 2626.00, "npi": [1487904546] } ] } ] } ] }, { "name": "MED-SUR SUPPLIES", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "270", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "932822368" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 9600.00, "providers": [{ "billed_charge": 126.59, "npi": [1912784786] } ] } ] }, { "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 697360.00, "providers": [{ "billed_charge": 850.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1193659.32, "providers": [{ "billed_charge": 2616.98, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 83200.00, "providers": [{ "billed_charge": 1392.49, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "811669007" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 162359.50, "providers": [{ "billed_charge": 290.10, "npi": [1295312197] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1730384.80, "providers": [{ "billed_charge": 1450.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "204399694" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 148533.00, "providers": [{ "billed_charge": 1740.60, "npi": [1689693319] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 4842443.43, "providers": [{ "billed_charge": 13269.90, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "203344171" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 580638.00, "providers": [{ "billed_charge": 96044.65, "npi": [1194916205] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 89857.00, "providers": [{ "billed_charge": 2385.60, "npi": [1609217157] } ] } ] } ] }, { "name": "STRAPPING OF SHOULDER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "29240", "description": "STRAPPING; SHOULDER (EG, VELPEAU)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464813023" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 984.56, "providers": [{ "billed_charge": 450.00, "npi": [1083038764] } ] } ] } ] }, { "name": "LABORATORY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "300", "description": "LABORATORY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 179486.54, "providers": [{ "billed_charge": 10456.00, "npi": [1982668133] } ] }, { "allowed_amount": 72519.22, "providers": [{ "billed_charge": 14431.00, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "930386868" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10398.00, "providers": [{ "billed_charge": 1892.00, "npi": [1477590198] } ] } ] }, { "tin": { "type": "ein", "value": "850105601" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 616.41, "providers": [{ "billed_charge": 617.00, "npi": [1215913470] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 76051.92, "providers": [{ "billed_charge": 1388.73, "npi": [1194782409] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 264.80, "providers": [{ "billed_charge": 64.00, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1166.96, "providers": [{ "billed_charge": 256.00, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 34230.56, "providers": [{ "billed_charge": 72.00, "npi": [1992798409] } ] }, { "allowed_amount": 38799.33, "providers": [{ "billed_charge": 908.00, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "752918774" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 601162.86, "providers": [{ "billed_charge": 17258.00, "npi": [1396087672] } ] }, { "allowed_amount": 321321.00, "providers": [{ "billed_charge": 2693.00, "npi": [1396087672] } ] } ] }, { "tin": { "type": "ein", "value": "201729674" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 55801.69, "providers": [{ "billed_charge": 1151.00, "npi": [1053360651] } ] } ] }, { "tin": { "type": "ein", "value": "562392010" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 991.02, "providers": [{ "billed_charge": 208.00, "npi": [1053357244] } ] } ] }, { "tin": { "type": "ein", "value": "30219309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21332.11, "providers": [{ "billed_charge": 2318.00, "npi": [1568419976] } ] } ] }, { "tin": { "type": "ein", "value": "820207116" }, "service_code": ["22", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.72, "providers": [{ "billed_charge": 46.62, "npi": [1154563963] } ] }, { "allowed_amount": 372.18, "providers": [{ "billed_charge": 137.02, "npi": [1154563963] } ] } ] }, { "tin": { "type": "ein", "value": "910565546" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 141666.76, "providers": [{ "billed_charge": 6473.77, "npi": [1518912609] } ] } ] }, { "tin": { "type": "ein", "value": "237293874" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4907.60, "providers": [{ "billed_charge": 864.00, "npi": [1417945627] } ] } ] }, { "tin": { "type": "ein", "value": "994231206" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6412.14, "providers": [{ "billed_charge": 113.93, "npi": [1184429185] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 71679.11, "providers": [{ "billed_charge": 40916.00, "npi": [1487771812] } ] }, { "allowed_amount": 105927.00, "providers": [{ "billed_charge": 15701.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "721054801" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 20499.26, "providers": [{ "billed_charge": 1092.69, "npi": [1588648315] } ] } ] }, { "tin": { "type": "ein", "value": "330704304" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 21931.17, "providers": [{ "billed_charge": 9343.00, "npi": [1234567893] } ] }, { "allowed_amount": 5787.12, "providers": [{ "billed_charge": 11395.52, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "386006309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5338.00, "providers": [{ "billed_charge": 1222.00, "npi": [1003878539] } ] } ] }, { "tin": { "type": "ein", "value": "364827272" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 34580.00, "providers": [{ "billed_charge": 3364.92, "npi": [1922542968] } ] } ] }, { "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67895.05, "providers": [{ "billed_charge": 408.00, "npi": [1124098421] } ] }, { "allowed_amount": 14009.54, "providers": [{ "billed_charge": 1076.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 99477.85, "providers": [{ "billed_charge": 2295.50, "npi": [1447355771] } ] } ] }, { "tin": { "type": "ein", "value": "410991680" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21526.07, "providers": [{ "billed_charge": 3118.00, "npi": [1922085299] } ] } ] }, { "tin": { "type": "ein", "value": "910565539" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 417021.24, "providers": [{ "billed_charge": 6232.00, "npi": [1801851258] } ] }, { "allowed_amount": 50132.90, "providers": [{ "billed_charge": 2505.00, "npi": [1801851258] } ] } ] }, { "tin": { "type": "ein", "value": "440545297" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14114.27, "providers": [{ "billed_charge": 2078.00, "npi": [1063494177] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 98.40, "providers": [{ "billed_charge": 34.14, "npi": [1285621839] } ] } ] } ] }, { "name": "BODY MASS INDEX DOCD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3008F", "description": "BODY MASS INDEX (BMI), DOCUMENTED (PV)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "204923281" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.88, "providers": [{ "billed_charge": 0.00, "npi": [1003985102] } ] } ] }, { "tin": { "type": "ein", "value": "810889110" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 522.25, "providers": [{ "billed_charge": 0.00, "npi": [1437516887] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16902.00, "providers": [{ "billed_charge": 0.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11369.85, "providers": [{ "billed_charge": 0.45, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10112.87, "providers": [{ "billed_charge": 0.64, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "621816823" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3825.49, "providers": [{ "billed_charge": 0.00, "npi": [1912979964] } ] } ] }, { "tin": { "type": "ein", "value": "362657618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2440.84, "providers": [{ "billed_charge": 0.00, "npi": [1801833983] } ] } ] }, { "tin": { "type": "ein", "value": "620864163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1301.21, "providers": [{ "billed_charge": 0.00, "npi": [1487604609] } ] } ] }, { "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1535.11, "providers": [{ "billed_charge": 0.12, "npi": [1811122880] } ] } ] } ] }, { "name": "LAB/CHEMISTRY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "LABORATORY - CHEMISTRY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7399.84, "providers": [{ "billed_charge": 3872.00, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "921385442" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 129754.79, "providers": [{ "billed_charge": 927.41, "npi": [1649051475] } ] } ] }, { "tin": { "type": "ein", "value": "390964813" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 30996.82, "providers": [{ "billed_charge": 533.00, "npi": [1619079597] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 297768.95, "providers": [{ "billed_charge": 18425.10, "npi": [1740215219] } ] }, { "allowed_amount": 483851.00, "providers": [{ "billed_charge": 12952.60, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 41963.01, "providers": [{ "billed_charge": 1393.00, "npi": [1821074196] } ] } ] }, { "tin": { "type": "ein", "value": "621600397" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 133644.90, "providers": [{ "billed_charge": 944.00, "npi": [1104870187] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 49363.50, "providers": [{ "billed_charge": 5789.78, "npi": [1265568638] } ] } ] }, { "tin": { "type": "ein", "value": "951691313" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 51812.26, "providers": [{ "billed_charge": 5042.62, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 376192.15, "providers": [{ "billed_charge": 43348.00, "npi": [0] } ] }, { "allowed_amount": 157254.46, "providers": [{ "billed_charge": 425.00, "npi": [1689772592] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 726250.28, "providers": [{ "billed_charge": 2357.91, "npi": [1326282484] } ] }, { "allowed_amount": 6611516.72, "providers": [{ "billed_charge": 40552.98, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "510103684" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 225260.95, "providers": [{ "billed_charge": 3375.30, "npi": [1134194038] } ] } ] }, { "tin": { "type": "ein", "value": "880502320" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 86678.78, "providers": [{ "billed_charge": 1698.51, "npi": [1255360160] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 574869.45, "providers": [{ "billed_charge": 9717.00, "npi": [1861439952] } ] }, { "allowed_amount": 145679.20, "providers": [{ "billed_charge": 45790.00, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "460517825" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17311.00, "providers": [{ "billed_charge": 1702.00, "npi": [1720058027] } ] } ] }, { "tin": { "type": "ein", "value": "860830701" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 186.99, "providers": [{ "billed_charge": 738.00, "npi": [1073576740] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 175688.07, "providers": [{ "billed_charge": 6333.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 202378.64, "providers": [{ "billed_charge": 8560.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 71679.11, "providers": [{ "billed_charge": 56587.00, "npi": [1487771812] } ] }, { "allowed_amount": 223754.00, "providers": [{ "billed_charge": 32536.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 337797.18, "providers": [{ "billed_charge": 1659.00, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "362513909" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 27870.64, "providers": [{ "billed_charge": 7509.00, "npi": [1003864810] } ] } ] }, { "tin": { "type": "ein", "value": "230469150" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 122973.90, "providers": [{ "billed_charge": 4791.00, "npi": [1356333579] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 84191.20, "providers": [{ "billed_charge": 8740.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "421406317" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 146.15, "providers": [{ "billed_charge": 883.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "464027347" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 11936.72, "providers": [{ "billed_charge": 397.81, "npi": [1871911016] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 69538.97, "providers": [{ "billed_charge": 9038.19, "npi": [1285621839] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 65269.77, "providers": [{ "billed_charge": 4019.00, "npi": [1194790055] } ] }, { "allowed_amount": 14784.64, "providers": [{ "billed_charge": 3892.00, "npi": [1194790055] } ] } ] }, { "tin": { "type": "ein", "value": "742802643" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 9303.21, "providers": [{ "billed_charge": 2661.13, "npi": [1053317362] } ] } ] }, { "tin": { "type": "ein", "value": "590657322" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 33892.08, "providers": [{ "billed_charge": 1161.00, "npi": [1700979465] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 57168.61, "providers": [{ "billed_charge": 6313.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17136.20, "providers": [{ "billed_charge": 761.00, "npi": [1770586794] } ] }, { "allowed_amount": 75479.34, "providers": [{ "billed_charge": 1132.00, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "42103602" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 141.64, "providers": [{ "billed_charge": 422.00, "npi": [1477527497] } ] } ] }, { "tin": { "type": "ein", "value": "946000533" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 77324.29, "providers": [{ "billed_charge": 1207.00, "npi": [1063406551] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 138849.90, "providers": [{ "billed_charge": 2857.47, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "390817515" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21799.48, "providers": [{ "billed_charge": 1440.32, "npi": [1275583619] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 166355.84, "providers": [{ "billed_charge": 10023.00, "npi": [1992798409] } ] }, { "allowed_amount": 85138.82, "providers": [{ "billed_charge": 0.00, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 437075.35, "providers": [{ "billed_charge": 6038.00, "npi": [1477531580] } ] }, { "allowed_amount": 75798.29, "providers": [{ "billed_charge": 0.00, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "880455713" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14816.00, "providers": [{ "billed_charge": 2966.00, "npi": [1770626426] } ] } ] }, { "tin": { "type": "ein", "value": "876000525" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 11438.29, "providers": [{ "billed_charge": 1041.47, "npi": [1588656870] } ] } ] }, { "tin": { "type": "ein", "value": "311538725" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 9989.23, "providers": [{ "billed_charge": 4556.00, "npi": [1063489342] } ] } ] }, { "tin": { "type": "ein", "value": "954518790" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1225.87, "providers": [{ "billed_charge": 0.00, "npi": [1234567893] } ] }, { "allowed_amount": 11863.49, "providers": [{ "billed_charge": 4354.70, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "942854057" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 23972.11, "providers": [{ "billed_charge": 2171.51, "npi": [1366452880] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19433.74, "providers": [{ "billed_charge": 162.00, "npi": [1427123132] } ] }, { "allowed_amount": 250.79, "providers": [{ "billed_charge": 959.00, "npi": [1427123132] } ] }, { "allowed_amount": 266666.82, "providers": [{ "billed_charge": 2459.00, "npi": [1013062769] } ] }, { "allowed_amount": 59720.58, "providers": [{ "billed_charge": 1115.00, "npi": [1558080861] } ] }, { "allowed_amount": 14871.70, "providers": [{ "billed_charge": 370.00, "npi": [1821143777] } ] }, { "allowed_amount": 183794.69, "providers": [{ "billed_charge": 5269.00, "npi": [1144375056] } ] }, { "allowed_amount": 15354.19, "providers": [{ "billed_charge": 0.00, "npi": [1144375056] } ] }, { "allowed_amount": 12674.35, "providers": [{ "billed_charge": 128.00, "npi": [1740354851] } ] }, { "allowed_amount": 1250.00, "providers": [{ "billed_charge": 215.00, "npi": [1639244262] } ] }, { "allowed_amount": 66658.75, "providers": [{ "billed_charge": 3116.00, "npi": [1558080861] } ] }, { "allowed_amount": 15446.46, "providers": [{ "billed_charge": 1021.00, "npi": [1821143777] } ] }, { "allowed_amount": 544561.00, "providers": [{ "billed_charge": 8928.00, "npi": [1144375056] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 225600.00, "providers": [{ "billed_charge": 26467.86, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "560552787" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2798.12, "providers": [{ "billed_charge": 296.00, "npi": [1144211301] } ] } ] }, { "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5640193.89, "providers": [{ "billed_charge": 44620.45, "npi": [1912446865] } ] } ] }, { "tin": { "type": "ein", "value": "461804561" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1708084.79, "providers": [{ "billed_charge": 14864.59, "npi": [1811968761] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 73352.74, "providers": [{ "billed_charge": 9768.60, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "390806250" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6352.00, "providers": [{ "billed_charge": 247.00, "npi": [1124083894] } ] } ] }, { "tin": { "type": "ein", "value": "911352172" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24937.96, "providers": [{ "billed_charge": 2591.00, "npi": [1366556227] } ] } ] }, { "tin": { "type": "ein", "value": "810240726" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 4201.85, "providers": [{ "billed_charge": 978.00, "npi": [1659475846] } ] } ] }, { "tin": { "type": "ein", "value": "994231206" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 130556.07, "providers": [{ "billed_charge": 5418.91, "npi": [1184429185] } ] } ] }, { "tin": { "type": "ein", "value": "932774817" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4362988.20, "providers": [{ "billed_charge": 16121.29, "npi": [1053198812] } ] } ] }, { "tin": { "type": "ein", "value": "42312909" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3770.78, "providers": [{ "billed_charge": 200.00, "npi": [1790717650] } ] } ] }, { "tin": { "type": "ein", "value": "352528741" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 30124.20, "providers": [{ "billed_charge": 1453.00, "npi": [1396882205] } ] } ] }, { "tin": { "type": "ein", "value": "113243405" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3550.22, "providers": [{ "billed_charge": 2660.76, "npi": [1972523348] } ] }, { "allowed_amount": 68273.85, "providers": [{ "billed_charge": 4450.72, "npi": [1033224704] } ] }, { "allowed_amount": 19852.95, "providers": [{ "billed_charge": 1107.00, "npi": [1972523348] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2886925.40, "providers": [{ "billed_charge": 12735.43, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 80803.30, "providers": [{ "billed_charge": 7940.00, "npi": [1124098421] } ] }, { "allowed_amount": 91169.91, "providers": [{ "billed_charge": 3731.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "860181654" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8100.00, "providers": [{ "billed_charge": 1895.00, "npi": [1427875061] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 158714.22, "providers": [{ "billed_charge": 8901.10, "npi": [1801821376] } ] }, { "allowed_amount": 282945.36, "providers": [{ "billed_charge": 2647.91, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "43633263" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3772.22, "providers": [{ "billed_charge": 403.00, "npi": [1972503910] } ] } ] } ] }, { "name": "LAB/IMMUNOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "302", "description": "LABORATORY - IMMUNOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "352263845" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2684.75, "providers": [{ "billed_charge": 120.64, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "330599494" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5754.29, "providers": [{ "billed_charge": 64.00, "npi": [0] } ] } ] } ] }, { "name": "LAB/NR DIALYSIS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "LABORATORY - NON-ROUTINE DIALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 975969.07, "providers": [{ "billed_charge": 180.91, "npi": [1386779270] } ] } ] }, { "tin": { "type": "ein", "value": "263563865" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1186937.88, "providers": [{ "billed_charge": 4106.34, "npi": [1437683877] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 9826248.15, "providers": [{ "billed_charge": 19012.95, "npi": [1386180859] } ] } ] } ] }, { "name": "LAB/HEMATOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "305", "description": "LABORATORY - HEMATOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 82396.03, "providers": [{ "billed_charge": 341.00, "npi": [1124098421] } ] }, { "allowed_amount": 21453.46, "providers": [{ "billed_charge": 1119.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 26010.48, "providers": [{ "billed_charge": 2700.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 19373.31, "providers": [{ "billed_charge": 1660.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5243.00, "providers": [{ "billed_charge": 305.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 24742.11, "providers": [{ "billed_charge": 5058.00, "npi": [1487771812] } ] }, { "allowed_amount": 58826.00, "providers": [{ "billed_charge": 5058.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 18098.65, "providers": [{ "billed_charge": 427.00, "npi": [1144375056] } ] }, { "allowed_amount": 1071.91, "providers": [{ "billed_charge": 213.00, "npi": [1144375056] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 25446.14, "providers": [{ "billed_charge": 0.00, "npi": [1861439952] } ] }, { "allowed_amount": 6539.00, "providers": [{ "billed_charge": 685.00, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 19314.10, "providers": [{ "billed_charge": 33.00, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 21117.23, "providers": [{ "billed_charge": 922.00, "npi": [1992798409] } ] }, { "allowed_amount": 85138.82, "providers": [{ "billed_charge": 0.00, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8299.95, "providers": [{ "billed_charge": 1242.22, "npi": [1285621839] } ] } ] } ] }, { "name": "LAB/BACT-MIRCO", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "306", "description": "LABORATORY - BACTERIOLOGY & MICROBIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5362.20, "providers": [{ "billed_charge": 957.00, "npi": [1124098421] } ] }, { "allowed_amount": 35113.49, "providers": [{ "billed_charge": 205.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 115141.03, "providers": [{ "billed_charge": 25233.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "840166760" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1603.53, "providers": [{ "billed_charge": 644.00, "npi": [1336245828] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7853.72, "providers": [{ "billed_charge": 955.00, "npi": [1992798409] } ] }, { "allowed_amount": 59767.91, "providers": [{ "billed_charge": 0.00, "npi": [1992798409] } ] } ] } ] }, { "name": "SYST BP LT 130 MM HG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3074F", "description": "MOST RECENT SYSTOLIC BLOOD PRESSURE LESS THAN 130 MM HG (DM), (HTN, CKD, CAD)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2141.00, "providers": [{ "billed_charge": 0.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "300520570" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 246.17, "providers": [{ "billed_charge": 0.00, "npi": [1275779225] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 436.65, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] }, { "allowed_amount": 5052.38, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8096.87, "providers": [{ "billed_charge": 0.32, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8979.72, "providers": [{ "billed_charge": 0.58, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "330645967" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 424.65, "providers": [{ "billed_charge": 0.00, "npi": [1649503319] } ] } ] }, { "tin": { "type": "ein", "value": "954322584" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2310.16, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] }, { "allowed_amount": 129.87, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] } ] }, { "tin": { "type": "ein", "value": "620864163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 429.37, "providers": [{ "billed_charge": 0.00, "npi": [1487604609] } ] } ] }, { "tin": { "type": "ein", "value": "330587303" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.44, "providers": [{ "billed_charge": 0.06, "npi": [1730180415] } ] } ] } ] }, { "name": "DIAST BP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3078F", "description": "MOST RECENT DIASTOLIC BLOOD PRESSURE LESS THAN 80 MM HG (HTN, CKD, CAD) (DM)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3910.40, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 7661.49, "providers": [{ "billed_charge": 0.29, "npi": [1538297726] } ] }, { "allowed_amount": 250.59, "providers": [{ "billed_charge": 0.01, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6650.43, "providers": [{ "billed_charge": 0.47, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "954322584" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2600.02, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] } ] } ] }, { "name": "DIAST BP 80-89 MM HG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3079F", "description": "MOST RECENT DIASTOLIC BLOOD PRESSURE 80-89 MM HG (HTN, CKD, CAD) (DM)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330185031" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.29, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.24, "providers": [{ "billed_charge": 0.01, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 267.39, "providers": [{ "billed_charge": 0.02, "npi": [1881636108] } ] } ] } ] }, { "name": "RADIATION RX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "333", "description": "RADIOLOGY--THERAPEUTIC - RADIATION THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 654343.00, "providers": [{ "billed_charge": 100146.00, "npi": [1689772592] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 31099.42, "providers": [{ "billed_charge": 5189.00, "npi": [1174582050] } ] } ] } ] }, { "name": "CHEMOTHERP-IV", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "335", "description": "RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 242617.56, "providers": [{ "billed_charge": 5402.00, "npi": [1689772592] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.07, "providers": [{ "billed_charge": 198.00, "npi": [1003863580] } ] }, { "allowed_amount": 5.97, "providers": [{ "billed_charge": 18.00, "npi": [1003863580] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12868.91, "providers": [{ "billed_charge": 1373.70, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "364257926" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 177.37, "providers": [{ "billed_charge": 114.66, "npi": [1881630614] } ] } ] }, { "tin": { "type": "ein", "value": "860828589" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 482.00, "providers": [{ "billed_charge": 36.00, "npi": [1851336432] } ] } ] }, { "tin": { "type": "ein", "value": "382084239" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1694.56, "providers": [{ "billed_charge": 736.18, "npi": [1932166386] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3523.63, "providers": [{ "billed_charge": 1146.60, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["12", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.65, "providers": [{ "billed_charge": 14.57, "npi": [1720279805] } ] }, { "allowed_amount": 5696.08, "providers": [{ "billed_charge": 9689.05, "npi": [1720279805] } ] }, { "allowed_amount": 2440.95, "providers": [{ "billed_charge": 1660.98, "npi": [1578549044] } ] }, { "allowed_amount": 909.88, "providers": [{ "billed_charge": 917.91, "npi": [1861018574] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5288.99, "providers": [{ "billed_charge": 1414.14, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1499.55, "providers": [{ "billed_charge": 401.13, "npi": [1932184322] } ] }, { "allowed_amount": 2215.82, "providers": [{ "billed_charge": 525.00, "npi": [1295726032] } ] }, { "allowed_amount": 7454.65, "providers": [{ "billed_charge": 1215.98, "npi": [1538144910] } ] }, { "allowed_amount": 5610.27, "providers": [{ "billed_charge": 1253.50, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14153.88, "providers": [{ "billed_charge": 2861.04, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 562.54, "providers": [{ "billed_charge": 315.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "900110660" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 461.26, "providers": [{ "billed_charge": 625.00, "npi": [1528150562] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 519.41, "providers": [{ "billed_charge": 96.00, "npi": [1174882948] } ] } ] } ] }, { "name": "ULTRASOUND", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "402", "description": "OTHER IMAGING SERVICES - ULTRASOUND", "allowed_amounts": [{ "tin": { "type": "ein", "value": "66068853" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 12214.53, "providers": [{ "billed_charge": 7317.00, "npi": [1427041581] } ] } ] } ] }, { "name": "PHYSICAL THERP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "420", "description": "PHYSICAL THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "475437700" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 78145.47, "providers": [{ "billed_charge": 6580.00, "npi": [1003939190] } ] } ] }, { "tin": { "type": "ein", "value": "420680452" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 835.10, "providers": [{ "billed_charge": 363.74, "npi": [1396837951] } ] } ] }, { "tin": { "type": "ein", "value": "521958352" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2062.50, "providers": [{ "billed_charge": 1428.00, "npi": [1811994809] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17391.14, "providers": [{ "billed_charge": 3036.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "592249372" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3600.00, "providers": [{ "billed_charge": 8536.00, "npi": [1740864164] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2374.40, "providers": [{ "billed_charge": 428.00, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8701.63, "providers": [{ "billed_charge": 4975.95, "npi": [1538465901] } ] } ] }, { "tin": { "type": "ein", "value": "770130154" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 136807.92, "providers": [{ "billed_charge": 2636.38, "npi": [1093704249] } ] } ] }, { "tin": { "type": "ein", "value": "431802466" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 352240.00, "providers": [{ "billed_charge": 6980.00, "npi": [1033161849] } ] } ] }, { "tin": { "type": "ein", "value": "910844563" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3751.00, "providers": [{ "billed_charge": 712.00, "npi": [1033174933] } ] } ] }, { "tin": { "type": "ein", "value": "223486125" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2002.00, "providers": [{ "billed_charge": 1683.99, "npi": [1013919620] } ] } ] }, { "tin": { "type": "ein", "value": "921958290" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 3991.58, "providers": [{ "billed_charge": 405.00, "npi": [1245946938] } ] } ] }, { "tin": { "type": "ein", "value": "481197295" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5046.42, "providers": [{ "billed_charge": 3050.74, "npi": [1457364408] } ] } ] }, { "tin": { "type": "ein", "value": "721549752" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 62328.00, "providers": [{ "billed_charge": 8232.00, "npi": [1982289690] } ] } ] }, { "tin": { "type": "ein", "value": "590624424" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21616.00, "providers": [{ "billed_charge": 4514.77, "npi": [1912964768] } ] } ] }, { "tin": { "type": "ein", "value": "270918901" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 172331.12, "providers": [{ "billed_charge": 3140.16, "npi": [1417280009] } ] } ] } ] }, { "name": "PHYS THERP/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "421", "description": "PHYSICAL THERAPY/VISIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800441909" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 26587.16, "providers": [{ "billed_charge": 2250.01, "npi": [1063726628] } ] } ] }, { "tin": { "type": "ein", "value": "464427659" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3485.62, "providers": [{ "billed_charge": 1500.00, "npi": [1205988854] } ] } ] }, { "tin": { "type": "ein", "value": "731709953" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12889.41, "providers": [{ "billed_charge": 2182.01, "npi": [1750335824] } ] } ] }, { "tin": { "type": "ein", "value": "205719568" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 25200.14, "providers": [{ "billed_charge": 1950.01, "npi": [1699008052] } ] } ] }, { "tin": { "type": "ein", "value": "953867863" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 29275.05, "providers": [{ "billed_charge": 1520.01, "npi": [1629475868] } ] } ] }, { "tin": { "type": "ein", "value": "320232613" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4857.90, "providers": [{ "billed_charge": 2025.01, "npi": [1609044924] } ] } ] }, { "tin": { "type": "ein", "value": "472783382" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13048.02, "providers": [{ "billed_charge": 648.00, "npi": [1295127256] } ] } ] }, { "tin": { "type": "ein", "value": "386006309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10551.00, "providers": [{ "billed_charge": 2518.00, "npi": [1003878539] } ] } ] }, { "tin": { "type": "ein", "value": "475058035" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 25840.07, "providers": [{ "billed_charge": 1330.00, "npi": [1679930119] } ] } ] } ] }, { "name": "OCCUPATION THER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "430", "description": "OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770130154" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 30196.24, "providers": [{ "billed_charge": 552.51, "npi": [1093704249] } ] } ] }, { "tin": { "type": "ein", "value": "431802466" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 304245.00, "providers": [{ "billed_charge": 5875.00, "npi": [1033161849] } ] } ] }, { "tin": { "type": "ein", "value": "721549752" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 63600.00, "providers": [{ "billed_charge": 9198.00, "npi": [1982289690] } ] } ] }, { "tin": { "type": "ein", "value": "880502320" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24967.67, "providers": [{ "billed_charge": 1537.13, "npi": [1255360160] } ] } ] }, { "tin": { "type": "ein", "value": "270918901" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 183789.64, "providers": [{ "billed_charge": 3285.82, "npi": [1417280009] } ] } ] }, { "tin": { "type": "ein", "value": "203283620" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1720.20, "providers": [{ "billed_charge": 275.30, "npi": [1932117975] } ] } ] } ] }, { "name": "EMERG ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "450", "description": "EMERGENCY ROOM - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680396600" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 179923.73, "providers": [{ "billed_charge": 48874.00, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "994231206" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 88338.19, "providers": [{ "billed_charge": 26575.22, "npi": [1184429185] } ] }, { "allowed_amount": 2063.35, "providers": [{ "billed_charge": 464.00, "npi": [1184429185] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 71679.11, "providers": [{ "billed_charge": 31941.00, "npi": [1487771812] } ] }, { "allowed_amount": 195774.08, "providers": [{ "billed_charge": 69825.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15354.19, "providers": [{ "billed_charge": 0.00, "npi": [1144375056] } ] }, { "allowed_amount": 16445.26, "providers": [{ "billed_charge": 19561.00, "npi": [1144375056] } ] }, { "allowed_amount": 56698.99, "providers": [{ "billed_charge": 43844.00, "npi": [1144375056] } ] } ] }, { "tin": { "type": "ein", "value": "205253134" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8820.26, "providers": [{ "billed_charge": 7197.33, "npi": [1417965559] } ] }, { "allowed_amount": 30190.44, "providers": [{ "billed_charge": 19936.54, "npi": [1417965559] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17726.30, "providers": [{ "billed_charge": 17333.00, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "421406317" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1119.28, "providers": [{ "billed_charge": 15430.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21432.92, "providers": [{ "billed_charge": 14289.98, "npi": [1285621839] } ] } ] } ] }, { "name": "CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "510", "description": "CLINIC - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5418.00, "providers": [{ "billed_charge": 1977.00, "npi": [1871543215] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 786.23, "providers": [{ "billed_charge": 852.00, "npi": [1992798409] } ] } ] } ] }, { "name": "RURAL/CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "521", "description": "FREE-STANDING CLINIC - RURAL HEALTH-CLINIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942699073" }, "service_code": ["22", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 7916.55, "providers": [{ "billed_charge": 1345.51, "npi": [1518089507] } ] }, { "allowed_amount": 4340.80, "providers": [{ "billed_charge": 950.32, "npi": [1518089507] } ] } ] }, { "tin": { "type": "ein", "value": "813679754" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1550.25, "providers": [{ "billed_charge": 220.09, "npi": [1215484142] } ] } ] } ] }, { "name": "VISIT RHC/FQHC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "525", "description": "Visit RHC/FQHC to facility.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821948361" }, "service_code": ["99", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 18492.00, "providers": [{ "billed_charge": 9248.00, "npi": [1891207684] } ] }, { "allowed_amount": 2575.00, "providers": [{ "billed_charge": 1303.00, "npi": [1891207684] } ] } ] } ] }, { "name": "URGENT CARE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "526", "description": "FREE-STANDING CLINIC - URGENT CARE CLINIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453583707" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2260.52, "providers": [{ "billed_charge": 718.00, "npi": [1326828575] } ] } ] } ] }, { "name": "SKILLED NURSE/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "551", "description": "SKILLED NURSING - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830750832" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 98092.55, "providers": [{ "billed_charge": 9720.06, "npi": [1104305036] } ] } ] }, { "tin": { "type": "ein", "value": "203942050" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 33867.04, "providers": [{ "billed_charge": 3000.00, "npi": [1518911890] } ] } ] }, { "tin": { "type": "ein", "value": "274394909" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10000.02, "providers": [{ "billed_charge": 1000.00, "npi": [1376848408] } ] } ] }, { "tin": { "type": "ein", "value": "271030968" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 45565.70, "providers": [{ "billed_charge": 4680.01, "npi": [1912228727] } ] } ] }, { "tin": { "type": "ein", "value": "832021807" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 230.01, "providers": [{ "billed_charge": 0.01, "npi": [1477038982] } ] } ] }, { "tin": { "type": "ein", "value": "472783382" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 89316.23, "providers": [{ "billed_charge": 5920.04, "npi": [1295127256] } ] } ] }, { "tin": { "type": "ein", "value": "824386502" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 35063.88, "providers": [{ "billed_charge": 700.00, "npi": [1811552680] } ] } ] }, { "tin": { "type": "ein", "value": "844841272" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14100.11, "providers": [{ "billed_charge": 1920.01, "npi": [1861012916] } ] } ] }, { "tin": { "type": "ein", "value": "770616280" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2277.84, "providers": [{ "billed_charge": 750.03, "npi": [1750484085] } ] } ] }, { "tin": { "type": "ein", "value": "883475837" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 66049.65, "providers": [{ "billed_charge": 3000.00, "npi": [1104548478] } ] } ] }, { "tin": { "type": "ein", "value": "351835133" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7332.01, "providers": [{ "billed_charge": 798.01, "npi": [1144225491] } ] } ] }, { "tin": { "type": "ein", "value": "475058035" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 187530.65, "providers": [{ "billed_charge": 12160.07, "npi": [1679930119] } ] } ] }, { "tin": { "type": "ein", "value": "871741881" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9600.02, "providers": [{ "billed_charge": 800.00, "npi": [1356014450] } ] } ] }, { "tin": { "type": "ein", "value": "320232613" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6258.02, "providers": [{ "billed_charge": 1560.00, "npi": [1609044924] } ] } ] }, { "tin": { "type": "ein", "value": "473442331" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2780.04, "providers": [{ "billed_charge": 280.02, "npi": [1386031250] } ] } ] }, { "tin": { "type": "ein", "value": "473932987" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9861.14, "providers": [{ "billed_charge": 600.00, "npi": [1679951859] } ] } ] } ] }, { "name": "SKILLED NURSE/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "559", "description": "SKILLED NURSING - OTHER SKILLED NURSING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "521590951" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3022.68, "providers": [{ "billed_charge": 705.92, "npi": [1518040765] } ] } ] } ] }, { "name": "AIDE/HOME HEALTH/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "571", "description": "HOME HEALTH AIDE - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853544109" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 153057.24, "providers": [{ "billed_charge": 450.00, "npi": [1881293942] } ] } ] }, { "tin": { "type": "ein", "value": "853499380" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 14136.04, "providers": [{ "billed_charge": 200.00, "npi": [1164021226] } ] } ] }, { "tin": { "type": "ein", "value": "954548279" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 149320.37, "providers": [{ "billed_charge": 1600.00, "npi": [1972893782] } ] } ] }, { "tin": { "type": "ein", "value": "841771224" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 34565.66, "providers": [{ "billed_charge": 7540.00, "npi": [1124684196] } ] } ] }, { "tin": { "type": "ein", "value": "850513021" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 285709.30, "providers": [{ "billed_charge": 4800.00, "npi": [1689207649] } ] } ] }, { "tin": { "type": "ein", "value": "651245571" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 31240.20, "providers": [{ "billed_charge": 1440.02, "npi": [1275644619] } ] } ] }, { "tin": { "type": "ein", "value": "824386502" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 250645.09, "providers": [{ "billed_charge": 2190.00, "npi": [1811552680] } ] } ] }, { "tin": { "type": "ein", "value": "203688688" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2778.68, "providers": [{ "billed_charge": 115.78, "npi": [1811045594] } ] } ] }, { "tin": { "type": "ein", "value": "800371210" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 48000.00, "providers": [{ "billed_charge": 160.00, "npi": [1609002120] } ] } ] }, { "tin": { "type": "ein", "value": "943452048" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1200.02, "providers": [{ "billed_charge": 300.00, "npi": [1861634115] } ] } ] }, { "tin": { "type": "ein", "value": "883475837" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 86672.52, "providers": [{ "billed_charge": 2400.00, "npi": [1104548478] } ] } ] }, { "tin": { "type": "ein", "value": "463671304" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 240219.04, "providers": [{ "billed_charge": 10200.00, "npi": [1871920587] } ] } ] } ] }, { "name": "DRUG/EPO<10,000 UNITS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "634", "description": "DRUGS REQ SPEC IDENTIFICATION - ERYTHROPOIETIN (EPO) LESS THAN 10,000 UNITS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 458760.00, "providers": [{ "billed_charge": 9600.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 81600.00, "providers": [{ "billed_charge": 74737.44, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1244004.40, "providers": [{ "billed_charge": 4200.00, "npi": [0] } ] } ] } ] }, { "name": "DRUG/DETAIL CODE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "636", "description": "DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*", "allowed_amounts": [{ "tin": { "type": "ein", "value": "730579285" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8118.00, "providers": [{ "billed_charge": 389.36, "npi": [1184721722] } ] }, { "allowed_amount": 49659.52, "providers": [{ "billed_charge": 521.07, "npi": [1184721722] } ] } ] }, { "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 97904.80, "providers": [{ "billed_charge": 1475.25, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "474757851" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17527.48, "providers": [{ "billed_charge": 552.00, "npi": [1003260480] } ] } ] }, { "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 53399.20, "providers": [{ "billed_charge": 180.00, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "921385442" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2125497.85, "providers": [{ "billed_charge": 49227.84, "npi": [1649051475] } ] } ] }, { "tin": { "type": "ein", "value": "204399694" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 432096.00, "providers": [{ "billed_charge": 16802.70, "npi": [1689693319] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 92195.84, "providers": [{ "billed_charge": 1023.15, "npi": [1821074196] } ] } ] }, { "tin": { "type": "ein", "value": "621600397" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 292178.02, "providers": [{ "billed_charge": 1370.00, "npi": [1104870187] } ] } ] }, { "tin": { "type": "ein", "value": "561936354" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 65323.62, "providers": [{ "billed_charge": 33290.00, "npi": [1740208081] } ] } ] }, { "tin": { "type": "ein", "value": "752918774" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 176684.60, "providers": [{ "billed_charge": 1578.00, "npi": [1396087672] } ] }, { "allowed_amount": 214214.00, "providers": [{ "billed_charge": 842.00, "npi": [1396087672] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3831373.85, "providers": [{ "billed_charge": 482512.44, "npi": [1689772592] } ] } ] }, { "tin": { "type": "ein", "value": "910565889" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 775477.90, "providers": [{ "billed_charge": 62791.65, "npi": [1487904546] } ] } ] }, { "tin": { "type": "ein", "value": "232939047" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 491882.93, "providers": [{ "billed_charge": 68861.00, "npi": [1831189638] } ] }, { "allowed_amount": 20957.46, "providers": [{ "billed_charge": 3924.00, "npi": [1831189638] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 110025.25, "providers": [{ "billed_charge": 123.25, "npi": [1932152337] } ] } ] }, { "tin": { "type": "ein", "value": "880502320" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 185270.35, "providers": [{ "billed_charge": 35814.90, "npi": [1255360160] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 127626.53, "providers": [{ "billed_charge": 6774.60, "npi": [1861439952] } ] }, { "allowed_amount": 11624.01, "providers": [{ "billed_charge": 0.00, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "203344171" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 971819.00, "providers": [{ "billed_charge": 28883.30, "npi": [1194916205] } ] } ] }, { "tin": { "type": "ein", "value": "260002031" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 135529.08, "providers": [{ "billed_charge": 188.71, "npi": [1104824739] } ] } ] }, { "tin": { "type": "ein", "value": "752932830" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2064759.60, "providers": [{ "billed_charge": 0.00, "npi": [1952333205] } ] }, { "allowed_amount": 18952.39, "providers": [{ "billed_charge": 907.00, "npi": [1952333205] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 273251.60, "providers": [{ "billed_charge": 75989.87, "npi": [1306938071] } ] }, { "allowed_amount": 71532.12, "providers": [{ "billed_charge": 307.31, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2377188.89, "providers": [{ "billed_charge": 10915.35, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 64388.11, "providers": [{ "billed_charge": 29931.00, "npi": [1487771812] } ] }, { "allowed_amount": 126819.08, "providers": [{ "billed_charge": 12679.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "811669007" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 833567.44, "providers": [{ "billed_charge": 11067.40, "npi": [1295312197] } ] } ] }, { "tin": { "type": "ein", "value": "860800150" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2361736.53, "providers": [{ "billed_charge": 40012.60, "npi": [1154392231] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 128069.00, "providers": [{ "billed_charge": 99178.21, "npi": [1609217157] } ] } ] }, { "tin": { "type": "ein", "value": "841343242" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8561.46, "providers": [{ "billed_charge": 54.00, "npi": [1689624686] } ] } ] }, { "tin": { "type": "ein", "value": "956002748" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 81542.55, "providers": [{ "billed_charge": 59.00, "npi": [1558410217] } ] } ] }, { "tin": { "type": "ein", "value": "940562680" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 719547.85, "providers": [{ "billed_charge": 60705.16, "npi": [1740348929] } ] }, { "allowed_amount": 21796.49, "providers": [{ "billed_charge": 395.49, "npi": [1740348929] } ] } ] }, { "tin": { "type": "ein", "value": "410991680" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 70018.06, "providers": [{ "billed_charge": 76269.75, "npi": [1922085299] } ] } ] }, { "tin": { "type": "ein", "value": "910565539" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 288315.79, "providers": [{ "billed_charge": 2358.93, "npi": [1801851258] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3557137.41, "providers": [{ "billed_charge": 826764.19, "npi": [1871543215] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 72464.53, "providers": [{ "billed_charge": 631.25, "npi": [1194790055] } ] }, { "allowed_amount": 26048.30, "providers": [{ "billed_charge": 1057.90, "npi": [1194790055] } ] } ] }, { "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1584502.21, "providers": [{ "billed_charge": 3628.00, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "431343281" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 821860.00, "providers": [{ "billed_charge": 1837.57, "npi": [1871665380] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 836019.54, "providers": [{ "billed_charge": 1817.88, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3025.96, "providers": [{ "billed_charge": 28.05, "npi": [1770586794] } ] }, { "allowed_amount": 183557.03, "providers": [{ "billed_charge": 759.28, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "340714593" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24943.00, "providers": [{ "billed_charge": 2139.90, "npi": [1902858152] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 93900.70, "providers": [{ "billed_charge": 3287.15, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16676.79, "providers": [{ "billed_charge": 166.50, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 41380.00, "providers": [{ "billed_charge": 621.95, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2245917.86, "providers": [{ "billed_charge": 115424.63, "npi": [1477531580] } ] }, { "allowed_amount": 75798.29, "providers": [{ "billed_charge": 0.00, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 13312.80, "providers": [{ "billed_charge": 2412.50, "npi": [1144375056] } ] }, { "allowed_amount": 63004.58, "providers": [{ "billed_charge": 89.60, "npi": [1144375056] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3396148.99, "providers": [{ "billed_charge": 94304.07, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "522093120" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 22847.54, "providers": [{ "billed_charge": 6.13, "npi": [1144291899] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 20773134.33, "providers": [{ "billed_charge": 145120.60, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "461804561" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1933039.35, "providers": [{ "billed_charge": 37431.00, "npi": [1811968761] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 81073.09, "providers": [{ "billed_charge": 51.75, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "237293874" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 252186.09, "providers": [{ "billed_charge": 1593.60, "npi": [1417945627] } ] } ] }, { "tin": { "type": "ein", "value": "810240726" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 97569.92, "providers": [{ "billed_charge": 288.00, "npi": [1659475846] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1211419.61, "providers": [{ "billed_charge": 10.00, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "994231206" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 72929.92, "providers": [{ "billed_charge": 652.75, "npi": [1184429185] } ] } ] }, { "tin": { "type": "ein", "value": "352528741" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 229436.66, "providers": [{ "billed_charge": 12011.11, "npi": [1396882205] } ] } ] }, { "tin": { "type": "ein", "value": "113243405" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 64574.00, "providers": [{ "billed_charge": 85.01, "npi": [1033224704] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 862497.71, "providers": [{ "billed_charge": 4172.62, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 37452.55, "providers": [{ "billed_charge": 31737.50, "npi": [1124098421] } ] }, { "allowed_amount": 23274.86, "providers": [{ "billed_charge": 0.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "621694180" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 13990.55, "providers": [{ "billed_charge": 0.00, "npi": [1326085424] } ] }, { "allowed_amount": 28496.68, "providers": [{ "billed_charge": 1053.82, "npi": [1326085424] } ] } ] }, { "tin": { "type": "ein", "value": "742781812" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 115756.28, "providers": [{ "billed_charge": 2586.28, "npi": [1679528889] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2989757.91, "providers": [{ "billed_charge": 411605.47, "npi": [1801821376] } ] }, { "allowed_amount": 356357.38, "providers": [{ "billed_charge": 6808.74, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3401574.80, "providers": [{ "billed_charge": 4946.50, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "811112022" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 84203.12, "providers": [{ "billed_charge": 3766.00, "npi": [1003281452] } ] } ] }, { "tin": { "type": "ein", "value": "390806367" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 235712.95, "providers": [{ "billed_charge": 470.40, "npi": [1114920048] } ] } ] }, { "tin": { "type": "ein", "value": "621113737" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 265012.64, "providers": [{ "billed_charge": 3958.91, "npi": [1023055126] } ] } ] } ] }, { "name": "HOSPICE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "650", "description": "HOSPICE SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "946068843" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 48667.12, "providers": [{ "billed_charge": 5600.00, "npi": [1124053558] } ] } ] } ] }, { "name": "HOSPICE/RTN HOME", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "651", "description": "HOSPICE SERVICES - ROUTINE HOME CARE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "473932987" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 318119.35, "providers": [{ "billed_charge": 6763.44, "npi": [1679043814] } ] } ] } ] }, { "name": "CT HEAD/BRAIN W/O DYE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "70450", "description": "COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834721282" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2445.75, "providers": [{ "billed_charge": 2932.00, "npi": [1144872052] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 1 VIEW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952598917" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.02, "providers": [{ "billed_charge": 87.00, "npi": [1699776526] } ] }, { "allowed_amount": 9.34, "providers": [{ "billed_charge": 29.00, "npi": [1699776526] } ] }, { "allowed_amount": 24.40, "providers": [{ "billed_charge": 29.00, "npi": [1699776526] } ] } ] }, { "tin": { "type": "ein", "value": "886000436" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.16, "providers": [{ "billed_charge": 93.00, "npi": [1548393127] } ] } ] }, { "tin": { "type": "ein", "value": "834721282" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 10541.28, "providers": [{ "billed_charge": 5630.00, "npi": [1144872052] } ] }, { "allowed_amount": 622.41, "providers": [{ "billed_charge": 1414.00, "npi": [1144872052] } ] } ] }, { "tin": { "type": "ein", "value": "880307447" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.36, "providers": [{ "billed_charge": 66.00, "npi": [1487606026] } ] } ] }, { "tin": { "type": "ein", "value": "956070877" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.55, "providers": [{ "billed_charge": 99.72, "npi": [1235296880] } ] } ] }, { "tin": { "type": "ein", "value": "845116186" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.90, "providers": [{ "billed_charge": 808.00, "npi": [1033745708] } ] }, { "allowed_amount": 50.80, "providers": [{ "billed_charge": 202.00, "npi": [1033745708] } ] }, { "allowed_amount": 17.09, "providers": [{ "billed_charge": 404.00, "npi": [1033745708] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 831.60, "providers": [{ "billed_charge": 1188.00, "npi": [1053355792] } ] }, { "allowed_amount": 16.63, "providers": [{ "billed_charge": 108.00, "npi": [1053355792] } ] }, { "allowed_amount": 229.53, "providers": [{ "billed_charge": 540.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "232665855" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6207.88, "providers": [{ "billed_charge": 8976.00, "npi": [1467403261] } ] } ] }, { "tin": { "type": "ein", "value": "880119638" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.43, "providers": [{ "billed_charge": 404.00, "npi": [1437196979] } ] }, { "allowed_amount": 775.30, "providers": [{ "billed_charge": 606.00, "npi": [1437196979] } ] } ] }, { "tin": { "type": "ein", "value": "952669833" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 191.88, "providers": [{ "billed_charge": 58.00, "npi": [1629156583] } ] }, { "allowed_amount": 527.10, "providers": [{ "billed_charge": 58.00, "npi": [1629156583] } ] } ] }, { "tin": { "type": "ein", "value": "863087969" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 493.27, "providers": [{ "billed_charge": 315.00, "npi": [1003779596] } ] }, { "allowed_amount": 33.75, "providers": [{ "billed_charge": 45.00, "npi": [1003779596] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 2 VIEWS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "71046", "description": "RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834721282" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.40, "providers": [{ "billed_charge": 216.00, "npi": [1144872052] } ] } ] }, { "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11", "49"], "billing_class": "professional", "payments": [{ "allowed_amount": 748.56, "providers": [{ "billed_charge": 676.24, "npi": [1386313740] } ] }, { "allowed_amount": 36.27, "providers": [{ "billed_charge": 36.27, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.42, "providers": [{ "billed_charge": 903.00, "npi": [1053355792] } ] }, { "allowed_amount": 408.74, "providers": [{ "billed_charge": 1548.00, "npi": [1053355792] } ] }, { "allowed_amount": 408.10, "providers": [{ "billed_charge": 645.00, "npi": [1053355792] } ] } ] } ] }, { "name": "CT ABD & PELV W/CONTRAST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "74177", "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1802.04, "providers": [{ "billed_charge": 4276.00, "npi": [1053355792] } ] }, { "allowed_amount": 748.30, "providers": [{ "billed_charge": 1069.00, "npi": [1053355792] } ] }, { "allowed_amount": 1279.54, "providers": [{ "billed_charge": 2138.00, "npi": [1053355792] } ] } ] } ] }, { "name": "ULTRASOUND BREAST COMPLETE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76641", "description": "ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1038.91, "providers": [{ "billed_charge": 710.07, "npi": [1386313740] } ] } ] } ] }, { "name": "ULTRASOUND BREAST LIMITED", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76642", "description": "ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 470.53, "providers": [{ "billed_charge": 161.31, "npi": [1386313740] } ] } ] } ] }, { "name": "US EXAM, ABDOM, COMPLETE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76700", "description": "ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 899.18, "providers": [{ "billed_charge": 968.48, "npi": [1386313740] } ] } ] } ] }, { "name": "UMBILICAL ARTERY ECHO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76820", "description": "DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942728480" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1588.49, "providers": [{ "billed_charge": 793.00, "npi": [1073606299] } ] } ] } ] }, { "name": "TRANSVAGINAL US, NON-OB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76830", "description": "ULTRASOUND, TRANSVAGINAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 752.50, "providers": [{ "billed_charge": 408.00, "npi": [1053355792] } ] }, { "allowed_amount": 861.30, "providers": [{ "billed_charge": 816.00, "npi": [1053355792] } ] } ] } ] }, { "name": "US EXAM, PELVIC, COMPLETE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76856", "description": "ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 753.15, "providers": [{ "billed_charge": 403.00, "npi": [1053355792] } ] }, { "allowed_amount": 1821.66, "providers": [{ "billed_charge": 1612.00, "npi": [1053355792] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS BI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77063", "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954651287" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 841.84, "providers": [{ "billed_charge": 1250.00, "npi": [1962457812] } ] } ] }, { "tin": { "type": "ein", "value": "951644042" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2511.22, "providers": [{ "billed_charge": 1188.00, "npi": [1477502797] } ] } ] }, { "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17116.83, "providers": [{ "billed_charge": 4890.45, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17085.70, "providers": [{ "billed_charge": 18356.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "941700729" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1972.13, "providers": [{ "billed_charge": 1305.00, "npi": [1881646909] } ] } ] } ] }, { "name": "SCR MAMMO BI INCL CAD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77067", "description": "SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954651287" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 997.42, "providers": [{ "billed_charge": 1480.00, "npi": [1962457812] } ] } ] }, { "tin": { "type": "ein", "value": "951644042" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2473.37, "providers": [{ "billed_charge": 1585.80, "npi": [1477502797] } ] } ] }, { "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16500.22, "providers": [{ "billed_charge": 11673.09, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16516.80, "providers": [{ "billed_charge": 23296.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "941700729" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1915.82, "providers": [{ "billed_charge": 1575.00, "npi": [1881646909] } ] } ] } ] }, { "name": "GUIDANCE FOR RADIAJ TX DLVR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77387", "description": "GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "650825133" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11227.29, "providers": [{ "billed_charge": 1026.00, "npi": [1760590962] } ] } ] }, { "tin": { "type": "ein", "value": "851303970" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1137.13, "providers": [{ "billed_charge": 1050.00, "npi": [1649895194] } ] } ] } ] }, { "name": "RADIATION TREATMENT DELIVERY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77407", "description": "RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "650825133" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10677.27, "providers": [{ "billed_charge": 16283.00, "npi": [1760590962] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.47, "providers": [{ "billed_charge": 149.50, "npi": [1730119553] } ] }, { "allowed_amount": 23206.96, "providers": [{ "billed_charge": 3597.22, "npi": [1730119553] } ] }, { "allowed_amount": 33.83, "providers": [{ "billed_charge": 149.50, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9087.60, "providers": [{ "billed_charge": 450.00, "npi": [1174113534] } ] }, { "allowed_amount": 14.73, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2608.37, "providers": [{ "billed_charge": 769.86, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.82, "providers": [{ "billed_charge": 30.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.20, "providers": [{ "billed_charge": 47.55, "npi": [1942257191] } ] }, { "allowed_amount": 6414.59, "providers": [{ "billed_charge": 1495.10, "npi": [1942257191] } ] }, { "allowed_amount": 17.82, "providers": [{ "billed_charge": 47.55, "npi": [1942257191] } ] } ] } ] }, { "name": "GENERAL HEALTH PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80050", "description": "GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3814.38, "providers": [{ "billed_charge": 2953.67, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93932.36, "providers": [{ "billed_charge": 77370.64, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1439.25, "providers": [{ "billed_charge": 383.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1239.15, "providers": [{ "billed_charge": 2280.60, "npi": [1063497451] } ] }, { "allowed_amount": 252.72, "providers": [{ "billed_charge": 179.55, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5844.11, "providers": [{ "billed_charge": 10190.31, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.49, "providers": [{ "billed_charge": 490.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1975.11, "providers": [{ "billed_charge": 3713.79, "npi": [1932145778] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2226.96, "providers": [{ "billed_charge": 499.97, "npi": [1730119553] } ] }, { "allowed_amount": 1510.07, "providers": [{ "billed_charge": 304.01, "npi": [1730119553] } ] }, { "allowed_amount": 42702.32, "providers": [{ "billed_charge": 2581.34, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.16, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] }, { "allowed_amount": 5464.74, "providers": [{ "billed_charge": 1014.00, "npi": [1174113534] } ] }, { "allowed_amount": 9087.74, "providers": [{ "billed_charge": 564.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4647.33, "providers": [{ "billed_charge": 1909.43, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3119.34, "providers": [{ "billed_charge": 585.00, "npi": [1316984388] } ] }, { "allowed_amount": 5304.89, "providers": [{ "billed_charge": 3120.00, "npi": [1316984388] } ] }, { "allowed_amount": 929.57, "providers": [{ "billed_charge": 429.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 485.46, "providers": [{ "billed_charge": 210.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1559.60, "providers": [{ "billed_charge": 2470.80, "npi": [1356409379] } ] }, { "allowed_amount": 22997.74, "providers": [{ "billed_charge": 6177.00, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 493.13, "providers": [{ "billed_charge": 691.72, "npi": [1942257191] } ] }, { "allowed_amount": 3290.08, "providers": [{ "billed_charge": 2797.82, "npi": [1942257191] } ] }, { "allowed_amount": 351.18, "providers": [{ "billed_charge": 209.46, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "954126874" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 951.16, "providers": [{ "billed_charge": 28.00, "npi": [1053305797] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 484.29, "providers": [{ "billed_charge": 391.47, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 635.80, "providers": [{ "billed_charge": 559.76, "npi": [1568431088] } ] }, { "allowed_amount": 466.20, "providers": [{ "billed_charge": 839.64, "npi": [1568431088] } ] }, { "allowed_amount": 124.96, "providers": [{ "billed_charge": 559.76, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1371.84, "providers": [{ "billed_charge": 1746.25, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1766.68, "providers": [{ "billed_charge": 887.04, "npi": [1861018574] } ] }, { "allowed_amount": 1558.30, "providers": [{ "billed_charge": 628.32, "npi": [1578549044] } ] }, { "allowed_amount": 55091.54, "providers": [{ "billed_charge": 15042.72, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 123.48, "providers": [{ "billed_charge": 59.69, "npi": [1295726032] } ] }, { "allowed_amount": 2052.59, "providers": [{ "billed_charge": 1224.94, "npi": [1063497451] } ] }, { "allowed_amount": 972.22, "providers": [{ "billed_charge": 596.85, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1920.49, "providers": [{ "billed_charge": 580.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2181.94, "providers": [{ "billed_charge": 1935.61, "npi": [1043256886] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 757.98, "providers": [{ "billed_charge": 164.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5786.87, "providers": [{ "billed_charge": 4505.96, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 130622.90, "providers": [{ "billed_charge": 34355.71, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1521.10, "providers": [{ "billed_charge": 2846.40, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2225.68, "providers": [{ "billed_charge": 700.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 207.06, "providers": [{ "billed_charge": 128.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3775.24, "providers": [{ "billed_charge": 3429.20, "npi": [1063497451] } ] }, { "allowed_amount": 1023.20, "providers": [{ "billed_charge": 1116.15, "npi": [1295726032] } ] }, { "allowed_amount": 1836.89, "providers": [{ "billed_charge": 2149.09, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "382084239" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 987.02, "providers": [{ "billed_charge": 1777.16, "npi": [1932166386] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12920.70, "providers": [{ "billed_charge": 10300.34, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.00, "providers": [{ "billed_charge": 60.50, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4305.71, "providers": [{ "billed_charge": 5514.90, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 461.81, "providers": [{ "billed_charge": 220.44, "npi": [1174882948] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80069", "description": "RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.59, "providers": [{ "billed_charge": 30.38, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4907.22, "providers": [{ "billed_charge": 1415.19, "npi": [1356409379] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1911.52, "providers": [{ "billed_charge": 743.60, "npi": [1720279805] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.77, "providers": [{ "billed_charge": 179.40, "npi": [1730119553] } ] }, { "allowed_amount": 982.12, "providers": [{ "billed_charge": 553.96, "npi": [1730119553] } ] }, { "allowed_amount": 1036.02, "providers": [{ "billed_charge": 374.56, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2773.62, "providers": [{ "billed_charge": 483.00, "npi": [1174113534] } ] }, { "allowed_amount": 314.00, "providers": [{ "billed_charge": 35.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1409.44, "providers": [{ "billed_charge": 1120.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35241.63, "providers": [{ "billed_charge": 34158.00, "npi": [1861994600] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50271.31, "providers": [{ "billed_charge": 51303.36, "npi": [1508499393] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6964.97, "providers": [{ "billed_charge": 7829.64, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26343.04, "providers": [{ "billed_charge": 187868.01, "npi": [1063011898] } ] } ] }, { "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8373.22, "providers": [{ "billed_charge": 18000.00, "npi": [1952189086] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 555.03, "providers": [{ "billed_charge": 52.40, "npi": [1730119553] } ] }, { "allowed_amount": 3462.24, "providers": [{ "billed_charge": 90.50, "npi": [1730119553] } ] }, { "allowed_amount": 1052.26, "providers": [{ "billed_charge": 61.92, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 596.20, "providers": [{ "billed_charge": 180.00, "npi": [1174113534] } ] }, { "allowed_amount": 269.70, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34165.63, "providers": [{ "billed_charge": 2582.64, "npi": [1720279805] } ] }, { "allowed_amount": 49.26, "providers": [{ "billed_charge": 12.24, "npi": [1861018574] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 182.40, "providers": [{ "billed_charge": 11.00, "npi": [1316984388] } ] }, { "allowed_amount": 310.46, "providers": [{ "billed_charge": 33.00, "npi": [1316984388] } ] }, { "allowed_amount": 988.18, "providers": [{ "billed_charge": 141.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2939.89, "providers": [{ "billed_charge": 170.31, "npi": [1356409379] } ] }, { "allowed_amount": 463.36, "providers": [{ "billed_charge": 121.65, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2821.13, "providers": [{ "billed_charge": 854.68, "npi": [1043256886] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81003", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2606.93, "providers": [{ "billed_charge": 137.06, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.68, "providers": [{ "billed_charge": 16.84, "npi": [1356409379] } ] }, { "allowed_amount": 900.76, "providers": [{ "billed_charge": 134.72, "npi": [1356409379] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "812", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCRE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834708723" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 1545.88, "providers": [{ "billed_charge": 3250.00, "npi": [1487214698] } ] } ] } ] }, { "name": "FMR1 GENE DETECTION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81243", "description": "FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILE X MENTAL RETARDATION) GENE ANALYSIS; EVALUATION T", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3879.48, "providers": [{ "billed_charge": 912.64, "npi": [1598314437] } ] } ] } ] }, { "name": "FETAL CHRMOML ANEUPLOIDY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81420", "description": "FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17242.45, "providers": [{ "billed_charge": 39470.60, "npi": [1598314437] } ] } ] } ] }, { "name": "FETAL CHRMOML MICRODELTJ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81422", "description": "FETAL CHROMOSOMAL MICRODELETION(S) GENOMIC SEQUENCE ANALYSIS (EG, DIGEORGE SYNDROME, CRI-DU-CHAT SYN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12257.19, "providers": [{ "billed_charge": 18217.20, "npi": [1598314437] } ] } ] } ] }, { "name": "UNLISTED MOLECULAR PATHOLOGY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81479", "description": "UNLISTED MOLECULAR PATHOLOGY PROCEDURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "465193717" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27839.63, "providers": [{ "billed_charge": 1266.75, "npi": [1467850859] } ] } ] } ] }, { "name": "NFCT DS BV RNA VAG FLU ALG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81513", "description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 45079.04, "providers": [{ "billed_charge": 42432.85, "npi": [1720279805] } ] } ] } ] }, { "name": "HEMO/OP OR HOME", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "820", "description": "HEMODIALYSIS - OUTPT OR HOME - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5421010.62, "providers": [{ "billed_charge": 374216.50, "npi": [1912446865] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 377.35, "providers": [{ "billed_charge": 276.22, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14569.50, "providers": [{ "billed_charge": 2920.05, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 269.30, "providers": [{ "billed_charge": 175.64, "npi": [1043256886] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1280146.10, "providers": [{ "billed_charge": 164100.30, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 828760.00, "providers": [{ "billed_charge": 104200.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1750588.75, "providers": [{ "billed_charge": 146878.72, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "811669007" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 763205.17, "providers": [{ "billed_charge": 73728.00, "npi": [1295312197] } ] } ] }, { "tin": { "type": "ein", "value": "204399694" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 591286.00, "providers": [{ "billed_charge": 387472.00, "npi": [1689693319] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2764460.59, "providers": [{ "billed_charge": 193144.00, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 233950.00, "providers": [{ "billed_charge": 388608.00, "npi": [1609217157] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["99", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6002890.56, "providers": [{ "billed_charge": 410431.00, "npi": [1326282484] } ] }, { "allowed_amount": 1997188.27, "providers": [{ "billed_charge": 132786.50, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "932718345" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 127200.00, "providers": [{ "billed_charge": 169001.00, "npi": [1538946397] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2062330.46, "providers": [{ "billed_charge": 49152.00, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "770462755" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2737908.00, "providers": [{ "billed_charge": 248800.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "203344171" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 685768.00, "providers": [{ "billed_charge": 285737.00, "npi": [1194916205] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5387118.12, "providers": [{ "billed_charge": 291456.00, "npi": [1386180859] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13594.27, "providers": [{ "billed_charge": 4798.30, "npi": [1720279805] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2982.83, "providers": [{ "billed_charge": 386.54, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY TEST FOR BLOOD, FECAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82274", "description": "BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 246.60, "providers": [{ "billed_charge": 278.60, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1827.50, "providers": [{ "billed_charge": 1514.34, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1204.57, "providers": [{ "billed_charge": 765.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 88176.00, "providers": [{ "billed_charge": 41958.00, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1008.64, "providers": [{ "billed_charge": 1719.90, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4693.82, "providers": [{ "billed_charge": 5947.73, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 223.01, "providers": [{ "billed_charge": 290.49, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.28, "providers": [{ "billed_charge": 162.44, "npi": [1174882948] } ] } ] } ] }, { "name": "ASSAY OF CK (CPK)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE (CK), (CPK); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 322.11, "providers": [{ "billed_charge": 75.54, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 809.98, "providers": [{ "billed_charge": 309.64, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18507.19, "providers": [{ "billed_charge": 2048.69, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.77, "providers": [{ "billed_charge": 68.91, "npi": [1043256886] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 270.57, "providers": [{ "billed_charge": 188.72, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1130.78, "providers": [{ "billed_charge": 432.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29432.13, "providers": [{ "billed_charge": 6333.60, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9037.32, "providers": [{ "billed_charge": 3177.49, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 624.32, "providers": [{ "billed_charge": 537.78, "npi": [1043256886] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40581.75, "providers": [{ "billed_charge": 9589.71, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9697.77, "providers": [{ "billed_charge": 1749.30, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1930.02, "providers": [{ "billed_charge": 691.55, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2145.48, "providers": [{ "billed_charge": 349.80, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17762.06, "providers": [{ "billed_charge": 5570.70, "npi": [1356409379] } ] } ] } ] }, { "name": "REAGENT STRIP/BLOOD GLUCOSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82948", "description": "GLUCOSE; BLOOD, REAGENT STRIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4804.22, "providers": [{ "billed_charge": 104.94, "npi": [1730119553] } ] }, { "allowed_amount": 82.80, "providers": [{ "billed_charge": 157.41, "npi": [1730119553] } ] } ] } ] }, { "name": "GLUCOSE TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82950", "description": "GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 470.48, "providers": [{ "billed_charge": 183.40, "npi": [1720279805] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82962", "description": "GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6922.52, "providers": [{ "billed_charge": 2223.88, "npi": [1730119553] } ] }, { "allowed_amount": 24.94, "providers": [{ "billed_charge": 128.56, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "880107050" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 706.29, "providers": [{ "billed_charge": 84.00, "npi": [1083675169] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7370.66, "providers": [{ "billed_charge": 2015.93, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3823.50, "providers": [{ "billed_charge": 842.66, "npi": [1720279805] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 275.67, "providers": [{ "billed_charge": 35.88, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 89.58, "providers": [{ "billed_charge": 30.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4696.04, "providers": [{ "billed_charge": 2764.16, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 178.13, "providers": [{ "billed_charge": 34.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 116766.45, "providers": [{ "billed_charge": 21175.77, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1157.63, "providers": [{ "billed_charge": 892.00, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1662.92, "providers": [{ "billed_charge": 853.30, "npi": [1538144910] } ] }, { "allowed_amount": 748.27, "providers": [{ "billed_charge": 589.40, "npi": [1295726032] } ] }, { "allowed_amount": 2288.16, "providers": [{ "billed_charge": 1455.30, "npi": [1063497451] } ] }, { "allowed_amount": 286.32, "providers": [{ "billed_charge": 108.66, "npi": [1932184322] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8498.57, "providers": [{ "billed_charge": 4812.55, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "382084239" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.44, "providers": [{ "billed_charge": 89.20, "npi": [1932166386] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.68, "providers": [{ "billed_charge": 77.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3099.34, "providers": [{ "billed_charge": 1873.20, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 207.72, "providers": [{ "billed_charge": 106.56, "npi": [1174882948] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37629.50, "providers": [{ "billed_charge": 3941.10, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.75, "providers": [{ "billed_charge": 45.72, "npi": [1043256886] } ] } ] } ] }, { "name": "ASSAY OF LACTIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83605", "description": "LACTATE (LACTIC ACID)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1462.48, "providers": [{ "billed_charge": 135.45, "npi": [1730119553] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15866.49, "providers": [{ "billed_charge": 2152.80, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1469.90, "providers": [{ "billed_charge": 77.74, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.62, "providers": [{ "billed_charge": 144.00, "npi": [1174113534] } ] }, { "allowed_amount": 314.00, "providers": [{ "billed_charge": 30.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 899.58, "providers": [{ "billed_charge": 120.60, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16463.08, "providers": [{ "billed_charge": 3366.80, "npi": [1720279805] } ] } ] } ] }, { "name": "LIPOPROTEIN BLD QUAN PART", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83704", "description": "LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S) (EG, BY NUCLEAR MAGNETIC RESONANC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1032.40, "providers": [{ "billed_charge": 1008.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 39422.69, "providers": [{ "billed_charge": 4838.48, "npi": [1730119553] } ] }, { "allowed_amount": 742.52, "providers": [{ "billed_charge": 154.55, "npi": [1730119553] } ] }, { "allowed_amount": 873.91, "providers": [{ "billed_charge": 586.00, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12540.94, "providers": [{ "billed_charge": 570.00, "npi": [1174113534] } ] }, { "allowed_amount": 167.20, "providers": [{ "billed_charge": 24.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.01, "providers": [{ "billed_charge": 23.00, "npi": [1316984388] } ] }, { "allowed_amount": 1811.83, "providers": [{ "billed_charge": 163.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1407.23, "providers": [{ "billed_charge": 164.15, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.60, "providers": [{ "billed_charge": 52.41, "npi": [1356409379] } ] }, { "allowed_amount": 25753.56, "providers": [{ "billed_charge": 3983.16, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.86, "providers": [{ "billed_charge": 22.86, "npi": [1942257191] } ] }, { "allowed_amount": 14657.25, "providers": [{ "billed_charge": 859.21, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2964.94, "providers": [{ "billed_charge": 2600.64, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY FOR CALPROTECTIN FECAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83993", "description": "CALPROTECTIN, FECAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 123.51, "providers": [{ "billed_charge": 70.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 418.16, "providers": [{ "billed_charge": 26.79, "npi": [1730119553] } ] }, { "allowed_amount": 15533.46, "providers": [{ "billed_charge": 493.11, "npi": [1730119553] } ] }, { "allowed_amount": 326.04, "providers": [{ "billed_charge": 98.64, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.35, "providers": [{ "billed_charge": 37.44, "npi": [1356409379] } ] }, { "allowed_amount": 14772.79, "providers": [{ "billed_charge": 1647.36, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12369.66, "providers": [{ "billed_charge": 551.04, "npi": [1942257191] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1728.21, "providers": [{ "billed_charge": 438.06, "npi": [1720279805] } ] } ] } ] }, { "name": "PROCALCITONIN (PCT)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84145", "description": "PROCALCITONIN (PCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1221.07, "providers": [{ "billed_charge": 705.64, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 501.21, "providers": [{ "billed_charge": 135.66, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 610.09, "providers": [{ "billed_charge": 451.95, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23233.27, "providers": [{ "billed_charge": 8423.05, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1019.31, "providers": [{ "billed_charge": 713.40, "npi": [1043256886] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1286.37, "providers": [{ "billed_charge": 100.94, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 667.40, "providers": [{ "billed_charge": 148.06, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 760.19, "providers": [{ "billed_charge": 557.47, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.60, "providers": [{ "billed_charge": 245.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2473.80, "providers": [{ "billed_charge": 2089.29, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7149.11, "providers": [{ "billed_charge": 2840.20, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1100.28, "providers": [{ "billed_charge": 1264.27, "npi": [1043256886] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1093.74, "providers": [{ "billed_charge": 371.98, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 508.74, "providers": [{ "billed_charge": 160.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34442.50, "providers": [{ "billed_charge": 5682.60, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6581.51, "providers": [{ "billed_charge": 3320.44, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 610.13, "providers": [{ "billed_charge": 526.92, "npi": [1932145778] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1082.62, "providers": [{ "billed_charge": 520.16, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25417.70, "providers": [{ "billed_charge": 8878.80, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37411.46, "providers": [{ "billed_charge": 7726.18, "npi": [1720279805] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1390.13, "providers": [{ "billed_charge": 415.03, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.63, "providers": [{ "billed_charge": 122.00, "npi": [1750348033] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84484", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7008.12, "providers": [{ "billed_charge": 519.97, "npi": [1730119553] } ] }, { "allowed_amount": 475.79, "providers": [{ "billed_charge": 44.96, "npi": [1730119553] } ] }, { "allowed_amount": 589.97, "providers": [{ "billed_charge": 25.41, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 564.22, "providers": [{ "billed_charge": 210.00, "npi": [1174113534] } ] }, { "allowed_amount": 562.60, "providers": [{ "billed_charge": 105.00, "npi": [1174113534] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3597.77, "providers": [{ "billed_charge": 300.58, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1954.74, "providers": [{ "billed_charge": 248.92, "npi": [1356409379] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.79, "providers": [{ "billed_charge": 316.08, "npi": [1720279805] } ] } ] } ] }, { "name": "BL SMEAR W/DIFF WBC COUNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85007", "description": "BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.29, "providers": [{ "billed_charge": 52.40, "npi": [1356409379] } ] }, { "allowed_amount": 12232.79, "providers": [{ "billed_charge": 786.00, "npi": [1356409379] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2076.77, "providers": [{ "billed_charge": 346.44, "npi": [1730119553] } ] }, { "allowed_amount": 2054.55, "providers": [{ "billed_charge": 445.68, "npi": [1730119553] } ] }, { "allowed_amount": 54235.51, "providers": [{ "billed_charge": 3028.51, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4992.90, "providers": [{ "billed_charge": 1068.00, "npi": [1174113534] } ] }, { "allowed_amount": 9730.56, "providers": [{ "billed_charge": 924.00, "npi": [1174113534] } ] }, { "allowed_amount": 90.76, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4161.13, "providers": [{ "billed_charge": 1131.34, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3983.02, "providers": [{ "billed_charge": 2017.00, "npi": [1316984388] } ] }, { "allowed_amount": 1464.43, "providers": [{ "billed_charge": 396.00, "npi": [1316984388] } ] }, { "allowed_amount": 452.17, "providers": [{ "billed_charge": 224.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 556.03, "providers": [{ "billed_charge": 252.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1654.75, "providers": [{ "billed_charge": 2096.50, "npi": [1356409379] } ] }, { "allowed_amount": 18008.18, "providers": [{ "billed_charge": 5570.70, "npi": [1356409379] } ] }, { "allowed_amount": 20.92, "providers": [{ "billed_charge": 59.90, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1130.00, "providers": [{ "billed_charge": 190.80, "npi": [1912991597] } ] }, { "allowed_amount": 318.00, "providers": [{ "billed_charge": 63.60, "npi": [1912991597] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 14871.90, "providers": [{ "billed_charge": 1752.57, "npi": [1942257191] } ] }, { "allowed_amount": 377.45, "providers": [{ "billed_charge": 246.14, "npi": [1942257191] } ] }, { "allowed_amount": 114.41, "providers": [{ "billed_charge": 52.90, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "752131429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.32, "providers": [{ "billed_charge": 144.00, "npi": [1811944101] } ] } ] }, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.47, "providers": [{ "billed_charge": 28.39, "npi": [1972080752] } ] }, { "allowed_amount": 43.59, "providers": [{ "billed_charge": 56.78, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 273.80, "providers": [{ "billed_charge": 181.52, "npi": [1568431088] } ] }, { "allowed_amount": 271.14, "providers": [{ "billed_charge": 181.52, "npi": [1568431088] } ] }, { "allowed_amount": 117.84, "providers": [{ "billed_charge": 45.38, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "332932965" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.54, "providers": [{ "billed_charge": 45.38, "npi": [1790597524] } ] }, { "allowed_amount": 224.24, "providers": [{ "billed_charge": 90.76, "npi": [1790597524] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 587.31, "providers": [{ "billed_charge": 491.85, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2516.89, "providers": [{ "billed_charge": 1006.40, "npi": [1578549044] } ] }, { "allowed_amount": 2314.11, "providers": [{ "billed_charge": 897.60, "npi": [1861018574] } ] }, { "allowed_amount": 47226.70, "providers": [{ "billed_charge": 9819.20, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1811.94, "providers": [{ "billed_charge": 365.40, "npi": [1538144910] } ] }, { "allowed_amount": 1382.62, "providers": [{ "billed_charge": 325.50, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "475583986" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1552.57, "providers": [{ "billed_charge": 645.00, "npi": [1699120857] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1247.33, "providers": [{ "billed_charge": 491.85, "npi": [1043256886] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85027", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11019.71, "providers": [{ "billed_charge": 665.16, "npi": [1730119553] } ] }, { "allowed_amount": 105.44, "providers": [{ "billed_charge": 71.76, "npi": [1730119553] } ] }, { "allowed_amount": 191.69, "providers": [{ "billed_charge": 31.74, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7923.94, "providers": [{ "billed_charge": 270.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.77, "providers": [{ "billed_charge": 90.60, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2147.69, "providers": [{ "billed_charge": 285.00, "npi": [1316984388] } ] }, { "allowed_amount": 888.96, "providers": [{ "billed_charge": 140.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.12, "providers": [{ "billed_charge": 50.54, "npi": [1356409379] } ] }, { "allowed_amount": 17181.64, "providers": [{ "billed_charge": 3184.02, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.20, "providers": [{ "billed_charge": 19.73, "npi": [1942257191] } ] }, { "allowed_amount": 313.41, "providers": [{ "billed_charge": 219.01, "npi": [1942257191] } ] }, { "allowed_amount": 86.34, "providers": [{ "billed_charge": 39.46, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "371925902" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.79, "providers": [{ "billed_charge": 54.00, "npi": [1356993703] } ] }, { "allowed_amount": 580.76, "providers": [{ "billed_charge": 108.00, "npi": [1356993703] } ] } ] } ] }, { "name": "CCPD/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "851", "description": "CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921385442" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 12651544.88, "providers": [{ "billed_charge": 381578.00, "npi": [1649051475] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 13197.07, "providers": [{ "billed_charge": 340.20, "npi": [1730119553] } ] }, { "allowed_amount": 465.83, "providers": [{ "billed_charge": 24.76, "npi": [1730119553] } ] }, { "allowed_amount": 1183.25, "providers": [{ "billed_charge": 71.16, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1053.62, "providers": [{ "billed_charge": 330.44, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954457756" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.42, "providers": [{ "billed_charge": 15.00, "npi": [1316984388] } ] }, { "allowed_amount": 557.78, "providers": [{ "billed_charge": 45.00, "npi": [1316984388] } ] }, { "allowed_amount": 56.30, "providers": [{ "billed_charge": 18.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.42, "providers": [{ "billed_charge": 29.95, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8251.39, "providers": [{ "billed_charge": 330.58, "npi": [1942257191] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7631.81, "providers": [{ "billed_charge": 630.36, "npi": [1720279805] } ] } ] } ] }, { "name": "THROMBOPLASTIN TIME, PARTIAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85730", "description": "THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.43, "providers": [{ "billed_charge": 19.43, "npi": [1730119553] } ] }, { "allowed_amount": 4447.96, "providers": [{ "billed_charge": 290.54, "npi": [1730119553] } ] }, { "allowed_amount": 1064.15, "providers": [{ "billed_charge": 70.94, "npi": [1730119553] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 166.70, "providers": [{ "billed_charge": 84.64, "npi": [1720279805] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6186.98, "providers": [{ "billed_charge": 988.80, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11730.88, "providers": [{ "billed_charge": 1100.68, "npi": [1356409379] } ] }, { "allowed_amount": 261.81, "providers": [{ "billed_charge": 196.55, "npi": [1356409379] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN, HS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86141", "description": "C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4451.51, "providers": [{ "billed_charge": 634.62, "npi": [1720279805] } ] } ] } ] }, { "name": "FLUORESCENT ANTIBODY, SCREEN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86255", "description": "FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1560.84, "providers": [{ "billed_charge": 988.31, "npi": [1609812445] } ] } ] } ] }, { "name": "TISS TRNSGLTMNASE EA IG CLAS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86364", "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 549.43, "providers": [{ "billed_charge": 193.40, "npi": [1720279805] } ] } ] } ] }, { "name": "MICROSOMAL ANTIBODY EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86376", "description": "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 522.92, "providers": [{ "billed_charge": 101.86, "npi": [1720279805] } ] } ] } ] }, { "name": "TB TEST CELL IMMUN MEASURE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86480", "description": "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16462.22, "providers": [{ "billed_charge": 15618.96, "npi": [1720279805] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86592", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8372.65, "providers": [{ "billed_charge": 418.60, "npi": [1720279805] } ] } ] } ] }, { "name": "HEP B SURFACE ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86706", "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2175.86, "providers": [{ "billed_charge": 375.90, "npi": [1720279805] } ] } ] } ] }, { "name": "RUBELLA ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86762", "description": "ANTIBODY; RUBELLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4041.93, "providers": [{ "billed_charge": 856.29, "npi": [1720279805] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29833.92, "providers": [{ "billed_charge": 5746.16, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 186.10, "providers": [{ "billed_charge": 29.94, "npi": [1356409379] } ] } ] } ] }, { "name": "VARICELLA-ZOSTER ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86787", "description": "ANTIBODY; VARICELLA-ZOSTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2846.88, "providers": [{ "billed_charge": 631.12, "npi": [1720279805] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40603.28, "providers": [{ "billed_charge": 7392.60, "npi": [1720279805] } ] } ] } ] }, { "name": "RBC ANTIBODY SCREEN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86850", "description": "ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 378.14, "providers": [{ "billed_charge": 195.28, "npi": [1730119553] } ] }, { "allowed_amount": 576.98, "providers": [{ "billed_charge": 513.38, "npi": [1730119553] } ] }, { "allowed_amount": 8950.17, "providers": [{ "billed_charge": 2286.98, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.12, "providers": [{ "billed_charge": 9.36, "npi": [1356409379] } ] }, { "allowed_amount": 1254.23, "providers": [{ "billed_charge": 84.24, "npi": [1356409379] } ] }, { "allowed_amount": 17.32, "providers": [{ "billed_charge": 9.36, "npi": [1356409379] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC ABO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86900", "description": "BLOOD TYPING, SEROLOGIC; ABO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9394.97, "providers": [{ "billed_charge": 1415.79, "npi": [1730119553] } ] }, { "allowed_amount": 483.55, "providers": [{ "billed_charge": 142.26, "npi": [1730119553] } ] }, { "allowed_amount": 699.11, "providers": [{ "billed_charge": 247.92, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4193.00, "providers": [{ "billed_charge": 426.74, "npi": [1356409379] } ] }, { "allowed_amount": 7.12, "providers": [{ "billed_charge": 44.92, "npi": [1356409379] } ] }, { "allowed_amount": 29.31, "providers": [{ "billed_charge": 22.46, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 401.56, "providers": [{ "billed_charge": 132.30, "npi": [1912991597] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.38, "providers": [{ "billed_charge": 59.19, "npi": [1942257191] } ] }, { "allowed_amount": 81.47, "providers": [{ "billed_charge": 59.19, "npi": [1942257191] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC RH(D)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86901", "description": "BLOOD TYPING, SEROLOGIC; RH (D)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 251.18, "providers": [{ "billed_charge": 69.96, "npi": [1730119553] } ] }, { "allowed_amount": 191.31, "providers": [{ "billed_charge": 122.43, "npi": [1730119553] } ] }, { "allowed_amount": 7230.53, "providers": [{ "billed_charge": 897.30, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.12, "providers": [{ "billed_charge": 74.88, "npi": [1356409379] } ] }, { "allowed_amount": 64.74, "providers": [{ "billed_charge": 112.32, "npi": [1356409379] } ] }, { "allowed_amount": 2327.54, "providers": [{ "billed_charge": 599.04, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 363.56, "providers": [{ "billed_charge": 132.30, "npi": [1912991597] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.63, "providers": [{ "billed_charge": 86.08, "npi": [1942257191] } ] }, { "allowed_amount": 81.47, "providers": [{ "billed_charge": 64.56, "npi": [1942257191] } ] } ] } ] }, { "name": "BLOOD CULTURE FOR BACTERIA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87040", "description": "CULTURE, BACTERIAL; BLOOD, AEROBIC, WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES (INCLU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.00, "providers": [{ "billed_charge": 53.82, "npi": [1730119553] } ] }, { "allowed_amount": 3668.84, "providers": [{ "billed_charge": 283.59, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2126.16, "providers": [{ "billed_charge": 482.94, "npi": [1356409379] } ] } ] } ] }, { "name": "CULTURE OTHR SPECIMN AEROBIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87070", "description": "CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.11, "providers": [{ "billed_charge": 90.51, "npi": [1720279805] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87077", "description": "CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2918.78, "providers": [{ "billed_charge": 1122.84, "npi": [1720279805] } ] } ] } ] }, { "name": "CULTURE SCREEN ONLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87081", "description": "CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.71, "providers": [{ "billed_charge": 162.47, "npi": [1720279805] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 654.75, "providers": [{ "billed_charge": 361.63, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21055.50, "providers": [{ "billed_charge": 4209.25, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 551.46, "providers": [{ "billed_charge": 729.80, "npi": [1043256886] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE MIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87186", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2436.77, "providers": [{ "billed_charge": 666.16, "npi": [1720279805] } ] } ] } ] }, { "name": "SMEAR, GRAM STAIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87205", "description": "SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.05, "providers": [{ "billed_charge": 49.38, "npi": [1720279805] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87340", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35468.64, "providers": [{ "billed_charge": 4773.12, "npi": [1720279805] } ] } ] } ] }, { "name": "HIV-1 AG W/HIV-1 & HIV-2 AB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87389", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 41579.81, "providers": [{ "billed_charge": 14043.25, "npi": [1720279805] } ] } ] } ] }, { "name": "INFLUENZA A/B AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87400", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, INFLUENZA, A OR B, EACH; (EG, ENZYME IM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461503904" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 187.17, "providers": [{ "billed_charge": 29.00, "npi": [1588901532] } ] } ] } ] }, { "name": "CORONAVIRUS AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87426", "description": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461503904" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 20975.89, "providers": [{ "billed_charge": 54033.00, "npi": [1588901532] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2777.40, "providers": [{ "billed_charge": 3354.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "954322584" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1122.80, "providers": [{ "billed_charge": 2041.00, "npi": [1710031588] } ] } ] }, { "tin": { "type": "ein", "value": "330073515" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 957.60, "providers": [{ "billed_charge": 1980.00, "npi": [1083903124] } ] } ] } ] }, { "name": "SARSCOV & INF VIR A&B AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87428", "description": "IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B", "allowed_amounts": [{ "tin": { "type": "ein", "value": "953123703" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.03, "providers": [{ "billed_charge": 422.00, "npi": [1891729745] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 52272.44, "providers": [{ "billed_charge": 66531.00, "npi": [1235107566] } ] }, { "allowed_amount": 795.60, "providers": [{ "billed_charge": 936.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "680360801" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 910.20, "providers": [{ "billed_charge": 1042.00, "npi": [1841407665] } ] }, { "allowed_amount": 2010.37, "providers": [{ "billed_charge": 2504.00, "npi": [1841407665] } ] } ] }, { "tin": { "type": "ein", "value": "571205856" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1715.47, "providers": [{ "billed_charge": 2862.00, "npi": [1144497678] } ] } ] } ] }, { "name": "CANDIDA, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87481", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25046.42, "providers": [{ "billed_charge": 21475.08, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 42617.48, "providers": [{ "billed_charge": 21125.04, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11652.48, "providers": [{ "billed_charge": 8597.05, "npi": [1689639544] } ] } ] } ] }, { "name": "CHYLMD PNEUM, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87486", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20347.87, "providers": [{ "billed_charge": 5614.40, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9780.77, "providers": [{ "billed_charge": 3123.01, "npi": [1689639544] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87491", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16281.46, "providers": [{ "billed_charge": 4316.07, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13971.00, "providers": [{ "billed_charge": 5772.54, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5841.24, "providers": [{ "billed_charge": 1579.05, "npi": [1689639544] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87494", "description": " Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29128.71, "providers": [{ "billed_charge": 20387.29, "npi": [1720279805] } ] } ] } ] }, { "name": "INFLUENZA DNA AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87502", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 637.71, "providers": [{ "billed_charge": 335.30, "npi": [1720279805] } ] } ] } ] }, { "name": "GARDNER VAG, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87511", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6991.19, "providers": [{ "billed_charge": 1579.05, "npi": [1790470763] } ] } ] } ] }, { "name": "HSV, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87529", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4076.48, "providers": [{ "billed_charge": 1543.96, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2022.74, "providers": [{ "billed_charge": 666.71, "npi": [1689639544] } ] } ] } ] }, { "name": "M. GENITALIUM AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87563", "description": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14574.36, "providers": [{ "billed_charge": 3789.72, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1114.83, "providers": [{ "billed_charge": 280.72, "npi": [1689639544] } ] } ] } ] }, { "name": "M.PNEUMON, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87581", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20671.37, "providers": [{ "billed_charge": 6035.48, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9874.54, "providers": [{ "billed_charge": 3228.28, "npi": [1689639544] } ] } ] } ] }, { "name": "N.GONORRHOEAE, DNA, AMP PROB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87591", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16129.39, "providers": [{ "billed_charge": 4210.80, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13272.01, "providers": [{ "billed_charge": 5649.72, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6041.85, "providers": [{ "billed_charge": 1228.15, "npi": [1689639544] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87624", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11570.36, "providers": [{ "billed_charge": 19037.10, "npi": [1720279805] } ] } ] } ] }, { "name": "RESP VIRUS 3-5 TARGETS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87631", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23876.46, "providers": [{ "billed_charge": 28811.26, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12039.79, "providers": [{ "billed_charge": 17113.33, "npi": [1689639544] } ] } ] } ] }, { "name": "SARS-COV-2 COVID-19 AMP PRB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87635", "description": "Infectious agent detection by nucleic acid (DNA or RNA); (SARS-CoV-2) [COVID-19], amplified probe te", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 174.45, "providers": [{ "billed_charge": 462.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 367.70, "providers": [{ "billed_charge": 501.00, "npi": [1871607762] } ] }, { "allowed_amount": 100.35, "providers": [{ "billed_charge": 167.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4092.55, "providers": [{ "billed_charge": 1975.49, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "861175591" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 12939.96, "providers": [{ "billed_charge": 12628.00, "npi": [1922124866] } ] } ] } ] }, { "name": "SARSCOV2&INF A&B&RSV AMP PRB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87637", "description": "IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811501590" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 330.46, "providers": [{ "billed_charge": 431.04, "npi": [1548771736] } ] } ] }, { "tin": { "type": "ein", "value": "861175591" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3659.26, "providers": [{ "billed_charge": 5724.00, "npi": [1922124866] } ] } ] }, { "tin": { "type": "ein", "value": "464710526" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16325.00, "providers": [{ "billed_charge": 22750.00, "npi": [1346989704] } ] } ] }, { "tin": { "type": "ein", "value": "393828965" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4961.32, "providers": [{ "billed_charge": 4960.00, "npi": [1720970445] } ] } ] }, { "tin": { "type": "ein", "value": "334198695" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11144.20, "providers": [{ "billed_charge": 11040.00, "npi": [1528953239] } ] } ] } ] }, { "name": "STAPH A, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87640", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6725.20, "providers": [{ "billed_charge": 2315.94, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4432.61, "providers": [{ "billed_charge": 1298.33, "npi": [1689639544] } ] } ] } ] }, { "name": "STREP A, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87651", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3012.31, "providers": [{ "billed_charge": 877.25, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 916.42, "providers": [{ "billed_charge": 175.45, "npi": [1689639544] } ] } ] } ] }, { "name": "STREP B, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87653", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13419.43, "providers": [{ "billed_charge": 4280.98, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 424.09, "providers": [{ "billed_charge": 42.11, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7353.20, "providers": [{ "billed_charge": 1859.77, "npi": [1689639544] } ] } ] } ] }, { "name": "TRICHOMONAS VAGINALIS AMPLIF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87661", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16772.60, "providers": [{ "billed_charge": 4210.80, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 48660.03, "providers": [{ "billed_charge": 10808.16, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4876.32, "providers": [{ "billed_charge": 1438.69, "npi": [1689639544] } ] } ] } ] }, { "name": "DETECT AGENT NOS, DNA, AMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87798", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16050.99, "providers": [{ "billed_charge": 10000.65, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3357.35, "providers": [{ "billed_charge": 2189.72, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7513.71, "providers": [{ "billed_charge": 4456.43, "npi": [1689639544] } ] } ] } ] }, { "name": "SARS-COV-2 COVID19 W/OPTIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87811", "description": "IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "953898275" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.75, "providers": [{ "billed_charge": 75.00, "npi": [1114918612] } ] } ] }, { "tin": { "type": "ein", "value": "330106028" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 668.36, "providers": [{ "billed_charge": 802.00, "npi": [1285616177] } ] }, { "allowed_amount": 101.09, "providers": [{ "billed_charge": 133.00, "npi": [1285616177] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88305", "description": "LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954457756" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1592.71, "providers": [{ "billed_charge": 1360.00, "npi": [1316984388] } ] }, { "allowed_amount": 158.32, "providers": [{ "billed_charge": 580.00, "npi": [1316984388] } ] } ] }, { "tin": { "type": "ein", "value": "330855183" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.31, "providers": [{ "billed_charge": 91.00, "npi": [1326234204] } ] } ] }, { "tin": { "type": "ein", "value": "43740411" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2127.97, "providers": [{ "billed_charge": 3255.50, "npi": [1396858791] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2982.13, "providers": [{ "billed_charge": 2684.00, "npi": [1639911688] } ] } ] }, { "tin": { "type": "ein", "value": "942547501" }, "service_code": ["22", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 624.96, "providers": [{ "billed_charge": 1960.00, "npi": [1598760985] } ] }, { "allowed_amount": 1226.40, "providers": [{ "billed_charge": 1880.00, "npi": [1598760985] } ] } ] }, { "tin": { "type": "ein", "value": "943166540" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2233.60, "providers": [{ "billed_charge": 1200.00, "npi": [1083671713] } ] }, { "allowed_amount": 9801.99, "providers": [{ "billed_charge": 17697.00, "npi": [1083671713] } ] }, { "allowed_amount": 250.83, "providers": [{ "billed_charge": 900.00, "npi": [1083671713] } ] } ] } ] }, { "name": "IMMUNOHISTO ANTB 1ST STAIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88342", "description": "IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943166540" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4107.85, "providers": [{ "billed_charge": 2392.00, "npi": [1083671713] } ] } ] } ] }, { "name": "IM ADMIN 1ST/ONLY COMPONENT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90460", "description": "IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, W COUNSELING BY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760460242" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 959.90, "providers": [{ "billed_charge": 45.00, "npi": [1225038326] } ] } ] } ] }, { "name": "ADMN SARSCOV2 VACC 1 DOSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90480", "description": "IMM ADMN SARSCOV2 VACCINE SINGLE DOSE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 43798.81, "providers": [{ "billed_charge": 36569.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21529.09, "providers": [{ "billed_charge": 11597.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "861175591" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 328.00, "providers": [{ "billed_charge": 165.00, "npi": [1922124866] } ] } ] }, { "tin": { "type": "ein", "value": "471370520" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2686.89, "providers": [{ "billed_charge": 1485.00, "npi": [1043628316] } ] } ] } ] }, { "name": "BH/INTENS OP/PSYCH", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "905", "description": "INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832765931" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 101713.36, "providers": [{ "billed_charge": 28000.00, "npi": [1982175345] } ] } ] }, { "tin": { "type": "ein", "value": "611813679" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1800.00, "providers": [{ "billed_charge": 450.00, "npi": [1750817383] } ] } ] }, { "tin": { "type": "ein", "value": "872691481" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 34184.53, "providers": [{ "billed_charge": 25311.00, "npi": [1558006429] } ] } ] }, { "tin": { "type": "ein", "value": "260605517" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 182056.81, "providers": [{ "billed_charge": 113775.00, "npi": [1003539586] } ] } ] }, { "tin": { "type": "ein", "value": "954628972" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 132710.10, "providers": [{ "billed_charge": 31100.00, "npi": [1740734268] } ] } ] }, { "tin": { "type": "ein", "value": "842968604" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14394.43, "providers": [{ "billed_charge": 18954.00, "npi": [1235904798] } ] } ] }, { "tin": { "type": "ein", "value": "823168571" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 144714.72, "providers": [{ "billed_charge": 79016.00, "npi": [1477056166] } ] } ] }, { "tin": { "type": "ein", "value": "811009718" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2100.00, "providers": [{ "billed_charge": 3000.00, "npi": [1194271270] } ] } ] }, { "tin": { "type": "ein", "value": "932390418" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 58935.32, "providers": [{ "billed_charge": 135000.00, "npi": [1386326478] } ] } ] }, { "tin": { "type": "ein", "value": "473567567" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 23034.26, "providers": [{ "billed_charge": 12415.00, "npi": [1063893428] } ] } ] }, { "tin": { "type": "ein", "value": "331378992" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 14531.09, "providers": [{ "billed_charge": 27500.00, "npi": [1205644689] } ] } ] }, { "tin": { "type": "ein", "value": "992032506" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 302090.36, "providers": [{ "billed_charge": 134460.00, "npi": [1972353100] } ] } ] }, { "tin": { "type": "ein", "value": "825215739" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 22000.00, "providers": [{ "billed_charge": 7000.00, "npi": [1891260576] } ] } ] }, { "tin": { "type": "ein", "value": "922218486" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 13200.00, "providers": [{ "billed_charge": 8400.00, "npi": [1376240374] } ] } ] }, { "tin": { "type": "ein", "value": "934467111" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 700.00, "providers": [{ "billed_charge": 3495.00, "npi": [1629826276] } ] } ] } ] }, { "name": "BH/INTENS OP/CHEM DEP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "906", "description": "INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "994587611" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5402.65, "providers": [{ "billed_charge": 22500.00, "npi": [1336961853] } ] } ] }, { "tin": { "type": "ein", "value": "920633280" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24048.00, "providers": [{ "billed_charge": 28056.00, "npi": [1851007066] } ] } ] }, { "tin": { "type": "ein", "value": "830999120" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 33021.50, "providers": [{ "billed_charge": 47173.50, "npi": [1437644457] } ] } ] }, { "tin": { "type": "ein", "value": "952878145" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6111.62, "providers": [{ "billed_charge": 1505.00, "npi": [1316086739] } ] } ] } ] }, { "name": "MENACWY-TT VACCINE IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90619", "description": "MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3327.00, "providers": [{ "billed_charge": 2730.00, "npi": [1659312593] } ] } ] } ] }, { "name": "9VHPV VACCINE 3 DOSE IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90651", "description": "HUMAN PAPILLOMAVIRUS VACCINE TYPES 6, 11, 16, 18, 31, 33, 45, 52, 58, NONAVALENT (9VHPV), 2 OR 3 DOS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14156.11, "providers": [{ "billed_charge": 19149.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17437.00, "providers": [{ "billed_charge": 19520.00, "npi": [1659312593] } ] } ] } ] }, { "name": "IIV3 VACC NO PRSV 0.5 ML IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90656", "description": "INFLUENZA VIRUS VACCINE, TRIVALENT (IIV3), SPLIT VIRUS, PRESERVATIVE FREE, 0.5 ML DOSAGE, FOR INTRAM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5254.40, "providers": [{ "billed_charge": 700.00, "npi": [1578672184] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8163.56, "providers": [{ "billed_charge": 2784.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 358.51, "providers": [{ "billed_charge": 470.00, "npi": [1659312593] } ] } ] } ] }, { "name": "PCV20 VACCINE IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90677", "description": "PCV20 VACCINE FOR INTRAMUSCULAR USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 685.60, "providers": [{ "billed_charge": 857.00, "npi": [1508968751] } ] } ] } ] }, { "name": "RV5 VACC 3 DOSE LIVE ORAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90680", "description": "ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE, FOR ORAL USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 560.00, "providers": [{ "billed_charge": 699.00, "npi": [1659312593] } ] } ] } ] }, { "name": "RVI VACC 2 DOSE LIVE ORAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90681", "description": "ROTAVIRUS VACCINE, HUMAN, ATTENUATED (RV1), 2 DOSE SCHEDULE, LIVE, FOR ORAL USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6396.06, "providers": [{ "billed_charge": 7423.00, "npi": [1235107566] } ] } ] } ] }, { "name": "TDAP VACCINE 7 YRS/> IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90715", "description": "TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271504911" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 757.05, "providers": [{ "billed_charge": 1595.00, "npi": [1205167350] } ] } ] }, { "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 763.00, "providers": [{ "billed_charge": 115.00, "npi": [1659312593] } ] } ] } ] }, { "name": "PSYCH DIAGNOSTIC EVALUATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90791", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 672.00, "providers": [{ "billed_charge": 900.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "871702628" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 8694.07, "providers": [{ "billed_charge": 16200.00, "npi": [1154994846] } ] }, { "allowed_amount": 162.00, "providers": [{ "billed_charge": 300.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4026.00, "providers": [{ "billed_charge": 5141.37, "npi": [1972138238] } ] }, { "allowed_amount": 29798.69, "providers": [{ "billed_charge": 38086.28, "npi": [1972138238] } ] }, { "allowed_amount": 3734.62, "providers": [{ "billed_charge": 4703.85, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6257.47, "providers": [{ "billed_charge": 10248.79, "npi": [1174292866] } ] }, { "allowed_amount": 3031.14, "providers": [{ "billed_charge": 4884.74, "npi": [1174292866] } ] }, { "allowed_amount": 8132.19, "providers": [{ "billed_charge": 13087.76, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYCH DIAG EVAL W/MED SRVCS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90792", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200374669" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2761.92, "providers": [{ "billed_charge": 4510.32, "npi": [1154697944] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 30 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90833", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 890.61, "providers": [{ "billed_charge": 1500.00, "npi": [1518269372] } ] }, { "allowed_amount": 65153.53, "providers": [{ "billed_charge": 63000.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 26447.85, "providers": [{ "billed_charge": 13825.00, "npi": [1023125465] } ] }, { "allowed_amount": 2906.85, "providers": [{ "billed_charge": 1295.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "263872254" }, "service_code": ["52", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 309.75, "providers": [{ "billed_charge": 225.00, "npi": [1437389616] } ] }, { "allowed_amount": 6675.63, "providers": [{ "billed_charge": 1350.00, "npi": [1437389616] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 806.00, "providers": [{ "billed_charge": 406.00, "npi": [1902390537] } ] }, { "allowed_amount": 19827.24, "providers": [{ "billed_charge": 9135.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "770545189" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1203.00, "providers": [{ "billed_charge": 600.00, "npi": [1447343710] } ] } ] }, { "tin": { "type": "ein", "value": "852938829" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 298.75, "providers": [{ "billed_charge": 250.00, "npi": [1245845932] } ] } ] }, { "tin": { "type": "ein", "value": "832675429" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 362.00, "providers": [{ "billed_charge": 337.64, "npi": [1235600834] } ] } ] }, { "tin": { "type": "ein", "value": "590712405" }, "service_code": ["22", "52"], "billing_class": "professional", "payments": [{ "allowed_amount": 2120.00, "providers": [{ "billed_charge": 350.00, "npi": [1306012836] } ] }, { "allowed_amount": 933.20, "providers": [{ "billed_charge": 175.00, "npi": [1306012836] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 44823.10, "providers": [{ "billed_charge": 19968.00, "npi": [1750368999] } ] }, { "allowed_amount": 3733.10, "providers": [{ "billed_charge": 1536.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "611897007" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 958.68, "providers": [{ "billed_charge": 530.31, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "941706811" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 12819.99, "providers": [{ "billed_charge": 8100.00, "npi": [1184785834] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2970.23, "providers": [{ "billed_charge": 1508.00, "npi": [1164512851] } ] }, { "allowed_amount": 1692.80, "providers": [{ "billed_charge": 754.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "330107822" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1275.42, "providers": [{ "billed_charge": 375.00, "npi": [1073628228] } ] } ] }, { "tin": { "type": "ein", "value": "825201238" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.68, "providers": [{ "billed_charge": 156.00, "npi": [1528693579] } ] }, { "allowed_amount": 601.16, "providers": [{ "billed_charge": 468.00, "npi": [1528693579] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 18034.10, "providers": [{ "billed_charge": 8190.00, "npi": [1508968967] } ] }, { "allowed_amount": 6807.95, "providers": [{ "billed_charge": 3276.00, "npi": [1508968967] } ] } ] }, { "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 5040.84, "providers": [{ "billed_charge": 2400.00, "npi": [1750584181] } ] }, { "allowed_amount": 5516.22, "providers": [{ "billed_charge": 2600.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "636727051" }, "service_code": ["22", "51", "52"], "billing_class": "professional", "payments": [{ "allowed_amount": 559.96, "providers": [{ "billed_charge": 450.00, "npi": [1548586951] } ] }, { "allowed_amount": 1790.90, "providers": [{ "billed_charge": 675.00, "npi": [1548586951] } ] }, { "allowed_amount": 2588.76, "providers": [{ "billed_charge": 225.00, "npi": [1548586951] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2323.37, "providers": [{ "billed_charge": 997.22, "npi": [1972138238] } ] }, { "allowed_amount": 278.76, "providers": [{ "billed_charge": 100.92, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "882977235" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1722.22, "providers": [{ "billed_charge": 990.00, "npi": [1659003457] } ] } ] }, { "tin": { "type": "ein", "value": "260522962" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 9379.53, "providers": [{ "billed_charge": 4049.52, "npi": [1881894483] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 5674.53, "providers": [{ "billed_charge": 2814.40, "npi": [1174292866] } ] }, { "allowed_amount": 7460.24, "providers": [{ "billed_charge": 3679.74, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "571205856" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.00, "providers": [{ "billed_charge": 347.00, "npi": [1144497678] } ] } ] }, { "tin": { "type": "ein", "value": "882250655" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2116.00, "providers": [{ "billed_charge": 792.00, "npi": [1689306920] } ] } ] } ] }, { "name": "PSYTX W PT 45 MINUTES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90834", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "12388703" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6000.00, "providers": [{ "billed_charge": 1600.00, "npi": [1619060662] } ] } ] }, { "tin": { "type": "ein", "value": "569703699" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 4460.00, "providers": [{ "billed_charge": 1800.00, "npi": [1669507836] } ] } ] }, { "tin": { "type": "ein", "value": "471973671" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2390.00, "providers": [{ "billed_charge": 2800.00, "npi": [1588068787] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2804.00, "providers": [{ "billed_charge": 4144.00, "npi": [1164512851] } ] }, { "allowed_amount": 5460.80, "providers": [{ "billed_charge": 7252.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "260279299" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8802.00, "providers": [{ "billed_charge": 1800.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522437605" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 88510.41, "providers": [{ "billed_charge": 7540.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "614108220" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.00, "providers": [{ "billed_charge": 175.00, "npi": [1518114586] } ] }, { "allowed_amount": 175.00, "providers": [{ "billed_charge": 175.00, "npi": [1518114586] } ] } ] }, { "tin": { "type": "ein", "value": "863015188" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3652.48, "providers": [{ "billed_charge": 4965.00, "npi": [1144999327] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1081.20, "providers": [{ "billed_charge": 1081.20, "npi": [1972138238] } ] }, { "allowed_amount": 405.45, "providers": [{ "billed_charge": 405.45, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 43404.33, "providers": [{ "billed_charge": 4100.00, "npi": [1234567893] } ] }, { "allowed_amount": 51091.51, "providers": [{ "billed_charge": 13500.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "991647415" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13704.18, "providers": [{ "billed_charge": 2730.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "453507503" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 5866.80, "providers": [{ "billed_charge": 5865.00, "npi": [1629352182] } ] } ] }, { "tin": { "type": "ein", "value": "474591265" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 24913.54, "providers": [{ "billed_charge": 16745.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.00, "providers": [{ "billed_charge": 375.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "194385204" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 591.06, "providers": [{ "billed_charge": 750.00, "npi": [1457420606] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 129.50, "providers": [{ "billed_charge": 185.00, "npi": [1902390537] } ] }, { "allowed_amount": 1665.00, "providers": [{ "billed_charge": 2220.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "943226225" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 134995.00, "providers": [{ "billed_charge": 9800.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "844708690" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2232.00, "providers": [{ "billed_charge": 372.00, "npi": [1396373544] } ] } ] }, { "tin": { "type": "ein", "value": "871702628" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6263.00, "providers": [{ "billed_charge": 7000.00, "npi": [1154994846] } ] }, { "allowed_amount": 224.00, "providers": [{ "billed_charge": 250.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "800543544" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1628.00, "providers": [{ "billed_charge": 2600.00, "npi": [1609194497] } ] }, { "allowed_amount": 1608.00, "providers": [{ "billed_charge": 2600.00, "npi": [1609194497] } ] } ] }, { "tin": { "type": "ein", "value": "680273974" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 929.00, "providers": [{ "billed_charge": 1455.00, "npi": [1669846986] } ] }, { "allowed_amount": 1202.80, "providers": [{ "billed_charge": 1455.00, "npi": [1669846986] } ] }, { "allowed_amount": 3164.00, "providers": [{ "billed_charge": 6305.00, "npi": [1669846986] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 69832.78, "providers": [{ "billed_charge": 79960.00, "npi": [1184199549] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.00, "providers": [{ "billed_charge": 624.96, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 447.32, "providers": [{ "billed_charge": 447.32, "npi": [1174292866] } ] }, { "allowed_amount": 1118.30, "providers": [{ "billed_charge": 1118.30, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "571205856" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2697.57, "providers": [{ "billed_charge": 10584.00, "npi": [1144497678] } ] } ] }, { "tin": { "type": "ein", "value": "341996544" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3161.00, "providers": [{ "billed_charge": 8017.00, "npi": [1700803418] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 45 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90836", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 27556.18, "providers": [{ "billed_charge": 26000.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "990722414" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1548.56, "providers": [{ "billed_charge": 1100.00, "npi": [1023870763] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.70, "providers": [{ "billed_charge": 238.70, "npi": [1174292866] } ] }, { "allowed_amount": 1954.81, "providers": [{ "billed_charge": 1174.30, "npi": [1174292866] } ] }, { "allowed_amount": 2459.82, "providers": [{ "billed_charge": 1670.90, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYTX W PT 60 MINUTES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90837", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 149079.66, "providers": [{ "billed_charge": 217800.00, "npi": [1518269372] } ] }, { "allowed_amount": 3582.00, "providers": [{ "billed_charge": 5400.00, "npi": [1518269372] } ] }, { "allowed_amount": 1072.00, "providers": [{ "billed_charge": 1000.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "956419205" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 276.48, "providers": [{ "billed_charge": 388.00, "npi": [1932121514] } ] } ] }, { "tin": { "type": "ein", "value": "462393939" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 13812.14, "providers": [{ "billed_charge": 10740.00, "npi": [1326417056] } ] } ] }, { "tin": { "type": "ein", "value": "452872078" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 297.52, "providers": [{ "billed_charge": 500.00, "npi": [1427320605] } ] }, { "allowed_amount": 163.02, "providers": [{ "billed_charge": 250.00, "npi": [1427320605] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 14893.61, "providers": [{ "billed_charge": 24315.00, "npi": [1023125465] } ] }, { "allowed_amount": 771.36, "providers": [{ "billed_charge": 1080.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "481263228" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.00, "providers": [{ "billed_charge": 350.00, "npi": [1093869588] } ] }, { "allowed_amount": 480.00, "providers": [{ "billed_charge": 2100.00, "npi": [1093869588] } ] } ] }, { "tin": { "type": "ein", "value": "475025949" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 880.67, "providers": [{ "billed_charge": 1496.00, "npi": [1760854442] } ] } ] }, { "tin": { "type": "ein", "value": "473179713" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3866.25, "providers": [{ "billed_charge": 2860.00, "npi": [1356792626] } ] } ] }, { "tin": { "type": "ein", "value": "572696219" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1184.94, "providers": [{ "billed_charge": 1400.00, "npi": [1407042070] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 13266.20, "providers": [{ "billed_charge": 19656.00, "npi": [1164512851] } ] }, { "allowed_amount": 9872.00, "providers": [{ "billed_charge": 13832.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "990671811" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7628.55, "providers": [{ "billed_charge": 4350.00, "npi": [1407888779] } ] } ] }, { "tin": { "type": "ein", "value": "873771599" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 525.00, "npi": [1477212645] } ] }, { "allowed_amount": 8034.96, "providers": [{ "billed_charge": 3820.00, "npi": [1477212645] } ] } ] }, { "tin": { "type": "ein", "value": "854353678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3200.00, "providers": [{ "billed_charge": 800.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "822549962" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.00, "providers": [{ "billed_charge": 200.00, "npi": [1124545470] } ] } ] }, { "tin": { "type": "ein", "value": "833701490" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 9724.00, "providers": [{ "billed_charge": 9760.00, "npi": [1396202206] } ] } ] }, { "tin": { "type": "ein", "value": "549952680" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 450.00, "providers": [{ "billed_charge": 450.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "475646573" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 203.00, "providers": [{ "billed_charge": 250.00, "npi": [1134578842] } ] } ] }, { "tin": { "type": "ein", "value": "263447487" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2384.11, "providers": [{ "billed_charge": 4750.00, "npi": [1215181300] } ] }, { "allowed_amount": 3144.32, "providers": [{ "billed_charge": 6500.00, "npi": [1215181300] } ] } ] }, { "tin": { "type": "ein", "value": "883777107" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 5250.12, "providers": [{ "billed_charge": 5250.00, "npi": [1306332317] } ] } ] }, { "tin": { "type": "ein", "value": "933051823" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 496.96, "providers": [{ "billed_charge": 700.00, "npi": [1598541435] } ] } ] }, { "tin": { "type": "ein", "value": "72348801" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 178.34, "providers": [{ "billed_charge": 195.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "551550407" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3623.72, "providers": [{ "billed_charge": 2500.00, "npi": [1083937627] } ] } ] }, { "tin": { "type": "ein", "value": "270643803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3600.00, "providers": [{ "billed_charge": 600.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "843506537" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3529.00, "providers": [{ "billed_charge": 4400.00, "npi": [1275177982] } ] } ] }, { "tin": { "type": "ein", "value": "833606496" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3571.50, "providers": [{ "billed_charge": 6930.00, "npi": [1124663059] } ] } ] }, { "tin": { "type": "ein", "value": "833404562" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 317.10, "providers": [{ "billed_charge": 460.00, "npi": [1447719513] } ] } ] }, { "tin": { "type": "ein", "value": "991759608" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 10112.80, "providers": [{ "billed_charge": 3100.00, "npi": [1952143430] } ] } ] }, { "tin": { "type": "ein", "value": "144508624" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.44, "providers": [{ "billed_charge": 300.00, "npi": [1356532360] } ] } ] }, { "tin": { "type": "ein", "value": "251901840" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 520.19, "providers": [{ "billed_charge": 1140.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "920986068" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.00, "providers": [{ "billed_charge": 574.00, "npi": [1558071027] } ] }, { "allowed_amount": 103.00, "providers": [{ "billed_charge": 287.00, "npi": [1558071027] } ] } ] }, { "tin": { "type": "ein", "value": "813242970" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1123.63, "providers": [{ "billed_charge": 2700.00, "npi": [1023508116] } ] } ] }, { "tin": { "type": "ein", "value": "273781010" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3001.00, "providers": [{ "billed_charge": 4410.00, "npi": [1316238678] } ] }, { "allowed_amount": 2723.09, "providers": [{ "billed_charge": 4410.00, "npi": [1316238678] } ] } ] }, { "tin": { "type": "ein", "value": "861747274" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3511.06, "providers": [{ "billed_charge": 7018.56, "npi": [1164014874] } ] }, { "allowed_amount": 2017.19, "providers": [{ "billed_charge": 4030.92, "npi": [1164014874] } ] } ] }, { "tin": { "type": "ein", "value": "844763002" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 56076.30, "providers": [{ "billed_charge": 9800.00, "npi": [1801486048] } ] } ] }, { "tin": { "type": "ein", "value": "833451302" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1322.18, "providers": [{ "billed_charge": 2200.00, "npi": [1205392099] } ] }, { "allowed_amount": 1910.20, "providers": [{ "billed_charge": 3200.00, "npi": [1205392099] } ] } ] }, { "tin": { "type": "ein", "value": "873630745" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 11558.14, "providers": [{ "billed_charge": 3400.00, "npi": [1891099164] } ] }, { "allowed_amount": 1560.32, "providers": [{ "billed_charge": 400.00, "npi": [1891099164] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 5511.34, "providers": [{ "billed_charge": 7108.07, "npi": [1972138238] } ] }, { "allowed_amount": 3644.09, "providers": [{ "billed_charge": 4965.43, "npi": [1972138238] } ] }, { "allowed_amount": 38785.97, "providers": [{ "billed_charge": 53468.06, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "863015188" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6188.44, "providers": [{ "billed_charge": 7210.00, "npi": [1144999327] } ] } ] }, { "tin": { "type": "ein", "value": "545920398" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19440.00, "providers": [{ "billed_charge": 2400.00, "npi": [1841462470] } ] } ] }, { "tin": { "type": "ein", "value": "271879320" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 9452.85, "providers": [{ "billed_charge": 10350.00, "npi": [1104522655] } ] }, { "allowed_amount": 4670.85, "providers": [{ "billed_charge": 5175.00, "npi": [1104522655] } ] } ] }, { "tin": { "type": "ein", "value": "923626980" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2850.00, "providers": [{ "billed_charge": 1800.00, "npi": [1700301827] } ] } ] }, { "tin": { "type": "ein", "value": "134447376" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 35939.00, "providers": [{ "billed_charge": 8875.00, "npi": [1003027145] } ] } ] }, { "tin": { "type": "ein", "value": "473457354" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 990.54, "providers": [{ "billed_charge": 1350.00, "npi": [1801385745] } ] }, { "allowed_amount": 9210.23, "providers": [{ "billed_charge": 12150.00, "npi": [1801385745] } ] } ] }, { "tin": { "type": "ein", "value": "884179016" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1099.90, "providers": [{ "billed_charge": 800.00, "npi": [1679266910] } ] } ] }, { "tin": { "type": "ein", "value": "832488525" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.40, "providers": [{ "billed_charge": 500.00, "npi": [1093362469] } ] } ] }, { "tin": { "type": "ein", "value": "464499043" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3607.30, "providers": [{ "billed_charge": 3012.16, "npi": [1740602549] } ] }, { "allowed_amount": 2493.05, "providers": [{ "billed_charge": 1514.80, "npi": [1740602549] } ] } ] }, { "tin": { "type": "ein", "value": "452060520" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2532.00, "providers": [{ "billed_charge": 2800.00, "npi": [1306117981] } ] }, { "allowed_amount": 2713.00, "providers": [{ "billed_charge": 3000.00, "npi": [1306117981] } ] } ] }, { "tin": { "type": "ein", "value": "853829922" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.00, "providers": [{ "billed_charge": 140.00, "npi": [1114529526] } ] } ] }, { "tin": { "type": "ein", "value": "854252623" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 385.20, "providers": [{ "billed_charge": 770.40, "npi": [1689260267] } ] }, { "allowed_amount": 1312.23, "providers": [{ "billed_charge": 2596.32, "npi": [1689260267] } ] } ] }, { "tin": { "type": "ein", "value": "943248971" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 404.00, "providers": [{ "billed_charge": 516.60, "npi": [1720181795] } ] } ] }, { "tin": { "type": "ein", "value": "871702628" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 24290.62, "providers": [{ "billed_charge": 59500.00, "npi": [1154994846] } ] }, { "allowed_amount": 2948.16, "providers": [{ "billed_charge": 7350.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "923873396" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13427.59, "providers": [{ "billed_charge": 7200.00, "npi": [1871310417] } ] } ] }, { "tin": { "type": "ein", "value": "800543544" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 5616.22, "providers": [{ "billed_charge": 7326.00, "npi": [1609194497] } ] }, { "allowed_amount": 3173.40, "providers": [{ "billed_charge": 4070.00, "npi": [1609194497] } ] } ] }, { "tin": { "type": "ein", "value": "824523426" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 388326.81, "providers": [{ "billed_charge": 33150.00, "npi": [1578393260] } ] } ] }, { "tin": { "type": "ein", "value": "820767207" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 6484.10, "providers": [{ "billed_charge": 7535.00, "npi": [1962818484] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 29298.44, "providers": [{ "billed_charge": 38705.40, "npi": [1174292866] } ] }, { "allowed_amount": 59575.41, "providers": [{ "billed_charge": 76789.08, "npi": [1174292866] } ] }, { "allowed_amount": 55130.26, "providers": [{ "billed_charge": 69530.64, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "872475331" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2063.67, "providers": [{ "billed_charge": 2000.00, "npi": [1982244273] } ] }, { "allowed_amount": 4522.31, "providers": [{ "billed_charge": 4800.00, "npi": [1982244273] } ] } ] }, { "tin": { "type": "ein", "value": "872835013" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2250.06, "providers": [{ "billed_charge": 2250.00, "npi": [1952089641] } ] }, { "allowed_amount": 6363.98, "providers": [{ "billed_charge": 7640.00, "npi": [1952089641] } ] } ] }, { "tin": { "type": "ein", "value": "870886661" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.25, "providers": [{ "billed_charge": 180.00, "npi": [1790357622] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 10021.15, "providers": [{ "billed_charge": 14652.00, "npi": [1750368999] } ] }, { "allowed_amount": 1560.80, "providers": [{ "billed_charge": 2442.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "824609087" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1473.94, "providers": [{ "billed_charge": 1540.00, "npi": [1538429188] } ] } ] }, { "tin": { "type": "ein", "value": "814241628" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3525.93, "providers": [{ "billed_charge": 4255.00, "npi": [1932651817] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3941.60, "providers": [{ "billed_charge": 6006.00, "npi": [1578672184] } ] }, { "allowed_amount": 5385.34, "providers": [{ "billed_charge": 8190.00, "npi": [1578672184] } ] } ] }, { "tin": { "type": "ein", "value": "214681351" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 27872.52, "providers": [{ "billed_charge": 4675.00, "npi": [1386628485] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2165.18, "providers": [{ "billed_charge": 540.00, "npi": [1234567893] } ] }, { "allowed_amount": 27209.19, "providers": [{ "billed_charge": 7300.00, "npi": [1234567893] } ] }, { "allowed_amount": 537.87, "providers": [{ "billed_charge": 750.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "545296105" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 16632.00, "providers": [{ "billed_charge": 5852.00, "npi": [1659498418] } ] }, { "allowed_amount": 4620.00, "providers": [{ "billed_charge": 2156.00, "npi": [1659498418] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 25782.65, "providers": [{ "billed_charge": 39600.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 10265.00, "providers": [{ "billed_charge": 14250.00, "npi": [1902390537] } ] }, { "allowed_amount": 525.00, "providers": [{ "billed_charge": 750.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "260089066" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 7698.61, "providers": [{ "billed_charge": 10744.00, "npi": [1417907940] } ] }, { "allowed_amount": 6613.40, "providers": [{ "billed_charge": 10112.00, "npi": [1417907940] } ] } ] }, { "tin": { "type": "ein", "value": "844779912" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2501.33, "providers": [{ "billed_charge": 2800.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "384054409" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2223.60, "providers": [{ "billed_charge": 4488.00, "npi": [1275035263] } ] } ] }, { "tin": { "type": "ein", "value": "832675429" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 699.94, "providers": [{ "billed_charge": 1319.40, "npi": [1235600834] } ] }, { "allowed_amount": 5620.45, "providers": [{ "billed_charge": 11154.12, "npi": [1235600834] } ] }, { "allowed_amount": 5588.13, "providers": [{ "billed_charge": 10870.56, "npi": [1235600834] } ] } ] }, { "tin": { "type": "ein", "value": "825065406" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 960.00, "providers": [{ "billed_charge": 110.00, "npi": [1225535545] } ] } ] }, { "tin": { "type": "ein", "value": "861438919" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1136.00, "providers": [{ "billed_charge": 1400.00, "npi": [1780881938] } ] } ] }, { "tin": { "type": "ein", "value": "813784845" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 45525.84, "providers": [{ "billed_charge": 17950.00, "npi": [1316179906] } ] }, { "allowed_amount": 13140.87, "providers": [{ "billed_charge": 5625.00, "npi": [1316179906] } ] } ] }, { "tin": { "type": "ein", "value": "861456641" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1030.83, "providers": [{ "billed_charge": 1129.50, "npi": [1487324463] } ] } ] }, { "tin": { "type": "ein", "value": "934609608" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 367.80, "providers": [{ "billed_charge": 420.00, "npi": [1659132520] } ] } ] }, { "tin": { "type": "ein", "value": "264354467" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5646.30, "providers": [{ "billed_charge": 1440.00, "npi": [1013130806] } ] } ] }, { "tin": { "type": "ein", "value": "568397160" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 903.70, "providers": [{ "billed_charge": 460.00, "npi": [1497979744] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 16742.42, "providers": [{ "billed_charge": 47212.74, "npi": [1154697944] } ] }, { "allowed_amount": 3097.18, "providers": [{ "billed_charge": 9257.40, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "941156581" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 268.00, "providers": [{ "billed_charge": 725.00, "npi": [1003267196] } ] } ] }, { "tin": { "type": "ein", "value": "934377878" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3596.04, "providers": [{ "billed_charge": 400.00, "npi": [1386993954] } ] } ] }, { "tin": { "type": "ein", "value": "851660843" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6750.00, "providers": [{ "billed_charge": 1550.00, "npi": [1477168524] } ] } ] }, { "tin": { "type": "ein", "value": "882794043" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1288.80, "providers": [{ "billed_charge": 2720.00, "npi": [1548990393] } ] } ] }, { "tin": { "type": "ein", "value": "843432588" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.74, "providers": [{ "billed_charge": 180.00, "npi": [1093452716] } ] } ] }, { "tin": { "type": "ein", "value": "852938829" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3544.39, "providers": [{ "billed_charge": 9100.00, "npi": [1245845932] } ] }, { "allowed_amount": 578.75, "providers": [{ "billed_charge": 1750.00, "npi": [1245845932] } ] } ] }, { "tin": { "type": "ein", "value": "582010734" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 328.27, "providers": [{ "billed_charge": 780.00, "npi": [1881990869] } ] } ] }, { "tin": { "type": "ein", "value": "932883334" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2948.00, "providers": [{ "billed_charge": 3520.00, "npi": [1710763834] } ] } ] }, { "tin": { "type": "ein", "value": "851441590" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 525.00, "npi": [1902422124] } ] } ] }, { "tin": { "type": "ein", "value": "822239719" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 34486.96, "providers": [{ "billed_charge": 10575.00, "npi": [1740332469] } ] } ] }, { "tin": { "type": "ein", "value": "821228675" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3452.67, "providers": [{ "billed_charge": 2145.00, "npi": [1225563752] } ] } ] }, { "tin": { "type": "ein", "value": "205261930" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 777.68, "providers": [{ "billed_charge": 776.15, "npi": [1497705495] } ] } ] }, { "tin": { "type": "ein", "value": "821066852" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 4413.98, "providers": [{ "billed_charge": 1890.00, "npi": [1396140513] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1238.68, "providers": [{ "billed_charge": 2080.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "841856765" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 750.22, "providers": [{ "billed_charge": 735.60, "npi": [1427671437] } ] }, { "allowed_amount": 735.60, "providers": [{ "billed_charge": 735.60, "npi": [1427671437] } ] } ] }, { "tin": { "type": "ein", "value": "553155709" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 878.19, "providers": [{ "billed_charge": 600.00, "npi": [1326170309] } ] } ] }, { "tin": { "type": "ein", "value": "851518210" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4901.74, "providers": [{ "billed_charge": 1225.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "680339380" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 19781.23, "providers": [{ "billed_charge": 1620.00, "npi": [1194880880] } ] } ] }, { "tin": { "type": "ein", "value": "246258363" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1400.00, "providers": [{ "billed_charge": 600.00, "npi": [1932304276] } ] }, { "allowed_amount": 4296.94, "providers": [{ "billed_charge": 2075.00, "npi": [1932304276] } ] } ] }, { "tin": { "type": "ein", "value": "464619637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6600.00, "providers": [{ "billed_charge": 1650.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "861505050" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1116.00, "providers": [{ "billed_charge": 1800.00, "npi": [1316499239] } ] }, { "allowed_amount": 14118.00, "providers": [{ "billed_charge": 22800.00, "npi": [1316499239] } ] } ] }, { "tin": { "type": "ein", "value": "753171544" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10712.00, "providers": [{ "billed_charge": 2000.00, "npi": [0] } ] } ] }, { "tin": { "type": "ein", "value": "922092996" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 104.93, "providers": [{ "billed_charge": 250.00, "npi": [1437848603] } ] }, { "allowed_amount": 589.70, "providers": [{ "billed_charge": 1250.00, "npi": [1437848603] } ] }, { "allowed_amount": 186.00, "providers": [{ "billed_charge": 300.00, "npi": [1437848603] } ] } ] }, { "tin": { "type": "ein", "value": "993948535" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 681.00, "providers": [{ "billed_charge": 250.00, "npi": [1811447535] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 83862.60, "providers": [{ "billed_charge": 128490.00, "npi": [1184199549] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 60 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90838", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 7434.95, "providers": [{ "billed_charge": 4550.00, "npi": [1750584181] } ] }, { "allowed_amount": 5571.00, "providers": [{ "billed_charge": 3530.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2499.61, "providers": [{ "billed_charge": 1595.70, "npi": [1174292866] } ] }, { "allowed_amount": 1022.50, "providers": [{ "billed_charge": 638.28, "npi": [1174292866] } ] } ] } ] }, { "name": "FAMILY PSYTX W/O PT 50 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90846", "description": "FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "144786002" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7509.86, "providers": [{ "billed_charge": 1250.00, "npi": [1962431015] } ] } ] } ] }, { "name": "FAMILY PSYTX W/PT 50 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90847", "description": "FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260089066" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 412.00, "providers": [{ "billed_charge": 515.00, "npi": [1417907940] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3325.87, "providers": [{ "billed_charge": 3323.05, "npi": [1972138238] } ] }, { "allowed_amount": 241.52, "providers": [{ "billed_charge": 241.52, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 17209.91, "providers": [{ "billed_charge": 17630.00, "npi": [1184199549] } ] } ] } ] }, { "name": "MULTIPLE FAMILY GROUP PSYTX", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90849", "description": "MULTIPLE-FAMILY GROUP PSYCHOTHERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680344702" }, "service_code": ["22", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.00, "providers": [{ "billed_charge": 320.00, "npi": [1962482513] } ] }, { "allowed_amount": 400.44, "providers": [{ "billed_charge": 960.00, "npi": [1962482513] } ] } ] }, { "tin": { "type": "ein", "value": "881465006" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1319.39, "providers": [{ "billed_charge": 1360.00, "npi": [1649910589] } ] } ] } ] }, { "name": "TCRANIAL MAGN STIM TX DELI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90868", "description": "THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "611897007" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 46350.97, "providers": [{ "billed_charge": 79750.00, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "923084561" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3419.40, "providers": [{ "billed_charge": 4224.90, "npi": [1649975681] } ] } ] }, { "tin": { "type": "ein", "value": "453150297" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17566.50, "providers": [{ "billed_charge": 5000.00, "npi": [1851492847] } ] } ] }, { "tin": { "type": "ein", "value": "260522962" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 22590.49, "providers": [{ "billed_charge": 167500.00, "npi": [1881894483] } ] } ] } ] }, { "name": "PSYCHOPHYSIOLOGICAL THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90876", "description": "INDIV PSYCHOPHYS BIOFEED TRAIN W/PSYTX 45 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853286578" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2916.00, "providers": [{ "billed_charge": 1000.00, "npi": [1912592452] } ] } ] } ] }, { "name": "PSTAY/REHAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "911", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330951143" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 39202.97, "providers": [{ "billed_charge": 56000.00, "npi": [1497132765] } ] } ] } ] }, { "name": "PSTAY/PARTIAL HOSP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "912", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832765931" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 84172.01, "providers": [{ "billed_charge": 22500.00, "npi": [1982175345] } ] } ] }, { "tin": { "type": "ein", "value": "452711976" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8100.00, "providers": [{ "billed_charge": 1606.49, "npi": [1134401466] } ] } ] }, { "tin": { "type": "ein", "value": "830999120" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 18519.62, "providers": [{ "billed_charge": 25162.50, "npi": [1437644457] } ] } ] } ] }, { "name": "PSYCHIATRIC CARE INTENSIVE 4", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "913", "description": "PSYCHIATRIC CARE INTENSIVE 4-6 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "465287582" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 84037.28, "providers": [{ "billed_charge": 82400.00, "npi": [1477090926] } ] } ] }, { "tin": { "type": "ein", "value": "872691481" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 30014.40, "providers": [{ "billed_charge": 10712.00, "npi": [1659054211] } ] } ] }, { "tin": { "type": "ein", "value": "260605517" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 233490.69, "providers": [{ "billed_charge": 124500.00, "npi": [1003539586] } ] } ] }, { "tin": { "type": "ein", "value": "331053010" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 341619.15, "providers": [{ "billed_charge": 155400.00, "npi": [1780004192] } ] } ] }, { "tin": { "type": "ein", "value": "471674418" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 800.00, "providers": [{ "billed_charge": 1000.00, "npi": [1083006944] } ] } ] }, { "tin": { "type": "ein", "value": "261722556" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 297817.33, "providers": [{ "billed_charge": 71396.00, "npi": [1659013324] } ] } ] }, { "tin": { "type": "ein", "value": "332009934" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 99077.55, "providers": [{ "billed_charge": 201500.00, "npi": [1083427561] } ] } ] }, { "tin": { "type": "ein", "value": "830900168" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 6922.34, "providers": [{ "billed_charge": 12600.00, "npi": [1558946731] } ] } ] }, { "tin": { "type": "ein", "value": "823168571" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 157156.00, "providers": [{ "billed_charge": 51458.00, "npi": [1477056166] } ] } ] }, { "tin": { "type": "ein", "value": "900919196" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 276638.26, "providers": [{ "billed_charge": 129000.00, "npi": [1174924310] } ] } ] }, { "tin": { "type": "ein", "value": "331378992" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 17581.33, "providers": [{ "billed_charge": 58500.00, "npi": [1205644689] } ] } ] }, { "tin": { "type": "ein", "value": "922218486" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 71400.00, "providers": [{ "billed_charge": 35200.00, "npi": [1376240374] } ] } ] }, { "tin": { "type": "ein", "value": "934467111" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 17329.79, "providers": [{ "billed_charge": 79900.00, "npi": [1629826276] } ] } ] } ] }, { "name": "SARSCV2 VAC 10MCG TRS-SUC IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "91320", "description": "SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 32052.01, "providers": [{ "billed_charge": 16421.83, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9871.20, "providers": [{ "billed_charge": 12480.00, "npi": [1578672184] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1751.00, "providers": [{ "billed_charge": 1606.00, "npi": [1235107566] } ] } ] } ] }, { "name": "IMM ADMN SARSCOV2 VACCINE SINGLE DOSE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "91321", "description": "SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3474.30, "providers": [{ "billed_charge": 1548.00, "npi": [1164512851] } ] } ] } ] }, { "name": "PSTAY/GROUP RX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "915", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "334032295" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 92732.73, "providers": [{ "billed_charge": 452400.00, "npi": [1437013414] } ] } ] }, { "tin": { "type": "ein", "value": "331378992" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 12994.70, "providers": [{ "billed_charge": 25000.00, "npi": [1205644689] } ] } ] } ] }, { "name": "SPEECH/HEARING THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "92507", "description": "TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461542880" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1715.44, "providers": [{ "billed_charge": 2840.00, "npi": [1538592746] } ] } ] }, { "tin": { "type": "ein", "value": "200483217" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1040.00, "providers": [{ "billed_charge": 1755.00, "npi": [1124044698] } ] } ] }, { "tin": { "type": "ein", "value": "851607233" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1318.95, "providers": [{ "billed_charge": 500.00, "npi": [1801971502] } ] } ] }, { "tin": { "type": "ein", "value": "946000509" }, "service_code": ["11", "99", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 639.74, "providers": [{ "billed_charge": 925.00, "npi": [1234567893] } ] }, { "allowed_amount": 93.37, "providers": [{ "billed_charge": 185.00, "npi": [1234567893] } ] }, { "allowed_amount": 653.59, "providers": [{ "billed_charge": 1295.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "872845057" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 927.00, "providers": [{ "billed_charge": 2250.00, "npi": [1104589365] } ] } ] }, { "tin": { "type": "ein", "value": "371740460" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3630.03, "providers": [{ "billed_charge": 4950.00, "npi": [1780015339] } ] } ] }, { "tin": { "type": "ein", "value": "874804768" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4250.17, "providers": [{ "billed_charge": 2400.00, "npi": [1669192282] } ] } ] }, { "tin": { "type": "ein", "value": "264829698" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5699.47, "providers": [{ "billed_charge": 2250.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ORAL FUNCTION THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "92526", "description": "TREATMENT OF SWALLOWING DYSFUNCTION AND/OR ORAL FUNCTION FOR FEEDING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851607233" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1318.95, "providers": [{ "billed_charge": 675.00, "npi": [1801971502] } ] } ] } ] }, { "name": "EVALUATE SWALLOWING FUNCTION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "92610", "description": "EVALUATION OF ORAL AND PHARYNGEAL SWALLOWING FUNCTION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851607233" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1582.74, "providers": [{ "billed_charge": 900.00, "npi": [1801971502] } ] } ] } ] }, { "name": "ELECTROCARDIOGRAM REPORT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "93010", "description": "ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800212487" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 7730.39, "providers": [{ "billed_charge": 510.23, "npi": [1134355597] } ] } ] }, { "tin": { "type": "ein", "value": "952835184" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1870.09, "providers": [{ "billed_charge": 300.00, "npi": [1689636730] } ] } ] }, { "tin": { "type": "ein", "value": "934387494" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17878.40, "providers": [{ "billed_charge": 660.00, "npi": [1912771569] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 7078.11, "providers": [{ "billed_charge": 351.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "330669356" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.75, "providers": [{ "billed_charge": 252.00, "npi": [1851481121] } ] }, { "allowed_amount": 77.30, "providers": [{ "billed_charge": 216.00, "npi": [1851481121] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.58, "providers": [{ "billed_charge": 114.00, "npi": [1306311576] } ] }, { "allowed_amount": 44813.95, "providers": [{ "billed_charge": 2442.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "462690851" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 9703.13, "providers": [{ "billed_charge": 480.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "770520285" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.00, "providers": [{ "billed_charge": 122.00, "npi": [1669575585] } ] }, { "allowed_amount": 569.02, "providers": [{ "billed_charge": 1769.00, "npi": [1669575585] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4823.31, "providers": [{ "billed_charge": 440.00, "npi": [1861432627] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 13028.33, "providers": [{ "billed_charge": 1266.00, "npi": [1326346438] } ] }, { "allowed_amount": 20550.44, "providers": [{ "billed_charge": 1412.00, "npi": [1881632149] } ] }, { "allowed_amount": 3345.13, "providers": [{ "billed_charge": 284.00, "npi": [1396044491] } ] }, { "allowed_amount": 12590.50, "providers": [{ "billed_charge": 777.00, "npi": [1407886138] } ] }, { "allowed_amount": 9645.13, "providers": [{ "billed_charge": 639.00, "npi": [1346265154] } ] } ] }, { "tin": { "type": "ein", "value": "943278555" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5280.00, "providers": [{ "billed_charge": 305.00, "npi": [1134110661] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.90, "providers": [{ "billed_charge": 96.00, "npi": [1235107566] } ] }, { "allowed_amount": 1114.40, "providers": [{ "billed_charge": 1152.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.80, "providers": [{ "billed_charge": 55.00, "npi": [1437292927] } ] }, { "allowed_amount": 448.60, "providers": [{ "billed_charge": 492.00, "npi": [1437292927] } ] }, { "allowed_amount": 165.00, "providers": [{ "billed_charge": 165.00, "npi": [1437292927] } ] } ] } ] }, { "name": "CARDIAC REHAB/MONITOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "93798", "description": "PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL SERVICES FOR OUTPATIENT CARDIAC REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "931144835" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.34, "providers": [{ "billed_charge": 223.34, "npi": [1962587964] } ] } ] } ] }, { "name": "CARDIAC REHAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "943", "description": "OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460319070" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 55610.88, "providers": [{ "billed_charge": 6881.00, "npi": [1437122009] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 66381.54, "providers": [{ "billed_charge": 6923.64, "npi": [1265568638] } ] } ] } ] }, { "name": "DRUG REHAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "944", "description": "OTHER THERAPEUTIC SERVICES - DRUG REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582341219" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 100718.00, "providers": [{ "billed_charge": 10788.00, "npi": [1487096038] } ] } ] } ] }, { "name": "ADDITIONAL RX SVS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "949", "description": "OTHER THERAPEUTIC SERVICES - OTHER THERAPEUTIC SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 26784.78, "providers": [{ "billed_charge": 35713.04, "npi": [1851889463] } ] } ] } ] }, { "name": "IMMUNOTHERAPY INJECTIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "95117", "description": "PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O", "allowed_amounts": [{ "tin": { "type": "ein", "value": "620863368" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 460.85, "providers": [{ "billed_charge": 190.00, "npi": [1073508347] } ] } ] }, { "tin": { "type": "ein", "value": "831377768" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.94, "providers": [{ "billed_charge": 168.00, "npi": [1215417191] } ] } ] }, { "tin": { "type": "ein", "value": "860217027" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 205.58, "providers": [{ "billed_charge": 420.00, "npi": [1952468381] } ] } ] } ] }, { "name": "HLTH BHV IVNTJ INDIV 1ST 30", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "96158", "description": "HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273483208" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1702.16, "providers": [{ "billed_charge": 483.14, "npi": [1234567893] } ] } ] } ] }, { "name": "THER/PROPH/DIAG IV INF INIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "96365", "description": "INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); INITIAL, U", "allowed_amounts": [{ "tin": { "type": "ein", "value": "392174796" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1188.18, "providers": [{ "billed_charge": 13268.64, "npi": [1962294108] } ] } ] } ] }, { "name": "THER/PROPH/DIAG IV INF ADDON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "96366", "description": "INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); EACH ADDIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "392174796" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 647.70, "providers": [{ "billed_charge": 500.00, "npi": [1962294108] } ] } ] } ] }, { "name": "THER/PROPH/DIAG INJ SC/IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "96372", "description": "THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1798.80, "providers": [{ "billed_charge": 630.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1296.34, "providers": [{ "billed_charge": 1140.00, "npi": [1659950475] } ] } ] }, { "tin": { "type": "ein", "value": "271670964" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 328.04, "providers": [{ "billed_charge": 420.00, "npi": [1447581095] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6146.56, "providers": [{ "billed_charge": 3577.00, "npi": [1457324204] } ] } ] }, { "tin": { "type": "ein", "value": "275548303" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 109.12, "providers": [{ "billed_charge": 390.00, "npi": [1336650068] } ] } ] } ] }, { "name": "HOT OR COLD PACKS THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97010", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; HOT OR COLD PACKS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "922523775" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2068.16, "providers": [{ "billed_charge": 0.12, "npi": [1447953674] } ] } ] } ] }, { "name": "MECHANICAL TRACTION THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97012", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2112.43, "providers": [{ "billed_charge": 335.67, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19405.34, "providers": [{ "billed_charge": 2492.00, "npi": [1255790358] } ] } ] } ] }, { "name": "ELECTRIC STIMULATION THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97014", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272834935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.73, "providers": [{ "billed_charge": 46.00, "npi": [1699087346] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12244.65, "providers": [{ "billed_charge": 1517.88, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 655.80, "providers": [{ "billed_charge": 82.40, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19143.38, "providers": [{ "billed_charge": 2430.00, "npi": [1255790358] } ] } ] } ] }, { "name": "WHIRLPOOL THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97022", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; WHIRLPOOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272834935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 170.98, "providers": [{ "billed_charge": 58.00, "npi": [1699087346] } ] } ] } ] }, { "name": "ELECTRICAL STIMULATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97032", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.93, "providers": [{ "billed_charge": 35.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "861150083" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2316.25, "providers": [{ "billed_charge": 440.00, "npi": [1962568493] } ] } ] }, { "tin": { "type": "ein", "value": "753227889" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1633.50, "providers": [{ "billed_charge": 420.00, "npi": [1689721359] } ] } ] } ] }, { "name": "ULTRASOUND THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97035", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.27, "providers": [{ "billed_charge": 35.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19606.79, "providers": [{ "billed_charge": 2610.00, "npi": [1255790358] } ] } ] } ] }, { "name": "THERAPEUTIC EXERCISES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97110", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3014.37, "providers": [{ "billed_charge": 3470.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 757.03, "providers": [{ "billed_charge": 400.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "272834935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 436.97, "providers": [{ "billed_charge": 550.00, "npi": [1699087346] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 64225.71, "providers": [{ "billed_charge": 28426.49, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "331103310" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 168.61, "providers": [{ "billed_charge": 55.00, "npi": [1558406728] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1706.93, "providers": [{ "billed_charge": 1800.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "472863935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1563.21, "providers": [{ "billed_charge": 1908.00, "npi": [1114317062] } ] } ] }, { "tin": { "type": "ein", "value": "203544685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3404.80, "providers": [{ "billed_charge": 3900.00, "npi": [1528281623] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.96, "providers": [{ "billed_charge": 201.00, "npi": [1609822030] } ] } ] }, { "tin": { "type": "ein", "value": "992288763" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1014.90, "providers": [{ "billed_charge": 1095.00, "npi": [1689412298] } ] } ] }, { "tin": { "type": "ein", "value": "810519858" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1307.67, "providers": [{ "billed_charge": 380.59, "npi": [1023057064] } ] } ] }, { "tin": { "type": "ein", "value": "562605608" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 141.93, "providers": [{ "billed_charge": 345.00, "npi": [1154401941] } ] } ] }, { "tin": { "type": "ein", "value": "901186951" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.76, "providers": [{ "billed_charge": 45.00, "npi": [1386671378] } ] } ] }, { "tin": { "type": "ein", "value": "547026241" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1981.54, "providers": [{ "billed_charge": 1000.00, "npi": [1063426807] } ] } ] }, { "tin": { "type": "ein", "value": "330061064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.36, "providers": [{ "billed_charge": 260.00, "npi": [1669472510] } ] } ] }, { "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 318.61, "providers": [{ "billed_charge": 170.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 27061.03, "providers": [{ "billed_charge": 9356.64, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "863160041" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 680.98, "providers": [{ "billed_charge": 516.00, "npi": [1861076812] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5576.35, "providers": [{ "billed_charge": 2279.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3201.85, "providers": [{ "billed_charge": 992.28, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1834.22, "providers": [{ "billed_charge": 1360.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "850486358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9589.69, "providers": [{ "billed_charge": 12020.00, "npi": [1659445443] } ] } ] }, { "tin": { "type": "ein", "value": "331544200" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 217.80, "providers": [{ "billed_charge": 300.00, "npi": [1699599878] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.42, "providers": [{ "billed_charge": 45.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "872867635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2347.76, "providers": [{ "billed_charge": 600.00, "npi": [1508520834] } ] } ] }, { "tin": { "type": "ein", "value": "363311720" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2075.34, "providers": [{ "billed_charge": 650.00, "npi": [1245373166] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9893.89, "providers": [{ "billed_charge": 5110.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "570492060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 285.64, "providers": [{ "billed_charge": 198.00, "npi": [1417149402] } ] } ] }, { "tin": { "type": "ein", "value": "853123939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1680.00, "providers": [{ "billed_charge": 2047.00, "npi": [1780291948] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19296.67, "providers": [{ "billed_charge": 3870.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "943099040" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6150.87, "providers": [{ "billed_charge": 3720.00, "npi": [1750497913] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2050.62, "providers": [{ "billed_charge": 1806.00, "npi": [1184354896] } ] } ] }, { "tin": { "type": "ein", "value": "880103557" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3957.00, "providers": [{ "billed_charge": 1820.00, "npi": [1245228972] } ] } ] }, { "tin": { "type": "ein", "value": "842136648" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 749.07, "providers": [{ "billed_charge": 950.00, "npi": [1942860176] } ] } ] }, { "tin": { "type": "ein", "value": "873156301" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2142.22, "providers": [{ "billed_charge": 1290.00, "npi": [1174285746] } ] }, { "allowed_amount": 158.05, "providers": [{ "billed_charge": 86.00, "npi": [1396407979] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4122.73, "providers": [{ "billed_charge": 2695.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "453462867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1193.54, "providers": [{ "billed_charge": 660.00, "npi": [1366717456] } ] } ] }, { "tin": { "type": "ein", "value": "821583890" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6464.72, "providers": [{ "billed_charge": 1045.00, "npi": [1679098263] } ] } ] }, { "tin": { "type": "ein", "value": "861150083" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2316.79, "providers": [{ "billed_charge": 704.00, "npi": [1962568493] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4901.76, "providers": [{ "billed_charge": 3100.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "270053243" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1428.09, "providers": [{ "billed_charge": 949.50, "npi": [1366510414] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1695.36, "providers": [{ "billed_charge": 960.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "823255983" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.16, "providers": [{ "billed_charge": 74.00, "npi": [1730732025] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 892.22, "providers": [{ "billed_charge": 306.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1666.49, "providers": [{ "billed_charge": 786.96, "npi": [1669501730] } ] } ] } ] }, { "name": "NEUROMUSCULAR REEDUCATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97112", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 822.10, "providers": [{ "billed_charge": 560.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2656.89, "providers": [{ "billed_charge": 2270.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "680444175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 298.44, "providers": [{ "billed_charge": 142.00, "npi": [1225156524] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 65511.19, "providers": [{ "billed_charge": 26374.48, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1631.81, "providers": [{ "billed_charge": 1900.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "331103310" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 172.36, "providers": [{ "billed_charge": 55.00, "npi": [1558406728] } ] } ] }, { "tin": { "type": "ein", "value": "200629289" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.00, "providers": [{ "billed_charge": 87.00, "npi": [1538131917] } ] } ] }, { "tin": { "type": "ein", "value": "547026241" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1247.81, "providers": [{ "billed_charge": 378.00, "npi": [1063426807] } ] } ] }, { "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.27, "providers": [{ "billed_charge": 70.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18763.49, "providers": [{ "billed_charge": 7043.04, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "863160041" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1461.65, "providers": [{ "billed_charge": 1292.00, "npi": [1861076812] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7186.70, "providers": [{ "billed_charge": 3660.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 924.33, "providers": [{ "billed_charge": 1131.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "901144537" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1736.75, "providers": [{ "billed_charge": 935.00, "npi": [1992371967] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2817.16, "providers": [{ "billed_charge": 213.12, "npi": [1255900296] } ] } ] }, { "tin": { "type": "ein", "value": "872867635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 679.84, "providers": [{ "billed_charge": 180.00, "npi": [1508520834] } ] } ] }, { "tin": { "type": "ein", "value": "464845389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 86.84, "providers": [{ "billed_charge": 103.00, "npi": [1215309422] } ] } ] }, { "tin": { "type": "ein", "value": "363311720" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2273.87, "providers": [{ "billed_charge": 1040.00, "npi": [1245373166] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5650.31, "providers": [{ "billed_charge": 2800.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "853123939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 630.00, "providers": [{ "billed_charge": 594.00, "npi": [1780291948] } ] } ] }, { "tin": { "type": "ein", "value": "753227889" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1584.00, "providers": [{ "billed_charge": 480.00, "npi": [1689721359] } ] } ] }, { "tin": { "type": "ein", "value": "450946475" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5298.16, "providers": [{ "billed_charge": 8000.00, "npi": [1154613495] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.52, "providers": [{ "billed_charge": 304.00, "npi": [1700516408] } ] } ] }, { "tin": { "type": "ein", "value": "873156301" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3037.12, "providers": [{ "billed_charge": 1976.00, "npi": [1174285746] } ] } ] }, { "tin": { "type": "ein", "value": "842136648" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 110.67, "providers": [{ "billed_charge": 110.00, "npi": [1942860176] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1205.16, "providers": [{ "billed_charge": 450.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "562325545" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 124.81, "providers": [{ "billed_charge": 100.00, "npi": [1184645863] } ] } ] }, { "tin": { "type": "ein", "value": "453462867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1240.53, "providers": [{ "billed_charge": 660.00, "npi": [1366717456] } ] } ] }, { "tin": { "type": "ein", "value": "821583890" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9619.65, "providers": [{ "billed_charge": 1399.11, "npi": [1679098263] } ] } ] }, { "tin": { "type": "ein", "value": "861150083" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2311.23, "providers": [{ "billed_charge": 701.80, "npi": [1962568493] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4912.28, "providers": [{ "billed_charge": 2975.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2337.44, "providers": [{ "billed_charge": 840.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1943.08, "providers": [{ "billed_charge": 1080.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1748.76, "providers": [{ "billed_charge": 1594.44, "npi": [1669501730] } ] } ] } ] }, { "name": "GAIT TRAINING THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97116", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 583.16, "providers": [{ "billed_charge": 210.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "821583890" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6212.52, "providers": [{ "billed_charge": 676.25, "npi": [1679098263] } ] } ] } ] }, { "name": "MANUAL THERAPY 1/> REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97140", "description": "MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 945.58, "providers": [{ "billed_charge": 555.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28333.37, "providers": [{ "billed_charge": 7859.33, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1588.71, "providers": [{ "billed_charge": 1785.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "331103310" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 217.86, "providers": [{ "billed_charge": 55.00, "npi": [1558406728] } ] } ] }, { "tin": { "type": "ein", "value": "472863935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1905.87, "providers": [{ "billed_charge": 1164.00, "npi": [1114317062] } ] } ] }, { "tin": { "type": "ein", "value": "943149505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 341.00, "providers": [{ "billed_charge": 159.00, "npi": [1184669756] } ] } ] }, { "tin": { "type": "ein", "value": "861863538" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 492.88, "providers": [{ "billed_charge": 450.00, "npi": [1700478278] } ] } ] }, { "tin": { "type": "ein", "value": "562605608" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 559.82, "providers": [{ "billed_charge": 642.00, "npi": [1154401941] } ] } ] }, { "tin": { "type": "ein", "value": "547026241" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1546.35, "providers": [{ "billed_charge": 414.00, "npi": [1063426807] } ] } ] }, { "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.93, "providers": [{ "billed_charge": 95.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 29384.83, "providers": [{ "billed_charge": 16169.92, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 167.00, "providers": [{ "billed_charge": 51.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2289.06, "providers": [{ "billed_charge": 656.96, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "331544200" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.18, "providers": [{ "billed_charge": 600.00, "npi": [1699599878] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 472.22, "providers": [{ "billed_charge": 374.75, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3074.72, "providers": [{ "billed_charge": 1320.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "872867635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2549.10, "providers": [{ "billed_charge": 640.00, "npi": [1508520834] } ] } ] }, { "tin": { "type": "ein", "value": "363311720" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1970.11, "providers": [{ "billed_charge": 650.00, "npi": [1245373166] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3234.29, "providers": [{ "billed_charge": 1540.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "570492060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 287.60, "providers": [{ "billed_charge": 186.00, "npi": [1417149402] } ] } ] }, { "tin": { "type": "ein", "value": "853123939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1470.00, "providers": [{ "billed_charge": 1260.00, "npi": [1780291948] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19586.84, "providers": [{ "billed_charge": 4105.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "943099040" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2169.03, "providers": [{ "billed_charge": 600.00, "npi": [1750497913] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4126.53, "providers": [{ "billed_charge": 3078.00, "npi": [1184354896] } ] }, { "allowed_amount": 518.00, "providers": [{ "billed_charge": 486.00, "npi": [1700516408] } ] } ] }, { "tin": { "type": "ein", "value": "842136648" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.21, "providers": [{ "billed_charge": 90.00, "npi": [1942860176] } ] } ] }, { "tin": { "type": "ein", "value": "453462867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1259.78, "providers": [{ "billed_charge": 660.00, "npi": [1366717456] } ] } ] }, { "tin": { "type": "ein", "value": "861150083" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2422.66, "providers": [{ "billed_charge": 803.00, "npi": [1962568493] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 182.00, "providers": [{ "billed_charge": 100.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "270053243" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1944.46, "providers": [{ "billed_charge": 1369.50, "npi": [1366510414] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1666.11, "providers": [{ "billed_charge": 660.00, "npi": [1871610287] } ] } ] } ] }, { "name": "BHV ID ASSMT BY PHYS/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97151", "description": "BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.65, "providers": [{ "billed_charge": 286.64, "npi": [1134800980] } ] }, { "allowed_amount": 17108.43, "providers": [{ "billed_charge": 12325.52, "npi": [1134800980] } ] } ] } ] }, { "name": "ADAPTIVE BEHAVIOR TX BY TECH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203887488" }, "service_code": ["11", "12", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 320.00, "providers": [{ "billed_charge": 408.00, "npi": [1699153700] } ] }, { "allowed_amount": 8476.00, "providers": [{ "billed_charge": 3060.00, "npi": [1699153700] } ] }, { "allowed_amount": 86092.00, "providers": [{ "billed_charge": 26367.00, "npi": [1699153700] } ] } ] }, { "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3124367.82, "providers": [{ "billed_charge": 480825.00, "npi": [1174148118] } ] }, { "allowed_amount": 574.88, "providers": [{ "billed_charge": 3150.00, "npi": [1174148118] } ] } ] }, { "tin": { "type": "ein", "value": "873968950" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 163921.32, "providers": [{ "billed_charge": 41415.00, "npi": [1386391050] } ] } ] }, { "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "99", "12", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 5735.64, "providers": [{ "billed_charge": 9047.38, "npi": [1134800980] } ] }, { "allowed_amount": 483159.00, "providers": [{ "billed_charge": 193598.92, "npi": [1134800980] } ] }, { "allowed_amount": 21762.07, "providers": [{ "billed_charge": 13214.10, "npi": [1134800980] } ] }, { "allowed_amount": 8821.31, "providers": [{ "billed_charge": 6040.54, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "432086187" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 906.88, "providers": [{ "billed_charge": 228.80, "npi": [1861666737] } ] } ] }, { "tin": { "type": "ein", "value": "270641010" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2380.00, "providers": [{ "billed_charge": 3900.00, "npi": [1417245218] } ] } ] }, { "tin": { "type": "ein", "value": "994342234" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2844.28, "providers": [{ "billed_charge": 1330.00, "npi": [1871391953] } ] } ] }, { "tin": { "type": "ein", "value": "510633134" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11486.64, "providers": [{ "billed_charge": 2585.00, "npi": [1780958025] } ] } ] }, { "tin": { "type": "ein", "value": "208561610" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 264.00, "providers": [{ "billed_charge": 132.00, "npi": [1831459742] } ] } ] }, { "tin": { "type": "ein", "value": "831347074" }, "service_code": ["99", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9366.94, "providers": [{ "billed_charge": 873.98, "npi": [1841778156] } ] }, { "allowed_amount": 2081.84, "providers": [{ "billed_charge": 520.46, "npi": [1841778156] } ] } ] }, { "tin": { "type": "ein", "value": "943068149" }, "service_code": ["99", "12", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 51315.37, "providers": [{ "billed_charge": 29027.10, "npi": [1619255841] } ] }, { "allowed_amount": 1551.87, "providers": [{ "billed_charge": 689.70, "npi": [1619255841] } ] }, { "allowed_amount": 172.43, "providers": [{ "billed_charge": 229.90, "npi": [1619255841] } ] } ] }, { "tin": { "type": "ein", "value": "205463958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 32547.00, "providers": [{ "billed_charge": 7300.00, "npi": [1700265824] } ] } ] }, { "tin": { "type": "ein", "value": "475250981" }, "service_code": ["99", "11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 5632.58, "providers": [{ "billed_charge": 3150.00, "npi": [1992165021] } ] }, { "allowed_amount": 472.00, "providers": [{ "billed_charge": 350.00, "npi": [1992165021] } ] }, { "allowed_amount": 3714.19, "providers": [{ "billed_charge": 1525.00, "npi": [1992165021] } ] } ] }, { "tin": { "type": "ein", "value": "264753045" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 20094.23, "providers": [{ "billed_charge": 13615.00, "npi": [1588967236] } ] }, { "allowed_amount": 2486.00, "providers": [{ "billed_charge": 1540.00, "npi": [1588967236] } ] } ] }, { "tin": { "type": "ein", "value": "872827894" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 41296.74, "providers": [{ "billed_charge": 64200.00, "npi": [1336802586] } ] } ] }, { "tin": { "type": "ein", "value": "461151074" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 43330.06, "providers": [{ "billed_charge": 16125.00, "npi": [1962838409] } ] } ] }, { "tin": { "type": "ein", "value": "843365484" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 53651.07, "providers": [{ "billed_charge": 16312.80, "npi": [1336789122] } ] } ] }, { "tin": { "type": "ein", "value": "853597638" }, "service_code": ["12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 6281.36, "providers": [{ "billed_charge": 1260.00, "npi": [1376204339] } ] }, { "allowed_amount": 76019.94, "providers": [{ "billed_charge": 7022.50, "npi": [1376204339] } ] } ] }, { "tin": { "type": "ein", "value": "854033384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 99324.00, "providers": [{ "billed_charge": 25044.00, "npi": [1376213421] } ] } ] } ] }, { "name": "ADAPT BEHAVIOR TX PHYS/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97155", "description": "ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1815436.58, "providers": [{ "billed_charge": 131250.00, "npi": [1174148118] } ] } ] }, { "tin": { "type": "ein", "value": "872827894" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18903.91, "providers": [{ "billed_charge": 18480.00, "npi": [1336802586] } ] } ] }, { "tin": { "type": "ein", "value": "873968950" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6035.00, "providers": [{ "billed_charge": 1645.00, "npi": [1386391050] } ] } ] }, { "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "99", "02", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 1425.32, "providers": [{ "billed_charge": 1018.08, "npi": [1134800980] } ] }, { "allowed_amount": 41574.79, "providers": [{ "billed_charge": 33410.68, "npi": [1134800980] } ] }, { "allowed_amount": 1666.19, "providers": [{ "billed_charge": 1149.45, "npi": [1134800980] } ] }, { "allowed_amount": 7469.21, "providers": [{ "billed_charge": 10804.83, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "943068149" }, "service_code": ["12", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 432.00, "providers": [{ "billed_charge": 444.24, "npi": [1619255841] } ] }, { "allowed_amount": 174.00, "providers": [{ "billed_charge": 222.12, "npi": [1619255841] } ] } ] }, { "tin": { "type": "ein", "value": "854033384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4241.12, "providers": [{ "billed_charge": 2713.20, "npi": [1376213421] } ] } ] }, { "tin": { "type": "ein", "value": "205463958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12524.00, "providers": [{ "billed_charge": 2950.00, "npi": [1700265824] } ] } ] } ] }, { "name": "FAM ADAPT BHV TX GDN PHY/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97156", "description": "FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 314417.21, "providers": [{ "billed_charge": 17150.00, "npi": [1174148118] } ] } ] }, { "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 4031.36, "providers": [{ "billed_charge": 3908.13, "npi": [1134800980] } ] }, { "allowed_amount": 10766.12, "providers": [{ "billed_charge": 7509.74, "npi": [1134800980] } ] }, { "allowed_amount": 11966.80, "providers": [{ "billed_charge": 16536.44, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "994342234" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15724.88, "providers": [{ "billed_charge": 2592.00, "npi": [1104690858] } ] } ] } ] }, { "name": "PT EVAL LOW COMPLEX 20 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97161", "description": "PHYSICAL THERAPY EVALUATION: LOW COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY WITH NO PERSONAL ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4890.68, "providers": [{ "billed_charge": 2691.15, "npi": [1992326730] } ] } ] } ] }, { "name": "PT EVAL MOD COMPLEX 30 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97162", "description": "PHYSICAL THERAPY EVALUATION: MODERATE COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY OF PRESENT P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2934.77, "providers": [{ "billed_charge": 1679.39, "npi": [1992326730] } ] } ] } ] }, { "name": "THERAPEUTIC ACTIVITIES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97530", "description": "THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.04, "providers": [{ "billed_charge": 160.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2931.67, "providers": [{ "billed_charge": 3054.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "680444175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 298.44, "providers": [{ "billed_charge": 134.00, "npi": [1225156524] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 88546.13, "providers": [{ "billed_charge": 47463.20, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1706.79, "providers": [{ "billed_charge": 1800.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "200629289" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 915.00, "providers": [{ "billed_charge": 480.00, "npi": [1538131917] } ] } ] }, { "tin": { "type": "ein", "value": "464813023" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13738.68, "providers": [{ "billed_charge": 19860.00, "npi": [1083038764] } ] } ] }, { "tin": { "type": "ein", "value": "810519858" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2966.17, "providers": [{ "billed_charge": 3311.52, "npi": [1023057064] } ] } ] }, { "tin": { "type": "ein", "value": "901186951" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 198.37, "providers": [{ "billed_charge": 225.00, "npi": [1386671378] } ] } ] }, { "tin": { "type": "ein", "value": "991584815" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.27, "providers": [{ "billed_charge": 70.00, "npi": [1952114720] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23870.57, "providers": [{ "billed_charge": 10230.55, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "863160041" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1987.53, "providers": [{ "billed_charge": 1501.00, "npi": [1861076812] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3268.73, "providers": [{ "billed_charge": 1890.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1334.76, "providers": [{ "billed_charge": 644.29, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1689.55, "providers": [{ "billed_charge": 1824.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "901144537" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6024.81, "providers": [{ "billed_charge": 4904.00, "npi": [1992371967] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2559.06, "providers": [{ "billed_charge": 2580.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "830968771" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.24, "providers": [{ "billed_charge": 300.00, "npi": [1942857958] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18061.70, "providers": [{ "billed_charge": 4276.88, "npi": [1255900296] } ] } ] }, { "tin": { "type": "ein", "value": "872867635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.05, "providers": [{ "billed_charge": 165.00, "npi": [1508520834] } ] } ] }, { "tin": { "type": "ein", "value": "922523775" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1983.10, "providers": [{ "billed_charge": 2400.00, "npi": [1447953674] } ] } ] }, { "tin": { "type": "ein", "value": "464845389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1003.38, "providers": [{ "billed_charge": 2808.00, "npi": [1215309422] } ] } ] }, { "tin": { "type": "ein", "value": "474738547" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 276.16, "providers": [{ "billed_charge": 180.00, "npi": [1578592424] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5797.77, "providers": [{ "billed_charge": 3400.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "770530841" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 118.59, "providers": [{ "billed_charge": 180.00, "npi": [1295860823] } ] } ] }, { "tin": { "type": "ein", "value": "474541280" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1472.64, "providers": [{ "billed_charge": 370.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "853123939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1365.00, "providers": [{ "billed_charge": 2247.00, "npi": [1780291948] } ] } ] }, { "tin": { "type": "ein", "value": "753227889" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1584.00, "providers": [{ "billed_charge": 1080.00, "npi": [1689721359] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2876.78, "providers": [{ "billed_charge": 2291.00, "npi": [1184354896] } ] }, { "allowed_amount": 509.22, "providers": [{ "billed_charge": 632.00, "npi": [1700516408] } ] } ] }, { "tin": { "type": "ein", "value": "873156301" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2805.35, "providers": [{ "billed_charge": 1422.00, "npi": [1174285746] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3216.74, "providers": [{ "billed_charge": 1275.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "562325545" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 123.20, "providers": [{ "billed_charge": 75.00, "npi": [1184645863] } ] } ] }, { "tin": { "type": "ein", "value": "453462867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1204.84, "providers": [{ "billed_charge": 270.00, "npi": [1366717456] } ] } ] }, { "tin": { "type": "ein", "value": "821583890" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18394.77, "providers": [{ "billed_charge": 4474.18, "npi": [1679098263] } ] } ] }, { "tin": { "type": "ein", "value": "861150083" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2421.12, "providers": [{ "billed_charge": 594.00, "npi": [1962568493] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4778.35, "providers": [{ "billed_charge": 3550.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2338.93, "providers": [{ "billed_charge": 1080.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1142.70, "providers": [{ "billed_charge": 735.92, "npi": [1669501730] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1652.93, "providers": [{ "billed_charge": 784.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "823255983" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1005.72, "providers": [{ "billed_charge": 1380.00, "npi": [1730732025] } ] } ] } ] }, { "name": "SENSORY INTEGRATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97533", "description": "SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "901144537" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1447.30, "providers": [{ "billed_charge": 824.00, "npi": [1992371967] } ] } ] } ] }, { "name": "SELF CARE MNGMENT TRAINING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97535", "description": "SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5773.49, "providers": [{ "billed_charge": 1530.86, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 662.74, "providers": [{ "billed_charge": 367.96, "npi": [1669501730] } ] } ] } ] }, { "name": "WOUND(S) CARE NON-SELECTIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97602", "description": "REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, WET-", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10467.73, "providers": [{ "billed_charge": 5700.00, "npi": [1770307274] } ] } ] } ] }, { "name": "MEDICAL NUTRITION, INDIV, IN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97802", "description": "MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853953549" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 998.75, "providers": [{ "billed_charge": 1183.46, "npi": [1558097824] } ] } ] } ] }, { "name": "MED NUTRITION, INDIV, SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97803", "description": "MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823338198" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.39, "providers": [{ "billed_charge": 262.50, "npi": [1104334465] } ] } ] }, { "tin": { "type": "ein", "value": "853953549" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 14246.43, "providers": [{ "billed_charge": 17361.10, "npi": [1558097824] } ] } ] } ] }, { "name": "CHIROPRACT MANJ 1-2 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98940", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3417.35, "providers": [{ "billed_charge": 1637.34, "npi": [1215558051] } ] } ] } ] }, { "name": "CHIROPRACT MANJ 3-4 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98941", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17951.11, "providers": [{ "billed_charge": 9961.55, "npi": [1215558051] } ] } ] } ] }, { "name": "CHIROPRACTIC MANJ 5 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98942", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 732.69, "providers": [{ "billed_charge": 705.19, "npi": [1215558051] } ] } ] } ] }, { "name": "MED SERV 10PM-8AM, 24 HR FAC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99053", "description": "SERVICE(S) PROVIDED BETWEEN 10:00 PM AND 8:00 AM AT 24-HOUR FACILITY, IN ADDITION TO BASIC SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8621.21, "providers": [{ "billed_charge": 604.00, "npi": [1780625871] } ] }, { "allowed_amount": 5584.79, "providers": [{ "billed_charge": 366.00, "npi": [1881632149] } ] }, { "allowed_amount": 9734.94, "providers": [{ "billed_charge": 665.00, "npi": [1326346438] } ] } ] }, { "tin": { "type": "ein", "value": "954873894" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3202.81, "providers": [{ "billed_charge": 243.19, "npi": [1235176702] } ] } ] }, { "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4590.85, "providers": [{ "billed_charge": 626.90, "npi": [1588960413] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6388.50, "providers": [{ "billed_charge": 450.00, "npi": [1447288345] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99203", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.24, "providers": [{ "billed_charge": 305.20, "npi": [1538297726] } ] }, { "allowed_amount": 305.20, "providers": [{ "billed_charge": 305.20, "npi": [1538297726] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99204", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3651.51, "providers": [{ "billed_charge": 5238.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3420.12, "providers": [{ "billed_charge": 4528.80, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870698478" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.02, "providers": [{ "billed_charge": 288.33, "npi": [1639314255] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2125.68, "providers": [{ "billed_charge": 1758.96, "npi": [1174292866] } ] }, { "allowed_amount": 2074.82, "providers": [{ "billed_charge": 2198.70, "npi": [1174292866] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 11309.87, "providers": [{ "billed_charge": 11115.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "330539376" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 5653.01, "providers": [{ "billed_charge": 6400.00, "npi": [1649217761] } ] }, { "allowed_amount": 929.70, "providers": [{ "billed_charge": 1400.00, "npi": [1649217761] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3808.74, "providers": [{ "billed_charge": 9957.00, "npi": [1871607762] } ] }, { "allowed_amount": 214.73, "providers": [{ "billed_charge": 638.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10805.05, "providers": [{ "billed_charge": 17850.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2397.65, "providers": [{ "billed_charge": 4940.00, "npi": [1023125465] } ] }, { "allowed_amount": 133.27, "providers": [{ "billed_charge": 310.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "770545189" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1203.00, "providers": [{ "billed_charge": 870.00, "npi": [1447343710] } ] } ] }, { "tin": { "type": "ein", "value": "272872791" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1665.68, "providers": [{ "billed_charge": 2040.00, "npi": [1730491945] } ] } ] }, { "tin": { "type": "ein", "value": "270980618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3149.54, "providers": [{ "billed_charge": 5037.20, "npi": [1578833059] } ] } ] }, { "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 772.33, "providers": [{ "billed_charge": 1008.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "271504911" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 104.88, "providers": [{ "billed_charge": 203.00, "npi": [1205167350] } ] } ] }, { "tin": { "type": "ein", "value": "330107822" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1275.00, "providers": [{ "billed_charge": 1000.00, "npi": [1073628228] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1835.63, "providers": [{ "billed_charge": 1242.25, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870698478" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 603.96, "providers": [{ "billed_charge": 1170.40, "npi": [1639314255] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2588.07, "providers": [{ "billed_charge": 5465.90, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 638.90, "providers": [{ "billed_charge": 1800.00, "npi": [1659950475] } ] }, { "allowed_amount": 55.51, "providers": [{ "billed_charge": 120.00, "npi": [1659950475] } ] } ] }, { "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 18810.71, "providers": [{ "billed_charge": 10450.00, "npi": [1750584181] } ] }, { "allowed_amount": 15756.03, "providers": [{ "billed_charge": 8800.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "330587303" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 616.13, "providers": [{ "billed_charge": 1168.00, "npi": [1730180415] } ] }, { "allowed_amount": 300.63, "providers": [{ "billed_charge": 753.00, "npi": [1730180415] } ] } ] }, { "tin": { "type": "ein", "value": "770440158" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2730.02, "providers": [{ "billed_charge": 3315.00, "npi": [1861121741] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99214", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 112198.68, "providers": [{ "billed_charge": 114500.00, "npi": [1518269372] } ] }, { "allowed_amount": 1106.00, "providers": [{ "billed_charge": 1500.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "593647972" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 134.26, "providers": [{ "billed_charge": 338.00, "npi": [1508817529] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 35599.68, "providers": [{ "billed_charge": 43405.00, "npi": [1023125465] } ] }, { "allowed_amount": 3934.20, "providers": [{ "billed_charge": 4335.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "680344702" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1898.00, "providers": [{ "billed_charge": 1506.00, "npi": [1962482513] } ] }, { "allowed_amount": 100.40, "providers": [{ "billed_charge": 502.00, "npi": [1962482513] } ] } ] }, { "tin": { "type": "ein", "value": "475260007" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1652.50, "providers": [{ "billed_charge": 1215.00, "npi": [1184080681] } ] }, { "allowed_amount": 3938.26, "providers": [{ "billed_charge": 2835.00, "npi": [1184080681] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 9690.68, "providers": [{ "billed_charge": 11154.00, "npi": [1750368999] } ] }, { "allowed_amount": 92388.83, "providers": [{ "billed_charge": 97812.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "611897007" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 494.71, "providers": [{ "billed_charge": 587.22, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "941706811" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 19873.58, "providers": [{ "billed_charge": 20000.00, "npi": [1184785834] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 13902.31, "providers": [{ "billed_charge": 14850.00, "npi": [1164512851] } ] }, { "allowed_amount": 3380.00, "providers": [{ "billed_charge": 2376.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "273081619" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 631.46, "providers": [{ "billed_charge": 900.00, "npi": [1912362567] } ] }, { "allowed_amount": 1755.71, "providers": [{ "billed_charge": 2400.00, "npi": [1912362567] } ] } ] }, { "tin": { "type": "ein", "value": "825201238" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.68, "providers": [{ "billed_charge": 275.00, "npi": [1528693579] } ] }, { "allowed_amount": 601.16, "providers": [{ "billed_charge": 825.00, "npi": [1528693579] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 12622.90, "providers": [{ "billed_charge": 12644.00, "npi": [1508968967] } ] }, { "allowed_amount": 38312.12, "providers": [{ "billed_charge": 36188.00, "npi": [1508968967] } ] } ] }, { "tin": { "type": "ein", "value": "870698478" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2521.36, "providers": [{ "billed_charge": 3764.79, "npi": [1639314255] } ] } ] }, { "tin": { "type": "ein", "value": "260522962" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 9192.20, "providers": [{ "billed_charge": 7050.75, "npi": [1881894483] } ] } ] }, { "tin": { "type": "ein", "value": "860828589" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 489.82, "providers": [{ "billed_charge": 797.16, "npi": [1851336432] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 24299.09, "providers": [{ "billed_charge": 31005.00, "npi": [1134309305] } ] }, { "allowed_amount": 2596.73, "providers": [{ "billed_charge": 5650.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 750.00, "providers": [{ "billed_charge": 750.00, "npi": [1902390537] } ] }, { "allowed_amount": 25316.24, "providers": [{ "billed_charge": 15750.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "260089066" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1232.00, "providers": [{ "billed_charge": 846.00, "npi": [1417907940] } ] }, { "allowed_amount": 2144.47, "providers": [{ "billed_charge": 2115.00, "npi": [1417907940] } ] } ] }, { "tin": { "type": "ein", "value": "832675429" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1087.50, "providers": [{ "billed_charge": 1445.00, "npi": [1235600834] } ] }, { "allowed_amount": 697.60, "providers": [{ "billed_charge": 867.00, "npi": [1235600834] } ] } ] }, { "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3466.57, "providers": [{ "billed_charge": 2380.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "911220843" }, "service_code": ["11", "22", "02", "19"], "billing_class": "professional", "payments": [{ "allowed_amount": 565.92, "providers": [{ "billed_charge": 851.40, "npi": [1023041159] } ] }, { "allowed_amount": 314.98, "providers": [{ "billed_charge": 851.40, "npi": [1023041159] } ] }, { "allowed_amount": 205.79, "providers": [{ "billed_charge": 319.00, "npi": [1023041159] } ] }, { "allowed_amount": 90.41, "providers": [{ "billed_charge": 319.00, "npi": [1023041159] } ] } ] }, { "tin": { "type": "ein", "value": "752613493" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 606.40, "providers": [{ "billed_charge": 969.00, "npi": [1174573596] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["22", "11", "23", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 661.71, "providers": [{ "billed_charge": 2574.00, "npi": [1235107566] } ] }, { "allowed_amount": 322.00, "providers": [{ "billed_charge": 858.00, "npi": [1235107566] } ] }, { "allowed_amount": 2941.71, "providers": [{ "billed_charge": 5148.00, "npi": [1235107566] } ] }, { "allowed_amount": 5085.07, "providers": [{ "billed_charge": 22308.00, "npi": [1235107566] } ] }, { "allowed_amount": 729.30, "providers": [{ "billed_charge": 858.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "752536818" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 307.59, "providers": [{ "billed_charge": 238.22, "npi": [1003811639] } ] } ] }, { "tin": { "type": "ein", "value": "832518744" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9064.96, "providers": [{ "billed_charge": 500.00, "npi": [1922579267] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 88946.06, "providers": [{ "billed_charge": 148713.84, "npi": [1154697944] } ] }, { "allowed_amount": 138.61, "providers": [{ "billed_charge": 751.08, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "941156581" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 636.00, "providers": [{ "billed_charge": 410.00, "npi": [1013950807] } ] }, { "allowed_amount": 724.36, "providers": [{ "billed_charge": 820.00, "npi": [1013950807] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "11", "19", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2148.50, "providers": [{ "billed_charge": 4709.00, "npi": [1437292927] } ] }, { "allowed_amount": 4337.76, "providers": [{ "billed_charge": 1500.00, "npi": [1437292927] } ] }, { "allowed_amount": 947.20, "providers": [{ "billed_charge": 1109.00, "npi": [1437292927] } ] }, { "allowed_amount": 647.20, "providers": [{ "billed_charge": 809.00, "npi": [1437292927] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.31, "providers": [{ "billed_charge": 447.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1529.58, "providers": [{ "billed_charge": 559.26, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "462708284" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 157.31, "providers": [{ "billed_charge": 305.00, "npi": [1891132106] } ] } ] }, { "tin": { "type": "ein", "value": "852938829" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1953.41, "providers": [{ "billed_charge": 2250.00, "npi": [1245845932] } ] }, { "allowed_amount": 384.73, "providers": [{ "billed_charge": 500.00, "npi": [1245845932] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1966.44, "providers": [{ "billed_charge": 1640.00, "npi": [1174661151] } ] }, { "allowed_amount": 476.97, "providers": [{ "billed_charge": 680.00, "npi": [1174661151] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1761.26, "providers": [{ "billed_charge": 1751.50, "npi": [1538297726] } ] }, { "allowed_amount": 8174.74, "providers": [{ "billed_charge": 11209.60, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2510.72, "providers": [{ "billed_charge": 4203.60, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "721533392" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 570.00, "providers": [{ "billed_charge": 845.76, "npi": [1265946289] } ] }, { "allowed_amount": 95.29, "providers": [{ "billed_charge": 422.88, "npi": [1265946289] } ] } ] }, { "tin": { "type": "ein", "value": "882977235" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 760.20, "providers": [{ "billed_charge": 704.00, "npi": [1659003457] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6166.41, "providers": [{ "billed_charge": 5387.27, "npi": [1972138238] } ] }, { "allowed_amount": 761.33, "providers": [{ "billed_charge": 761.33, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 851.35, "providers": [{ "billed_charge": 1963.50, "npi": [1811122880] } ] } ] }, { "tin": { "type": "ein", "value": "954482087" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 842.40, "providers": [{ "billed_charge": 1376.00, "npi": [1831159003] } ] } ] }, { "tin": { "type": "ein", "value": "330539376" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3223.41, "providers": [{ "billed_charge": 4500.00, "npi": [1649217761] } ] }, { "allowed_amount": 250.00, "providers": [{ "billed_charge": 250.00, "npi": [1649217761] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 840.00, "providers": [{ "billed_charge": 900.00, "npi": [1275581894] } ] }, { "allowed_amount": 20810.53, "providers": [{ "billed_charge": 25500.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "680360801" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.32, "providers": [{ "billed_charge": 325.00, "npi": [1841407665] } ] }, { "allowed_amount": 2898.75, "providers": [{ "billed_charge": 4000.00, "npi": [1841407665] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15636.49, "providers": [{ "billed_charge": 17750.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "990722414" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2485.51, "providers": [{ "billed_charge": 3000.00, "npi": [1023870763] } ] } ] }, { "tin": { "type": "ein", "value": "872955332" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1546.75, "providers": [{ "billed_charge": 1845.00, "npi": [1972266732] } ] } ] }, { "tin": { "type": "ein", "value": "800543544" }, "service_code": ["11", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1050.20, "providers": [{ "billed_charge": 1716.00, "npi": [1609194497] } ] }, { "allowed_amount": 148.89, "providers": [{ "billed_charge": 858.00, "npi": [1609194497] } ] } ] }, { "tin": { "type": "ein", "value": "900730400" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.28, "providers": [{ "billed_charge": 389.00, "npi": [1417238908] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 11655.71, "providers": [{ "billed_charge": 10115.00, "npi": [1174292866] } ] }, { "allowed_amount": 816.70, "providers": [{ "billed_charge": 578.00, "npi": [1174292866] } ] }, { "allowed_amount": 10843.34, "providers": [{ "billed_charge": 8912.48, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "571205856" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 640.26, "providers": [{ "billed_charge": 1134.00, "npi": [1144497678] } ] }, { "allowed_amount": 4572.63, "providers": [{ "billed_charge": 6319.00, "npi": [1144497678] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99215", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923084561" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1290.30, "providers": [{ "billed_charge": 2028.00, "npi": [1649975681] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "11", "19", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 259.72, "providers": [{ "billed_charge": 1005.00, "npi": [1437292927] } ] }, { "allowed_amount": 740.60, "providers": [{ "billed_charge": 3015.00, "npi": [1437292927] } ] }, { "allowed_amount": 1287.00, "providers": [{ "billed_charge": 1145.00, "npi": [1437292927] } ] }, { "allowed_amount": 1145.00, "providers": [{ "billed_charge": 1145.00, "npi": [1437292927] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "475397655" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1735.00, "providers": [{ "billed_charge": 1846.00, "npi": [1902279656] } ] } ] }, { "tin": { "type": "ein", "value": "263668328" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1688.16, "providers": [{ "billed_charge": 5175.00, "npi": [1861627242] } ] } ] }, { "tin": { "type": "ein", "value": "261938693" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 53129.09, "providers": [{ "billed_charge": 16450.00, "npi": [1144493461] } ] } ] }, { "tin": { "type": "ein", "value": "611661781" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.90, "providers": [{ "billed_charge": 300.00, "npi": [1386980985] } ] } ] }, { "tin": { "type": "ein", "value": "924018597" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 5665.00, "providers": [{ "billed_charge": 1260.00, "npi": [1326727074] } ] } ] }, { "tin": { "type": "ein", "value": "880476261" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.24, "providers": [{ "billed_charge": 240.00, "npi": [1467791525] } ] } ] }, { "tin": { "type": "ein", "value": "602141894" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 25740.38, "providers": [{ "billed_charge": 6000.00, "npi": [1619950870] } ] } ] }, { "tin": { "type": "ein", "value": "330515386" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6835.80, "providers": [{ "billed_charge": 1840.00, "npi": [1437103942] } ] } ] }, { "tin": { "type": "ein", "value": "471509303" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1200.00, "providers": [{ "billed_charge": 200.00, "npi": [1841446010] } ] } ] }, { "tin": { "type": "ein", "value": "813585158" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 168173.93, "providers": [{ "billed_charge": 7000.00, "npi": [1285171546] } ] } ] }, { "tin": { "type": "ein", "value": "953628253" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2901.36, "providers": [{ "billed_charge": 800.00, "npi": [1306034434] } ] } ] }, { "tin": { "type": "ein", "value": "272374581" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 457.92, "providers": [{ "billed_charge": 1240.00, "npi": [1962712828] } ] } ] }, { "tin": { "type": "ein", "value": "822994185" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3874.12, "providers": [{ "billed_charge": 4662.00, "npi": [1861986465] } ] }, { "allowed_amount": 1341.84, "providers": [{ "billed_charge": 1998.00, "npi": [1861986465] } ] } ] }, { "tin": { "type": "ein", "value": "920479309" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4791.23, "providers": [{ "billed_charge": 20292.00, "npi": [1932824638] } ] } ] }, { "tin": { "type": "ein", "value": "200987396" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1027.59, "providers": [{ "billed_charge": 4662.00, "npi": [1558427526] } ] }, { "allowed_amount": 286.20, "providers": [{ "billed_charge": 1110.00, "npi": [1558427526] } ] } ] }, { "tin": { "type": "ein", "value": "760617615" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 273.14, "providers": [{ "billed_charge": 556.00, "npi": [1215010079] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "222785804" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3661.60, "providers": [{ "billed_charge": 5390.00, "npi": [1386739332] } ] } ] }, { "tin": { "type": "ein", "value": "911491167" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1473.84, "providers": [{ "billed_charge": 796.00, "npi": [1194099390] } ] } ] }, { "tin": { "type": "ein", "value": "263668328" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4957.88, "providers": [{ "billed_charge": 13760.00, "npi": [1861627242] } ] } ] }, { "tin": { "type": "ein", "value": "261938693" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8274.43, "providers": [{ "billed_charge": 3600.00, "npi": [1144493461] } ] } ] }, { "tin": { "type": "ein", "value": "452716222" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12150.05, "providers": [{ "billed_charge": 4883.00, "npi": [1326336058] } ] }, { "allowed_amount": 184.11, "providers": [{ "billed_charge": 257.00, "npi": [1326336058] } ] } ] }, { "tin": { "type": "ein", "value": "263872254" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3246.10, "providers": [{ "billed_charge": 900.00, "npi": [1437389616] } ] } ] }, { "tin": { "type": "ein", "value": "205962516" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17128.08, "providers": [{ "billed_charge": 900.00, "npi": [1811023443] } ] } ] }, { "tin": { "type": "ein", "value": "204770445" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1953.34, "providers": [{ "billed_charge": 1951.02, "npi": [1831124791] } ] } ] }, { "tin": { "type": "ein", "value": "833546595" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2501.28, "providers": [{ "billed_charge": 2240.00, "npi": [1588120240] } ] } ] }, { "tin": { "type": "ein", "value": "934497656" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9701.71, "providers": [{ "billed_charge": 6490.02, "npi": [1184490385] } ] } ] }, { "tin": { "type": "ein", "value": "953998577" }, "service_code": ["52", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16791.71, "providers": [{ "billed_charge": 3650.00, "npi": [1063540938] } ] }, { "allowed_amount": 638.22, "providers": [{ "billed_charge": 1000.00, "npi": [1063540938] } ] } ] }, { "tin": { "type": "ein", "value": "951691313" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 42671.73, "providers": [{ "billed_charge": 25559.00, "npi": [0] } ] }, { "allowed_amount": 713.25, "providers": [{ "billed_charge": 419.00, "npi": [1669617197] } ] } ] }, { "tin": { "type": "ein", "value": "900730395" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 325.00, "providers": [{ "billed_charge": 353.00, "npi": [1124374822] } ] } ] }, { "tin": { "type": "ein", "value": "223894435" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3016.19, "providers": [{ "billed_charge": 900.00, "npi": [1598938508] } ] } ] }, { "tin": { "type": "ein", "value": "272374581" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1155.98, "providers": [{ "billed_charge": 3248.00, "npi": [1962712828] } ] } ] }, { "tin": { "type": "ein", "value": "860846208" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1796.64, "providers": [{ "billed_charge": 1266.00, "npi": [1659316008] } ] } ] }, { "tin": { "type": "ein", "value": "954170981" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4284.95, "providers": [{ "billed_charge": 3024.00, "npi": [1881669489] } ] } ] }, { "tin": { "type": "ein", "value": "993641050" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 574.77, "providers": [{ "billed_charge": 1960.00, "npi": [1427892546] } ] } ] }, { "tin": { "type": "ein", "value": "869243860" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3736.96, "providers": [{ "billed_charge": 6400.00, "npi": [1629606413] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 767.02, "providers": [{ "billed_charge": 394.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 10691.08, "providers": [{ "billed_charge": 8760.00, "npi": [1104889138] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952835184" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4794.48, "providers": [{ "billed_charge": 8680.00, "npi": [1689636730] } ] } ] }, { "tin": { "type": "ein", "value": "800212487" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5092.16, "providers": [{ "billed_charge": 7058.45, "npi": [1134355597] } ] } ] }, { "tin": { "type": "ein", "value": "942728480" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3112.60, "providers": [{ "billed_charge": 3152.00, "npi": [1548343510] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 25624.09, "providers": [{ "billed_charge": 32268.00, "npi": [1780625871] } ] }, { "allowed_amount": 5904.25, "providers": [{ "billed_charge": 7696.00, "npi": [1407886138] } ] }, { "allowed_amount": 1552.46, "providers": [{ "billed_charge": 1836.00, "npi": [1346265154] } ] }, { "allowed_amount": 12282.60, "providers": [{ "billed_charge": 16266.00, "npi": [1881632149] } ] }, { "allowed_amount": 57509.19, "providers": [{ "billed_charge": 70138.00, "npi": [1326346438] } ] } ] }, { "tin": { "type": "ein", "value": "261336258" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4117.88, "providers": [{ "billed_charge": 6050.10, "npi": [1881868164] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 10123.00, "providers": [{ "billed_charge": 9698.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17668.53, "providers": [{ "billed_charge": 24877.96, "npi": [1588960413] } ] } ] }, { "tin": { "type": "ein", "value": "954873894" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17717.10, "providers": [{ "billed_charge": 24490.75, "npi": [1235176702] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 25810.80, "providers": [{ "billed_charge": 25070.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 27021.17, "providers": [{ "billed_charge": 29554.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 51952.20, "providers": [{ "billed_charge": 55794.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 32632.00, "providers": [{ "billed_charge": 30551.00, "npi": [1861432627] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99285", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800212487" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 11653.17, "providers": [{ "billed_charge": 17815.53, "npi": [1134355597] } ] } ] }, { "tin": { "type": "ein", "value": "952835184" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 11441.14, "providers": [{ "billed_charge": 26376.00, "npi": [1689636730] } ] } ] }, { "tin": { "type": "ein", "value": "464467849" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3683.70, "providers": [{ "billed_charge": 4377.00, "npi": [1649692716] } ] } ] }, { "tin": { "type": "ein", "value": "934387494" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 46327.24, "providers": [{ "billed_charge": 47880.00, "npi": [1912771569] } ] } ] }, { "tin": { "type": "ein", "value": "954534163" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 18313.88, "providers": [{ "billed_charge": 20142.00, "npi": [1184048712] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 7407.58, "providers": [{ "billed_charge": 8220.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 90831.71, "providers": [{ "billed_charge": 86021.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "462690851" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 30105.45, "providers": [{ "billed_charge": 35252.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 23790.75, "providers": [{ "billed_charge": 42021.12, "npi": [1588960413] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 31806.61, "providers": [{ "billed_charge": 34751.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8728.50, "providers": [{ "billed_charge": 9780.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 20843.40, "providers": [{ "billed_charge": 21242.00, "npi": [1861432627] } ] } ] }, { "tin": { "type": "ein", "value": "871451688" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17319.32, "providers": [{ "billed_charge": 22437.51, "npi": [1124698139] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1378.00, "providers": [{ "billed_charge": 1286.00, "npi": [1457306979] } ] }, { "allowed_amount": 48310.93, "providers": [{ "billed_charge": 60200.00, "npi": [1881632149] } ] }, { "allowed_amount": 1367.00, "providers": [{ "billed_charge": 1415.00, "npi": [1578720124] } ] }, { "allowed_amount": 18835.69, "providers": [{ "billed_charge": 38076.00, "npi": [1396044491] } ] }, { "allowed_amount": 24472.95, "providers": [{ "billed_charge": 29715.00, "npi": [1346265154] } ] }, { "allowed_amount": 52981.70, "providers": [{ "billed_charge": 70234.00, "npi": [1780625871] } ] }, { "allowed_amount": 72945.81, "providers": [{ "billed_charge": 92229.00, "npi": [1326346438] } ] }, { "allowed_amount": 32417.52, "providers": [{ "billed_charge": 39620.00, "npi": [1477508984] } ] }, { "allowed_amount": 14983.15, "providers": [{ "billed_charge": 18266.00, "npi": [1407886138] } ] } ] }, { "tin": { "type": "ein", "value": "943278555" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 23049.21, "providers": [{ "billed_charge": 20655.00, "npi": [1134110661] } ] } ] }, { "tin": { "type": "ein", "value": "953192932" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4090.80, "providers": [{ "billed_charge": 5550.00, "npi": [1871535286] } ] } ] }, { "tin": { "type": "ein", "value": "953056292" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6930.16, "providers": [{ "billed_charge": 10045.00, "npi": [1740214733] } ] } ] }, { "tin": { "type": "ein", "value": "990970557" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 16196.62, "providers": [{ "billed_charge": 17550.00, "npi": [1376305755] } ] } ] }, { "tin": { "type": "ein", "value": "274096788" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 18734.20, "providers": [{ "billed_charge": 25256.73, "npi": [1972953230] } ] } ] } ] }, { "name": "CRITICAL CARE, FIRST HOUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99291", "description": "CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "222785804" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8824.80, "providers": [{ "billed_charge": 12228.00, "npi": [1639264682] } ] } ] }, { "tin": { "type": "ein", "value": "261938693" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7009.02, "providers": [{ "billed_charge": 1950.00, "npi": [1144493461] } ] } ] }, { "tin": { "type": "ein", "value": "272374581" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 352.07, "providers": [{ "billed_charge": 832.00, "npi": [1962712828] } ] } ] }, { "tin": { "type": "ein", "value": "330515386" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7780.40, "providers": [{ "billed_charge": 1424.00, "npi": [1437103942] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99308", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883982344" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 593.06, "providers": [{ "billed_charge": 696.00, "npi": [1669192472] } ] }, { "allowed_amount": 213.30, "providers": [{ "billed_charge": 232.00, "npi": [1669192472] } ] } ] }, { "tin": { "type": "ein", "value": "853351517" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1028.46, "providers": [{ "billed_charge": 1500.00, "npi": [1356944235] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99309", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821938082" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 703.30, "providers": [{ "billed_charge": 1020.00, "npi": [1497265565] } ] } ] }, { "tin": { "type": "ein", "value": "821053156" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 8250.58, "providers": [{ "billed_charge": 3600.00, "npi": [1699288993] } ] } ] }, { "tin": { "type": "ein", "value": "923467328" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 5616.18, "providers": [{ "billed_charge": 3616.00, "npi": [1154010072] } ] } ] }, { "tin": { "type": "ein", "value": "883982344" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 611.05, "providers": [{ "billed_charge": 672.00, "npi": [1669192472] } ] } ] }, { "tin": { "type": "ein", "value": "954797181" }, "service_code": ["02", "31"], "billing_class": "professional", "payments": [{ "allowed_amount": 203.00, "providers": [{ "billed_charge": 300.00, "npi": [1275670036] } ] }, { "allowed_amount": 537.28, "providers": [{ "billed_charge": 900.00, "npi": [1275670036] } ] } ] }, { "tin": { "type": "ein", "value": "208748539" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 5762.94, "providers": [{ "billed_charge": 5280.00, "npi": [1720261506] } ] } ] } ] }, { "name": "HOME VISIT EST PATIENT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99349", "description": "HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462394520" }, "service_code": ["13"], "billing_class": "professional", "payments": [{ "allowed_amount": 1423.92, "providers": [{ "billed_charge": 1400.00, "npi": [1063825289] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923084561" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1290.30, "providers": [{ "billed_charge": 1152.00, "npi": [1649975681] } ] } ] } ] }, { "name": "NEONATE CRIT CARE SUBSQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99469", "description": "SUBSEQUENT INPATIENT NEONATAL CRITICAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A CRITICA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "532883635" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 223403.31, "providers": [{ "billed_charge": 19500.00, "npi": [1285669861] } ] } ] }, { "tin": { "type": "ein", "value": "464150987" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11064.01, "providers": [{ "billed_charge": 2727.00, "npi": [1437555265] } ] } ] } ] }, { "name": "PED CRIT CARE AGE 2-5 SUBSQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99476", "description": "SUBSEQUENT INPATIENT PEDIATRIC CRITICAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A CRITIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "232592835" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 326085.10, "providers": [{ "billed_charge": 258034.00, "npi": [1497850291] } ] } ] } ] }, { "name": "HOME INFUSION/VISIT, 2 HRS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99601", "description": "HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208983819" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3657.75, "providers": [{ "billed_charge": 2250.00, "npi": [1013134113] } ] } ] } ] }, { "name": "HOME INFUSION EACH ADDTL HR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99602", "description": "HOME INFUSION/SPECIALTY DRUG ADMINISTRATION, PER VISIT (UP TO 2 HOURS); EACH ADDITIONAL HOUR (LIST S", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208983819" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3465.00, "providers": [{ "billed_charge": 3150.00, "npi": [1013134113] } ] } ] } ] }, { "name": "GRND MLGE PER STATUTE MILE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE, PER STATUTE MILE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "421406317" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.90, "providers": [{ "billed_charge": 84.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TUBING FOR BREAST PUMP REPLA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4281", "description": "TUBING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1336.05, "providers": [{ "billed_charge": 399.24, "npi": [1477222834] } ] } ] } ] }, { "name": "ADAPTER FOR BREAST PUMP REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4282", "description": "ADAPTER FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1639.47, "providers": [{ "billed_charge": 496.72, "npi": [1477222834] } ] } ] } ] }, { "name": "CAP BRST PUMP BOTLE REPLCMNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4283", "description": "CAP FOR BREAST PUMP BOTTLE, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1173.39, "providers": [{ "billed_charge": 95.03, "npi": [1477222834] } ] } ] } ] }, { "name": "BRST SHIELD&SPLSH PROTCTR PU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4284", "description": "BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1576.51, "providers": [{ "billed_charge": 191.73, "npi": [1477222834] } ] } ] } ] }, { "name": "POLYCARBATE BOTTLE BRST PUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4285", "description": "POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.30, "providers": [{ "billed_charge": 174.05, "npi": [1477222834] } ] } ] } ] }, { "name": "LOCKING RING BRST PUMP REPLC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4286", "description": "LOCKING RING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1554.67, "providers": [{ "billed_charge": 132.60, "npi": [1477222834] } ] } ] } ] }, { "name": "Disposable collection and storage bag for breast milk, any size, any type, each", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4287", "description": "Disposable collection and storage bag for breast milk, any size, any type, each", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4792.54, "providers": [{ "billed_charge": 2772.00, "npi": [1477222834] } ] } ] } ] }, { "name": "INTERMIT URIN CATH; COUDE TI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4352", "description": "INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "412681900" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 673.50, "providers": [{ "billed_charge": 3330.00, "npi": [1497616148] } ] } ] }, { "tin": { "type": "ein", "value": "332155824" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 218723.57, "providers": [{ "billed_charge": 64837.80, "npi": [1093525552] } ] } ] } ] }, { "name": "ELEC STIM SPPLS 2 LD PER MTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4595", "description": "ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5362.30, "providers": [{ "billed_charge": 5994.45, "npi": [1770511552] } ] } ] } ] }, { "name": "TUBING W/INTGR HEAT ELEM W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4604", "description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12301.70, "providers": [{ "billed_charge": 2034.24, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 330.69, "providers": [{ "billed_charge": 125.00, "npi": [1144767542] } ] } ] } ] }, { "name": "ALGINAT/OTH FIBR GELL PAD 16", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A6196", "description": "ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ IN OR LESS, EACH DRES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "332155824" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 30029.50, "providers": [{ "billed_charge": 14738.40, "npi": [1093525552] } ] } ] } ] }, { "name": "FULL FCE MASK POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7030", "description": "FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5880.12, "providers": [{ "billed_charge": 2370.10, "npi": [1477222834] } ] } ] } ] }, { "name": "FCE MASK INTERFCE REPL FULL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7031", "description": "FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6790.65, "providers": [{ "billed_charge": 2670.28, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 604.67, "providers": [{ "billed_charge": 1000.00, "npi": [1144767542] } ] } ] } ] }, { "name": "CUSHN NASAL MASK INTF REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7032", "description": "CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 723.26, "providers": [{ "billed_charge": 261.77, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1085.62, "providers": [{ "billed_charge": 1115.00, "npi": [1144767542] } ] } ] } ] }, { "name": "PILLW NASL CANNULA TYPE INTF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7033", "description": "PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 754.11, "providers": [{ "billed_charge": 424.79, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2802.44, "providers": [{ "billed_charge": 3115.00, "npi": [1144767542] } ] } ] } ] }, { "name": "NASL INTERFCE POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7034", "description": "NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1720.25, "providers": [{ "billed_charge": 1208.16, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4569.97, "providers": [{ "billed_charge": 1390.38, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2475.73, "providers": [{ "billed_charge": 1880.00, "npi": [1144767542] } ] } ] } ] }, { "name": "HEADGEAR USED W/POS ARWAY PR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7035", "description": "HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4749.55, "providers": [{ "billed_charge": 1111.57, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8051.86, "providers": [{ "billed_charge": 627.13, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1693.32, "providers": [{ "billed_charge": 305.00, "npi": [1144767542] } ] } ] } ] }, { "name": "TUBING USED W/POS ARWAY PRES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7037", "description": "TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3010.04, "providers": [{ "billed_charge": 405.54, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 291.77, "providers": [{ "billed_charge": 68.00, "npi": [1144767542] } ] } ] } ] }, { "name": "FLTR DISPBL W/POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7038", "description": "FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5428.15, "providers": [{ "billed_charge": 666.93, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 17366.74, "providers": [{ "billed_charge": 954.91, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5547.70, "providers": [{ "billed_charge": 2058.00, "npi": [1144767542] } ] } ] } ] }, { "name": "WATR CHAMB HUMDIFIR USED W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7046", "description": "WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3146.58, "providers": [{ "billed_charge": 204.72, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 711.56, "providers": [{ "billed_charge": 95.00, "npi": [1144767542] } ] } ] } ] }, { "name": "VACUUM DRN CLCT U & TUBING K", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7048", "description": "VACUUM DRAINAGE COLLECTION UNIT AND TUBING KIT, INCLUDING ALL SUPPLIES NEEDED FOR COLLECTION UNIT CH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911668113" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9300.63, "providers": [{ "billed_charge": 1950.00, "npi": [1306878905] } ] } ] } ] }, { "name": "INJ GADOTERATE MEGLMNE 0.1ML", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9575", "description": "INJECTION, GADOTERATE MEGLUMINE, 0.1 ML", "allowed_amounts": [{ "tin": { "type": "ein", "value": "956419205" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4460.65, "providers": [{ "billed_charge": 1648.00, "npi": [1932121514] } ] } ] } ] }, { "name": "ENTERAL FEED SPL KIT; PUMP F", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "B4035", "description": "ENTERAL FEEDING SUPPLY KIT; PUMP FED, PER DAY, INCLUDES BUT NOT LIMITED TO FEEDING/FLUSHING SYRINGE,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "314379441" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9235.05, "providers": [{ "billed_charge": 342.00, "npi": [1275198780] } ] } ] } ] }, { "name": "OCCLUSAL ORTHOTIC APPLIANCE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "D7880", "description": "OCCLUSAL ORTHOTIC APPLIANCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680177804" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3784.00, "providers": [{ "billed_charge": 6000.00, "npi": [1346393105] } ] } ] } ] }, { "name": "H2O CIRCULTNG HEAT PAD WPUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0217", "description": "WATER CIRCULATING HEAT PAD WITH PUMP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3000.00, "providers": [{ "billed_charge": 3000.00, "npi": [1770511552] } ] } ] } ] }, { "name": "HUMDIFIR HEAT USED W/POS ARW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0562", "description": "HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 25839.21, "providers": [{ "billed_charge": 8197.28, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7135.62, "providers": [{ "billed_charge": 1979.54, "npi": [1477222834] } ] } ] } ] }, { "name": "NEBULIZER WITH COMPRESSOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0570", "description": "NEBULIZER, WITH COMPRESSOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.47, "providers": [{ "billed_charge": 37.47, "npi": [1174749972] } ] } ] } ] }, { "name": "CONTINUOUS POS AIRWAY PRESSU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0601", "description": "CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 22318.57, "providers": [{ "billed_charge": 22380.45, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11070.20, "providers": [{ "billed_charge": 7831.27, "npi": [1477222834] } ] } ] } ] }, { "name": "BREAST PUMP ELECTRIC ANY TYP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0603", "description": "BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11450.81, "providers": [{ "billed_charge": 9759.72, "npi": [1477222834] } ] } ] } ] }, { "name": "TENS DEVICE 4/> LEADS MX NER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0730", "description": "TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) DEVICE, 4 OR MORE LEADS, FOR MULTIPLE NERVE STIMU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4168.24, "providers": [{ "billed_charge": 8487.00, "npi": [1770511552] } ] } ] } ] }, { "name": "O2 CONC 85%/>02 CONC PRSC FL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1390", "description": "OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2819.65, "providers": [{ "billed_charge": 2065.22, "npi": [1477222834] } ] } ] } ] }, { "name": "E-STIM 1/>NOT WND CARE PART", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0283", "description": "ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "922523775" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 644.17, "providers": [{ "billed_charge": 100.00, "npi": [1447953674] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1173.87, "providers": [{ "billed_charge": 600.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11504.54, "providers": [{ "billed_charge": 504.90, "npi": [1255900296] } ] } ] } ] }, { "name": "DIR SNS RN HH/HOSPICE SET EA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0299", "description": "DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE (RN) IN THE HOME HEALTH OR HOSPICE SETTING, EA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 23252.31, "providers": [{ "billed_charge": 16387.50, "npi": [1770307274] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 1-7", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0480", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823146637" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16731.27, "providers": [{ "billed_charge": 5459.02, "npi": [1861994600] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53188.18, "providers": [{ "billed_charge": 23365.03, "npi": [1508499393] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 22/", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0483", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11872.36, "providers": [{ "billed_charge": 42075.00, "npi": [1952189086] } ] } ] } ] }, { "name": "MED ASST TX METHADONE;WEEKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2067", "description": "MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462568903" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.00, "providers": [{ "billed_charge": 471.00, "npi": [1841356490] } ] }, { "allowed_amount": 8572.20, "providers": [{ "billed_charge": 10833.00, "npi": [1740346303] } ] } ] } ] }, { "name": "VISIT CPLX INHERENT E&M ASSO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2211", "description": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911220843" }, "service_code": ["11", "02", "19"], "billing_class": "professional", "payments": [{ "allowed_amount": 345.32, "providers": [{ "billed_charge": 105.60, "npi": [1023041159] } ] }, { "allowed_amount": 648.14, "providers": [{ "billed_charge": 158.40, "npi": [1023041159] } ] }, { "allowed_amount": 282.69, "providers": [{ "billed_charge": 52.80, "npi": [1023041159] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1354.16, "providers": [{ "billed_charge": 270.00, "npi": [1750368999] } ] }, { "allowed_amount": 22725.90, "providers": [{ "billed_charge": 2340.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4324.34, "providers": [{ "billed_charge": 522.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 30760.60, "providers": [{ "billed_charge": 4440.00, "npi": [1508968967] } ] }, { "allowed_amount": 13581.52, "providers": [{ "billed_charge": 1924.00, "npi": [1508968967] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 996.81, "providers": [{ "billed_charge": 177.87, "npi": [1538297726] } ] }, { "allowed_amount": 1562.36, "providers": [{ "billed_charge": 296.45, "npi": [1538297726] } ] }, { "allowed_amount": 7281.98, "providers": [{ "billed_charge": 1600.83, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "462394520" }, "service_code": ["13"], "billing_class": "professional", "payments": [{ "allowed_amount": 2894.54, "providers": [{ "billed_charge": 284.00, "npi": [1063825289] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.00, "providers": [{ "billed_charge": 90.00, "npi": [1235107566] } ] }, { "allowed_amount": 2375.09, "providers": [{ "billed_charge": 450.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "812073947" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 370.00, "providers": [{ "billed_charge": 45.00, "npi": [1972057990] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "11", "19", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1886.39, "providers": [{ "billed_charge": 404.00, "npi": [1437292927] } ] }, { "allowed_amount": 573.73, "providers": [{ "billed_charge": 344.00, "npi": [1437292927] } ] }, { "allowed_amount": 459.06, "providers": [{ "billed_charge": 172.00, "npi": [1437292927] } ] }, { "allowed_amount": 322.49, "providers": [{ "billed_charge": 331.00, "npi": [1437292927] } ] } ] } ] }, { "name": "BMI DOC ABV NML PARAM & F/U", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G8417", "description": "BMI IS DOCUMENTED ABOVE NORMAL PARAMETERS AND A FOLLOW-UP PLAN IS DOCUMENTED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13400.50, "providers": [{ "billed_charge": 0.00, "npi": [1275581894] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC;METHDONE ADM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0020", "description": "ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943303140" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 152.00, "providers": [{ "billed_charge": 744.00, "npi": [1730226473] } ] } ] }, { "tin": { "type": "ein", "value": "330234191" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2101.60, "providers": [{ "billed_charge": 2232.00, "npi": [1316040223] } ] } ] } ] }, { "name": "MENTL HLTH SVC PLAN DVLP NON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0032", "description": "MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NONPHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272992358" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.00, "providers": [{ "billed_charge": 720.00, "npi": [1962736595] } ] }, { "allowed_amount": 6454.02, "providers": [{ "billed_charge": 6570.00, "npi": [1962736595] } ] } ] }, { "tin": { "type": "ein", "value": "811441959" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3011.34, "providers": [{ "billed_charge": 1035.00, "npi": [1437665130] } ] }, { "allowed_amount": 135.00, "providers": [{ "billed_charge": 143.75, "npi": [1437665130] } ] } ] } ] }, { "name": "ORAL MEDADMIN DIR OBSERV", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0033", "description": "ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942219349" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 14658.11, "providers": [{ "billed_charge": 734.54, "npi": [1396076147] } ] } ] } ] }, { "name": "THERAPEUTIC BEHAVIORAL SRVC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2019", "description": "THERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "270407388" }, "service_code": ["12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1053.03, "providers": [{ "billed_charge": 1040.00, "npi": [1134467657] } ] }, { "allowed_amount": 9732.42, "providers": [{ "billed_charge": 5326.50, "npi": [1134467657] } ] } ] }, { "tin": { "type": "ein", "value": "330599891" }, "service_code": ["99", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3293.00, "providers": [{ "billed_charge": 1267.50, "npi": [1234567893] } ] }, { "allowed_amount": 421.25, "providers": [{ "billed_charge": 243.75, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "272992358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23073.21, "providers": [{ "billed_charge": 22779.80, "npi": [1962736595] } ] } ] }, { "tin": { "type": "ein", "value": "811441959" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3134.28, "providers": [{ "billed_charge": 524.99, "npi": [1437665130] } ] } ] }, { "tin": { "type": "ein", "value": "464150758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13219.80, "providers": [{ "billed_charge": 3679.50, "npi": [1871915678] } ] } ] } ] }, { "name": "BOTULINUM TOXIN TYPE A PER U", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0585", "description": "INJECTION, ONABOTULINUMTOXINA, 1 UNIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330102201" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 37496.36, "providers": [{ "billed_charge": 16680.00, "npi": [1003860537] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3185.00, "providers": [{ "billed_charge": 1125.00, "npi": [1649372673] } ] } ] } ] }, { "name": "INJ CEFAZOLIN SODIUM 500MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0690", "description": "INJECTION, CEFAZOLIN SODIUM, 500 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274694772" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 15962.28, "providers": [{ "billed_charge": 50.40, "npi": [1982900973] } ] } ] } ] }, { "name": "INJ TESTOSTERONE CYPION 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1071", "description": "INJECTION, TESTOSTERONE CYPIONATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1347.50, "providers": [{ "billed_charge": 133.50, "npi": [1659950475] } ] } ] }, { "tin": { "type": "ein", "value": "271670964" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 269.16, "providers": [{ "billed_charge": 70.20, "npi": [1447581095] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.52, "providers": [{ "billed_charge": 285.00, "npi": [1457324204] } ] } ] } ] }, { "name": "INJ TRIAMCINOLON ACETONID NO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3301", "description": "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330645967" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 255.23, "providers": [{ "billed_charge": 513.00, "npi": [1649503319] } ] } ] } ] }, { "name": "INJ VIT B-12 CYNOCOBLMN TO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3420", "description": "INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1,000 MCG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.00, "providers": [{ "billed_charge": 10.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.84, "providers": [{ "billed_charge": 280.00, "npi": [1457324204] } ] } ] } ] }, { "name": "UNCLASSIFIED DRUGS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3490", "description": "UNCLASSIFIED DRUGS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822331839" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5201.60, "providers": [{ "billed_charge": 1680.00, "npi": [1447774344] } ] } ] }, { "tin": { "type": "ein", "value": "474634585" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 31919.77, "providers": [{ "billed_charge": 54800.34, "npi": [1194185421] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2273.30, "providers": [{ "billed_charge": 2140.00, "npi": [1457324204] } ] } ] } ] }, { "name": "UNCLASSIFIED BIOLOGICS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3590", "description": "UNCLASSIFIED BIOLOGICS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474634585" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.75, "providers": [{ "billed_charge": 3737.78, "npi": [1194185421] } ] } ] } ] }, { "name": "PRSC RX ORAL NONCHEMOTHAPEUT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J8499", "description": "PRESCRIPTION DRUG, ORAL, NONCHEMOTHERAPEUTIC, NOS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "01", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 1540.09, "providers": [{ "billed_charge": 1539.63, "npi": [0] } ] }, { "allowed_amount": 14.57, "providers": [{ "billed_charge": 14.57, "npi": [0] } ] }, { "allowed_amount": 192.86, "providers": [{ "billed_charge": 192.86, "npi": [0] } ] } ] } ] }, { "name": "GLBAL FEE URGNT CARE CENTERS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9083", "description": "GLOBAL FEE URGENT CARE CENTERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463164188" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 9600.80, "providers": [{ "billed_charge": 22438.00, "npi": [1134546575] } ] } ] }, { "tin": { "type": "ein", "value": "934895258" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 14108.13, "providers": [{ "billed_charge": 18280.00, "npi": [1114798071] } ] } ] }, { "tin": { "type": "ein", "value": "814317635" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.00, "providers": [{ "billed_charge": 1365.96, "npi": [1952915365] } ] } ] }, { "tin": { "type": "ein", "value": "593209688" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 844.00, "providers": [{ "billed_charge": 983.00, "npi": [1073565610] } ] } ] }, { "tin": { "type": "ein", "value": "901133689" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1395.00, "providers": [{ "billed_charge": 2822.50, "npi": [1609229764] } ] } ] }, { "tin": { "type": "ein", "value": "10790511" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3165.15, "providers": [{ "billed_charge": 6728.00, "npi": [1033195474] } ] } ] } ] }, { "name": "NRS CARE HOM; REGISTERED NUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9123", "description": "NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 27299.67, "providers": [{ "billed_charge": 12825.00, "npi": [1770307274] } ] } ] } ] }, { "name": "HOME INFUS TX IMMUOTHAPY; PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9338", "description": "HOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273281682" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 39911.81, "providers": [{ "billed_charge": 35000.00, "npi": [1346526845] } ] } ] } ] }, { "name": "INTNSVE OP PSYC SVC PER DIEM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9480", "description": "INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680344702" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19681.52, "providers": [{ "billed_charge": 34914.00, "npi": [1962482513] } ] } ] } ] }, { "name": "HIT ABX ANTIVIRL/ANTIFUNGAL;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9502", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 8 HOURS, ADMINISTRAT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274694772" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 73017.12, "providers": [{ "billed_charge": 10450.00, "npi": [1982900973] } ] } ] } ] }, { "name": "HOME INJECTABLE THERAPY NOC-", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9542", "description": "HOME INJECTABLE THERAPY, NOT OTHERWISE CLASSIFIED, INCLUDING ADMINISTRATIVE SERVICES, PROFESSIONAL P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474634585" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 37466.45, "providers": [{ "billed_charge": 1850.00, "npi": [1194185421] } ] } ] } ] }, { "name": "TELEHEALTH TRANS MIN PROF SR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "T1014", "description": "TELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 15866.80, "providers": [{ "billed_charge": 304.14, "npi": [1164512851] } ] } ] } ] }, { "name": "SNF PDPM HIPPS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "ZZZZZ", "description": "SNF PDPM HIPPS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942728480" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 846.03, "providers": [{ "billed_charge": 0.00, "npi": [1548343510] } ] } ] }, { "tin": { "type": "ein", "value": "861747274" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 660.79, "providers": [{ "billed_charge": 0.00, "npi": [1164014874] } ] }, { "allowed_amount": 132.10, "providers": [{ "billed_charge": 0.00, "npi": [1164014874] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "02", "81", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 367.88, "providers": [{ "billed_charge": 0.00, "npi": [1720279805] } ] }, { "allowed_amount": 4844.16, "providers": [{ "billed_charge": 0.00, "npi": [1538297726] } ] }, { "allowed_amount": 3415.54, "providers": [{ "billed_charge": 0.00, "npi": [1538297726] } ] }, { "allowed_amount": 330.15, "providers": [{ "billed_charge": 0.00, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3231.99, "providers": [{ "billed_charge": 0.00, "npi": [1477222834] } ] }, { "allowed_amount": 330.81, "providers": [{ "billed_charge": 0.00, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4870.52, "providers": [{ "billed_charge": 0.00, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "263447487" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1178.38, "providers": [{ "billed_charge": 0.00, "npi": [1215181300] } ] }, { "allowed_amount": 2062.59, "providers": [{ "billed_charge": 0.00, "npi": [1215181300] } ] }, { "allowed_amount": 345.81, "providers": [{ "billed_charge": 0.00, "npi": [1215181300] } ] } ] }, { "tin": { "type": "ein", "value": "363907436" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.60, "providers": [{ "billed_charge": 0.00, "npi": [1043242886] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 834.18, "providers": [{ "billed_charge": 0.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2359.83, "providers": [{ "billed_charge": 0.00, "npi": [1134309305] } ] }, { "allowed_amount": 5703.92, "providers": [{ "billed_charge": 0.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3202.52, "providers": [{ "billed_charge": 0.00, "npi": [1356409379] } ] }, { "allowed_amount": 28.00, "providers": [{ "billed_charge": 0.00, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 265.00, "providers": [{ "billed_charge": 0.00, "npi": [1184199549] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 22417.39, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] }, { "allowed_amount": 5431.43, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] }, { "allowed_amount": 2298.00, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] } ] } ] } ] }