{ "reporting_entity_name": "Centene Management Company LLC", "reporting_entity_type": "Third Party Administrator", "version": "2.0.0", "last_updated_on": "2026-07-29", "out_of_network": [{ "name": "Under Proprietary Laboratory Analyses", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0340U", "description": "Under Proprietary Laboratory Analyses", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14498.94, "providers": [{ "billed_charge": 76800.00, "npi": [1234567893] } ] } ] } ] }, { "name": "Proprietary Laboratory Analysis (PLA)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0345U", "description": "Proprietary Laboratory Analysis (PLA) for the GeneSight Psychotropic test by Assurex Health and Myriad Genetics", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1202.48, "providers": [{ "billed_charge": 5500.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MyProstateScore 2.0 (MPS 2.0)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0403U", "description": "Gene expression profiling for prostate cancer risk stratification", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474172816" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1520.00, "providers": [{ "billed_charge": 3980.00, "npi": [1467073460] } ] } ] } ] }, { "name": "Cologuard Plus test by Exact Sciences Laboratories LLC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0464U", "description": "Cologuard Plus test by Exact Sciences Laboratories LLC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 923395.20, "providers": [{ "billed_charge": 1232400.00, "npi": [1234567893] } ] } ] } ] }, { "name": "Caris Assure Caris MPI Inc", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0485U", "description": "Caris Assure Caris MPI Inc", "allowed_amounts": [{ "tin": { "type": "ein", "value": "743126687" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 104752.37, "providers": [{ "billed_charge": 1260000.00, "npi": [1225872658] } ] } ] } ] }, { "name": "Northstar Response test developed by BillionToOne Laboratory", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0486U", "description": "the analysis of cell-free circulating tumor DNA from pan-solid tumors", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18234.53, "providers": [{ "billed_charge": 85501.00, "npi": [1245937325] } ] } ] } ] }, { "name": "Proprietary Laboratory Analyses (PLA) code", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0487U", "description": "Proprietary Laboratory Analyses (PLA) code", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14712.44, "providers": [{ "billed_charge": 70070.40, "npi": [1245937325] } ] } ] } ] }, { "name": "a specialized, single-gene noninvasive prenatal test NIP that analyzes cell-free fetal DNA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0489U", "description": "a specialized, single-gene noninvasive prenatal test (NIPT) that analyzes cell-free fetal DNA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2307.24, "providers": [{ "billed_charge": 28932.00, "npi": [1598314437] } ] } ] } ] }, { "name": "Proprietary Laboratory Analyses (PLA)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0493U", "description": "Proprietary Laboratory Analyses (PLA) code assigned to the Prospera test developed by Natera", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 919.59, "providers": [{ "billed_charge": 3249.00, "npi": [1234567893] } ] } ] } ] }, { "name": "Proprietary Laboratory Analysis (PLA) code for the Guardant Shield test,", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0537U", "description": "Proprietary Laboratory Analysis (PLA) code for the Guardant Shield test,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883933025" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 178652.50, "providers": [{ "billed_charge": 688160.00, "npi": [1538857099] } ] } ] } ] }, { "name": "Guardant Reveal,", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0569U", "description": "a blood test used to detect cell-free circulating tumor DNA (ctDNA) in patients with solid tumors.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "454139254" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 42000.00, "providers": [{ "billed_charge": 105000.00, "npi": [1184045619] } ] } ] } ] }, { "name": "Under Digital Pathology Glass Microscope Slides Digitization Procedures", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "0830T", "description": "Under Digital Pathology Glass Microscope Slides Digitization Procedures", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113272376" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.00, "providers": [{ "billed_charge": 280.00, "npi": [1215921549] } ] } ] } ] }, { "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": "237169388" }, "service_code": ["56"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4500.00, "providers": [{ "billed_charge": 4500.00, "npi": [1528071214] } ] } ] }, { "tin": { "type": "ein", "value": "751571205" }, "service_code": ["56"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1590.00, "providers": [{ "billed_charge": 7485.00, "npi": [1558333542] } ] } ] }, { "tin": { "type": "ein", "value": "471323448" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 351920.00, "providers": [{ "billed_charge": 351920.00, "npi": [1922408517] } ] } ] }, { "tin": { "type": "ein", "value": "825128901" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1828750.00, "providers": [{ "billed_charge": 14322770.00, "npi": [1740771195] } ] } ] } ] }, { "name": "ROOM-BOARD/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "110", "description": "ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 228695.32, "providers": [{ "billed_charge": 89268.00, "npi": [1184179194] } ] }, { "allowed_amount": 980065.47, "providers": [{ "billed_charge": 266180.00, "npi": [1083937593] } ] }, { "allowed_amount": 1685177.47, "providers": [{ "billed_charge": 614656.00, "npi": [1497871628] } ] }, { "allowed_amount": 1805298.72, "providers": [{ "billed_charge": 583710.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 291000.00, "providers": [{ "billed_charge": 480738.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 324000.00, "providers": [{ "billed_charge": 999147.52, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 241221.84, "providers": [{ "billed_charge": 39990.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 80610.75, "providers": [{ "billed_charge": 37880.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1108105.05, "providers": [{ "billed_charge": 209352.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21480.54, "providers": [{ "billed_charge": 5208.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 894683.59, "providers": [{ "billed_charge": 197530.65, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25777.21, "providers": [{ "billed_charge": 2616.30, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1959635.09, "providers": [{ "billed_charge": 737534.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 73187.84, "providers": [{ "billed_charge": 38896.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 907423.00, "providers": [{ "billed_charge": 619858.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 372982.03, "providers": [{ "billed_charge": 168657.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1460442.57, "providers": [{ "billed_charge": 625974.00, "npi": [1740233782] } ] }, { "allowed_amount": 318747.23, "providers": [{ "billed_charge": 122550.00, "npi": [1295788735] } ] }, { "allowed_amount": 5888432.18, "providers": [{ "billed_charge": 2215148.00, "npi": [1730132234] } ] }, { "allowed_amount": 798599.65, "providers": [{ "billed_charge": 339700.00, "npi": [1932152337] } ] }, { "allowed_amount": 183473.69, "providers": [{ "billed_charge": 58050.00, "npi": [1982666111] } ] }, { "allowed_amount": 1726647.18, "providers": [{ "billed_charge": 774648.00, "npi": [1295843787] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 758743.02, "providers": [{ "billed_charge": 911902.00, "npi": [1679578439] } ] } ] } ] }, { "name": "MED-SUR-GY/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "111", "description": "ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752770738" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 377793.84, "providers": [{ "billed_charge": 179790.00, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 403878.64, "providers": [{ "billed_charge": 379004.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 160950.34, "providers": [{ "billed_charge": 143623.48, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 51326.41, "providers": [{ "billed_charge": 15470.00, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 283244.33, "providers": [{ "billed_charge": 113739.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 176314.82, "providers": [{ "billed_charge": 92885.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1994494.09, "providers": [{ "billed_charge": 1154270.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 342026.47, "providers": [{ "billed_charge": 348978.00, "npi": [1932123247] } ] } ] } ] }, { "name": "OB/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "112", "description": "ROOM AND BOARD - PRIVATE -OB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5343.66, "providers": [{ "billed_charge": 1860.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9428.36, "providers": [{ "billed_charge": 10683.00, "npi": [1932123247] } ] } ] } ] }, { "name": "ROOM-BOARD/SEMI", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "120", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746002164" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 133527.02, "providers": [{ "billed_charge": 62390.04, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 78065.61, "providers": [{ "billed_charge": 40299.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11492.75, "providers": [{ "billed_charge": 12652.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 343059.13, "providers": [{ "billed_charge": 80304.00, "npi": [1730132234] } ] }, { "allowed_amount": 2439316.76, "providers": [{ "billed_charge": 893477.00, "npi": [1982666111] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 391600.55, "providers": [{ "billed_charge": 161563.74, "npi": [1639992514] } ] } ] } ] }, { "name": "MED-SUR-GY/2 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "121", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -MEDICAL/SURGICAL/GYN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 351840.66, "providers": [{ "billed_charge": 132990.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13800.32, "providers": [{ "billed_charge": 9357.84, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 128501.41, "providers": [{ "billed_charge": 27729.20, "npi": [1033120423] } ] } ] } ] }, { "name": "PSTAY/2 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "124", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203078922" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 157000.00, "providers": [{ "billed_charge": 392500.00, "npi": [1851346407] } ] } ] }, { "tin": { "type": "ein", "value": "272849780" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 453000.00, "providers": [{ "billed_charge": 996600.00, "npi": [1093021719] } ] } ] }, { "tin": { "type": "ein", "value": "201021264" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 315000.00, "providers": [{ "billed_charge": 787500.00, "npi": [1023015120] } ] } ] }, { "tin": { "type": "ein", "value": "800176343" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 426260.82, "providers": [{ "billed_charge": 700800.00, "npi": [1578547667] } ] } ] }, { "tin": { "type": "ein", "value": "460826192" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 661514.59, "providers": [{ "billed_charge": 1364000.00, "npi": [1689098790] } ] } ] }, { "tin": { "type": "ein", "value": "850520285" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19000.00, "providers": [{ "billed_charge": 61046.43, "npi": [1285258640] } ] } ] }, { "tin": { "type": "ein", "value": "731726290" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 171000.00, "providers": [{ "billed_charge": 427500.00, "npi": [1861598633] } ] } ] }, { "tin": { "type": "ein", "value": "352565165" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38000.00, "providers": [{ "billed_charge": 122092.86, "npi": [1740791748] } ] } ] }, { "tin": { "type": "ein", "value": "800940225" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 182194.57, "providers": [{ "billed_charge": 350213.73, "npi": [1215354899] } ] } ] }, { "tin": { "type": "ein", "value": "621864265" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 456000.00, "providers": [{ "billed_charge": 1140000.00, "npi": [1598764359] } ] } ] }, { "tin": { "type": "ein", "value": "921353734" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28000.00, "providers": [{ "billed_charge": 140000.00, "npi": [1104538461] } ] } ] }, { "tin": { "type": "ein", "value": "621864266" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 174000.00, "providers": [{ "billed_charge": 435000.00, "npi": [1730187568] } ] } ] } ] }, { "name": "DETOX/2 BED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "126", "description": "ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471323448" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30210.00, "providers": [{ "billed_charge": 30210.00, "npi": [1922408517] } ] } ] }, { "tin": { "type": "ein", "value": "825128901" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20625.00, "providers": [{ "billed_charge": 171435.00, "npi": [1740771195] } ] } ] } ] }, { "name": "ANESTH, LENS SURGERY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "142", "description": "ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "412931896" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 2182.68, "providers": [{ "billed_charge": 2700.00, "npi": [1134129000] } ] } ] }, { "tin": { "type": "ein", "value": "260507982" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.63, "providers": [{ "billed_charge": 770.00, "npi": [1477131753] } ] } ] }, { "tin": { "type": "ein", "value": "261608087" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 5720.00, "providers": [{ "billed_charge": 10375.00, "npi": [1033261714] } ] } ] } ] }, { "name": "NURSERY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "170", "description": "NURSERY -GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 95312.55, "providers": [{ "billed_charge": 34888.00, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3011.50, "providers": [{ "billed_charge": 2408.00, "npi": [1528027786] } ] } ] } ] }, { "name": "NURSERY/LEVEL II", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "172", "description": "NURSERY -NEWBORN - LEVEL II", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742577746" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39000.00, "providers": [{ "billed_charge": 285436.80, "npi": [1124796081] } ] } ] } ] }, { "name": "INTENSIVE CARE OR ICU", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "200", "description": "INTENSIVE CARE - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741166904" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 54606.52, "providers": [{ "billed_charge": 33602.04, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4820.10, "providers": [{ "billed_charge": 4645.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1570559.77, "providers": [{ "billed_charge": 893912.00, "npi": [1730132234] } ] }, { "allowed_amount": 1041177.44, "providers": [{ "billed_charge": 664325.00, "npi": [1982666111] } ] }, { "allowed_amount": 328626.09, "providers": [{ "billed_charge": 188192.00, "npi": [1740233782] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 88633.71, "providers": [{ "billed_charge": 134757.00, "npi": [1679578439] } ] } ] } ] }, { "name": "ICU/MEDICAL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "202", "description": "INTENSIVE CARE - MEDICAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 54423.39, "providers": [{ "billed_charge": 48257.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 287283.38, "providers": [{ "billed_charge": 193028.00, "npi": [1891789772] } ] } ] } ] }, { "name": "POST ICU", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "206", "description": "INTENSIVE CARE - POST ICU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11907.86, "providers": [{ "billed_charge": 2841.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 349810.35, "providers": [{ "billed_charge": 114330.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 78859.33, "providers": [{ "billed_charge": 16326.84, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 194009.50, "providers": [{ "billed_charge": 66565.92, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 401768.24, "providers": [{ "billed_charge": 132153.09, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 65437.30, "providers": [{ "billed_charge": 26260.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 272133.20, "providers": [{ "billed_charge": 110502.69, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 110808.62, "providers": [{ "billed_charge": 76610.00, "npi": [1033165501] } ] }, { "allowed_amount": 69587.78, "providers": [{ "billed_charge": 34126.00, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 844411.48, "providers": [{ "billed_charge": 205251.25, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 169511.80, "providers": [{ "billed_charge": 87182.52, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 567120.85, "providers": [{ "billed_charge": 592810.35, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 122321.38, "providers": [{ "billed_charge": 80665.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 89737.68, "providers": [{ "billed_charge": 46452.00, "npi": [1740233782] } ] }, { "allowed_amount": 90909.77, "providers": [{ "billed_charge": 76538.00, "npi": [1932152337] } ] }, { "allowed_amount": 1911367.47, "providers": [{ "billed_charge": 1242329.00, "npi": [1982666111] } ] }, { "allowed_amount": 119515.85, "providers": [{ "billed_charge": 76780.00, "npi": [1295843787] } ] }, { "allowed_amount": 1497458.51, "providers": [{ "billed_charge": 1051853.00, "npi": [1730132234] } ] } ] } ] }, { "name": "POST CCU", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "214", "description": "CORONARY CARE - POST-CCU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 649929.99, "providers": [{ "billed_charge": 186945.00, "npi": [1205900370] } ] } ] } ] }, { "name": "PHARMACY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "250", "description": "PHARMACY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208737126" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.54, "providers": [{ "billed_charge": 3269.05, "npi": [1104086941] } ] } ] }, { "tin": { "type": "ein", "value": "510570864" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.44, "providers": [{ "billed_charge": 4221.85, "npi": [1255579389] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 434.86, "providers": [{ "billed_charge": 55960.90, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "720411322" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 182.32, "providers": [{ "billed_charge": 607.73, "npi": [1548796378] } ] } ] }, { "tin": { "type": "ein", "value": "922766125" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.88, "providers": [{ "billed_charge": 5784.73, "npi": [1255012779] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "12", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13938.68, "providers": [{ "billed_charge": 24032.20, "npi": [1194743013] } ] }, { "allowed_amount": 8004.75, "providers": [{ "billed_charge": 13801.30, "npi": [1720480627] } ] }, { "allowed_amount": 18895.48, "providers": [{ "billed_charge": 32578.40, "npi": [1720480627] } ] }, { "allowed_amount": 16238.50, "providers": [{ "billed_charge": 27997.40, "npi": [1720480627] } ] }, { "allowed_amount": 32929.85, "providers": [{ "billed_charge": 157008.20, "npi": [1194743013] } ] }, { "allowed_amount": 246.94, "providers": [{ "billed_charge": 425.75, "npi": [1194743013] } ] }, { "allowed_amount": 22919.44, "providers": [{ "billed_charge": 39516.20, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "393782106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.67, "providers": [{ "billed_charge": 16649.82, "npi": [1124983002] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 766.92, "providers": [{ "billed_charge": 6772.17, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 190.82, "providers": [{ "billed_charge": 1284.23, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.16, "providers": [{ "billed_charge": 11050.50, "npi": [1295843787] } ] }, { "allowed_amount": 0.88, "providers": [{ "billed_charge": 12650.00, "npi": [1982666111] } ] }, { "allowed_amount": 1.21, "providers": [{ "billed_charge": 32981.73, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "932775366" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.05, "providers": [{ "billed_charge": 12487.54, "npi": [1518822485] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.04, "providers": [{ "billed_charge": 20.10, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "923094590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 3291.35, "npi": [1477234995] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 109.60, "providers": [{ "billed_charge": 13802.98, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "752312009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30.95, "providers": [{ "billed_charge": 99.00, "npi": [1225038938] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 51.06, "providers": [{ "billed_charge": 26744.00, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53.37, "providers": [{ "billed_charge": 385.22, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "922950626" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16.28, "providers": [{ "billed_charge": 12863.55, "npi": [1992486419] } ] } ] }, { "tin": { "type": "ein", "value": "394604245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.05, "providers": [{ "billed_charge": 436.82, "npi": [1699649400] } ] } ] }, { "tin": { "type": "ein", "value": "852354189" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 347.84, "providers": [{ "billed_charge": 6105.74, "npi": [1215609896] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 476.08, "providers": [{ "billed_charge": 1223.60, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "881723756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.03, "providers": [{ "billed_charge": 105470.34, "npi": [1689319501] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3473.33, "providers": [{ "billed_charge": 29529.00, "npi": [1891765178] } ] }, { "allowed_amount": 3275.36, "providers": [{ "billed_charge": 58574.43, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "393916039" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.04, "providers": [{ "billed_charge": 4633.15, "npi": [1699653279] } ] } ] }, { "tin": { "type": "ein", "value": "832040784" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.02, "providers": [{ "billed_charge": 7041.93, "npi": [1366917528] } ] } ] }, { "tin": { "type": "ein", "value": "824314476" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 597.23, "providers": [{ "billed_charge": 45801.36, "npi": [1467930420] } ] } ] }, { "tin": { "type": "ein", "value": "311439334" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.38, "providers": [{ "billed_charge": 24.60, "npi": [1417037045] } ] } ] }, { "tin": { "type": "ein", "value": "992497065" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.10, "providers": [{ "billed_charge": 12586.47, "npi": [1083444780] } ] } ] }, { "tin": { "type": "ein", "value": "452497248" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22.74, "providers": [{ "billed_charge": 35.00, "npi": [1639422504] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59.11, "providers": [{ "billed_charge": 84361.71, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "832041336" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.89, "providers": [{ "billed_charge": 11650.41, "npi": [1245705417] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.30, "providers": [{ "billed_charge": 35546.87, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "992762070" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.56, "providers": [{ "billed_charge": 15208.49, "npi": [1124865126] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72.54, "providers": [{ "billed_charge": 84225.73, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1728.24, "providers": [{ "billed_charge": 1904.08, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "760714523" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20.80, "providers": [{ "billed_charge": 32.00, "npi": [1598744856] } ] } ] }, { "tin": { "type": "ein", "value": "383813467" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.84, "providers": [{ "billed_charge": 12018.33, "npi": [1497053912] } ] } ] }, { "tin": { "type": "ein", "value": "393793693" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.15, "providers": [{ "billed_charge": 4221.91, "npi": [1205791183] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 823.57, "providers": [{ "billed_charge": 158654.92, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 486.10, "providers": [{ "billed_charge": 170792.55, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 888.99, "providers": [{ "billed_charge": 38472.53, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.37, "providers": [{ "billed_charge": 22822.92, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "810232122" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.17, "providers": [{ "billed_charge": 10.57, "npi": [1881650737] } ] } ] }, { "tin": { "type": "ein", "value": "832040998" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.59, "providers": [{ "billed_charge": 11503.02, "npi": [1083189245] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.50, "providers": [{ "billed_charge": 511.65, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 334.21, "providers": [{ "billed_charge": 146938.06, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.14, "providers": [{ "billed_charge": 68072.75, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "320579508" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.14, "providers": [{ "billed_charge": 12204.82, "npi": [1790250959] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 899.05, "providers": [{ "billed_charge": 2435.02, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "460962386" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 141.87, "providers": [{ "billed_charge": 10077.05, "npi": [1275957508] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 80.69, "providers": [{ "billed_charge": 7922.38, "npi": [1447883301] } ] } ] }, { "tin": { "type": "ein", "value": "922858146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 12703.05, "npi": [1184305609] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38.88, "providers": [{ "billed_charge": 117.08, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "921924347" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.07, "providers": [{ "billed_charge": 501.56, "npi": [1639875750] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1069.18, "providers": [{ "billed_charge": 96337.09, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 83.47, "providers": [{ "billed_charge": 48718.88, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.03, "providers": [{ "billed_charge": 10725.56, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "992496750" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.10, "providers": [{ "billed_charge": 21037.95, "npi": [1811727514] } ] } ] }, { "tin": { "type": "ein", "value": "832041052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13.57, "providers": [{ "billed_charge": 13883.32, "npi": [1255806410] } ] } ] } ] }, { "name": "DRUGS/GENERIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "251", "description": "PHARMACY - GENERIC DRUGS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 48.82, "providers": [{ "billed_charge": 8458.40, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "844983621" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.08, "providers": [{ "billed_charge": 3811.05, "npi": [1780297598] } ] } ] }, { "tin": { "type": "ein", "value": "611780130" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.03, "providers": [{ "billed_charge": 3658.61, "npi": [1356893531] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57.46, "providers": [{ "billed_charge": 52725.14, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.49, "providers": [{ "billed_charge": 1208.71, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "822174187" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 79.45, "npi": [1811475346] } ] } ] } ] }, { "name": "DRUGS/NONGENERIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "252", "description": "PHARMACY - NON-GENERIC DRUGS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.33, "providers": [{ "billed_charge": 27551.88, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "392717734" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.04, "providers": [{ "billed_charge": 6771.97, "npi": [1093604662] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31.14, "providers": [{ "billed_charge": 93123.42, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29.87, "providers": [{ "billed_charge": 77292.52, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21.79, "providers": [{ "billed_charge": 17376.51, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "873083628" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.91, "providers": [{ "billed_charge": 6985.68, "npi": [1013670132] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3619.75, "providers": [{ "billed_charge": 7399.50, "npi": [1689629941] } ] }, { "allowed_amount": 706.61, "providers": [{ "billed_charge": 8424.25, "npi": [1033165501] } ] }, { "allowed_amount": 337.85, "providers": [{ "billed_charge": 5008.50, "npi": [1528027786] } ] }, { "allowed_amount": 54.74, "providers": [{ "billed_charge": 7236.75, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.08, "providers": [{ "billed_charge": 6863.28, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.24, "providers": [{ "billed_charge": 15632.08, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "992545052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.34, "providers": [{ "billed_charge": 16778.00, "npi": [1619760907] } ] } ] }, { "tin": { "type": "ein", "value": "863189225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.71, "providers": [{ "billed_charge": 5548.82, "npi": [1194484345] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34.73, "providers": [{ "billed_charge": 31694.58, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "760431829" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22.11, "providers": [{ "billed_charge": 14817.67, "npi": [1104199017] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29.95, "providers": [{ "billed_charge": 44713.31, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "934295804" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.63, "providers": [{ "billed_charge": 8735.33, "npi": [1851165013] } ] } ] }, { "tin": { "type": "ein", "value": "333807317" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.55, "providers": [{ "billed_charge": 8002.39, "npi": [1083586747] } ] } ] }, { "tin": { "type": "ein", "value": "473344271" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13.59, "providers": [{ "billed_charge": 10170.85, "npi": [1003280629] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.04, "providers": [{ "billed_charge": 36202.97, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22.69, "providers": [{ "billed_charge": 17624.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32.29, "providers": [{ "billed_charge": 6334.19, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.61, "providers": [{ "billed_charge": 35270.59, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.73, "providers": [{ "billed_charge": 16524.65, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "995017291" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31.85, "providers": [{ "billed_charge": 11948.00, "npi": [1851112098] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 398.62, "providers": [{ "billed_charge": 330180.30, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "333466645" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.55, "providers": [{ "billed_charge": 2558.04, "npi": [1639975758] } ] } ] }, { "tin": { "type": "ein", "value": "871528012" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.59, "providers": [{ "billed_charge": 17290.71, "npi": [1912677295] } ] } ] } ] }, { "name": "DRUGS/INCIDNT RAD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "255", "description": "PHARMACY - DRUGS INCIDENT TO RADIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 102.54, "providers": [{ "billed_charge": 902.00, "npi": [1952306672] } ] } ] } ] }, { "name": "IV SOLUTIONS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "258", "description": "PHARMACY - IV SOLUTIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "881716225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.82, "providers": [{ "billed_charge": 2222.11, "npi": [1053175794] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 122.84, "providers": [{ "billed_charge": 152480.44, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 217.38, "providers": [{ "billed_charge": 341724.09, "npi": [1265124986] } ] } ] } ] }, { "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": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.00, "providers": [{ "billed_charge": 79312.20, "npi": [1629828405] } ] }, { "allowed_amount": 63.59, "providers": [{ "billed_charge": 256842.00, "npi": [1497871628] } ] }, { "allowed_amount": 18.47, "providers": [{ "billed_charge": 107423.20, "npi": [1184179194] } ] }, { "allowed_amount": 2.14, "providers": [{ "billed_charge": 1118.50, "npi": [1083937593] } ] }, { "allowed_amount": 82.62, "providers": [{ "billed_charge": 423970.50, "npi": [1083937593] } ] }, { "allowed_amount": 41.86, "providers": [{ "billed_charge": 317580.50, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.92, "providers": [{ "billed_charge": 5480.50, "npi": [1447883301] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 64.80, "providers": [{ "billed_charge": 331634.84, "npi": [1891789772] } ] }, { "allowed_amount": 2.55, "providers": [{ "billed_charge": 8912.50, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.82, "providers": [{ "billed_charge": 4179.09, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 94.62, "providers": [{ "billed_charge": 219118.25, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 300.31, "providers": [{ "billed_charge": 2640.39, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.84, "providers": [{ "billed_charge": 27641.22, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 164.48, "providers": [{ "billed_charge": 234.93, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.72, "providers": [{ "billed_charge": 11823.28, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27.06, "providers": [{ "billed_charge": 124238.15, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25.91, "providers": [{ "billed_charge": 66710.50, "npi": [1952723967] } ] } ] } ] }, { "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": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2365.98, "providers": [{ "billed_charge": 17178.08, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13223.80, "providers": [{ "billed_charge": 147456.00, "npi": [1992753222] } ] }, { "allowed_amount": 155.66, "providers": [{ "billed_charge": 1357.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10435.94, "providers": [{ "billed_charge": 55255.34, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "465557331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 301.34, "providers": [{ "billed_charge": 3921.14, "npi": [1194125146] } ] } ] }, { "tin": { "type": "ein", "value": "824785286" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29809.81, "providers": [{ "billed_charge": 124264.00, "npi": [1699244624] } ] }, { "allowed_amount": 2387.61, "providers": [{ "billed_charge": 4564.00, "npi": [1699244624] } ] } ] }, { "tin": { "type": "ein", "value": "922766125" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 895.51, "providers": [{ "billed_charge": 11259.50, "npi": [1255012779] } ] } ] }, { "tin": { "type": "ein", "value": "331493792" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2302.87, "providers": [{ "billed_charge": 22519.36, "npi": [1942022546] } ] } ] }, { "tin": { "type": "ein", "value": "760436439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6320.91, "providers": [{ "billed_charge": 41354.05, "npi": [1689650616] } ] } ] }, { "tin": { "type": "ein", "value": "393782106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6745.56, "providers": [{ "billed_charge": 79794.37, "npi": [1124983002] } ] } ] }, { "tin": { "type": "ein", "value": "751277293" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 643.12, "providers": [{ "billed_charge": 1748.00, "npi": [1598750721] } ] } ] }, { "tin": { "type": "ein", "value": "932775366" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5337.45, "providers": [{ "billed_charge": 51009.26, "npi": [1518822485] } ] } ] }, { "tin": { "type": "ein", "value": "851978933" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2600.44, "providers": [{ "billed_charge": 17374.74, "npi": [1265044333] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1134.89, "providers": [{ "billed_charge": 6013.00, "npi": [1477643690] } ] }, { "allowed_amount": 10991.80, "providers": [{ "billed_charge": 144794.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38199.00, "providers": [{ "billed_charge": 148325.21, "npi": [1548226988] } ] }, { "allowed_amount": 72.33, "providers": [{ "billed_charge": 1614.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 147588.64, "providers": [{ "billed_charge": 251481.00, "npi": [1205900370] } ] }, { "allowed_amount": 71.97, "providers": [{ "billed_charge": 1957.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "832329088" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4389.45, "providers": [{ "billed_charge": 31272.00, "npi": [1780436287] } ] }, { "allowed_amount": 2598.70, "providers": [{ "billed_charge": 28868.82, "npi": [1457820995] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79879.89, "providers": [{ "billed_charge": 327816.27, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 854.19, "providers": [{ "billed_charge": 1941.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.64, "providers": [{ "billed_charge": 119435.84, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "882917489" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 334.88, "providers": [{ "billed_charge": 2232.95, "npi": [1043942089] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4575.53, "providers": [{ "billed_charge": 29890.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "922950626" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1146.57, "providers": [{ "billed_charge": 28063.00, "npi": [1992486419] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4903.77, "providers": [{ "billed_charge": 35503.81, "npi": [1891765178] } ] }, { "allowed_amount": 93.62, "providers": [{ "billed_charge": 565.35, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43031.71, "providers": [{ "billed_charge": 312721.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "262978009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4164.88, "providers": [{ "billed_charge": 8667.73, "npi": [1407344880] } ] }, { "allowed_amount": 17123.34, "providers": [{ "billed_charge": 37270.14, "npi": [1407010622] } ] }, { "allowed_amount": 13249.15, "providers": [{ "billed_charge": 33298.59, "npi": [1619308319] } ] } ] }, { "tin": { "type": "ein", "value": "393916039" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2537.89, "providers": [{ "billed_charge": 20235.17, "npi": [1699653279] } ] } ] }, { "tin": { "type": "ein", "value": "882931023" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1931.63, "providers": [{ "billed_charge": 30781.23, "npi": [1740911213] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 472.18, "providers": [{ "billed_charge": 6554.00, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "741385192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 237.56, "providers": [{ "billed_charge": 3154.00, "npi": [1972581940] } ] }, { "allowed_amount": 712.82, "providers": [{ "billed_charge": 6421.00, "npi": [1972581940] } ] } ] }, { "tin": { "type": "ein", "value": "832040784" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2369.52, "providers": [{ "billed_charge": 24065.25, "npi": [1366917528] } ] } ] }, { "tin": { "type": "ein", "value": "454435955" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1592.54, "providers": [{ "billed_charge": 11965.14, "npi": [1467897447] } ] } ] }, { "tin": { "type": "ein", "value": "824314476" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14791.94, "providers": [{ "billed_charge": 172172.95, "npi": [1467930420] } ] } ] }, { "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5416.32, "providers": [{ "billed_charge": 10212.25, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26813.34, "providers": [{ "billed_charge": 301418.17, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "473248194" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1505.19, "providers": [{ "billed_charge": 26700.00, "npi": [1588111082] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46135.98, "providers": [{ "billed_charge": 164355.69, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "873083628" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 712.44, "providers": [{ "billed_charge": 6659.07, "npi": [1013670132] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4462.94, "providers": [{ "billed_charge": 40153.20, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 964.38, "providers": [{ "billed_charge": 3579.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13536.87, "providers": [{ "billed_charge": 298135.75, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "800810304" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2670.59, "providers": [{ "billed_charge": 15623.19, "npi": [1295213601] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2743.88, "providers": [{ "billed_charge": 51077.60, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "383813467" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3512.35, "providers": [{ "billed_charge": 29885.00, "npi": [1497053912] } ] } ] }, { "tin": { "type": "ein", "value": "851961472" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7068.96, "providers": [{ "billed_charge": 98505.42, "npi": [1235747304] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14932.01, "providers": [{ "billed_charge": 174875.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 162.90, "providers": [{ "billed_charge": 35762.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4772.80, "providers": [{ "billed_charge": 35921.10, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 924.96, "providers": [{ "billed_charge": 37154.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1006.41, "providers": [{ "billed_charge": 3438.98, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 223295.22, "providers": [{ "billed_charge": 580546.52, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752865177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9198.52, "providers": [{ "billed_charge": 20641.93, "npi": [1922002674] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 460.14, "providers": [{ "billed_charge": 162097.02, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 446.23, "providers": [{ "billed_charge": 84309.11, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "820756286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5883.22, "providers": [{ "billed_charge": 15767.19, "npi": [1821501875] } ] } ] }, { "tin": { "type": "ein", "value": "921924347" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10251.39, "providers": [{ "billed_charge": 88084.95, "npi": [1639875750] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27369.72, "providers": [{ "billed_charge": 296811.31, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3778.68, "providers": [{ "billed_charge": 28075.92, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14710.28, "providers": [{ "billed_charge": 155749.57, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "813351512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 199.04, "providers": [{ "billed_charge": 2092.35, "npi": [1891210639] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23523.18, "providers": [{ "billed_charge": 115894.26, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "822174187" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1371.81, "providers": [{ "billed_charge": 17611.80, "npi": [1811475346] } ] } ] }, { "tin": { "type": "ein", "value": "871528012" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5804.64, "providers": [{ "billed_charge": 34244.15, "npi": [1912677295] } ] } ] }, { "tin": { "type": "ein", "value": "880803328" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1109.10, "providers": [{ "billed_charge": 16360.74, "npi": [1467199448] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59477.97, "providers": [{ "billed_charge": 285180.00, "npi": [1497871628] } ] }, { "allowed_amount": 102951.54, "providers": [{ "billed_charge": 435615.00, "npi": [1083937593] } ] }, { "allowed_amount": 36979.48, "providers": [{ "billed_charge": 228792.00, "npi": [1184179194] } ] }, { "allowed_amount": 234.05, "providers": [{ "billed_charge": 2440.00, "npi": [1083937593] } ] }, { "allowed_amount": 26601.10, "providers": [{ "billed_charge": 149191.00, "npi": [1629828405] } ] }, { "allowed_amount": 80991.54, "providers": [{ "billed_charge": 564280.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "851931245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2309.37, "providers": [{ "billed_charge": 41956.72, "npi": [1750909974] } ] } ] }, { "tin": { "type": "ein", "value": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10698.79, "providers": [{ "billed_charge": 80360.08, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36527.34, "providers": [{ "billed_charge": 103290.68, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 335732.10, "providers": [{ "billed_charge": 926017.20, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1580.67, "providers": [{ "billed_charge": 25640.15, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "474866295" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.68, "providers": [{ "billed_charge": 291.77, "npi": [1992172019] } ] } ] }, { "tin": { "type": "ein", "value": "931617297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 367.69, "providers": [{ "billed_charge": 2507.00, "npi": [1417633736] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8285.30, "providers": [{ "billed_charge": 14285.00, "npi": [1194743013] } ] }, { "allowed_amount": 445.44, "providers": [{ "billed_charge": 768.00, "npi": [1720480627] } ] }, { "allowed_amount": 4206.16, "providers": [{ "billed_charge": 7252.00, "npi": [1720480627] } ] }, { "allowed_amount": 8542.82, "providers": [{ "billed_charge": 14729.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 301.34, "providers": [{ "billed_charge": 94515.91, "npi": [1477516466] } ] }, { "allowed_amount": 637.89, "providers": [{ "billed_charge": 4345.94, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "992545052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2815.46, "providers": [{ "billed_charge": 18600.00, "npi": [1619760907] } ] } ] }, { "tin": { "type": "ein", "value": "364755936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10670.09, "providers": [{ "billed_charge": 26883.36, "npi": [1598196206] } ] }, { "allowed_amount": 10635.63, "providers": [{ "billed_charge": 28845.49, "npi": [1679903967] } ] }, { "allowed_amount": 9200.24, "providers": [{ "billed_charge": 24551.37, "npi": [1831629526] } ] } ] }, { "tin": { "type": "ein", "value": "814928222" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4061.19, "providers": [{ "billed_charge": 57500.00, "npi": [1710417761] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 168479.17, "providers": [{ "billed_charge": 830595.75, "npi": [1295843787] } ] }, { "allowed_amount": 340.21, "providers": [{ "billed_charge": 1586.50, "npi": [1295788735] } ] }, { "allowed_amount": 91562.72, "providers": [{ "billed_charge": 490572.25, "npi": [1740233782] } ] }, { "allowed_amount": 115.15, "providers": [{ "billed_charge": 4541.00, "npi": [1932152337] } ] }, { "allowed_amount": 75320.89, "providers": [{ "billed_charge": 519011.00, "npi": [1295788735] } ] }, { "allowed_amount": 2377.51, "providers": [{ "billed_charge": 10662.75, "npi": [1740233782] } ] }, { "allowed_amount": 108841.27, "providers": [{ "billed_charge": 687971.00, "npi": [1932152337] } ] }, { "allowed_amount": 521694.75, "providers": [{ "billed_charge": 3333241.75, "npi": [1730132234] } ] }, { "allowed_amount": 1022.29, "providers": [{ "billed_charge": 11170.00, "npi": [1730132234] } ] }, { "allowed_amount": 127523.88, "providers": [{ "billed_charge": 753697.00, "npi": [1982666111] } ] }, { "allowed_amount": 830.21, "providers": [{ "billed_charge": 10324.00, "npi": [1982666111] } ] } ] }, { "tin": { "type": "ein", "value": "992078911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1838.97, "providers": [{ "billed_charge": 12713.00, "npi": [1770333403] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2775.37, "providers": [{ "billed_charge": 5860.10, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "465735510" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 132.70, "providers": [{ "billed_charge": 5000.00, "npi": [1164827093] } ] } ] }, { "tin": { "type": "ein", "value": "720502505" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 48.11, "providers": [{ "billed_charge": 76.00, "npi": [1811973100] } ] } ] }, { "tin": { "type": "ein", "value": "923094590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 578.03, "providers": [{ "billed_charge": 7958.25, "npi": [1477234995] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 843.66, "providers": [{ "billed_charge": 1829.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "922748191" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 566.74, "providers": [{ "billed_charge": 8468.00, "npi": [1811678337] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59803.64, "providers": [{ "billed_charge": 217231.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "995017291" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 331.75, "providers": [{ "billed_charge": 2694.00, "npi": [1851112098] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72868.67, "providers": [{ "billed_charge": 410037.55, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "750703337" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1234.45, "providers": [{ "billed_charge": 1564.00, "npi": [1861475626] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 93.62, "providers": [{ "billed_charge": 103.50, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1102.49, "providers": [{ "billed_charge": 10531.14, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1359.16, "providers": [{ "billed_charge": 9363.20, "npi": [1124796081] } ] }, { "allowed_amount": 13343.48, "providers": [{ "billed_charge": 52674.60, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "920323729" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2002.77, "providers": [{ "billed_charge": 103362.00, "npi": [1003539073] } ] } ] }, { "tin": { "type": "ein", "value": "832041336" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3743.09, "providers": [{ "billed_charge": 67009.75, "npi": [1245705417] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4207.93, "providers": [{ "billed_charge": 40777.70, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5548.00, "providers": [{ "billed_charge": 52777.29, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2474.09, "providers": [{ "billed_charge": 20687.81, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "472971495" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2868.29, "providers": [{ "billed_charge": 73179.75, "npi": [1659744662] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 998.41, "providers": [{ "billed_charge": 1100.00, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "882898646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2191.87, "providers": [{ "billed_charge": 30236.32, "npi": [1699406173] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69427.71, "providers": [{ "billed_charge": 578121.21, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 102201.82, "providers": [{ "billed_charge": 1090108.99, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "883464149" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4611.31, "providers": [{ "billed_charge": 36718.59, "npi": [1881322469] } ] } ] }, { "tin": { "type": "ein", "value": "844983621" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 790.81, "providers": [{ "billed_charge": 14374.16, "npi": [1780297598] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9967.18, "providers": [{ "billed_charge": 28484.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "393793693" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1036.72, "providers": [{ "billed_charge": 18160.00, "npi": [1205791183] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10317.20, "providers": [{ "billed_charge": 29963.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "472616215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1637.90, "providers": [{ "billed_charge": 17850.00, "npi": [1922468156] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41260.01, "providers": [{ "billed_charge": 206451.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3463.43, "providers": [{ "billed_charge": 25886.16, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "473637912" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 526.16, "providers": [{ "billed_charge": 11238.00, "npi": [1215449954] } ] } ] }, { "tin": { "type": "ein", "value": "934295804" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1861.29, "providers": [{ "billed_charge": 21323.24, "npi": [1851165013] } ] } ] }, { "tin": { "type": "ein", "value": "832040998" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3362.32, "providers": [{ "billed_charge": 45621.50, "npi": [1083189245] } ] } ] }, { "tin": { "type": "ein", "value": "301205721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3698.97, "providers": [{ "billed_charge": 72618.00, "npi": [1588215461] } ] } ] }, { "tin": { "type": "ein", "value": "473344271" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1513.45, "providers": [{ "billed_charge": 7166.57, "npi": [1003280629] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2127.54, "providers": [{ "billed_charge": 15269.20, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11679.62, "providers": [{ "billed_charge": 303717.37, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 430.15, "providers": [{ "billed_charge": 8506.00, "npi": [1124092036] } ] }, { "allowed_amount": 280.86, "providers": [{ "billed_charge": 971.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10137.52, "providers": [{ "billed_charge": 82038.41, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38093.28, "providers": [{ "billed_charge": 405553.24, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "320579508" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2105.36, "providers": [{ "billed_charge": 42725.25, "npi": [1790250959] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7861.01, "providers": [{ "billed_charge": 21292.00, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17926.90, "providers": [{ "billed_charge": 78653.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "460962386" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1747.89, "providers": [{ "billed_charge": 17916.25, "npi": [1275957508] } ] } ] }, { "tin": { "type": "ein", "value": "464084062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 938.46, "providers": [{ "billed_charge": 33917.89, "npi": [1669872610] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3345.28, "providers": [{ "billed_charge": 54420.42, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "922858146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2544.10, "providers": [{ "billed_charge": 35033.00, "npi": [1184305609] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 91371.34, "providers": [{ "billed_charge": 601357.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7300.19, "providers": [{ "billed_charge": 70949.10, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "882923822" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1742.37, "providers": [{ "billed_charge": 26345.12, "npi": [1770214256] } ] } ] }, { "tin": { "type": "ein", "value": "851820772" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7923.87, "providers": [{ "billed_charge": 115614.23, "npi": [1285252593] } ] } ] }, { "tin": { "type": "ein", "value": "832041052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5749.77, "providers": [{ "billed_charge": 60525.75, "npi": [1255806410] } ] } ] } ] }, { "name": "INFUSION PUMP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "261", "description": "IV THERAPY - INFUSION PUMP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4500.79, "providers": [{ "billed_charge": 23972.14, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1059.51, "providers": [{ "billed_charge": 7588.11, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "934295804" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2206.80, "providers": [{ "billed_charge": 24998.96, "npi": [1851165013] } ] } ] }, { "tin": { "type": "ein", "value": "333807317" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 199.05, "providers": [{ "billed_charge": 7694.17, "npi": [1083586747] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5676.80, "providers": [{ "billed_charge": 26341.88, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "473344271" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1943.04, "providers": [{ "billed_charge": 7521.75, "npi": [1003280629] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3893.06, "providers": [{ "billed_charge": 11837.93, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18098.42, "providers": [{ "billed_charge": 118864.77, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 551.64, "providers": [{ "billed_charge": 4960.76, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6385.91, "providers": [{ "billed_charge": 33091.88, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3118.12, "providers": [{ "billed_charge": 15005.70, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3339.56, "providers": [{ "billed_charge": 21200.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8856.51, "providers": [{ "billed_charge": 40205.49, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2001.56, "providers": [{ "billed_charge": 17291.48, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13541.87, "providers": [{ "billed_charge": 77147.23, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "844983621" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5489.36, "providers": [{ "billed_charge": 40550.35, "npi": [1780297598] } ] } ] }, { "tin": { "type": "ein", "value": "611780130" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1899.08, "providers": [{ "billed_charge": 17406.02, "npi": [1356893531] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12586.74, "providers": [{ "billed_charge": 97876.59, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4749.06, "providers": [{ "billed_charge": 25251.61, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 37776.57, "providers": [{ "billed_charge": 211845.17, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1419.92, "providers": [{ "billed_charge": 8205.45, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1841.58, "providers": [{ "billed_charge": 10629.74, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "822174187" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 852.98, "providers": [{ "billed_charge": 4012.32, "npi": [1811475346] } ] } ] }, { "tin": { "type": "ein", "value": "851978933" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 569.87, "providers": [{ "billed_charge": 1779.90, "npi": [1265044333] } ] } ] } ] }, { "name": "IV THER/PHARM/SERV", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "262", "description": "IV THERAPY - IV THERAPY/PHARMACY SRVCS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "465557331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1369.30, "providers": [{ "billed_charge": 10579.63, "npi": [1194125146] } ] } ] } ] }, { "name": "IV THER/DRUGS/SUPPLY DELV", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "263", "description": "IV THERAPY - DRUG/SUPPLY DELV", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760431829" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 507.13, "providers": [{ "billed_charge": 4538.00, "npi": [1104199017] } ] } ] } ] }, { "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": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 101.06, "providers": [{ "billed_charge": 2336.67, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 458.64, "providers": [{ "billed_charge": 2859.49, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 145.80, "providers": [{ "billed_charge": 3095.13, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 312.75, "providers": [{ "billed_charge": 4234.05, "npi": [1679976120] } ] } ] } ] }, { "name": "NON-STER SUPPLY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "271", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 251.24, "providers": [{ "billed_charge": 680.55, "npi": [1114435260] } ] } ] } ] }, { "name": "STERILE SUPPLY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "272", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 557.86, "providers": [{ "billed_charge": 3592.14, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 235.11, "providers": [{ "billed_charge": 2107.63, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 190.75, "providers": [{ "billed_charge": 516.52, "npi": [1114435260] } ] } ] } ] }, { "name": "PROSTHETIC DEV", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "274", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC DEVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 195.74, "providers": [{ "billed_charge": 89.00, "npi": [1336172105] } ] } ] } ] }, { "name": "SUPPLY/IMPLANTS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "278", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 607.30, "providers": [{ "billed_charge": 5394.85, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.56, "providers": [{ "billed_charge": 74.80, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.51, "providers": [{ "billed_charge": 209.44, "npi": [1952306672] } ] } ] } ] }, { "name": "LABORATORY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "300", "description": "LABORATORY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208737126" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 369.88, "providers": [{ "billed_charge": 24050.18, "npi": [1104086941] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.02, "providers": [{ "billed_charge": 186.00, "npi": [1992753222] } ] }, { "allowed_amount": 682.11, "providers": [{ "billed_charge": 77854.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "933189938" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 316.32, "providers": [{ "billed_charge": 14706.76, "npi": [1083488829] } ] } ] }, { "tin": { "type": "ein", "value": "465557331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 533.90, "providers": [{ "billed_charge": 39211.93, "npi": [1194125146] } ] } ] }, { "tin": { "type": "ein", "value": "824785286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3907.00, "providers": [{ "billed_charge": 473503.00, "npi": [1699244624] } ] } ] }, { "tin": { "type": "ein", "value": "470484764" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 711.46, "providers": [{ "billed_charge": 3627.00, "npi": [1508941097] } ] } ] }, { "tin": { "type": "ein", "value": "426004813" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 681.67, "providers": [{ "billed_charge": 1174.00, "npi": [1376544320] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29.26, "providers": [{ "billed_charge": 330.00, "npi": [1033165501] } ] }, { "allowed_amount": 14.02, "providers": [{ "billed_charge": 266421.00, "npi": [1033165501] } ] }, { "allowed_amount": 20.74, "providers": [{ "billed_charge": 191095.00, "npi": [1275592131] } ] }, { "allowed_amount": 14.60, "providers": [{ "billed_charge": 223445.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "750755367" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 81.54, "providers": [{ "billed_charge": 43941.34, "npi": [1396746129] } ] } ] }, { "tin": { "type": "ein", "value": "331493792" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1283.70, "providers": [{ "billed_charge": 27596.40, "npi": [1942022546] } ] } ] }, { "tin": { "type": "ein", "value": "760436439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 514.78, "providers": [{ "billed_charge": 144922.26, "npi": [1689650616] } ] } ] }, { "tin": { "type": "ein", "value": "393782106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1531.94, "providers": [{ "billed_charge": 24785.23, "npi": [1124983002] } ] } ] }, { "tin": { "type": "ein", "value": "932775366" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 948.96, "providers": [{ "billed_charge": 41422.79, "npi": [1518822485] } ] } ] }, { "tin": { "type": "ein", "value": "844755191" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 105.44, "providers": [{ "billed_charge": 12437.00, "npi": [1437750163] } ] } ] }, { "tin": { "type": "ein", "value": "851978933" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.60, "providers": [{ "billed_charge": 71406.29, "npi": [1265044333] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2792.72, "providers": [{ "billed_charge": 43012.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 441.54, "providers": [{ "billed_charge": 2482.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11705.53, "providers": [{ "billed_charge": 1607986.00, "npi": [1205900370] } ] }, { "allowed_amount": 623.32, "providers": [{ "billed_charge": 15279.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "832329088" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.66, "providers": [{ "billed_charge": 6651.51, "npi": [1457820995] } ] }, { "allowed_amount": 163.23, "providers": [{ "billed_charge": 14046.44, "npi": [1780436287] } ] } ] }, { "tin": { "type": "ein", "value": "843178470" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 200.86, "providers": [{ "billed_charge": 694.00, "npi": [1861028268] } ] } ] }, { "tin": { "type": "ein", "value": "752312009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 469.59, "providers": [{ "billed_charge": 1502.00, "npi": [1225038938] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 313.74, "providers": [{ "billed_charge": 3552.57, "npi": [1629089966] } ] }, { "allowed_amount": 13007.97, "providers": [{ "billed_charge": 43963.74, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "882917489" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47.20, "providers": [{ "billed_charge": 29815.43, "npi": [1043942089] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24.10, "providers": [{ "billed_charge": 1884.00, "npi": [1164526786] }, { "billed_charge": 48495.50, "npi": [1619115383] } ] }, { "allowed_amount": 31.17, "providers": [{ "billed_charge": 37964.50, "npi": [1578780870] } ] } ] }, { "tin": { "type": "ein", "value": "393916039" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47.20, "providers": [{ "billed_charge": 38008.83, "npi": [1699653279] } ] } ] }, { "tin": { "type": "ein", "value": "262978009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1739.35, "providers": [{ "billed_charge": 105678.77, "npi": [1407010622] } ] }, { "allowed_amount": 2259.33, "providers": [{ "billed_charge": 63830.42, "npi": [1619308319] } ] }, { "allowed_amount": 1184.59, "providers": [{ "billed_charge": 44320.02, "npi": [1407344880] } ] } ] }, { "tin": { "type": "ein", "value": "233069260" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 192.55, "providers": [{ "billed_charge": 12854.00, "npi": [1770573586] } ] } ] }, { "tin": { "type": "ein", "value": "741385192" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 74.93, "providers": [{ "billed_charge": 1783.05, "npi": [1972581940] } ] } ] }, { "tin": { "type": "ein", "value": "871585575" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 105.44, "providers": [{ "billed_charge": 9421.98, "npi": [1619549474] } ] } ] }, { "tin": { "type": "ein", "value": "454435955" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1130.70, "providers": [{ "billed_charge": 102149.19, "npi": [1467897447] } ] } ] }, { "tin": { "type": "ein", "value": "736061037" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 76.78, "providers": [{ "billed_charge": 455.91, "npi": [1720022379] } ] } ] }, { "tin": { "type": "ein", "value": "752796815" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 192.46, "providers": [{ "billed_charge": 18623.00, "npi": [1295736734] } ] } ] }, { "tin": { "type": "ein", "value": "824314476" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 590.12, "providers": [{ "billed_charge": 189892.03, "npi": [1467930420] } ] } ] }, { "tin": { "type": "ein", "value": "934242663" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 34754.52, "npi": [1740054436] } ] } ] }, { "tin": { "type": "ein", "value": "752663904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 244.16, "providers": [{ "billed_charge": 447.00, "npi": [1578547345] } ] } ] }, { "tin": { "type": "ein", "value": "852007987" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 111.90, "providers": [{ "billed_charge": 18633.72, "npi": [1144838947] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.52, "providers": [{ "billed_charge": 254577.95, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "813334196" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 691.95, "providers": [{ "billed_charge": 79463.08, "npi": [1013499383] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1141.04, "providers": [{ "billed_charge": 21730.10, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1126.63, "providers": [{ "billed_charge": 210094.92, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20.53, "providers": [{ "billed_charge": 101.00, "npi": [1003192311] } ] }, { "allowed_amount": 254.40, "providers": [{ "billed_charge": 6008.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "750827446" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1319.82, "providers": [{ "billed_charge": 216264.61, "npi": [1528064649] } ] }, { "allowed_amount": 24.92, "providers": [{ "billed_charge": 1016.99, "npi": [1528064649] } ] } ] }, { "tin": { "type": "ein", "value": "800810304" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1464.09, "providers": [{ "billed_charge": 152528.31, "npi": [1295213601] } ] } ] }, { "tin": { "type": "ein", "value": "871558323" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 111.34, "providers": [{ "billed_charge": 21216.07, "npi": [1063084820] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22.37, "providers": [{ "billed_charge": 1978.48, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "383813467" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24.02, "providers": [{ "billed_charge": 72512.73, "npi": [1497053912] } ] } ] }, { "tin": { "type": "ein", "value": "751300105" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7593.40, "providers": [{ "billed_charge": 7877.99, "npi": [1679560866] } ] } ] }, { "tin": { "type": "ein", "value": "851961472" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 135.50, "providers": [{ "billed_charge": 74836.24, "npi": [1235747304] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 88.50, "providers": [{ "billed_charge": 218395.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "752301801" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4082.57, "providers": [{ "billed_charge": 5132.13, "npi": [1831170273] } ] } ] }, { "tin": { "type": "ein", "value": "646008520" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 306.89, "providers": [{ "billed_charge": 727.00, "npi": [1154317527] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1557.54, "providers": [{ "billed_charge": 7435.00, "npi": [1598749707] } ] }, { "allowed_amount": 16366.08, "providers": [{ "billed_charge": 234175.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7087.10, "providers": [{ "billed_charge": 1017255.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 717.82, "providers": [{ "billed_charge": 14941.75, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "882394440" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.86, "providers": [{ "billed_charge": 27690.66, "npi": [1396429700] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 156.39, "providers": [{ "billed_charge": 189.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 462886.35, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752865177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 882.56, "providers": [{ "billed_charge": 7783.79, "npi": [1922002674] } ] } ] }, { "tin": { "type": "ein", "value": "331929227" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.83, "providers": [{ "billed_charge": 16892.66, "npi": [1144112129] } ] } ] }, { "tin": { "type": "ein", "value": "820756286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41.30, "providers": [{ "billed_charge": 29769.23, "npi": [1821501875] } ] } ] }, { "tin": { "type": "ein", "value": "921924347" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41.30, "providers": [{ "billed_charge": 7037.36, "npi": [1639875750] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 153.40, "providers": [{ "billed_charge": 237421.21, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 94.40, "providers": [{ "billed_charge": 139268.65, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "813351512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35.40, "providers": [{ "billed_charge": 66438.91, "npi": [1891210639] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 85.74, "providers": [{ "billed_charge": 202166.19, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "452663071" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6642.35, "providers": [{ "billed_charge": 10219.00, "npi": [1184911877] } ] } ] }, { "tin": { "type": "ein", "value": "880803328" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 641.85, "providers": [{ "billed_charge": 18266.90, "npi": [1467199448] } ] } ] }, { "tin": { "type": "ein", "value": "824540200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 18350.00, "npi": [1124669262] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 133.00, "providers": [{ "billed_charge": 495.00, "npi": [1083937593] } ] }, { "allowed_amount": 130.87, "providers": [{ "billed_charge": 495.00, "npi": [1497871628] } ] } ] }, { "tin": { "type": "ein", "value": "851931245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 106.00, "providers": [{ "billed_charge": 91008.24, "npi": [1750909974] } ] } ] }, { "tin": { "type": "ein", "value": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 708.75, "providers": [{ "billed_charge": 135910.60, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "510570864" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1226.60, "providers": [{ "billed_charge": 65383.00, "npi": [1255579389] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.23, "providers": [{ "billed_charge": 20128.25, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "813562144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 254.54, "providers": [{ "billed_charge": 144193.17, "npi": [1639663370] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3582.96, "providers": [{ "billed_charge": 102968.00, "npi": [1689641680] } ] }, { "allowed_amount": 191.18, "providers": [{ "billed_charge": 2028.00, "npi": [1447228747] } ] }, { "allowed_amount": 681.83, "providers": [{ "billed_charge": 14468.00, "npi": [1093783391] } ] }, { "allowed_amount": 286.77, "providers": [{ "billed_charge": 11907.00, "npi": [1003885641] } ] } ] }, { "tin": { "type": "ein", "value": "474866295" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 485.10, "providers": [{ "billed_charge": 41784.45, "npi": [1992172019] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "12", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 37.12, "providers": [{ "billed_charge": 64.00, "npi": [1194743013, 1720480627] } ] }, { "allowed_amount": 259.84, "providers": [{ "billed_charge": 448.00, "npi": [1720480627] } ] }, { "allowed_amount": 2075.24, "providers": [{ "billed_charge": 3578.00, "npi": [1720480627] } ] }, { "allowed_amount": 1126.36, "providers": [{ "billed_charge": 2446.00, "npi": [1194743013] } ] }, { "allowed_amount": 2532.28, "providers": [{ "billed_charge": 4366.00, "npi": [1194743013] } ] }, { "allowed_amount": 928.00, "providers": [{ "billed_charge": 1600.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 110.88, "providers": [{ "billed_charge": 2256.28, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 580.73, "providers": [{ "billed_charge": 41446.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "364755936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2321.60, "providers": [{ "billed_charge": 79479.92, "npi": [1598196206] } ] }, { "allowed_amount": 3318.15, "providers": [{ "billed_charge": 91930.29, "npi": [1679903967] } ] }, { "allowed_amount": 2065.96, "providers": [{ "billed_charge": 48147.90, "npi": [1831629526] } ] } ] }, { "tin": { "type": "ein", "value": "851778208" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 550.79, "providers": [{ "billed_charge": 95655.92, "npi": [1366056194] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10437.67, "providers": [{ "billed_charge": 93867.15, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6404.26, "providers": [{ "billed_charge": 37764.00, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "741282696" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1075.79, "providers": [{ "billed_charge": 2103.00, "npi": [1154317774] } ] } ] }, { "tin": { "type": "ein", "value": "814928222" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 373.72, "providers": [{ "billed_charge": 127500.00, "npi": [1710417761] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1719.93, "providers": [{ "billed_charge": 187101.75, "npi": [1730132234] } ] }, { "allowed_amount": 1280.87, "providers": [{ "billed_charge": 113045.25, "npi": [1982666111] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 268.25, "providers": [{ "billed_charge": 1233.57, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "352644167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 58.90, "providers": [{ "billed_charge": 953.91, "npi": [1801364450] } ] } ] }, { "tin": { "type": "ein", "value": "720502505" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1404.44, "providers": [{ "billed_charge": 3242.00, "npi": [1811973100] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 772.52, "providers": [{ "billed_charge": 5452.30, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "621867232" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.38, "providers": [{ "billed_charge": 691.00, "npi": [1093791170] } ] } ] }, { "tin": { "type": "ein", "value": "821550918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3887.13, "providers": [{ "billed_charge": 4619.46, "npi": [1730183658] } ] } ] }, { "tin": { "type": "ein", "value": "752829613" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 75.96, "providers": [{ "billed_charge": 409.00, "npi": [1386647717] } ] } ] }, { "tin": { "type": "ein", "value": "410991680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1233.51, "providers": [{ "billed_charge": 3498.00, "npi": [1013994359] } ] } ] }, { "tin": { "type": "ein", "value": "881716225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 390.75, "providers": [{ "billed_charge": 53159.18, "npi": [1053175794] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 833.56, "providers": [{ "billed_charge": 31635.25, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.86, "providers": [{ "billed_charge": 145801.51, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "720535375" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1200.51, "providers": [{ "billed_charge": 3050.00, "npi": [1275536799] } ] } ] }, { "tin": { "type": "ein", "value": "452497248" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 945.39, "providers": [{ "billed_charge": 1454.45, "npi": [1841844735] } ] } ] }, { "tin": { "type": "ein", "value": "920323729" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 490.64, "providers": [{ "billed_charge": 231723.00, "npi": [1003539073] } ] } ] }, { "tin": { "type": "ein", "value": "462605366" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 45.96, "providers": [{ "billed_charge": 182.00, "npi": [1306281126] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53.10, "providers": [{ "billed_charge": 145549.01, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "992762070" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 159.00, "providers": [{ "billed_charge": 25765.34, "npi": [1124865126] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2206.52, "providers": [{ "billed_charge": 2931.00, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "882898646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 62.83, "providers": [{ "billed_charge": 26577.01, "npi": [1699406173] } ] } ] }, { "tin": { "type": "ein", "value": "472971495" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 129.30, "providers": [{ "billed_charge": 50997.36, "npi": [1659744662] } ] } ] }, { "tin": { "type": "ein", "value": "760714523" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 93772.25, "providers": [{ "billed_charge": 144414.00, "npi": [1598744856] } ] }, { "allowed_amount": 17940.65, "providers": [{ "billed_charge": 27601.00, "npi": [1598744856] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 40.18, "providers": [{ "billed_charge": 2607.88, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6913.34, "providers": [{ "billed_charge": 2150885.99, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "814974144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 471.26, "providers": [{ "billed_charge": 10402.79, "npi": [1982113601] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19766.25, "providers": [{ "billed_charge": 4507350.71, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "393793693" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 534.22, "providers": [{ "billed_charge": 5991.25, "npi": [1205791183] } ] } ] }, { "tin": { "type": "ein", "value": "756001193" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 204.28, "providers": [{ "billed_charge": 896.00, "npi": [1720096019] } ] } ] }, { "tin": { "type": "ein", "value": "453780407" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 119.15, "providers": [{ "billed_charge": 331.00, "npi": [1407121189] } ] } ] }, { "tin": { "type": "ein", "value": "751584559" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 604.33, "providers": [{ "billed_charge": 3275.00, "npi": [1255325817] } ] } ] }, { "tin": { "type": "ein", "value": "472616215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 126.07, "providers": [{ "billed_charge": 56175.00, "npi": [1922468156] } ] } ] }, { "tin": { "type": "ein", "value": "866007596" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3309.33, "providers": [{ "billed_charge": 5471.00, "npi": [1194706655] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 417.76, "providers": [{ "billed_charge": 256042.40, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "756003896" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 208.97, "providers": [{ "billed_charge": 965.00, "npi": [1275581852] } ] } ] }, { "tin": { "type": "ein", "value": "472166397" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 40400.00, "npi": [1093191397] } ] } ] }, { "tin": { "type": "ein", "value": "452662980" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8078.85, "providers": [{ "billed_charge": 12429.00, "npi": [1154618742] } ] }, { "allowed_amount": 19780.15, "providers": [{ "billed_charge": 30431.00, "npi": [1154618742] } ] } ] }, { "tin": { "type": "ein", "value": "473637912" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 68.11, "providers": [{ "billed_charge": 48049.00, "npi": [1215449954] } ] } ] }, { "tin": { "type": "ein", "value": "301205721" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1226.60, "providers": [{ "billed_charge": 253521.00, "npi": [1588215461] } ] }, { "allowed_amount": 142.63, "providers": [{ "billed_charge": 357.00, "npi": [1588215461] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1008.10, "providers": [{ "billed_charge": 331629.74, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.29, "providers": [{ "billed_charge": 8004.00, "npi": [1124092036] } ] }, { "allowed_amount": 13097.17, "providers": [{ "billed_charge": 696941.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13.14, "providers": [{ "billed_charge": 9788.58, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 631.33, "providers": [{ "billed_charge": 693573.31, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10084.42, "providers": [{ "billed_charge": 27314.00, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1732.95, "providers": [{ "billed_charge": 18758.00, "npi": [1194787218] } ] }, { "allowed_amount": 13.24, "providers": [{ "billed_charge": 137.00, "npi": [1821004151] } ] }, { "allowed_amount": 1052.10, "providers": [{ "billed_charge": 7718.00, "npi": [1821004151] } ] }, { "allowed_amount": 664.23, "providers": [{ "billed_charge": 6523.00, "npi": [1447883301] } ] } ] }, { "tin": { "type": "ein", "value": "464084062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 106.00, "providers": [{ "billed_charge": 56314.71, "npi": [1669872610] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79.49, "providers": [{ "billed_charge": 411.65, "npi": [1962497800] } ] }, { "allowed_amount": 2602.13, "providers": [{ "billed_charge": 7834.11, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 518.12, "providers": [{ "billed_charge": 51058.00, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "273026151" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 623.81, "providers": [{ "billed_charge": 643.00, "npi": [1326349986] } ] } ] }, { "tin": { "type": "ein", "value": "882923822" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 58.90, "providers": [{ "billed_charge": 41602.62, "npi": [1770214256] } ] } ] }, { "tin": { "type": "ein", "value": "851820772" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 219.85, "providers": [{ "billed_charge": 69946.68, "npi": [1285252593] } ] } ] } ] }, { "name": "LAB/CHEMISTRY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "LABORATORY - CHEMISTRY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 79936.89, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "922719659" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 19775.26, "npi": [1386325801] } ] } ] }, { "tin": { "type": "ein", "value": "871142127" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31.06, "providers": [{ "billed_charge": 40730.00, "npi": [1073183141] } ] } ] }, { "tin": { "type": "ein", "value": "611267229" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1112.11, "providers": [{ "billed_charge": 6417.42, "npi": [1477500015] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23", "19"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1693.67, "providers": [{ "billed_charge": 775545.00, "npi": [1992753222] } ] }, { "allowed_amount": 157.27, "providers": [{ "billed_charge": 1270.00, "npi": [1992753222] } ] }, { "allowed_amount": 78.32, "providers": [{ "billed_charge": 741.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 130.47, "providers": [{ "billed_charge": 205255.42, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "933189938" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 33422.60, "npi": [1083488829] } ] } ] }, { "tin": { "type": "ein", "value": "465557331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.60, "providers": [{ "billed_charge": 12405.11, "npi": [1194125146] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 153.78, "providers": [{ "billed_charge": 340190.00, "npi": [1528027786] } ] }, { "allowed_amount": 251.90, "providers": [{ "billed_charge": 283969.00, "npi": [1033165501] } ] }, { "allowed_amount": 274.80, "providers": [{ "billed_charge": 266891.00, "npi": [1689629941] } ] }, { "allowed_amount": 45.80, "providers": [{ "billed_charge": 15632.00, "npi": [1073294740] } ] }, { "allowed_amount": 14.47, "providers": [{ "billed_charge": 699.00, "npi": [1033165501] } ] }, { "allowed_amount": 229.00, "providers": [{ "billed_charge": 319275.00, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "922766125" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59.00, "providers": [{ "billed_charge": 87356.04, "npi": [1255012779] } ] } ] }, { "tin": { "type": "ein", "value": "820641535" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 96743.32, "npi": [1134783913] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27.04, "providers": [{ "billed_charge": 31105.09, "npi": [1265568638] } ] } ] }, { "tin": { "type": "ein", "value": "760698013" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 916.52, "providers": [{ "billed_charge": 1173.00, "npi": [1780786699] } ] } ] }, { "tin": { "type": "ein", "value": "331493792" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 184.32, "providers": [{ "billed_charge": 65246.68, "npi": [1942022546] } ] } ] }, { "tin": { "type": "ein", "value": "393782106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 105.44, "providers": [{ "billed_charge": 88428.97, "npi": [1124983002] } ] } ] }, { "tin": { "type": "ein", "value": "751277293" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21.10, "providers": [{ "billed_charge": 184.00, "npi": [1598750721] } ] } ] }, { "tin": { "type": "ein", "value": "760431829" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2458.89, "providers": [{ "billed_charge": 80450.04, "npi": [1104199017] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 312.73, "providers": [{ "billed_charge": 68178.00, "npi": [1548226988] } ] }, { "allowed_amount": 228.44, "providers": [{ "billed_charge": 3001.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.93, "providers": [{ "billed_charge": 15482.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "752312009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2557.93, "providers": [{ "billed_charge": 8182.00, "npi": [1225038938] } ] } ] }, { "tin": { "type": "ein", "value": "832329088" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27.23, "providers": [{ "billed_charge": 24577.53, "npi": [1780436287] } ] }, { "allowed_amount": 117.78, "providers": [{ "billed_charge": 63288.71, "npi": [1457820995] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 661.71, "providers": [{ "billed_charge": 386523.19, "npi": [1629089966] } ] }, { "allowed_amount": 1730.75, "providers": [{ "billed_charge": 39236.73, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59.30, "providers": [{ "billed_charge": 23512.67, "npi": [1174582050] } ] }, { "allowed_amount": 17.10, "providers": [{ "billed_charge": 4866.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 230.32, "providers": [{ "billed_charge": 145340.52, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1150.11, "providers": [{ "billed_charge": 154989.39, "npi": [1184262800] } ] }, { "allowed_amount": 20.09, "providers": [{ "billed_charge": 983.43, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "370661230" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 160.36, "providers": [{ "billed_charge": 324.00, "npi": [1174580831] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.30, "providers": [{ "billed_charge": 109872.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "922950626" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 65.60, "providers": [{ "billed_charge": 88356.00, "npi": [1992486419] } ] } ] }, { "tin": { "type": "ein", "value": "881723756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 17551.97, "npi": [1689319501] } ] } ] }, { "tin": { "type": "ein", "value": "861747068" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 51.98, "providers": [{ "billed_charge": 29163.88, "npi": [1740950179] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.06, "providers": [{ "billed_charge": 67987.09, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "741303720" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.40, "providers": [{ "billed_charge": 1433.00, "npi": [1093744187] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 65.88, "providers": [{ "billed_charge": 245833.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57.21, "providers": [{ "billed_charge": 205318.00, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "832040784" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 624.67, "providers": [{ "billed_charge": 68089.00, "npi": [1366917528] } ] } ] }, { "tin": { "type": "ein", "value": "203904667" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 48.20, "providers": [{ "billed_charge": 27881.73, "npi": [1376662296] } ] } ] }, { "tin": { "type": "ein", "value": "621762526" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 854.67, "providers": [{ "billed_charge": 969.00, "npi": [1790722346] } ] } ] }, { "tin": { "type": "ein", "value": "741718215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2407.48, "providers": [{ "billed_charge": 2873.50, "npi": [1699772541] } ] } ] }, { "tin": { "type": "ein", "value": "873083628" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.30, "providers": [{ "billed_charge": 91439.16, "npi": [1013670132] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 249.28, "providers": [{ "billed_charge": 252384.09, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 637.02, "providers": [{ "billed_charge": 531656.65, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.89, "providers": [{ "billed_charge": 21782.00, "npi": [1003192311] } ] }, { "allowed_amount": 38.19, "providers": [{ "billed_charge": 407.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 111.19, "providers": [{ "billed_charge": 1306.81, "npi": [1265772362] } ] }, { "allowed_amount": 133.04, "providers": [{ "billed_charge": 131306.83, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 309.51, "providers": [{ "billed_charge": 176980.86, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "752559845" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 154.48, "providers": [{ "billed_charge": 867.00, "npi": [1992707228] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 120.45, "providers": [{ "billed_charge": 921044.50, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47.20, "providers": [{ "billed_charge": 106075.33, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "831954982" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26.78, "providers": [{ "billed_charge": 80178.00, "npi": [1104381292] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 160.68, "providers": [{ "billed_charge": 330420.00, "npi": [1104845015] } ] }, { "allowed_amount": 10.04, "providers": [{ "billed_charge": 348.50, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57.58, "providers": [{ "billed_charge": 45590.17, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "334202263" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 1342.96, "npi": [1366246324] } ] } ] }, { "tin": { "type": "ein", "value": "882394440" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 21064.27, "npi": [1396429700] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2299.61, "providers": [{ "billed_charge": 16791.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "823463299" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 265.50, "providers": [{ "billed_charge": 247007.91, "npi": [1649770488] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 126.46, "providers": [{ "billed_charge": 351120.75, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "352528741" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 976.82, "providers": [{ "billed_charge": 1835.00, "npi": [1306889597] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 198.09, "providers": [{ "billed_charge": 91579.80, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "882221512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 64.90, "providers": [{ "billed_charge": 94245.39, "npi": [1598497638] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 138.18, "providers": [{ "billed_charge": 143856.61, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "202797853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 249.73, "providers": [{ "billed_charge": 541.57, "npi": [1154324952] } ] } ] }, { "tin": { "type": "ein", "value": "611780130" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53.10, "providers": [{ "billed_charge": 50419.17, "npi": [1356893531] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.60, "providers": [{ "billed_charge": 102997.48, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "822174187" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 129.80, "providers": [{ "billed_charge": 48600.88, "npi": [1811475346] } ] } ] }, { "tin": { "type": "ein", "value": "880803328" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 224.50, "providers": [{ "billed_charge": 51023.14, "npi": [1467199448] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 424.62, "providers": [{ "billed_charge": 1315814.00, "npi": [1497871628] } ] }, { "allowed_amount": 444.84, "providers": [{ "billed_charge": 1921620.00, "npi": [1871619254] } ] }, { "allowed_amount": 181.98, "providers": [{ "billed_charge": 1805274.00, "npi": [1083937593] } ] }, { "allowed_amount": 141.54, "providers": [{ "billed_charge": 453381.00, "npi": [1629828405] }, { "billed_charge": 743868.00, "npi": [1184179194] } ] } ] }, { "tin": { "type": "ein", "value": "237309937" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 725.11, "providers": [{ "billed_charge": 2183.00, "npi": [1649299827] } ] } ] }, { "tin": { "type": "ein", "value": "510570864" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.79, "providers": [{ "billed_charge": 13915.00, "npi": [1255579389] } ] } ] }, { "tin": { "type": "ein", "value": "464007700" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32.90, "providers": [{ "billed_charge": 10659.32, "npi": [1396138970] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 243.10, "providers": [{ "billed_charge": 142840.39, "npi": [1356960132] } ] }, { "allowed_amount": 320.06, "providers": [{ "billed_charge": 4752.70, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 121.58, "providers": [{ "billed_charge": 774832.00, "npi": [1689641680] } ] }, { "allowed_amount": 54.63, "providers": [{ "billed_charge": 112859.00, "npi": [1003885641] } ] } ] }, { "tin": { "type": "ein", "value": "720411322" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 264.55, "providers": [{ "billed_charge": 959.00, "npi": [1548796378] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 73.94, "providers": [{ "billed_charge": 266814.00, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "12", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5126.04, "providers": [{ "billed_charge": 8838.00, "npi": [1194743013] } ] }, { "allowed_amount": 5853.94, "providers": [{ "billed_charge": 10093.00, "npi": [1720480627] } ] }, { "allowed_amount": 16531.16, "providers": [{ "billed_charge": 70764.00, "npi": [1194743013] } ] }, { "allowed_amount": 31202.26, "providers": [{ "billed_charge": 53797.00, "npi": [1720480627] } ] }, { "allowed_amount": 24637.82, "providers": [{ "billed_charge": 42479.00, "npi": [1194743013] } ] }, { "allowed_amount": 30026.60, "providers": [{ "billed_charge": 51770.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "540551711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 527.12, "providers": [{ "billed_charge": 873.00, "npi": [1336103738] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 489.93, "providers": [{ "billed_charge": 303229.40, "npi": [1477516466] } ] }, { "allowed_amount": 648.30, "providers": [{ "billed_charge": 13070.55, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47.79, "providers": [{ "billed_charge": 85889.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "751844139" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.34, "providers": [{ "billed_charge": 17590.02, "npi": [1265430177] } ] } ] }, { "tin": { "type": "ein", "value": "202848116" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.48, "providers": [{ "billed_charge": 38255.50, "npi": [1629138029] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1925.62, "providers": [{ "billed_charge": 1232267.50, "npi": [1982666111] } ] }, { "allowed_amount": 34.00, "providers": [{ "billed_charge": 5508.25, "npi": [1295788735] } ] }, { "allowed_amount": 1069.77, "providers": [{ "billed_charge": 853507.00, "npi": [1932152337] } ] }, { "allowed_amount": 1416.16, "providers": [{ "billed_charge": 1429262.25, "npi": [1295843787] } ] }, { "allowed_amount": 121.58, "providers": [{ "billed_charge": 9637.25, "npi": [1740233782] } ] }, { "allowed_amount": 475.13, "providers": [{ "billed_charge": 725389.50, "npi": [1740233782] } ] }, { "allowed_amount": 25.15, "providers": [{ "billed_charge": 480.75, "npi": [1295843787] } ] }, { "allowed_amount": 12.58, "providers": [{ "billed_charge": 6188.00, "npi": [1932152337] } ] }, { "allowed_amount": 7270.66, "providers": [{ "billed_charge": 4903679.00, "npi": [1730132234] } ] }, { "allowed_amount": 104.61, "providers": [{ "billed_charge": 14290.00, "npi": [1730132234] } ] }, { "allowed_amount": 970.79, "providers": [{ "billed_charge": 564961.65, "npi": [1295788735] } ] } ] }, { "tin": { "type": "ein", "value": "992078911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35.40, "providers": [{ "billed_charge": 49044.00, "npi": [1770333403] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 489.48, "providers": [{ "billed_charge": 593830.06, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.02, "providers": [{ "billed_charge": 21913.55, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 108.86, "providers": [{ "billed_charge": 482.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "923094590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.60, "providers": [{ "billed_charge": 30391.00, "npi": [1477234995] } ] } ] }, { "tin": { "type": "ein", "value": "922748191" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41.30, "providers": [{ "billed_charge": 56007.26, "npi": [1811678337] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31.00, "providers": [{ "billed_charge": 7998.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1652.00, "providers": [{ "billed_charge": 10949.58, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 410.78, "providers": [{ "billed_charge": 1467.07, "npi": [1740288505] } ] }, { "allowed_amount": 6865.35, "providers": [{ "billed_charge": 17115.39, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 465.06, "providers": [{ "billed_charge": 1137515.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "995017291" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 645.29, "providers": [{ "billed_charge": 28645.05, "npi": [1851112098] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 271.40, "providers": [{ "billed_charge": 777204.16, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "750703337" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1588.00, "providers": [{ "billed_charge": 2144.00, "npi": [1861475626] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.86, "providers": [{ "billed_charge": 333.25, "npi": [1336172105] } ] }, { "allowed_amount": 222.10, "providers": [{ "billed_charge": 654902.15, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "720535375" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 134.48, "providers": [{ "billed_charge": 263.00, "npi": [1275536799] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 64.90, "providers": [{ "billed_charge": 83746.91, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "992497065" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 34696.57, "npi": [1083444780] } ] } ] }, { "tin": { "type": "ein", "value": "412101361" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.37, "providers": [{ "billed_charge": 15567.78, "npi": [1962504340] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.58, "providers": [{ "billed_charge": 28917.90, "npi": [1548286172] } ] }, { "allowed_amount": 183.42, "providers": [{ "billed_charge": 275994.25, "npi": [1124796081] } ] }, { "allowed_amount": 370.08, "providers": [{ "billed_charge": 124945.20, "npi": [1124796081] } ] }, { "allowed_amount": 1184.01, "providers": [{ "billed_charge": 64426.45, "npi": [1548286172] } ] } ] }, { "tin": { "type": "ein", "value": "590657322" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 271.64, "providers": [{ "billed_charge": 916.00, "npi": [1700979465] } ] } ] }, { "tin": { "type": "ein", "value": "392717734" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 85940.35, "npi": [1093604662] } ] } ] }, { "tin": { "type": "ein", "value": "832041336" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 288.69, "providers": [{ "billed_charge": 103364.05, "npi": [1245705417] } ] } ] }, { "tin": { "type": "ein", "value": "843654542" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.52, "providers": [{ "billed_charge": 3087.46, "npi": [1245878990] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 55891.10, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "390806181" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 722.95, "providers": [{ "billed_charge": 2445.00, "npi": [1861447179] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 67352.18, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7987.23, "providers": [{ "billed_charge": 8800.00, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.07, "providers": [{ "billed_charge": 68279.32, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.79, "providers": [{ "billed_charge": 2592.11, "npi": [1649273434] }, { "billed_charge": 32975.36, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "844983621" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.80, "providers": [{ "billed_charge": 80733.77, "npi": [1780297598] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.31, "providers": [{ "billed_charge": 48104.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 194.65, "providers": [{ "billed_charge": 84478.87, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "756001193" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 74.78, "providers": [{ "billed_charge": 328.00, "npi": [1720096019] } ] }, { "allowed_amount": 802.80, "providers": [{ "billed_charge": 4551.00, "npi": [1720096019] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53.82, "providers": [{ "billed_charge": 30462.00, "npi": [1285798918] } ] }, { "allowed_amount": 170.47, "providers": [{ "billed_charge": 872.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "453780407" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 827.91, "providers": [{ "billed_charge": 2300.00, "npi": [1407121189] } ] } ] }, { "tin": { "type": "ein", "value": "751584559" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 226.23, "providers": [{ "billed_charge": 9812.00, "npi": [1255325817] } ] } ] }, { "tin": { "type": "ein", "value": "720423651" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 614.56, "providers": [{ "billed_charge": 2209.00, "npi": [1366436123] } ] } ] }, { "tin": { "type": "ein", "value": "451834769" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1951.24, "providers": [{ "billed_charge": 4196.00, "npi": [1144227539] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.91, "providers": [{ "billed_charge": 212936.79, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 573.36, "providers": [{ "billed_charge": 700669.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 289.10, "providers": [{ "billed_charge": 238419.76, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53.56, "providers": [{ "billed_charge": 272963.75, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "934295804" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.80, "providers": [{ "billed_charge": 62404.60, "npi": [1851165013] } ] } ] }, { "tin": { "type": "ein", "value": "832040998" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 471.20, "providers": [{ "billed_charge": 120158.05, "npi": [1083189245] } ] } ] }, { "tin": { "type": "ein", "value": "851919095" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31.45, "providers": [{ "billed_charge": 9932.55, "npi": [1316617707] } ] } ] }, { "tin": { "type": "ein", "value": "334308303" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 1504.34, "npi": [1174310841] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 254.11, "providers": [{ "billed_charge": 437094.80, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 51972.58, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 111.37, "providers": [{ "billed_charge": 141011.70, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "320579508" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 441.70, "providers": [{ "billed_charge": 99313.99, "npi": [1790250959] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 150.21, "providers": [{ "billed_charge": 431610.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "460962386" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 265.00, "providers": [{ "billed_charge": 49436.00, "npi": [1275957508] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46.78, "providers": [{ "billed_charge": 72263.00, "npi": [1194787218] } ] }, { "allowed_amount": 5.31, "providers": [{ "billed_charge": 19159.00, "npi": [1447883301] } ] } ] }, { "tin": { "type": "ein", "value": "922858146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 152.64, "providers": [{ "billed_charge": 82119.25, "npi": [1184305609] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 271.67, "providers": [{ "billed_charge": 146294.73, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "420504780" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 147.05, "providers": [{ "billed_charge": 249.97, "npi": [1083708226] } ] } ] }, { "tin": { "type": "ein", "value": "464084062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59.00, "providers": [{ "billed_charge": 19725.08, "npi": [1669872610] } ] } ] }, { "tin": { "type": "ein", "value": "923637942" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.80, "providers": [{ "billed_charge": 39041.69, "npi": [1679263883] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26.78, "providers": [{ "billed_charge": 34522.00, "npi": [1891789772] } ] }, { "allowed_amount": 606.60, "providers": [{ "billed_charge": 2009509.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3121.18, "providers": [{ "billed_charge": 9397.60, "npi": [1962497800] } ] }, { "allowed_amount": 175.26, "providers": [{ "billed_charge": 907.59, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "621596506" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 461.73, "providers": [{ "billed_charge": 5871.00, "npi": [1497792527] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 66.03, "providers": [{ "billed_charge": 34977.74, "npi": [1124305065] } ] }, { "allowed_amount": 64.73, "providers": [{ "billed_charge": 22518.62, "npi": [1851108765] } ] } ] }, { "tin": { "type": "ein", "value": "581725656" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1719.83, "providers": [{ "billed_charge": 36803.00, "npi": [1770522906] } ] } ] }, { "tin": { "type": "ein", "value": "992496750" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29.50, "providers": [{ "billed_charge": 38378.57, "npi": [1811727514] } ] } ] }, { "tin": { "type": "ein", "value": "921938142" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.90, "providers": [{ "billed_charge": 5434.04, "npi": [1801579875] } ] } ] }, { "tin": { "type": "ein", "value": "832041052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 229.70, "providers": [{ "billed_charge": 91327.05, "npi": [1255806410] } ] } ] } ] }, { "name": "LAB/IMMUNOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "302", "description": "LABORATORY - IMMUNOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 146.38, "providers": [{ "billed_charge": 18363.00, "npi": [1871619254] } ] }, { "allowed_amount": 99.95, "providers": [{ "billed_charge": 15794.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 78.83, "providers": [{ "billed_charge": 4486.15, "npi": [1548286172] } ] }, { "allowed_amount": 36.02, "providers": [{ "billed_charge": 19669.60, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 952.88, "providers": [{ "billed_charge": 58490.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22.64, "providers": [{ "billed_charge": 4203.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 160.99, "providers": [{ "billed_charge": 15438.22, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 525.48, "providers": [{ "billed_charge": 906.00, "npi": [1720480627] } ] }, { "allowed_amount": 603.20, "providers": [{ "billed_charge": 1040.00, "npi": [1194743013] } ] }, { "allowed_amount": 77.72, "providers": [{ "billed_charge": 134.00, "npi": [1194743013] } ] }, { "allowed_amount": 155.44, "providers": [{ "billed_charge": 268.00, "npi": [1720480627] } ] }, { "allowed_amount": 163.56, "providers": [{ "billed_charge": 282.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32.69, "providers": [{ "billed_charge": 470.45, "npi": [1477516466] } ] }, { "allowed_amount": 60.45, "providers": [{ "billed_charge": 18800.75, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47.44, "providers": [{ "billed_charge": 3160.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26.61, "providers": [{ "billed_charge": 4578.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.95, "providers": [{ "billed_charge": 5253.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.22, "providers": [{ "billed_charge": 6087.25, "npi": [1740233782] } ] }, { "allowed_amount": 84.03, "providers": [{ "billed_charge": 26612.00, "npi": [1730132234] } ] }, { "allowed_amount": 195.80, "providers": [{ "billed_charge": 21210.00, "npi": [1982666111] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 61.50, "providers": [{ "billed_charge": 4779.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2181.23, "providers": [{ "billed_charge": 119028.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.88, "providers": [{ "billed_charge": 85.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19.99, "providers": [{ "billed_charge": 1716.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21.18, "providers": [{ "billed_charge": 315.25, "npi": [1629089966] } ] }, { "allowed_amount": 106.85, "providers": [{ "billed_charge": 1507.92, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28.47, "providers": [{ "billed_charge": 10503.27, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52.96, "providers": [{ "billed_charge": 1324.00, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.45, "providers": [{ "billed_charge": 9738.93, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 639.08, "providers": [{ "billed_charge": 11604.53, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 798.86, "providers": [{ "billed_charge": 9091.08, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 186.10, "providers": [{ "billed_charge": 31516.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.25, "providers": [{ "billed_charge": 22106.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 259.42, "providers": [{ "billed_charge": 38241.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 140.94, "providers": [{ "billed_charge": 4013.00, "npi": [1336172105] } ] } ] } ] }, { "name": "LAB/HEMATOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "305", "description": "LABORATORY - HEMATOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.31, "providers": [{ "billed_charge": 2910.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23.31, "providers": [{ "billed_charge": 587.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41.42, "providers": [{ "billed_charge": 935.83, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 76.19, "providers": [{ "billed_charge": 18866.90, "npi": [1124796081] } ] }, { "allowed_amount": 31.52, "providers": [{ "billed_charge": 4517.20, "npi": [1548286172] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26.79, "providers": [{ "billed_charge": 171891.00, "npi": [1992753222] } ] }, { "allowed_amount": 11.66, "providers": [{ "billed_charge": 267.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 197.63, "providers": [{ "billed_charge": 10607.93, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 489.34, "providers": [{ "billed_charge": 3106.39, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.82, "providers": [{ "billed_charge": 23312.89, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.28, "providers": [{ "billed_charge": 234.00, "npi": [1033165501] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 422.04, "providers": [{ "billed_charge": 465.00, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.41, "providers": [{ "billed_charge": 11390.26, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 89.31, "providers": [{ "billed_charge": 318.97, "npi": [1740288505] } ] }, { "allowed_amount": 922.67, "providers": [{ "billed_charge": 2229.25, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.69, "providers": [{ "billed_charge": 614.51, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "12", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3320.50, "providers": [{ "billed_charge": 5725.00, "npi": [1720480627] } ] }, { "allowed_amount": 9999.78, "providers": [{ "billed_charge": 17241.00, "npi": [1194743013] } ] }, { "allowed_amount": 8430.88, "providers": [{ "billed_charge": 17638.00, "npi": [1194743013] } ] }, { "allowed_amount": 410.64, "providers": [{ "billed_charge": 708.00, "npi": [1194743013] } ] }, { "allowed_amount": 6948.40, "providers": [{ "billed_charge": 11980.00, "npi": [1720480627] } ] }, { "allowed_amount": 12023.98, "providers": [{ "billed_charge": 20731.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 63.08, "providers": [{ "billed_charge": 1440.99, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13.00, "providers": [{ "billed_charge": 229.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.27, "providers": [{ "billed_charge": 583.69, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 623.04, "providers": [{ "billed_charge": 1875.84, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "581725656" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18.64, "providers": [{ "billed_charge": 836.00, "npi": [1770522906] } ] } ] } ] }, { "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": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2369.07, "providers": [{ "billed_charge": 141792.00, "npi": [1497871628] } ] }, { "allowed_amount": 3015.18, "providers": [{ "billed_charge": 218396.00, "npi": [1083937593] } ] }, { "allowed_amount": 1076.85, "providers": [{ "billed_charge": 84784.00, "npi": [1184179194] } ] }, { "allowed_amount": 3230.55, "providers": [{ "billed_charge": 207709.00, "npi": [1871619254] } ] }, { "allowed_amount": 430.74, "providers": [{ "billed_charge": 52552.00, "npi": [1629828405] } ] } ] }, { "tin": { "type": "ein", "value": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3209.25, "providers": [{ "billed_charge": 97660.76, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 226.68, "providers": [{ "billed_charge": 1606.87, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18323.41, "providers": [{ "billed_charge": 256715.00, "npi": [1992753222] } ] }, { "allowed_amount": 76.97, "providers": [{ "billed_charge": 941.00, "npi": [1992753222] } ] }, { "allowed_amount": 52.64, "providers": [{ "billed_charge": 266.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7685.00, "providers": [{ "billed_charge": 27245.42, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10483.55, "providers": [{ "billed_charge": 359687.04, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4473.20, "providers": [{ "billed_charge": 91593.17, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2257.64, "providers": [{ "billed_charge": 42023.00, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1133.64, "providers": [{ "billed_charge": 39545.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9014.02, "providers": [{ "billed_charge": 68307.00, "npi": [1033165501] } ] }, { "allowed_amount": 9756.00, "providers": [{ "billed_charge": 48177.00, "npi": [1689629941] } ] }, { "allowed_amount": 9512.10, "providers": [{ "billed_charge": 50509.00, "npi": [1275592131] } ] }, { "allowed_amount": 5121.90, "providers": [{ "billed_charge": 57519.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4494.52, "providers": [{ "billed_charge": 53576.75, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12812.20, "providers": [{ "billed_charge": 22090.00, "npi": [1720480627] } ] }, { "allowed_amount": 6765.12, "providers": [{ "billed_charge": 11664.00, "npi": [1194743013] } ] }, { "allowed_amount": 2880.28, "providers": [{ "billed_charge": 4966.00, "npi": [1194743013] } ] }, { "allowed_amount": 2992.80, "providers": [{ "billed_charge": 5160.00, "npi": [1720480627] } ] }, { "allowed_amount": 12325.58, "providers": [{ "billed_charge": 21251.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 711.93, "providers": [{ "billed_charge": 18120.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 221.88, "providers": [{ "billed_charge": 1615.07, "npi": [1477516466] } ] }, { "allowed_amount": 4093.23, "providers": [{ "billed_charge": 56737.60, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "992545052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 671.79, "providers": [{ "billed_charge": 27196.00, "npi": [1619760907] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3119.80, "providers": [{ "billed_charge": 83957.00, "npi": [1740233782] } ] }, { "allowed_amount": 2873.49, "providers": [{ "billed_charge": 86177.25, "npi": [1932152337] } ] }, { "allowed_amount": 82.10, "providers": [{ "billed_charge": 2377.00, "npi": [1730132234] }, { "billed_charge": 197.75, "npi": [1740233782] } ] }, { "allowed_amount": 18636.70, "providers": [{ "billed_charge": 543343.25, "npi": [1730132234] } ] }, { "allowed_amount": 4541.36, "providers": [{ "billed_charge": 119724.00, "npi": [1982666111] } ] }, { "allowed_amount": 7635.30, "providers": [{ "billed_charge": 195224.50, "npi": [1295843787] } ] }, { "allowed_amount": 2627.20, "providers": [{ "billed_charge": 87165.75, "npi": [1295788735] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43823.96, "providers": [{ "billed_charge": 137428.75, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 727.40, "providers": [{ "billed_charge": 8405.90, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3926.60, "providers": [{ "billed_charge": 64033.00, "npi": [1477643690] } ] }, { "allowed_amount": 76.17, "providers": [{ "billed_charge": 1841.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.80, "providers": [{ "billed_charge": 949.00, "npi": [1548226988] } ] }, { "allowed_amount": 7107.21, "providers": [{ "billed_charge": 34212.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 40.49, "providers": [{ "billed_charge": 908.15, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3057.76, "providers": [{ "billed_charge": 38272.33, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11959.35, "providers": [{ "billed_charge": 41442.75, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752682017" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 96.80, "providers": [{ "billed_charge": 1039.00, "npi": [1114998911] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 105.44, "providers": [{ "billed_charge": 4435.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 333.71, "providers": [{ "billed_charge": 826.39, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1334.98, "providers": [{ "billed_charge": 41622.85, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5262.90, "providers": [{ "billed_charge": 51428.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "995017291" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2781.81, "providers": [{ "billed_charge": 44608.68, "npi": [1851112098] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3015.18, "providers": [{ "billed_charge": 120582.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1027.18, "providers": [{ "billed_charge": 26629.75, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79653.03, "providers": [{ "billed_charge": 2225016.64, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8625.60, "providers": [{ "billed_charge": 129395.75, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 702.90, "providers": [{ "billed_charge": 5180.00, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 37.15, "providers": [{ "billed_charge": 2429.95, "npi": [1548286172] } ] }, { "allowed_amount": 26704.02, "providers": [{ "billed_charge": 587643.70, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "392717734" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1497.65, "providers": [{ "billed_charge": 40876.36, "npi": [1093604662] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8272.54, "providers": [{ "billed_charge": 89075.60, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1348.66, "providers": [{ "billed_charge": 23876.96, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "873083628" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2995.30, "providers": [{ "billed_charge": 72382.94, "npi": [1013670132] } ] } ] }, { "tin": { "type": "ein", "value": "992762070" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 76.97, "providers": [{ "billed_charge": 10843.61, "npi": [1124865126] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 106.00, "providers": [{ "billed_charge": 2723.39, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3851.10, "providers": [{ "billed_charge": 88600.83, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 333.57, "providers": [{ "billed_charge": 10832.22, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1950.22, "providers": [{ "billed_charge": 6091.16, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11959.35, "providers": [{ "billed_charge": 33086.34, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1062.54, "providers": [{ "billed_charge": 21982.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4497.68, "providers": [{ "billed_charge": 12875.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5519.70, "providers": [{ "billed_charge": 25871.75, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12213.18, "providers": [{ "billed_charge": 215042.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "863189225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1764.60, "providers": [{ "billed_charge": 40433.59, "npi": [1194484345] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12389.35, "providers": [{ "billed_charge": 349969.84, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 273.51, "providers": [{ "billed_charge": 3354.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11549.12, "providers": [{ "billed_charge": 142200.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14548.26, "providers": [{ "billed_charge": 53256.25, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2759.85, "providers": [{ "billed_charge": 4081.23, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "751748586" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1539.30, "providers": [{ "billed_charge": 26193.00, "npi": [1508899204] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4917.22, "providers": [{ "billed_charge": 50145.25, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6217.37, "providers": [{ "billed_charge": 191373.34, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6413.00, "providers": [{ "billed_charge": 20415.64, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "621692446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 264.75, "providers": [{ "billed_charge": 1152.40, "npi": [1497708929] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25135.00, "providers": [{ "billed_charge": 97075.75, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "473344271" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 923.69, "providers": [{ "billed_charge": 11680.56, "npi": [1003280629] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1283.70, "providers": [{ "billed_charge": 40045.28, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3078.06, "providers": [{ "billed_charge": 44198.31, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "752890358" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 855.78, "providers": [{ "billed_charge": 10016.75, "npi": [1548291883] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9774.88, "providers": [{ "billed_charge": 201758.67, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5519.70, "providers": [{ "billed_charge": 10968.04, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "882221512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1036.34, "providers": [{ "billed_charge": 13215.98, "npi": [1598497638] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 646.11, "providers": [{ "billed_charge": 37919.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "260684968" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 205.24, "providers": [{ "billed_charge": 7806.00, "npi": [1902047376] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9812.80, "providers": [{ "billed_charge": 38512.26, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2584.44, "providers": [{ "billed_charge": 257971.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 584.66, "providers": [{ "billed_charge": 1760.32, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1060.00, "providers": [{ "billed_charge": 54703.23, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4065.05, "providers": [{ "billed_charge": 116142.22, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 613.30, "providers": [{ "billed_charge": 2542.02, "npi": [1124305065] } ] } ] }, { "tin": { "type": "ein", "value": "871528012" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2353.45, "providers": [{ "billed_charge": 56360.68, "npi": [1912677295] } ] } ] } ] }, { "name": "LAB/UROLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "307", "description": "LABORATORY - UROLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1575.86, "providers": [{ "billed_charge": 2717.00, "npi": [1194743013] } ] }, { "allowed_amount": 3987.50, "providers": [{ "billed_charge": 6875.00, "npi": [1720480627] } ] }, { "allowed_amount": 4655.08, "providers": [{ "billed_charge": 8026.00, "npi": [1194743013] } ] }, { "allowed_amount": 429.20, "providers": [{ "billed_charge": 740.00, "npi": [1720480627] } ] }, { "allowed_amount": 6490.78, "providers": [{ "billed_charge": 11191.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.34, "providers": [{ "billed_charge": 2730.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.17, "providers": [{ "billed_charge": 26.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.20, "providers": [{ "billed_charge": 59.97, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.39, "providers": [{ "billed_charge": 6592.95, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.57, "providers": [{ "billed_charge": 38407.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.87, "providers": [{ "billed_charge": 1676.78, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52.39, "providers": [{ "billed_charge": 138.61, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.12, "providers": [{ "billed_charge": 22.00, "npi": [1114435260] } ] } ] } ] }, { "name": "LAB/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "309", "description": "LABORATORY - OTHER LABORATORY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4728.16, "providers": [{ "billed_charge": 11995.00, "npi": [1194743013] } ] }, { "allowed_amount": 3638.92, "providers": [{ "billed_charge": 6274.00, "npi": [1194743013] } ] }, { "allowed_amount": 791.70, "providers": [{ "billed_charge": 1365.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 65.38, "providers": [{ "billed_charge": 2977.35, "npi": [1124796081] } ] }, { "allowed_amount": 31.76, "providers": [{ "billed_charge": 266.80, "npi": [1548286172] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 716.64, "providers": [{ "billed_charge": 7973.50, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15054.06, "providers": [{ "billed_charge": 7387.52, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2150.58, "providers": [{ "billed_charge": 1003.74, "npi": [1265772362] } ] } ] } ] }, { "name": "PATHOLOGY LAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "310", "description": "LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "750800628" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1081.12, "providers": [{ "billed_charge": 1864.00, "npi": [1194743013] } ] }, { "allowed_amount": 1846.72, "providers": [{ "billed_charge": 3184.00, "npi": [1720480627] } ] }, { "allowed_amount": 21698.96, "providers": [{ "billed_charge": 37412.00, "npi": [1720480627] } ] }, { "allowed_amount": 461.68, "providers": [{ "billed_charge": 796.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 416.78, "providers": [{ "billed_charge": 3044.00, "npi": [1083937593] } ] }, { "allowed_amount": 5031.29, "providers": [{ "billed_charge": 18148.00, "npi": [1184179194] } ] }, { "allowed_amount": 8184.06, "providers": [{ "billed_charge": 23950.00, "npi": [1497871628] } ] }, { "allowed_amount": 16456.30, "providers": [{ "billed_charge": 55705.00, "npi": [1871619254] } ] }, { "allowed_amount": 2049.12, "providers": [{ "billed_charge": 9816.00, "npi": [1629828405] } ] }, { "allowed_amount": 15335.21, "providers": [{ "billed_charge": 44618.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28242.63, "providers": [{ "billed_charge": 126671.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2524.68, "providers": [{ "billed_charge": 4497.12, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13848.12, "providers": [{ "billed_charge": 62296.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3098.52, "providers": [{ "billed_charge": 18924.00, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1507.59, "providers": [{ "billed_charge": 4342.00, "npi": [1952723967] } ] } ] } ] }, { "name": "DX X-RAY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "320", "description": "RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 872.18, "providers": [{ "billed_charge": 6398.75, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "208737126" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 666.11, "providers": [{ "billed_charge": 3840.15, "npi": [1104086941] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 776.72, "providers": [{ "billed_charge": 59816.96, "npi": [1124796081] } ] }, { "allowed_amount": 238.52, "providers": [{ "billed_charge": 3326.40, "npi": [1548286172] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25.67, "providers": [{ "billed_charge": 202424.00, "npi": [1992753222] } ] }, { "allowed_amount": 680.75, "providers": [{ "billed_charge": 1914.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22388.97, "providers": [{ "billed_charge": 168764.27, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6444.24, "providers": [{ "billed_charge": 50478.75, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "474866295" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 526.05, "providers": [{ "billed_charge": 24509.18, "npi": [1992172019] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11776.32, "providers": [{ "billed_charge": 94963.00, "npi": [1689629941] } ] }, { "allowed_amount": 7889.67, "providers": [{ "billed_charge": 91731.00, "npi": [1528027786] } ] }, { "allowed_amount": 576.88, "providers": [{ "billed_charge": 3005.00, "npi": [1568818417] } ] }, { "allowed_amount": 11014.16, "providers": [{ "billed_charge": 83725.00, "npi": [1033165501] } ] }, { "allowed_amount": 10407.31, "providers": [{ "billed_charge": 108529.00, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 298.65, "providers": [{ "billed_charge": 88498.18, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "800810304" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1940.63, "providers": [{ "billed_charge": 70145.46, "npi": [1295213601] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 191.50, "providers": [{ "billed_charge": 3663.12, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10417.45, "providers": [{ "billed_charge": 112313.75, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 796.92, "providers": [{ "billed_charge": 30254.00, "npi": [1194743013] } ] }, { "allowed_amount": 16743.44, "providers": [{ "billed_charge": 28868.00, "npi": [1194743013] } ] }, { "allowed_amount": 5536.10, "providers": [{ "billed_charge": 9545.00, "npi": [1720480627] } ] }, { "allowed_amount": 1194.22, "providers": [{ "billed_charge": 2059.00, "npi": [1194743013] } ] }, { "allowed_amount": 26265.88, "providers": [{ "billed_charge": 45286.00, "npi": [1720480627] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 224.70, "providers": [{ "billed_charge": 61090.44, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 150.36, "providers": [{ "billed_charge": 91666.63, "npi": [1477516466] } ] }, { "allowed_amount": 86.99, "providers": [{ "billed_charge": 2641.93, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 704.64, "providers": [{ "billed_charge": 30784.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "760436439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 108.07, "providers": [{ "billed_charge": 11267.22, "npi": [1689650616] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3377.31, "providers": [{ "billed_charge": 29736.00, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1024.79, "providers": [{ "billed_charge": 6790.00, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 201.82, "providers": [{ "billed_charge": 442238.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "202848116" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 696.78, "providers": [{ "billed_charge": 4359.00, "npi": [1629138029] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 33991.68, "providers": [{ "billed_charge": 248163.50, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "992078911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 369.87, "providers": [{ "billed_charge": 16489.00, "npi": [1770333403] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 585.45, "providers": [{ "billed_charge": 8321.25, "npi": [1740233782] } ] }, { "allowed_amount": 383.50, "providers": [{ "billed_charge": 1978.00, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "831954982" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2092.60, "providers": [{ "billed_charge": 12268.25, "npi": [1104381292] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16679.82, "providers": [{ "billed_charge": 369521.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16303.89, "providers": [{ "billed_charge": 144510.25, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "751748586" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2442.28, "providers": [{ "billed_charge": 13856.25, "npi": [1508899204] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11128.68, "providers": [{ "billed_charge": 100364.25, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.99, "providers": [{ "billed_charge": 347.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2376.69, "providers": [{ "billed_charge": 65532.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16027.70, "providers": [{ "billed_charge": 110866.06, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.99, "providers": [{ "billed_charge": 799.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3846.07, "providers": [{ "billed_charge": 40694.68, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 156.77, "providers": [{ "billed_charge": 576.49, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17434.94, "providers": [{ "billed_charge": 121655.75, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "621692446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 597.40, "providers": [{ "billed_charge": 6574.21, "npi": [1497708929] } ] } ] }, { "tin": { "type": "ein", "value": "752890358" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1387.22, "providers": [{ "billed_charge": 19194.75, "npi": [1548291883] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1313.11, "providers": [{ "billed_charge": 106845.89, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 130.57, "providers": [{ "billed_charge": 1864.94, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16146.52, "providers": [{ "billed_charge": 318933.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "260684968" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 521.94, "providers": [{ "billed_charge": 6420.00, "npi": [1902047376] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86.99, "providers": [{ "billed_charge": 30161.99, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.12, "providers": [{ "billed_charge": 19743.45, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 285.53, "providers": [{ "billed_charge": 20520.00, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3950.16, "providers": [{ "billed_charge": 51030.25, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "454435955" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1460.65, "providers": [{ "billed_charge": 54763.38, "npi": [1467897447] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34617.72, "providers": [{ "billed_charge": 303763.50, "npi": [1336172105] } ] } ] } ] }, { "name": "DX X-RAY/CHEST", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "324", "description": "RADIOLOGY - DIAGNOSTIC - CHEST X-RAY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16971.84, "providers": [{ "billed_charge": 300388.00, "npi": [1497871628] } ] }, { "allowed_amount": 23955.75, "providers": [{ "billed_charge": 424321.00, "npi": [1083937593] } ] }, { "allowed_amount": 22113.47, "providers": [{ "billed_charge": 383615.00, "npi": [1871619254] } ] }, { "allowed_amount": 3435.51, "providers": [{ "billed_charge": 52715.00, "npi": [1629828405] } ] }, { "allowed_amount": 7628.18, "providers": [{ "billed_charge": 140749.00, "npi": [1184179194] } ] } ] }, { "tin": { "type": "ein", "value": "510570864" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 366.74, "providers": [{ "billed_charge": 424.00, "npi": [1255579389] } ] } ] }, { "tin": { "type": "ein", "value": "871142127" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1110.01, "providers": [{ "billed_charge": 2310.00, "npi": [1073183141] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4196.16, "providers": [{ "billed_charge": 14681.96, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35621.01, "providers": [{ "billed_charge": 138128.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "824785286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 966.40, "providers": [{ "billed_charge": 5824.00, "npi": [1699244624] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7430.55, "providers": [{ "billed_charge": 64791.00, "npi": [1689641680] } ] }, { "allowed_amount": 627.99, "providers": [{ "billed_charge": 4935.00, "npi": [1003885641] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14348.78, "providers": [{ "billed_charge": 61265.25, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17694.88, "providers": [{ "billed_charge": 160397.50, "npi": [1932152337] } ] }, { "allowed_amount": 15334.19, "providers": [{ "billed_charge": 134374.00, "npi": [1740233782] } ] }, { "allowed_amount": 28852.89, "providers": [{ "billed_charge": 248795.75, "npi": [1982666111] } ] }, { "allowed_amount": 109469.96, "providers": [{ "billed_charge": 973836.25, "npi": [1730132234] } ] }, { "allowed_amount": 38297.01, "providers": [{ "billed_charge": 314047.75, "npi": [1295843787] } ] }, { "allowed_amount": 10315.58, "providers": [{ "billed_charge": 96667.75, "npi": [1295788735] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8019.76, "providers": [{ "billed_charge": 24290.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53551.90, "providers": [{ "billed_charge": 155757.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16098.90, "providers": [{ "billed_charge": 91109.08, "npi": [1629089966] } ] }, { "allowed_amount": 1281.35, "providers": [{ "billed_charge": 8006.26, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3527.07, "providers": [{ "billed_charge": 9030.00, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14637.23, "providers": [{ "billed_charge": 36838.75, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 781.47, "providers": [{ "billed_charge": 3841.25, "npi": [1093810327] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1564.10, "providers": [{ "billed_charge": 12954.88, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7559.90, "providers": [{ "billed_charge": 48865.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14869.72, "providers": [{ "billed_charge": 143740.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4906.65, "providers": [{ "billed_charge": 112680.00, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 279.74, "providers": [{ "billed_charge": 3286.08, "npi": [1124796081] } ] }, { "allowed_amount": 4386.03, "providers": [{ "billed_charge": 35044.80, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 853.07, "providers": [{ "billed_charge": 7914.85, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 210.47, "providers": [{ "billed_charge": 1612.56, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8889.16, "providers": [{ "billed_charge": 35760.96, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "750827446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 758.76, "providers": [{ "billed_charge": 9544.04, "npi": [1528064649] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7555.97, "providers": [{ "billed_charge": 124219.10, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5542.30, "providers": [{ "billed_charge": 24219.18, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16663.18, "providers": [{ "billed_charge": 290066.31, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 374.06, "providers": [{ "billed_charge": 733.48, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17023.04, "providers": [{ "billed_charge": 39281.05, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1169.16, "providers": [{ "billed_charge": 8120.00, "npi": [1821011248] } ] }, { "allowed_amount": 86.99, "providers": [{ "billed_charge": 952.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7670.07, "providers": [{ "billed_charge": 18212.12, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 524.55, "providers": [{ "billed_charge": 2338.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20121.78, "providers": [{ "billed_charge": 215987.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18896.01, "providers": [{ "billed_charge": 101850.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5995.82, "providers": [{ "billed_charge": 36366.45, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2434.15, "providers": [{ "billed_charge": 6538.88, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "823463299" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 976.36, "providers": [{ "billed_charge": 20379.90, "npi": [1649770488] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2993.43, "providers": [{ "billed_charge": 26595.47, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4866.96, "providers": [{ "billed_charge": 13140.20, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 842.01, "providers": [{ "billed_charge": 12106.00, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2936.84, "providers": [{ "billed_charge": 49800.16, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9221.11, "providers": [{ "billed_charge": 41048.94, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5354.70, "providers": [{ "billed_charge": 93347.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 847.70, "providers": [{ "billed_charge": 2296.00, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 346.50, "providers": [{ "billed_charge": 5105.00, "npi": [1194787218] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14212.25, "providers": [{ "billed_charge": 38491.14, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21537.32, "providers": [{ "billed_charge": 375063.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1191.96, "providers": [{ "billed_charge": 11415.49, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3362.49, "providers": [{ "billed_charge": 8005.84, "npi": [1124305065] } ] }, { "allowed_amount": 187.95, "providers": [{ "billed_charge": 366.74, "npi": [1851108765] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 369.87, "providers": [{ "billed_charge": 4516.11, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1452.00, "providers": [{ "billed_charge": 11282.24, "npi": [1346753118] } ] } ] } ] }, { "name": "CHEMOTHER/INJ", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "331", "description": "RADIOLOGY-THERAPEUTIC - CHEMOTHERAPY-INJECTED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8906.48, "providers": [{ "billed_charge": 15356.00, "npi": [1194743013] } ] } ] } ] }, { "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": "750800628" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12963.00, "providers": [{ "billed_charge": 22350.00, "npi": [1194743013] } ] } ] } ] }, { "name": "CT SCAN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "350", "description": "CT SCAN - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 955.64, "providers": [{ "billed_charge": 11634.00, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3578.01, "providers": [{ "billed_charge": 119621.72, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7378.59, "providers": [{ "billed_charge": 114327.63, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12008.29, "providers": [{ "billed_charge": 259061.04, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "824785286" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19178.61, "providers": [{ "billed_charge": 478654.00, "npi": [1699244624] } ] }, { "allowed_amount": 4216.35, "providers": [{ "billed_charge": 21952.00, "npi": [1699244624] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4480.36, "providers": [{ "billed_charge": 240467.77, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19216.42, "providers": [{ "billed_charge": 224923.50, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "813562144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2097.62, "providers": [{ "billed_charge": 18914.00, "npi": [1639663370] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1398.08, "providers": [{ "billed_charge": 41631.00, "npi": [1568818417] } ] }, { "allowed_amount": 30288.10, "providers": [{ "billed_charge": 670928.00, "npi": [1033165501] } ] }, { "allowed_amount": 28098.95, "providers": [{ "billed_charge": 601113.00, "npi": [1275592131] } ] }, { "allowed_amount": 30824.67, "providers": [{ "billed_charge": 691989.00, "npi": [1528027786] } ] }, { "allowed_amount": 43209.87, "providers": [{ "billed_charge": 829223.00, "npi": [1689629941] } ] } ] }, { "tin": { "type": "ein", "value": "750827446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 661.61, "providers": [{ "billed_charge": 26577.68, "npi": [1528064649] } ] } ] }, { "tin": { "type": "ein", "value": "820641535" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.12, "providers": [{ "billed_charge": 18900.00, "npi": [1134783913] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209.02, "providers": [{ "billed_charge": 400.50, "npi": [1003883158] } ] }, { "allowed_amount": 27974.22, "providers": [{ "billed_charge": 387432.75, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15899.58, "providers": [{ "billed_charge": 95441.71, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2680.81, "providers": [{ "billed_charge": 205046.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "383813467" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1054.40, "providers": [{ "billed_charge": 56491.00, "npi": [1497053912] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5729.54, "providers": [{ "billed_charge": 135259.00, "npi": [1821011248] } ] }, { "allowed_amount": 104.51, "providers": [{ "billed_charge": 3762.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4308.68, "providers": [{ "billed_charge": 23061.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7575.25, "providers": [{ "billed_charge": 269500.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25229.24, "providers": [{ "billed_charge": 223315.00, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4244.17, "providers": [{ "billed_charge": 86163.25, "npi": [1730132234] } ] }, { "allowed_amount": 1877.08, "providers": [{ "billed_charge": 48602.25, "npi": [1982666111] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 81280.84, "providers": [{ "billed_charge": 1015513.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 313.49, "providers": [{ "billed_charge": 13224.00, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59203.18, "providers": [{ "billed_charge": 2413790.00, "npi": [1679578439] } ] }, { "allowed_amount": 628.58, "providers": [{ "billed_charge": 38361.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30546.14, "providers": [{ "billed_charge": 358035.00, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "751748586" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1654.28, "providers": [{ "billed_charge": 18430.00, "npi": [1508899204] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3369.90, "providers": [{ "billed_charge": 83702.41, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 49098.40, "providers": [{ "billed_charge": 613953.50, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30346.49, "providers": [{ "billed_charge": 161818.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2424.35, "providers": [{ "billed_charge": 30312.74, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29889.98, "providers": [{ "billed_charge": 375272.75, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "823463299" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3015.73, "providers": [{ "billed_charge": 77548.14, "npi": [1649770488] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12813.41, "providers": [{ "billed_charge": 438558.26, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "752890358" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7897.84, "providers": [{ "billed_charge": 110894.75, "npi": [1548291883] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46270.18, "providers": [{ "billed_charge": 901394.00, "npi": [1124092036] } ] }, { "allowed_amount": 209.02, "providers": [{ "billed_charge": 3077.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15966.72, "providers": [{ "billed_charge": 418791.27, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "260684968" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4140.30, "providers": [{ "billed_charge": 44471.00, "npi": [1902047376] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1859.06, "providers": [{ "billed_charge": 17169.55, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "881723756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.12, "providers": [{ "billed_charge": 14976.98, "npi": [1689319501] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15033.98, "providers": [{ "billed_charge": 331766.38, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4906.36, "providers": [{ "billed_charge": 180806.00, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13173.50, "providers": [{ "billed_charge": 303756.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19498.43, "providers": [{ "billed_charge": 256633.25, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 999.92, "providers": [{ "billed_charge": 23519.27, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4885.64, "providers": [{ "billed_charge": 214047.27, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5306.27, "providers": [{ "billed_charge": 150833.54, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 82275.63, "providers": [{ "billed_charge": 947963.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "992496750" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 288.14, "providers": [{ "billed_charge": 8914.24, "npi": [1811727514] } ] } ] }, { "tin": { "type": "ein", "value": "824314476" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5253.25, "providers": [{ "billed_charge": 123093.65, "npi": [1467930420] } ] } ] } ] }, { "name": "CT SCAN/HEAD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "351", "description": "CT SCAN - HEAD SCAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21619.72, "providers": [{ "billed_charge": 200587.00, "npi": [1083937593] } ] }, { "allowed_amount": 5589.02, "providers": [{ "billed_charge": 52888.00, "npi": [1184179194] } ] }, { "allowed_amount": 3913.38, "providers": [{ "billed_charge": 29267.00, "npi": [1629828405] } ] }, { "allowed_amount": 16912.39, "providers": [{ "billed_charge": 190096.00, "npi": [1871619254] } ] }, { "allowed_amount": 11436.83, "providers": [{ "billed_charge": 122349.00, "npi": [1497871628] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 873.63, "providers": [{ "billed_charge": 47062.40, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12308.41, "providers": [{ "billed_charge": 137762.64, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 60517.17, "providers": [{ "billed_charge": 1207268.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3466.62, "providers": [{ "billed_charge": 46370.00, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2515.68, "providers": [{ "billed_charge": 60856.50, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10564.75, "providers": [{ "billed_charge": 135533.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 736.33, "providers": [{ "billed_charge": 43949.00, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5404.91, "providers": [{ "billed_charge": 67799.94, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3335.29, "providers": [{ "billed_charge": 390823.14, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6584.66, "providers": [{ "billed_charge": 164224.50, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 675.19, "providers": [{ "billed_charge": 24085.06, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12255.90, "providers": [{ "billed_charge": 302352.20, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11164.07, "providers": [{ "billed_charge": 204227.96, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 702.70, "providers": [{ "billed_charge": 23000.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1149.66, "providers": [{ "billed_charge": 66814.20, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23805.15, "providers": [{ "billed_charge": 151976.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 42257.55, "providers": [{ "billed_charge": 559685.75, "npi": [1295843787] } ] }, { "allowed_amount": 63272.83, "providers": [{ "billed_charge": 708900.75, "npi": [1982666111] } ] }, { "allowed_amount": 22235.61, "providers": [{ "billed_charge": 288621.75, "npi": [1740233782] } ] }, { "allowed_amount": 37575.09, "providers": [{ "billed_charge": 482107.75, "npi": [1932152337] } ] }, { "allowed_amount": 167.22, "providers": [{ "billed_charge": 3209.00, "npi": [1730132234, 1740233782] } ] }, { "allowed_amount": 157973.47, "providers": [{ "billed_charge": 2075865.50, "npi": [1730132234] } ] }, { "allowed_amount": 18046.60, "providers": [{ "billed_charge": 268423.25, "npi": [1295788735] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12606.34, "providers": [{ "billed_charge": 333060.75, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9343.93, "providers": [{ "billed_charge": 216001.09, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5075.95, "providers": [{ "billed_charge": 154412.75, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18373.64, "providers": [{ "billed_charge": 99462.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1227.71, "providers": [{ "billed_charge": 45077.13, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6992.88, "providers": [{ "billed_charge": 240836.25, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6157.13, "providers": [{ "billed_charge": 80340.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209.02, "providers": [{ "billed_charge": 6960.00, "npi": [1205900370] } ] }, { "allowed_amount": 251405.93, "providers": [{ "billed_charge": 967477.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10826.44, "providers": [{ "billed_charge": 121035.22, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 854.32, "providers": [{ "billed_charge": 9748.38, "npi": [1629089966] } ] }, { "allowed_amount": 13468.13, "providers": [{ "billed_charge": 203192.12, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1588.71, "providers": [{ "billed_charge": 13667.71, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4490.54, "providers": [{ "billed_charge": 108523.23, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9300.58, "providers": [{ "billed_charge": 227319.25, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3132.00, "providers": [{ "billed_charge": 105668.18, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1778.71, "providers": [{ "billed_charge": 22400.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2622.52, "providers": [{ "billed_charge": 84476.16, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8461.58, "providers": [{ "billed_charge": 117945.35, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20151.59, "providers": [{ "billed_charge": 198603.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5196.22, "providers": [{ "billed_charge": 89951.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10306.92, "providers": [{ "billed_charge": 111229.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1974.36, "providers": [{ "billed_charge": 43327.78, "npi": [1124305065] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2349.36, "providers": [{ "billed_charge": 57211.50, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3676.39, "providers": [{ "billed_charge": 122833.15, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12288.68, "providers": [{ "billed_charge": 539044.75, "npi": [1336172105] } ] } ] } ] }, { "name": "CT SCAN/BODY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "352", "description": "CT SCAN - BODY SCAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 97424.28, "providers": [{ "billed_charge": 1305170.00, "npi": [1871619254] } ] }, { "allowed_amount": 31401.29, "providers": [{ "billed_charge": 472782.00, "npi": [1184179194] } ] }, { "allowed_amount": 48119.12, "providers": [{ "billed_charge": 717094.00, "npi": [1497871628] } ] }, { "allowed_amount": 113815.00, "providers": [{ "billed_charge": 1374554.00, "npi": [1083937593] } ] }, { "allowed_amount": 86.99, "providers": [{ "billed_charge": 379.00, "npi": [1184179194] } ] }, { "allowed_amount": 21869.43, "providers": [{ "billed_charge": 277015.00, "npi": [1629828405] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12303.88, "providers": [{ "billed_charge": 200720.89, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 523.11, "providers": [{ "billed_charge": 2704.00, "npi": [1992753222] } ] }, { "allowed_amount": 357.78, "providers": [{ "billed_charge": 2704.00, "npi": [1992753222] } ] }, { "allowed_amount": 85456.94, "providers": [{ "billed_charge": 1293459.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39357.31, "providers": [{ "billed_charge": 501453.04, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1748.99, "providers": [{ "billed_charge": 39402.76, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209.36, "providers": [{ "billed_charge": 4150.00, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15163.46, "providers": [{ "billed_charge": 662677.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 350.66, "providers": [{ "billed_charge": 15922.75, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32007.97, "providers": [{ "billed_charge": 507182.59, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 271350.96, "providers": [{ "billed_charge": 8170316.50, "npi": [1730132234] } ] }, { "allowed_amount": 557.98, "providers": [{ "billed_charge": 9478.75, "npi": [1295843787] } ] }, { "allowed_amount": 58352.21, "providers": [{ "billed_charge": 1965295.75, "npi": [1932152337] } ] }, { "allowed_amount": 56450.93, "providers": [{ "billed_charge": 2115387.50, "npi": [1982666111] } ] }, { "allowed_amount": 1387.36, "providers": [{ "billed_charge": 26434.25, "npi": [1730132234] } ] }, { "allowed_amount": 38012.45, "providers": [{ "billed_charge": 1072183.50, "npi": [1740233782] } ] }, { "allowed_amount": 31714.81, "providers": [{ "billed_charge": 999541.00, "npi": [1295788735] } ] }, { "allowed_amount": 353.90, "providers": [{ "billed_charge": 10974.75, "npi": [1982666111] } ] }, { "allowed_amount": 80447.14, "providers": [{ "billed_charge": 1926105.00, "npi": [1295843787] } ] }, { "allowed_amount": 1115.96, "providers": [{ "billed_charge": 17050.50, "npi": [1740233782] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4425.98, "providers": [{ "billed_charge": 123383.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2044.05, "providers": [{ "billed_charge": 55765.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2372.39, "providers": [{ "billed_charge": 37644.00, "npi": [1205900370] } ] }, { "allowed_amount": 91791.86, "providers": [{ "billed_charge": 1938590.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34738.75, "providers": [{ "billed_charge": 740310.94, "npi": [1629089966] } ] }, { "allowed_amount": 5397.12, "providers": [{ "billed_charge": 108572.93, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27718.12, "providers": [{ "billed_charge": 410005.34, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11147.79, "providers": [{ "billed_charge": 137527.72, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1017.58, "providers": [{ "billed_charge": 66805.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 772.99, "providers": [{ "billed_charge": 11807.00, "npi": [1093810327] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5026.53, "providers": [{ "billed_charge": 226877.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43661.39, "providers": [{ "billed_charge": 724493.00, "npi": [1548387418] } ] }, { "allowed_amount": 221.19, "providers": [{ "billed_charge": 6471.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46646.03, "providers": [{ "billed_charge": 1491668.37, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209.02, "providers": [{ "billed_charge": 4132.00, "npi": [1336172105] } ] }, { "allowed_amount": 3081.68, "providers": [{ "billed_charge": 163219.50, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24075.98, "providers": [{ "billed_charge": 424560.98, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 792.31, "providers": [{ "billed_charge": 53769.37, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1764.05, "providers": [{ "billed_charge": 18480.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7092.45, "providers": [{ "billed_charge": 319191.41, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21000.76, "providers": [{ "billed_charge": 1201874.95, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24582.03, "providers": [{ "billed_charge": 364289.14, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39994.66, "providers": [{ "billed_charge": 2398272.65, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5366.77, "providers": [{ "billed_charge": 57700.06, "npi": [1649273434] } ] }, { "allowed_amount": 749.79, "providers": [{ "billed_charge": 6484.35, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26676.90, "providers": [{ "billed_charge": 447974.64, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13459.78, "providers": [{ "billed_charge": 218312.42, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46757.19, "providers": [{ "billed_charge": 474471.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 277.60, "providers": [{ "billed_charge": 9003.00, "npi": [1932123247] } ] }, { "allowed_amount": 26120.62, "providers": [{ "billed_charge": 635234.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11337.67, "providers": [{ "billed_charge": 374802.63, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5332.50, "providers": [{ "billed_charge": 110756.63, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 350.66, "providers": [{ "billed_charge": 61493.00, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32386.28, "providers": [{ "billed_charge": 419521.51, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 351.24, "providers": [{ "billed_charge": 14395.50, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5412.88, "providers": [{ "billed_charge": 392501.81, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11071.94, "providers": [{ "billed_charge": 182974.03, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 494.25, "providers": [{ "billed_charge": 10562.59, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17733.13, "providers": [{ "billed_charge": 246953.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25752.52, "providers": [{ "billed_charge": 423620.31, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3450.71, "providers": [{ "billed_charge": 54377.00, "npi": [1194787218] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24003.22, "providers": [{ "billed_charge": 356577.06, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 82690.55, "providers": [{ "billed_charge": 1173823.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1067.87, "providers": [{ "billed_charge": 49196.89, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10699.76, "providers": [{ "billed_charge": 400263.96, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 753.49, "providers": [{ "billed_charge": 6484.35, "npi": [1851108765] } ] }, { "allowed_amount": 6567.26, "providers": [{ "billed_charge": 111186.35, "npi": [1124305065] } ] } ] } ] }, { "name": "OR SERVICES", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "360", "description": "OPERATING ROOM SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8824.15, "providers": [{ "billed_charge": 14666.00, "npi": [1871619254] } ] }, { "allowed_amount": 18250.82, "providers": [{ "billed_charge": 46001.68, "npi": [1497871628] } ] }, { "allowed_amount": 50439.70, "providers": [{ "billed_charge": 131184.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11887.13, "providers": [{ "billed_charge": 29549.00, "npi": [1477643690] } ] }, { "allowed_amount": 23023.20, "providers": [{ "billed_charge": 55412.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 110043.36, "providers": [{ "billed_charge": 285024.60, "npi": [1124796081] } ] }, { "allowed_amount": 322384.64, "providers": [{ "billed_charge": 1636889.45, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6043.32, "providers": [{ "billed_charge": 10618.00, "npi": [1205900370] } ] }, { "allowed_amount": 332970.51, "providers": [{ "billed_charge": 411499.98, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23", "19"], "billing_class": "institutional", "payments": [{ "allowed_amount": 147742.34, "providers": [{ "billed_charge": 271224.18, "npi": [1992753222] } ] }, { "allowed_amount": 680.00, "providers": [{ "billed_charge": 2836.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9669.31, "providers": [{ "billed_charge": 16656.54, "npi": [1629089966] } ] }, { "allowed_amount": 10466.56, "providers": [{ "billed_charge": 17301.93, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38822.38, "providers": [{ "billed_charge": 107164.15, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1478.24, "providers": [{ "billed_charge": 2922.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15323.77, "providers": [{ "billed_charge": 16996.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10394.51, "providers": [{ "billed_charge": 10260.00, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34437.54, "providers": [{ "billed_charge": 82566.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10625.95, "providers": [{ "billed_charge": 50041.00, "npi": [1407191984] } ] }, { "allowed_amount": 14866.56, "providers": [{ "billed_charge": 24484.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7010.25, "providers": [{ "billed_charge": 30070.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9669.31, "providers": [{ "billed_charge": 10122.50, "npi": [1932152337] } ] }, { "allowed_amount": 463810.33, "providers": [{ "billed_charge": 845444.38, "npi": [1730132234] } ] }, { "allowed_amount": 19338.62, "providers": [{ "billed_charge": 24024.50, "npi": [1740233782] } ] }, { "allowed_amount": 229004.14, "providers": [{ "billed_charge": 778948.00, "npi": [1982666111] } ] }, { "allowed_amount": 47931.55, "providers": [{ "billed_charge": 145890.25, "npi": [1982666111] } ] }, { "allowed_amount": 39141.68, "providers": [{ "billed_charge": 82750.50, "npi": [1295843787] } ] }, { "allowed_amount": 12768.99, "providers": [{ "billed_charge": 34078.25, "npi": [1730132234] } ] }, { "allowed_amount": 57106.46, "providers": [{ "billed_charge": 141967.50, "npi": [1932152337] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59228.10, "providers": [{ "billed_charge": 47724.15, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17933.96, "providers": [{ "billed_charge": 146564.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 44079.42, "providers": [{ "billed_charge": 52379.83, "npi": [1932123247] } ] } ] } ] }, { "name": "OR/MINOR", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "361", "description": "OPERATING ROOM SERVICES - MINOR SURGERY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5404.44, "providers": [{ "billed_charge": 24809.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 45861.30, "providers": [{ "billed_charge": 46783.00, "npi": [1205900370] } ] }, { "allowed_amount": 906.65, "providers": [{ "billed_charge": 1651.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 926.66, "providers": [{ "billed_charge": 8811.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26759.80, "providers": [{ "billed_charge": 64013.63, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2376.11, "providers": [{ "billed_charge": 5568.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 942.92, "providers": [{ "billed_charge": 2377.00, "npi": [1679578439] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 560.24, "providers": [{ "billed_charge": 7770.59, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 349.29, "providers": [{ "billed_charge": 1350.00, "npi": [1942526447] } ] }, { "allowed_amount": 12852.66, "providers": [{ "billed_charge": 50490.00, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "932115414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.05, "providers": [{ "billed_charge": 560.00, "npi": [1013444892] } ] } ] }, { "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 510.46, "providers": [{ "billed_charge": 2200.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 922.91, "providers": [{ "billed_charge": 990.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "273656127" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 202.03, "providers": [{ "billed_charge": 2040.00, "npi": [1659984441] } ] } ] }, { "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 121.42, "providers": [{ "billed_charge": 390.00, "npi": [1891855656] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1691.44, "providers": [{ "billed_charge": 6282.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "823021953" }, "service_code": ["13", "31"], "billing_class": "professional", "payments": [{ "allowed_amount": 289.18, "providers": [{ "billed_charge": 1724.49, "npi": [1447760814] } ] }, { "allowed_amount": 23.35, "providers": [{ "billed_charge": 138.60, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 905.38, "providers": [{ "billed_charge": 4850.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "844939989" }, "service_code": ["81", "31"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.70, "providers": [{ "billed_charge": 177.00, "npi": [1639791007] } ] }, { "allowed_amount": 154.11, "providers": [{ "billed_charge": 588.00, "npi": [1639791007] } ] } ] }, { "tin": { "type": "ein", "value": "854247861" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.35, "providers": [{ "billed_charge": 75.00, "npi": [1093144560] } ] } ] }, { "tin": { "type": "ein", "value": "994816352" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.67, "providers": [{ "billed_charge": 15.00, "npi": [1427002823] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1027.40, "providers": [{ "billed_charge": 6160.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.94, "providers": [{ "billed_charge": 50.00, "npi": [1234567893] } ] }, { "allowed_amount": 83764.47, "providers": [{ "billed_charge": 522209.22, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.34, "providers": [{ "billed_charge": 100.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.50, "providers": [{ "billed_charge": 546.39, "npi": [1730617523] } ] } ] }, { "tin": { "type": "ein", "value": "760579754" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.67, "providers": [{ "billed_charge": 26.49, "npi": [1043506777] } ] } ] }, { "tin": { "type": "ein", "value": "862433458" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.43, "providers": [{ "billed_charge": 380.00, "npi": [1982278800] } ] } ] }, { "tin": { "type": "ein", "value": "760430777" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.01, "providers": [{ "billed_charge": 33.68, "npi": [1780730606] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 65.14, "providers": [{ "billed_charge": 350.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "994843175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.29, "providers": [{ "billed_charge": 640.00, "npi": [1992003552] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 448.32, "providers": [{ "billed_charge": 1440.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.67, "providers": [{ "billed_charge": 16.00, "npi": [1942400601] } ] } ] }, { "tin": { "type": "ein", "value": "851746454" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.37, "providers": [{ "billed_charge": 656.25, "npi": [1154917896] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.59, "providers": [{ "billed_charge": 150.10, "npi": [1942535828] } ] }, { "allowed_amount": 7.94, "providers": [{ "billed_charge": 30.02, "npi": [1942535828] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 784.63, "providers": [{ "billed_charge": 3570.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "751414940" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.05, "providers": [{ "billed_charge": 93.75, "npi": [1578897765] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1613.57, "providers": [{ "billed_charge": 2595.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.26, "providers": [{ "billed_charge": 140.00, "npi": [1629099221] } ] } ] } ] }, { "name": "ANESTHESIA", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "370", "description": "ANESTHESIA - GENERAL CLASSIFICATIION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 731.96, "providers": [{ "billed_charge": 1262.00, "npi": [1194743013] } ] } ] } ] }, { "name": "BLOOD/PKD RED", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "381", "description": "BLOOD - PACKED RED CELLS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1365.33, "providers": [{ "billed_charge": 3672.00, "npi": [1205900370] } ] } ] } ] }, { "name": "BLOOD/STOR-PROC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "390", "description": "BLOOD STORAGE AND PROCESSING - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 277.84, "providers": [{ "billed_charge": 1504.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1512.73, "providers": [{ "billed_charge": 4010.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 591.71, "providers": [{ "billed_charge": 6868.75, "npi": [1295843787] } ] }, { "allowed_amount": 1307.24, "providers": [{ "billed_charge": 7843.25, "npi": [1982666111] } ] }, { "allowed_amount": 294.40, "providers": [{ "billed_charge": 981.25, "npi": [1932152337] } ] }, { "allowed_amount": 3179.57, "providers": [{ "billed_charge": 39992.75, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 382.72, "providers": [{ "billed_charge": 3710.00, "npi": [1679578439] } ] } ] } ] }, { "name": "BLOOD/ADMIN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "391", "description": "BLOOD STORAGE AND PROCESSING - BLOOD ADMINISTRATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6669.11, "providers": [{ "billed_charge": 5652.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 705.62, "providers": [{ "billed_charge": 3533.00, "npi": [1982666111] }, { "billed_charge": 1391.00, "npi": [1295843787] }, { "billed_charge": 1043.25, "npi": [1740233782] } ] }, { "allowed_amount": 4949.75, "providers": [{ "billed_charge": 10432.50, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 458.65, "providers": [{ "billed_charge": 2713.00, "npi": [1679578439] } ] } ] } ] }, { "name": "MAMMOGRAPHY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "401", "description": "OTHER IMAGING SERVICES - MAMMOGRAPHY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4446.93, "providers": [{ "billed_charge": 27351.05, "npi": [1629089966] } ] } ] } ] }, { "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": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11079.15, "providers": [{ "billed_charge": 413366.00, "npi": [1871619254] } ] }, { "allowed_amount": 1503.01, "providers": [{ "billed_charge": 61233.00, "npi": [1184179194] } ] }, { "allowed_amount": 1586.93, "providers": [{ "billed_charge": 79388.00, "npi": [1629828405] } ] }, { "allowed_amount": 14005.54, "providers": [{ "billed_charge": 476779.00, "npi": [1083937593] } ] }, { "allowed_amount": 4586.31, "providers": [{ "billed_charge": 192773.00, "npi": [1497871628] } ] }, { "allowed_amount": 104.51, "providers": [{ "billed_charge": 4498.50, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1853.71, "providers": [{ "billed_charge": 48462.40, "npi": [1124796081] } ] }, { "allowed_amount": 2549.85, "providers": [{ "billed_charge": 49770.56, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23", "19"], "billing_class": "institutional", "payments": [{ "allowed_amount": 357.78, "providers": [{ "billed_charge": 1093.00, "npi": [1992753222] } ] }, { "allowed_amount": 18143.61, "providers": [{ "billed_charge": 104906.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8995.79, "providers": [{ "billed_charge": 83570.50, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1048.88, "providers": [{ "billed_charge": 9390.24, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1674.88, "providers": [{ "billed_charge": 11957.50, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1040.73, "providers": [{ "billed_charge": 32984.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1878.63, "providers": [{ "billed_charge": 17083.00, "npi": [1033165501] } ] }, { "allowed_amount": 1253.89, "providers": [{ "billed_charge": 16442.00, "npi": [1689629941] } ] }, { "allowed_amount": 1965.81, "providers": [{ "billed_charge": 21868.00, "npi": [1528027786] } ] }, { "allowed_amount": 1695.83, "providers": [{ "billed_charge": 22335.00, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1605.38, "providers": [{ "billed_charge": 46120.02, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 723.35, "providers": [{ "billed_charge": 5020.02, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3031.16, "providers": [{ "billed_charge": 21543.75, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 449.40, "providers": [{ "billed_charge": 2150.67, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4048.96, "providers": [{ "billed_charge": 31754.41, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1273.68, "providers": [{ "billed_charge": 2196.00, "npi": [1194743013] } ] }, { "allowed_amount": 2104.82, "providers": [{ "billed_charge": 3629.00, "npi": [1194743013] } ] }, { "allowed_amount": 10019.50, "providers": [{ "billed_charge": 17275.00, "npi": [1720480627] } ] }, { "allowed_amount": 448.92, "providers": [{ "billed_charge": 774.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 261.28, "providers": [{ "billed_charge": 3193.40, "npi": [1477516466] } ] }, { "allowed_amount": 4010.96, "providers": [{ "billed_charge": 48567.61, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1122.43, "providers": [{ "billed_charge": 4665.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 898.80, "providers": [{ "billed_charge": 7441.80, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1821.36, "providers": [{ "billed_charge": 84017.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10244.67, "providers": [{ "billed_charge": 69609.75, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7419.46, "providers": [{ "billed_charge": 233936.75, "npi": [1982666111] } ] }, { "allowed_amount": 5019.84, "providers": [{ "billed_charge": 128553.75, "npi": [1932152337] } ] }, { "allowed_amount": 5855.94, "providers": [{ "billed_charge": 156739.25, "npi": [1740233782] } ] }, { "allowed_amount": 30944.81, "providers": [{ "billed_charge": 875423.50, "npi": [1730132234] } ] }, { "allowed_amount": 4489.49, "providers": [{ "billed_charge": 96109.00, "npi": [1295788735] } ] }, { "allowed_amount": 9876.51, "providers": [{ "billed_charge": 250050.50, "npi": [1295843787] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3974.48, "providers": [{ "billed_charge": 67365.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 846.54, "providers": [{ "billed_charge": 13842.82, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8131.32, "providers": [{ "billed_charge": 54380.00, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4754.89, "providers": [{ "billed_charge": 60080.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4077.93, "providers": [{ "billed_charge": 30732.00, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2236.20, "providers": [{ "billed_charge": 29905.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1106.18, "providers": [{ "billed_charge": 7349.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2788.53, "providers": [{ "billed_charge": 28567.73, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18442.03, "providers": [{ "billed_charge": 181855.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6107.99, "providers": [{ "billed_charge": 65180.07, "npi": [1629089966] } ] }, { "allowed_amount": 13746.69, "providers": [{ "billed_charge": 101548.78, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1725.99, "providers": [{ "billed_charge": 10549.12, "npi": [1184262800] } ] }, { "allowed_amount": 62.72, "providers": [{ "billed_charge": 715.17, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8992.36, "providers": [{ "billed_charge": 63718.33, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3770.56, "providers": [{ "billed_charge": 21345.50, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1924.77, "providers": [{ "billed_charge": 58217.80, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1431.33, "providers": [{ "billed_charge": 20853.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1802.72, "providers": [{ "billed_charge": 13244.83, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2752.83, "providers": [{ "billed_charge": 19364.23, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1026.15, "providers": [{ "billed_charge": 45193.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10339.47, "providers": [{ "billed_charge": 69905.56, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8104.89, "providers": [{ "billed_charge": 281683.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209.02, "providers": [{ "billed_charge": 3888.80, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3000.89, "providers": [{ "billed_charge": 99202.00, "npi": [1407191984] } ] }, { "allowed_amount": 104.51, "providers": [{ "billed_charge": 1294.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2698.64, "providers": [{ "billed_charge": 70635.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1141.26, "providers": [{ "billed_charge": 8646.50, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5711.85, "providers": [{ "billed_charge": 151519.46, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8569.76, "providers": [{ "billed_charge": 61497.75, "npi": [1336172105] } ] } ] } ] }, { "name": "SCRN MAMMOGRAPHY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "403", "description": "OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14181.77, "providers": [{ "billed_charge": 89992.51, "npi": [1629089966] } ] } ] } ] }, { "name": "RESPIRATORY SVC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "410", "description": "RESPIRATORY SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 325.93, "providers": [{ "billed_charge": 19565.00, "npi": [1871619254] } ] }, { "allowed_amount": 470.97, "providers": [{ "billed_charge": 13868.00, "npi": [1497871628] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 263.96, "providers": [{ "billed_charge": 112.00, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 521.11, "providers": [{ "billed_charge": 15147.00, "npi": [1205900370] } ] } ] } ] }, { "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": "208847736" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1697.63, "providers": [{ "billed_charge": 7518.00, "npi": [1952538431] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38.08, "providers": [{ "billed_charge": 2124.00, "npi": [1083937593] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 243.92, "providers": [{ "billed_charge": 2203.92, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25.22, "providers": [{ "billed_charge": 179.00, "npi": [1205900370] } ] }, { "allowed_amount": 267.18, "providers": [{ "billed_charge": 6920.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 233.87, "providers": [{ "billed_charge": 10426.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 45053.67, "providers": [{ "billed_charge": 322586.67, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57.00, "providers": [{ "billed_charge": 1020.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38.08, "providers": [{ "billed_charge": 214.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 365.60, "providers": [{ "billed_charge": 12532.50, "npi": [1982666111] } ] }, { "allowed_amount": 179.22, "providers": [{ "billed_charge": 1479.50, "npi": [1982666111] } ] }, { "allowed_amount": 307.52, "providers": [{ "billed_charge": 8276.00, "npi": [1932152337] } ] }, { "allowed_amount": 112.07, "providers": [{ "billed_charge": 3655.50, "npi": [1740233782] } ] }, { "allowed_amount": 183.71, "providers": [{ "billed_charge": 3014.75, "npi": [1295843787] } ] }, { "allowed_amount": 40.35, "providers": [{ "billed_charge": 295.75, "npi": [1740233782] } ] }, { "allowed_amount": 670.95, "providers": [{ "billed_charge": 4637.25, "npi": [1730132234] } ] }, { "allowed_amount": 74.05, "providers": [{ "billed_charge": 995.75, "npi": [1932152337] } ] }, { "allowed_amount": 76.21, "providers": [{ "billed_charge": 20786.25, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 88.84, "providers": [{ "billed_charge": 430.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14065.79, "providers": [{ "billed_charge": 26478.11, "npi": [1538465901] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 292.40, "providers": [{ "billed_charge": 1173.50, "npi": [1336172105] } ] } ] } ] }, { "name": "PHYS THERP/EVAL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "424", "description": "PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.10, "providers": [{ "billed_charge": 671.00, "npi": [1083937593] } ] }, { "allowed_amount": 1985.46, "providers": [{ "billed_charge": 10745.00, "npi": [1871619254] } ] }, { "allowed_amount": 1032.72, "providers": [{ "billed_charge": 6294.00, "npi": [1497871628] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 439.49, "providers": [{ "billed_charge": 1592.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2219.49, "providers": [{ "billed_charge": 4842.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 595.98, "providers": [{ "billed_charge": 1806.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7638.57, "providers": [{ "billed_charge": 28016.62, "npi": [1629089966] } ] }, { "allowed_amount": 270.55, "providers": [{ "billed_charge": 1108.40, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 567.12, "providers": [{ "billed_charge": 789.52, "npi": [1538465901] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 199.63, "providers": [{ "billed_charge": 459.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 256.98, "providers": [{ "billed_charge": 1854.00, "npi": [1033165501] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 744.94, "providers": [{ "billed_charge": 1661.57, "npi": [1447250253] } ] }, { "allowed_amount": 161.55, "providers": [{ "billed_charge": 395.47, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 95.48, "providers": [{ "billed_charge": 553.94, "npi": [1477516466] } ] }, { "allowed_amount": 708.29, "providers": [{ "billed_charge": 2769.70, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2254.11, "providers": [{ "billed_charge": 12843.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 389.06, "providers": [{ "billed_charge": 1902.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 557.84, "providers": [{ "billed_charge": 2052.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 93.69, "providers": [{ "billed_charge": 371.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2635.52, "providers": [{ "billed_charge": 18089.25, "npi": [1932152337] } ] }, { "allowed_amount": 235.56, "providers": [{ "billed_charge": 1853.00, "npi": [1295788735] } ] }, { "allowed_amount": 6853.57, "providers": [{ "billed_charge": 45015.25, "npi": [1730132234] } ] }, { "allowed_amount": 976.50, "providers": [{ "billed_charge": 5297.50, "npi": [1730132234] } ] }, { "allowed_amount": 1637.16, "providers": [{ "billed_charge": 13395.50, "npi": [1295843787] } ] }, { "allowed_amount": 2726.84, "providers": [{ "billed_charge": 19596.25, "npi": [1982666111] } ] }, { "allowed_amount": 120.30, "providers": [{ "billed_charge": 926.50, "npi": [1740233782] }, { "billed_charge": 982.25, "npi": [1982666111] } ] }, { "allowed_amount": 506.11, "providers": [{ "billed_charge": 3706.00, "npi": [1295788735] } ] }, { "allowed_amount": 152.77, "providers": [{ "billed_charge": 926.50, "npi": [1932152337] } ] }, { "allowed_amount": 951.99, "providers": [{ "billed_charge": 6236.50, "npi": [1740233782] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 735.68, "providers": [{ "billed_charge": 860.00, "npi": [1336172105] } ] }, { "allowed_amount": 195.28, "providers": [{ "billed_charge": 215.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 297.75, "providers": [{ "billed_charge": 2225.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 304.53, "providers": [{ "billed_charge": 1099.55, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 767.33, "providers": [{ "billed_charge": 2658.00, "npi": [1932123247] } ] } ] } ] }, { "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": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 102.94, "providers": [{ "billed_charge": 594.48, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1036.07, "providers": [{ "billed_charge": 5175.00, "npi": [1497871628] } ] }, { "allowed_amount": 912.60, "providers": [{ "billed_charge": 4460.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35.95, "providers": [{ "billed_charge": 2524.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1676.84, "providers": [{ "billed_charge": 10415.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 313.66, "providers": [{ "billed_charge": 1791.79, "npi": [1629089966] } ] }, { "allowed_amount": 2871.93, "providers": [{ "billed_charge": 12326.89, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 304.20, "providers": [{ "billed_charge": 1136.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1273.42, "providers": [{ "billed_charge": 2826.15, "npi": [1538465901] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 77.02, "providers": [{ "billed_charge": 1291.50, "npi": [1295843787] } ] }, { "allowed_amount": 223.98, "providers": [{ "billed_charge": 3427.50, "npi": [1932152337] } ] }, { "allowed_amount": 120.64, "providers": [{ "billed_charge": 1027.00, "npi": [1730132234] } ] }, { "allowed_amount": 155.88, "providers": [{ "billed_charge": 5694.25, "npi": [1982666111] } ] }, { "allowed_amount": 38.51, "providers": [{ "billed_charge": 874.50, "npi": [1982666111] }, { "billed_charge": 6590.50, "npi": [1730132234] } ] } ] } ] }, { "name": "OCCUP THERP/EVAL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "434", "description": "OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 866.52, "providers": [{ "billed_charge": 2067.64, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1180.13, "providers": [{ "billed_charge": 4318.26, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.55, "providers": [{ "billed_charge": 398.00, "npi": [1548226988] } ] }, { "allowed_amount": 303.66, "providers": [{ "billed_charge": 796.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2889.90, "providers": [{ "billed_charge": 5111.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 120.56, "providers": [{ "billed_charge": 374.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 644.68, "providers": [{ "billed_charge": 3767.50, "npi": [1730132234] } ] }, { "allowed_amount": 483.51, "providers": [{ "billed_charge": 3088.75, "npi": [1740233782] } ] }, { "allowed_amount": 322.34, "providers": [{ "billed_charge": 2124.50, "npi": [1982666111] } ] }, { "allowed_amount": 1934.04, "providers": [{ "billed_charge": 12743.50, "npi": [1295843787] } ] }, { "allowed_amount": 161.17, "providers": [{ "billed_charge": 1007.50, "npi": [1740233782] } ] }, { "allowed_amount": 276.64, "providers": [{ "billed_charge": 2015.00, "npi": [1295788735] } ] }, { "allowed_amount": 1568.30, "providers": [{ "billed_charge": 10010.00, "npi": [1932152337] } ] }, { "allowed_amount": 3536.67, "providers": [{ "billed_charge": 22251.25, "npi": [1982666111] } ] }, { "allowed_amount": 6448.78, "providers": [{ "billed_charge": 39227.00, "npi": [1730132234] } ] }, { "allowed_amount": 470.49, "providers": [{ "billed_charge": 2760.00, "npi": [1295788735] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 200.54, "providers": [{ "billed_charge": 327.50, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 172.30, "providers": [{ "billed_charge": 891.00, "npi": [1033165501] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 203.88, "providers": [{ "billed_charge": 1330.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 407.97, "providers": [{ "billed_charge": 997.19, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 366.76, "providers": [{ "billed_charge": 1059.00, "npi": [1932123247] } ] } ] } ] }, { "name": "SPEECH PATH/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "441", "description": "SPEECH-LANGUAGE PATHOLOGY - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263286977" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 500.00, "providers": [{ "billed_charge": 875.00, "npi": [1326297441] } ] } ] } ] }, { "name": "SPEECH PATH/EVAL", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "444", "description": "SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 408.09, "providers": [{ "billed_charge": 2371.75, "npi": [1982666111] } ] }, { "allowed_amount": 147.47, "providers": [{ "billed_charge": 5156.75, "npi": [1730132234] } ] } ] } ] }, { "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": "871142127" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 66992.77, "providers": [{ "billed_charge": 253579.00, "npi": [1073183141] } ] } ] }, { "tin": { "type": "ein", "value": "852489965" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46423.67, "providers": [{ "billed_charge": 156234.36, "npi": [1619588613] } ] } ] }, { "tin": { "type": "ein", "value": "871224784" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1759.33, "providers": [{ "billed_charge": 16818.95, "npi": [1003489212] } ] } ] }, { "tin": { "type": "ein", "value": "933189938" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17686.84, "providers": [{ "billed_charge": 173404.88, "npi": [1083488829] } ] } ] }, { "tin": { "type": "ein", "value": "741386053" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1312.32, "providers": [{ "billed_charge": 5369.00, "npi": [1720088123] } ] } ] }, { "tin": { "type": "ein", "value": "465557331" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12898.26, "providers": [{ "billed_charge": 65558.32, "npi": [1194125146] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14048.87, "providers": [{ "billed_charge": 49432.00, "npi": [1487271375] } ] }, { "allowed_amount": 275268.49, "providers": [{ "billed_charge": 800094.00, "npi": [1275592131] } ] }, { "allowed_amount": 18139.31, "providers": [{ "billed_charge": 57230.00, "npi": [1073294740] } ] }, { "allowed_amount": 281563.69, "providers": [{ "billed_charge": 718672.00, "npi": [1528027786] } ] }, { "allowed_amount": 286589.10, "providers": [{ "billed_charge": 868736.00, "npi": [1689629941] } ] }, { "allowed_amount": 27166.72, "providers": [{ "billed_charge": 77292.00, "npi": [1568818417] } ] }, { "allowed_amount": 283484.53, "providers": [{ "billed_charge": 840504.00, "npi": [1033165501] } ] } ] }, { "tin": { "type": "ein", "value": "922766125" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6235.20, "providers": [{ "billed_charge": 61406.60, "npi": [1255012779] } ] } ] }, { "tin": { "type": "ein", "value": "741109636" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3641.56, "providers": [{ "billed_charge": 14081.25, "npi": [1093708679] } ] } ] }, { "tin": { "type": "ein", "value": "820641535" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 97400.68, "providers": [{ "billed_charge": 835671.85, "npi": [1134783913] } ] } ] }, { "tin": { "type": "ein", "value": "331493792" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5658.87, "providers": [{ "billed_charge": 38555.59, "npi": [1942022546] } ] } ] }, { "tin": { "type": "ein", "value": "760436439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 42464.27, "providers": [{ "billed_charge": 270785.13, "npi": [1689650616] } ] } ] }, { "tin": { "type": "ein", "value": "393782106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 48707.81, "providers": [{ "billed_charge": 452635.96, "npi": [1124983002] } ] } ] }, { "tin": { "type": "ein", "value": "932775366" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22568.05, "providers": [{ "billed_charge": 191039.88, "npi": [1518822485] } ] } ] }, { "tin": { "type": "ein", "value": "851978933" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41324.40, "providers": [{ "billed_charge": 300357.41, "npi": [1265044333] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1568138.73, "providers": [{ "billed_charge": 2292719.28, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 547804.96, "providers": [{ "billed_charge": 990570.10, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752682017" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13627.05, "providers": [{ "billed_charge": 71469.00, "npi": [1114998911] } ] } ] }, { "tin": { "type": "ein", "value": "882917489" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24909.30, "providers": [{ "billed_charge": 231504.90, "npi": [1043942089] } ] } ] }, { "tin": { "type": "ein", "value": "922466057" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31033.52, "providers": [{ "billed_charge": 234375.00, "npi": [1659057081] } ] } ] }, { "tin": { "type": "ein", "value": "334253489" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6245.86, "providers": [{ "billed_charge": 29169.02, "npi": [1518752302] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 44675.29, "providers": [{ "billed_charge": 224322.50, "npi": [1619115383] } ] }, { "allowed_amount": 57061.05, "providers": [{ "billed_charge": 247342.00, "npi": [1093810327] } ] }, { "allowed_amount": 26991.34, "providers": [{ "billed_charge": 148693.00, "npi": [1124137054] } ] }, { "allowed_amount": 112.99, "providers": [{ "billed_charge": 1006.50, "npi": [1447355771] } ] }, { "allowed_amount": 8101.37, "providers": [{ "billed_charge": 47946.00, "npi": [1164526786] } ] }, { "allowed_amount": 18479.80, "providers": [{ "billed_charge": 84052.00, "npi": [1578780870] } ] } ] }, { "tin": { "type": "ein", "value": "843475920" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2808.17, "providers": [{ "billed_charge": 14650.00, "npi": [1063051159] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 206967.76, "providers": [{ "billed_charge": 968059.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "393916039" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2074.13, "providers": [{ "billed_charge": 18415.86, "npi": [1699653279] } ] } ] }, { "tin": { "type": "ein", "value": "741385192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7743.56, "providers": [{ "billed_charge": 25668.00, "npi": [1972581940] } ] } ] }, { "tin": { "type": "ein", "value": "832040784" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10578.36, "providers": [{ "billed_charge": 117098.96, "npi": [1366917528] } ] } ] }, { "tin": { "type": "ein", "value": "871585575" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1044.22, "providers": [{ "billed_charge": 12270.04, "npi": [1619549474] } ] } ] }, { "tin": { "type": "ein", "value": "752796815" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6509.92, "providers": [{ "billed_charge": 37789.00, "npi": [1295736734] } ] } ] }, { "tin": { "type": "ein", "value": "934242663" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16278.85, "providers": [{ "billed_charge": 162865.60, "npi": [1740054436] } ] } ] }, { "tin": { "type": "ein", "value": "824314476" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 89013.98, "providers": [{ "billed_charge": 715503.74, "npi": [1467930420] } ] } ] }, { "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36923.20, "providers": [{ "billed_charge": 73044.50, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "852007987" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5359.03, "providers": [{ "billed_charge": 81996.00, "npi": [1144838947] } ] } ] }, { "tin": { "type": "ein", "value": "831872200" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 136345.75, "providers": [{ "billed_charge": 1216072.81, "npi": [1194290106] } ] } ] }, { "tin": { "type": "ein", "value": "473248194" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10340.35, "providers": [{ "billed_charge": 133500.00, "npi": [1588111082] } ] } ] }, { "tin": { "type": "ein", "value": "814584169" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 85730.07, "providers": [{ "billed_charge": 484041.65, "npi": [1376064295] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 37566.30, "providers": [{ "billed_charge": 96971.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "750827446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 56887.35, "providers": [{ "billed_charge": 531333.55, "npi": [1528064649] } ] } ] }, { "tin": { "type": "ein", "value": "843073061" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 120384.05, "providers": [{ "billed_charge": 1562471.52, "npi": [1750932117] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 209755.23, "providers": [{ "billed_charge": 541128.14, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 546640.57, "providers": [{ "billed_charge": 1168404.64, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "383813467" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26955.93, "providers": [{ "billed_charge": 71747.00, "npi": [1497053912] } ] } ] }, { "tin": { "type": "ein", "value": "851961472" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28078.41, "providers": [{ "billed_charge": 453364.95, "npi": [1235747304] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 551466.49, "providers": [{ "billed_charge": 3221067.00, "npi": [1679557888] } ] }, { "allowed_amount": 28683.79, "providers": [{ "billed_charge": 103997.00, "npi": [1598749707] } ] } ] }, { "tin": { "type": "ein", "value": "933488698" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79600.12, "providers": [{ "billed_charge": 490678.83, "npi": [1740042175] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 604371.70, "providers": [{ "billed_charge": 4721828.70, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "831954982" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 98733.82, "providers": [{ "billed_charge": 151367.00, "npi": [1104381292] } ] } ] }, { "tin": { "type": "ein", "value": "842589283" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15239.57, "providers": [{ "billed_charge": 122490.30, "npi": [1902453970] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7182.53, "providers": [{ "billed_charge": 36797.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "823463299" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 141446.60, "providers": [{ "billed_charge": 978154.38, "npi": [1649770488] } ] } ] }, { "tin": { "type": "ein", "value": "752890358" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 109413.48, "providers": [{ "billed_charge": 185249.00, "npi": [1548291883] } ] } ] }, { "tin": { "type": "ein", "value": "882221512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13865.26, "providers": [{ "billed_charge": 57560.66, "npi": [1598497638] } ] } ] }, { "tin": { "type": "ein", "value": "260684968" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 45096.56, "providers": [{ "billed_charge": 96701.50, "npi": [1902047376] } ] } ] }, { "tin": { "type": "ein", "value": "820756286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8967.37, "providers": [{ "billed_charge": 39997.15, "npi": [1821501875] } ] } ] }, { "tin": { "type": "ein", "value": "852382362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72387.11, "providers": [{ "billed_charge": 314733.05, "npi": [1538854872] } ] } ] }, { "tin": { "type": "ein", "value": "831871919" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 141585.47, "providers": [{ "billed_charge": 1178187.19, "npi": [1558836569] } ] } ] }, { "tin": { "type": "ein", "value": "811988087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 71352.41, "providers": [{ "billed_charge": 625248.88, "npi": [1073058939] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 227617.19, "providers": [{ "billed_charge": 967310.00, "npi": [1184179194] } ] }, { "allowed_amount": 139763.43, "providers": [{ "billed_charge": 691173.00, "npi": [1629828405] } ] }, { "allowed_amount": 407066.63, "providers": [{ "billed_charge": 1728901.00, "npi": [1497871628] } ] }, { "allowed_amount": 704288.12, "providers": [{ "billed_charge": 3138913.00, "npi": [1083937593] } ] }, { "allowed_amount": 699259.04, "providers": [{ "billed_charge": 3054794.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "851931245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19650.04, "providers": [{ "billed_charge": 319106.88, "npi": [1750909974] } ] } ] }, { "tin": { "type": "ein", "value": "510570864" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 81607.69, "providers": [{ "billed_charge": 305497.00, "npi": [1255579389] } ] } ] }, { "tin": { "type": "ein", "value": "461852177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 72028.19, "providers": [{ "billed_charge": 285950.32, "npi": [1205263423] } ] } ] }, { "tin": { "type": "ein", "value": "822437084" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2140.48, "providers": [{ "billed_charge": 15049.00, "npi": [1205342755] } ] } ] }, { "tin": { "type": "ein", "value": "746000756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3525.06, "providers": [{ "billed_charge": 15872.58, "npi": [1316936990] } ] } ] }, { "tin": { "type": "ein", "value": "824884205" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53618.79, "providers": [{ "billed_charge": 340841.76, "npi": [1295223477] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 239896.08, "providers": [{ "billed_charge": 1488425.00, "npi": [1689641680] } ] }, { "allowed_amount": 39367.81, "providers": [{ "billed_charge": 272457.00, "npi": [1093783391] } ] }, { "allowed_amount": 11624.96, "providers": [{ "billed_charge": 97508.00, "npi": [1447228747] } ] }, { "allowed_amount": 34649.96, "providers": [{ "billed_charge": 168600.00, "npi": [1003885641] } ] } ] }, { "tin": { "type": "ein", "value": "474866295" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 59378.85, "providers": [{ "billed_charge": 5815894.17, "npi": [1992172019] } ] } ] }, { "tin": { "type": "ein", "value": "832804506" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11460.45, "providers": [{ "billed_charge": 98023.65, "npi": [1174089866] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12103.44, "providers": [{ "billed_charge": 20868.00, "npi": [1194743013] } ] }, { "allowed_amount": 264478.26, "providers": [{ "billed_charge": 455997.00, "npi": [1720480627] } ] }, { "allowed_amount": 10585.00, "providers": [{ "billed_charge": 18250.00, "npi": [1720480627] } ] }, { "allowed_amount": 180686.24, "providers": [{ "billed_charge": 311528.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 485255.20, "providers": [{ "billed_charge": 1348482.83, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 54396.51, "providers": [{ "billed_charge": 270479.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "851778208" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16855.64, "providers": [{ "billed_charge": 176376.92, "npi": [1366056194] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16105.24, "providers": [{ "billed_charge": 103821.00, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "741282696" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12043.31, "providers": [{ "billed_charge": 46916.00, "npi": [1942294939] } ] } ] }, { "tin": { "type": "ein", "value": "814928222" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47187.20, "providers": [{ "billed_charge": 570000.00, "npi": [1710417761] } ] } ] }, { "tin": { "type": "ein", "value": "992078911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 95066.67, "providers": [{ "billed_charge": 615030.00, "npi": [1770333403] } ] } ] }, { "tin": { "type": "ein", "value": "465735510" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3081.30, "providers": [{ "billed_charge": 40250.00, "npi": [1164827093] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24343.34, "providers": [{ "billed_charge": 79099.30, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4055.30, "providers": [{ "billed_charge": 11357.50, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "851929979" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9317.29, "providers": [{ "billed_charge": 86853.87, "npi": [1851180400] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24587.39, "providers": [{ "billed_charge": 137988.98, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "995017291" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18790.24, "providers": [{ "billed_charge": 73001.94, "npi": [1851112098] } ] } ] }, { "tin": { "type": "ein", "value": "852713042" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 635344.69, "providers": [{ "billed_charge": 3288457.49, "npi": [1376141556] } ] } ] }, { "tin": { "type": "ein", "value": "881716225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1666.26, "providers": [{ "billed_charge": 9908.94, "npi": [1053175794] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9905.53, "providers": [{ "billed_charge": 25281.55, "npi": [1548286172] } ] }, { "allowed_amount": 249507.54, "providers": [{ "billed_charge": 1140172.15, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "392717734" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 33568.88, "providers": [{ "billed_charge": 225433.64, "npi": [1093604662] } ] } ] }, { "tin": { "type": "ein", "value": "463017479" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 61744.87, "providers": [{ "billed_charge": 395186.35, "npi": [1538508635] } ] } ] }, { "tin": { "type": "ein", "value": "992762070" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31473.44, "providers": [{ "billed_charge": 227222.43, "npi": [1124865126] } ] } ] }, { "tin": { "type": "ein", "value": "853503076" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13712.40, "providers": [{ "billed_charge": 109359.72, "npi": [1124623889] } ] } ] }, { "tin": { "type": "ein", "value": "994033449" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 53365.66, "providers": [{ "billed_charge": 322467.12, "npi": [1902644263] } ] } ] }, { "tin": { "type": "ein", "value": "760714523" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 33268.95, "providers": [{ "billed_charge": 51183.00, "npi": [1598744856] } ] }, { "allowed_amount": 150693.87, "providers": [{ "billed_charge": 235025.00, "npi": [1598744856] } ] } ] }, { "tin": { "type": "ein", "value": "333069853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 234808.87, "providers": [{ "billed_charge": 1547317.90, "npi": [1629882402] } ] } ] }, { "tin": { "type": "ein", "value": "751752253" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1211.72, "providers": [{ "billed_charge": 2112.25, "npi": [1922031541] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 126729.28, "providers": [{ "billed_charge": 259853.87, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 62221.38, "providers": [{ "billed_charge": 429276.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "393793693" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20662.41, "providers": [{ "billed_charge": 187900.84, "npi": [1205791183] } ] } ] }, { "tin": { "type": "ein", "value": "751584559" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10874.31, "providers": [{ "billed_charge": 32260.00, "npi": [1255325817] } ] } ] }, { "tin": { "type": "ein", "value": "472616215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9548.14, "providers": [{ "billed_charge": 104750.00, "npi": [1922468156] } ] } ] }, { "tin": { "type": "ein", "value": "756003896" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1214.56, "providers": [{ "billed_charge": 3351.00, "npi": [1275581852] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 219438.70, "providers": [{ "billed_charge": 866800.40, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "751748586" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 93579.72, "providers": [{ "billed_charge": 170253.75, "npi": [1508899204] } ] } ] }, { "tin": { "type": "ein", "value": "452662980" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12901.85, "providers": [{ "billed_charge": 19849.00, "npi": [1154618742] } ] }, { "allowed_amount": 7339.15, "providers": [{ "billed_charge": 11291.00, "npi": [1154618742] } ] } ] }, { "tin": { "type": "ein", "value": "832040998" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19446.17, "providers": [{ "billed_charge": 198306.56, "npi": [1083189245] } ] } ] }, { "tin": { "type": "ein", "value": "751977850" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17451.88, "providers": [{ "billed_charge": 33986.75, "npi": [1396778064] } ] } ] }, { "tin": { "type": "ein", "value": "473344271" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 40342.31, "providers": [{ "billed_charge": 255744.65, "npi": [1003280629] } ] } ] }, { "tin": { "type": "ein", "value": "920937062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38254.11, "providers": [{ "billed_charge": 165526.66, "npi": [1558056895] } ] } ] }, { "tin": { "type": "ein", "value": "994033554" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 142263.96, "providers": [{ "billed_charge": 803830.48, "npi": [1912745274] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 429464.96, "providers": [{ "billed_charge": 4769487.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "464901030" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 238975.34, "providers": [{ "billed_charge": 994889.75, "npi": [1679976120] } ] } ] }, { "tin": { "type": "ein", "value": "320579508" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 26969.08, "providers": [{ "billed_charge": 285009.16, "npi": [1790250959] } ] } ] }, { "tin": { "type": "ein", "value": "742206635" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 415.58, "providers": [{ "billed_charge": 2361.83, "npi": [1205833985] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 144567.50, "providers": [{ "billed_charge": 660466.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43834.92, "providers": [{ "billed_charge": 118730.06, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 504963.79, "providers": [{ "billed_charge": 1050767.66, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 649410.44, "providers": [{ "billed_charge": 2914791.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39662.91, "providers": [{ "billed_charge": 119419.52, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "990418594" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 47204.34, "providers": [{ "billed_charge": 381340.86, "npi": [1174385439] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 131588.42, "providers": [{ "billed_charge": 276541.54, "npi": [1124305065] } ] }, { "allowed_amount": 68117.54, "providers": [{ "billed_charge": 138395.99, "npi": [1851108765] } ] } ] }, { "tin": { "type": "ein", "value": "273026151" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4621.80, "providers": [{ "billed_charge": 5060.00, "npi": [1326349986] } ] } ] }, { "tin": { "type": "ein", "value": "752771437" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11981.11, "providers": [{ "billed_charge": 24864.75, "npi": [1457382798] } ] } ] }, { "tin": { "type": "ein", "value": "882923822" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4313.18, "providers": [{ "billed_charge": 76399.66, "npi": [1770214256] } ] } ] }, { "tin": { "type": "ein", "value": "832041052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21277.45, "providers": [{ "billed_charge": 222286.52, "npi": [1255806410] } ] } ] }, { "tin": { "type": "ein", "value": "208737126" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 41230.00, "providers": [{ "billed_charge": 137001.63, "npi": [1104086941] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1495357.72, "providers": [{ "billed_charge": 2962410.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "882501936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 79046.01, "providers": [{ "billed_charge": 486649.89, "npi": [1750013769] } ] } ] }, { "tin": { "type": "ein", "value": "822913146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5348.49, "providers": [{ "billed_charge": 40110.00, "npi": [1972517365] } ] } ] }, { "tin": { "type": "ein", "value": "824785286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 180051.09, "providers": [{ "billed_charge": 1340947.00, "npi": [1699244624] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 219394.26, "providers": [{ "billed_charge": 375194.50, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46152.50, "providers": [{ "billed_charge": 151347.27, "npi": [1265568638] } ] } ] }, { "tin": { "type": "ein", "value": "750755367" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11789.81, "providers": [{ "billed_charge": 63808.75, "npi": [1396746129] } ] } ] }, { "tin": { "type": "ein", "value": "931592669" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7965.66, "providers": [{ "billed_charge": 87331.11, "npi": [1639853443] } ] } ] }, { "tin": { "type": "ein", "value": "751277293" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1048.95, "providers": [{ "billed_charge": 8200.00, "npi": [1598750721] } ] } ] }, { "tin": { "type": "ein", "value": "844755191" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7214.03, "providers": [{ "billed_charge": 28001.00, "npi": [1437750163] } ] } ] }, { "tin": { "type": "ein", "value": "760431829" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29102.88, "providers": [{ "billed_charge": 201030.40, "npi": [1104199017] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 267534.01, "providers": [{ "billed_charge": 1533672.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 225353.36, "providers": [{ "billed_charge": 1131617.00, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "752312009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5692.34, "providers": [{ "billed_charge": 18208.00, "npi": [1225038938] } ] } ] }, { "tin": { "type": "ein", "value": "832329088" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 42462.72, "providers": [{ "billed_charge": 146120.90, "npi": [1780436287] } ] }, { "allowed_amount": 19382.54, "providers": [{ "billed_charge": 213939.94, "npi": [1457820995] } ] } ] }, { "tin": { "type": "ein", "value": "333807317" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12298.48, "providers": [{ "billed_charge": 24158.76, "npi": [1083586747] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 379398.70, "providers": [{ "billed_charge": 1552362.70, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8287.69, "providers": [{ "billed_charge": 13144.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "843683956" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 177670.53, "providers": [{ "billed_charge": 485329.70, "npi": [1184262800] } ] } ] }, { "tin": { "type": "ein", "value": "751301362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16928.04, "providers": [{ "billed_charge": 72881.00, "npi": [1821087164] } ] } ] }, { "tin": { "type": "ein", "value": "922950626" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10403.57, "providers": [{ "billed_charge": 101339.88, "npi": [1992486419] } ] } ] }, { "tin": { "type": "ein", "value": "394604245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2445.38, "providers": [{ "billed_charge": 22283.92, "npi": [1699649400] } ] } ] }, { "tin": { "type": "ein", "value": "852354189" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 56984.20, "providers": [{ "billed_charge": 85704.41, "npi": [1215609896] } ] } ] }, { "tin": { "type": "ein", "value": "881723756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 60945.25, "providers": [{ "billed_charge": 469945.80, "npi": [1689319501] } ] } ] }, { "tin": { "type": "ein", "value": "861747068" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5359.32, "providers": [{ "billed_charge": 22677.29, "npi": [1740950179] } ] } ] }, { "tin": { "type": "ein", "value": "752051646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 58788.06, "providers": [{ "billed_charge": 499043.47, "npi": [1891765178] } ] } ] }, { "tin": { "type": "ein", "value": "741303720" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11119.65, "providers": [{ "billed_charge": 23781.00, "npi": [1093744187] } ] } ] }, { "tin": { "type": "ein", "value": "720551963" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 586.95, "providers": [{ "billed_charge": 925.00, "npi": [1972549855] } ] } ] }, { "tin": { "type": "ein", "value": "262978009" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52502.86, "providers": [{ "billed_charge": 131225.26, "npi": [1619308319] } ] }, { "allowed_amount": 15335.53, "providers": [{ "billed_charge": 42372.08, "npi": [1407344880] } ] }, { "allowed_amount": 88113.66, "providers": [{ "billed_charge": 222290.92, "npi": [1407010622] } ] } ] }, { "tin": { "type": "ein", "value": "813556450" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4410.91, "providers": [{ "billed_charge": 32150.00, "npi": [1467935866] } ] } ] }, { "tin": { "type": "ein", "value": "882931023" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15656.91, "providers": [{ "billed_charge": 259826.57, "npi": [1740911213] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 229375.97, "providers": [{ "billed_charge": 404854.50, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "233069260" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6649.45, "providers": [{ "billed_charge": 84976.00, "npi": [1770573586] } ] } ] }, { "tin": { "type": "ein", "value": "454435955" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 44738.18, "providers": [{ "billed_charge": 294624.61, "npi": [1467897447] } ] } ] }, { "tin": { "type": "ein", "value": "203904667" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14337.38, "providers": [{ "billed_charge": 60578.50, "npi": [1376662296] } ] } ] }, { "tin": { "type": "ein", "value": "741718215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2856.17, "providers": [{ "billed_charge": 3496.50, "npi": [1699772541] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 301245.96, "providers": [{ "billed_charge": 836755.91, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "873083628" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30683.26, "providers": [{ "billed_charge": 235698.45, "npi": [1013670132] } ] } ] }, { "tin": { "type": "ein", "value": "813334196" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 34934.80, "providers": [{ "billed_charge": 212303.55, "npi": [1013499383] } ] } ] }, { "tin": { "type": "ein", "value": "800810304" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 64346.29, "providers": [{ "billed_charge": 418966.02, "npi": [1295213601] } ] } ] }, { "tin": { "type": "ein", "value": "871558323" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3824.83, "providers": [{ "billed_charge": 28535.44, "npi": [1063084820] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 68942.00, "providers": [{ "billed_charge": 839500.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 492260.12, "providers": [{ "billed_charge": 815327.00, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 147217.94, "providers": [{ "billed_charge": 264750.82, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "334202263" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3820.97, "providers": [{ "billed_charge": 24673.51, "npi": [1366246324] } ] } ] }, { "tin": { "type": "ein", "value": "882394440" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 44811.81, "providers": [{ "billed_charge": 510954.63, "npi": [1396429700] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 322328.76, "providers": [{ "billed_charge": 1508858.79, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752865177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29890.93, "providers": [{ "billed_charge": 53843.46, "npi": [1922002674] } ] } ] }, { "tin": { "type": "ein", "value": "331929227" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7559.88, "providers": [{ "billed_charge": 42723.33, "npi": [1144112129] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 496982.92, "providers": [{ "billed_charge": 853417.50, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "621692446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31485.71, "providers": [{ "billed_charge": 124554.91, "npi": [1497708929] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 303648.34, "providers": [{ "billed_charge": 511482.65, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "812527918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9796.97, "providers": [{ "billed_charge": 39723.00, "npi": [1396280756] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 292506.81, "providers": [{ "billed_charge": 840620.90, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "611780130" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19657.99, "providers": [{ "billed_charge": 146831.30, "npi": [1356893531] } ] } ] }, { "tin": { "type": "ein", "value": "921924347" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39386.10, "providers": [{ "billed_charge": 597186.83, "npi": [1639875750] } ] } ] }, { "tin": { "type": "ein", "value": "813351512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19932.11, "providers": [{ "billed_charge": 178255.95, "npi": [1891210639] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 281310.45, "providers": [{ "billed_charge": 452241.36, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "333466645" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8395.33, "providers": [{ "billed_charge": 62742.74, "npi": [1639975758] } ] } ] }, { "tin": { "type": "ein", "value": "871528012" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18421.63, "providers": [{ "billed_charge": 103168.61, "npi": [1912677295] } ] } ] }, { "tin": { "type": "ein", "value": "822174187" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31525.43, "providers": [{ "billed_charge": 173792.40, "npi": [1811475346] } ] } ] }, { "tin": { "type": "ein", "value": "880803328" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4741.87, "providers": [{ "billed_charge": 31638.55, "npi": [1467199448] } ] } ] }, { "tin": { "type": "ein", "value": "464007700" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35473.41, "providers": [{ "billed_charge": 113770.25, "npi": [1396138970] } ] } ] }, { "tin": { "type": "ein", "value": "364867084" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 632.83, "providers": [{ "billed_charge": 6925.00, "npi": [1376870840] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 130691.50, "providers": [{ "billed_charge": 406173.24, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 452508.11, "providers": [{ "billed_charge": 2106265.86, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "813562144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36807.85, "providers": [{ "billed_charge": 244436.70, "npi": [1639663370] } ] } ] }, { "tin": { "type": "ein", "value": "741698143" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2642.76, "providers": [{ "billed_charge": 7350.00, "npi": [1124052162] } ] } ] }, { "tin": { "type": "ein", "value": "720411322" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5712.89, "providers": [{ "billed_charge": 14357.00, "npi": [1548796378] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 385533.11, "providers": [{ "billed_charge": 649489.25, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "931617297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4084.01, "providers": [{ "billed_charge": 37575.15, "npi": [1417633736] } ] } ] }, { "tin": { "type": "ein", "value": "992545052" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6746.21, "providers": [{ "billed_charge": 28820.00, "npi": [1619760907] } ] } ] }, { "tin": { "type": "ein", "value": "364755936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 65720.33, "providers": [{ "billed_charge": 171747.92, "npi": [1831629526] } ] }, { "allowed_amount": 78446.89, "providers": [{ "billed_charge": 188555.18, "npi": [1679903967] } ] }, { "allowed_amount": 56114.06, "providers": [{ "billed_charge": 152130.74, "npi": [1598196206] } ] } ] }, { "tin": { "type": "ein", "value": "331073948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1713.64, "providers": [{ "billed_charge": 8260.42, "npi": [1063411767] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 37500.64, "providers": [{ "billed_charge": 331736.00, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "751844139" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 50257.55, "providers": [{ "billed_charge": 92413.08, "npi": [1265430177] } ] } ] }, { "tin": { "type": "ein", "value": "202848116" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43325.94, "providers": [{ "billed_charge": 77015.75, "npi": [1629138029] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 334819.85, "providers": [{ "billed_charge": 1481212.75, "npi": [1295788735] } ] }, { "allowed_amount": 697750.33, "providers": [{ "billed_charge": 3535706.00, "npi": [1982666111] } ] }, { "allowed_amount": 2932360.26, "providers": [{ "billed_charge": 13129563.75, "npi": [1730132234] } ] }, { "allowed_amount": 735090.59, "providers": [{ "billed_charge": 3706008.75, "npi": [1295843787] } ] }, { "allowed_amount": 429437.22, "providers": [{ "billed_charge": 2031972.25, "npi": [1740233782] } ] }, { "allowed_amount": 500812.56, "providers": [{ "billed_charge": 2379115.75, "npi": [1932152337] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 831789.22, "providers": [{ "billed_charge": 1522088.00, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "923094590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8414.96, "providers": [{ "billed_charge": 90473.32, "npi": [1477234995] } ] } ] }, { "tin": { "type": "ein", "value": "851984103" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1687.40, "providers": [{ "billed_charge": 28254.12, "npi": [1376151365] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13883.73, "providers": [{ "billed_charge": 33142.54, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "742730328" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10890.33, "providers": [{ "billed_charge": 46209.58, "npi": [1124074273] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 485280.33, "providers": [{ "billed_charge": 1793395.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "752829613" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3670.47, "providers": [{ "billed_charge": 12827.00, "npi": [1386647717] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 860976.51, "providers": [{ "billed_charge": 1632397.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "334228227" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13938.86, "providers": [{ "billed_charge": 82565.11, "npi": [1538950837] } ] } ] }, { "tin": { "type": "ein", "value": "831617286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69345.01, "providers": [{ "billed_charge": 665355.21, "npi": [1619567021] } ] } ] }, { "tin": { "type": "ein", "value": "992497065" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15522.07, "providers": [{ "billed_charge": 118690.86, "npi": [1083444780] } ] } ] }, { "tin": { "type": "ein", "value": "412101361" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18224.28, "providers": [{ "billed_charge": 24641.20, "npi": [1962504340] } ] } ] }, { "tin": { "type": "ein", "value": "920323729" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 95310.19, "providers": [{ "billed_charge": 51133.00, "npi": [1003539073] } ] } ] }, { "tin": { "type": "ein", "value": "832041336" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18138.14, "providers": [{ "billed_charge": 195795.24, "npi": [1245705417] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 86739.71, "providers": [{ "billed_charge": 731756.39, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "472971495" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21486.96, "providers": [{ "billed_charge": 296569.73, "npi": [1659744662] } ] } ] }, { "tin": { "type": "ein", "value": "262294680" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19044.19, "providers": [{ "billed_charge": 20982.00, "npi": [1164688495] } ] } ] }, { "tin": { "type": "ein", "value": "882898646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4659.84, "providers": [{ "billed_charge": 80542.00, "npi": [1699406173] } ] } ] }, { "tin": { "type": "ein", "value": "814974144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4373.31, "providers": [{ "billed_charge": 21539.41, "npi": [1982113601] } ] } ] }, { "tin": { "type": "ein", "value": "931469666" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 506172.26, "providers": [{ "billed_charge": 3575284.36, "npi": [1265124986] } ] } ] }, { "tin": { "type": "ein", "value": "883464149" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 28265.60, "providers": [{ "billed_charge": 510650.05, "npi": [1881322469] } ] } ] }, { "tin": { "type": "ein", "value": "844983621" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27775.20, "providers": [{ "billed_charge": 155848.54, "npi": [1780297598] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 303591.94, "providers": [{ "billed_charge": 627570.40, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69847.44, "providers": [{ "billed_charge": 149292.00, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "453780407" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2393.73, "providers": [{ "billed_charge": 6650.00, "npi": [1407121189] } ] } ] }, { "tin": { "type": "ein", "value": "863189225" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27262.30, "providers": [{ "billed_charge": 168373.70, "npi": [1194484345] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 728853.58, "providers": [{ "billed_charge": 1625192.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "872698268" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100248.34, "providers": [{ "billed_charge": 691411.40, "npi": [1861163826] } ] } ] }, { "tin": { "type": "ein", "value": "472166397" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4037.87, "providers": [{ "billed_charge": 51750.00, "npi": [1093191397] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 355629.86, "providers": [{ "billed_charge": 649311.75, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "934295804" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32109.21, "providers": [{ "billed_charge": 207018.40, "npi": [1851165013] } ] } ] }, { "tin": { "type": "ein", "value": "301205721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 154553.32, "providers": [{ "billed_charge": 181870.00, "npi": [1588215461] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 309499.47, "providers": [{ "billed_charge": 1231139.11, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "813040663" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9454.12, "providers": [{ "billed_charge": 37864.81, "npi": [1902366305] } ] }, { "allowed_amount": 22303.82, "providers": [{ "billed_charge": 83712.78, "npi": [1346729159] } ] }, { "allowed_amount": 21615.86, "providers": [{ "billed_charge": 56487.94, "npi": [1144781501] } ] } ] }, { "tin": { "type": "ein", "value": "460962386" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10336.52, "providers": [{ "billed_charge": 109033.24, "npi": [1275957508] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36201.96, "providers": [{ "billed_charge": 196677.00, "npi": [1447883301] } ] }, { "allowed_amount": 11828.18, "providers": [{ "billed_charge": 53802.00, "npi": [1821004151] } ] }, { "allowed_amount": 5728.01, "providers": [{ "billed_charge": 44946.00, "npi": [1780867390] } ] }, { "allowed_amount": 58322.08, "providers": [{ "billed_charge": 392685.00, "npi": [1194787218] } ] } ] }, { "tin": { "type": "ein", "value": "621762420" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2397.29, "providers": [{ "billed_charge": 20266.46, "npi": [1528026267] } ] } ] }, { "tin": { "type": "ein", "value": "464084062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17495.56, "providers": [{ "billed_charge": 32051.57, "npi": [1669872610] } ] } ] }, { "tin": { "type": "ein", "value": "922858146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11641.34, "providers": [{ "billed_charge": 121533.28, "npi": [1184305609] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 40287.96, "providers": [{ "billed_charge": 358795.00, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "581725656" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6673.48, "providers": [{ "billed_charge": 38369.00, "npi": [1770522906] } ] } ] }, { "tin": { "type": "ein", "value": "992496750" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38912.39, "providers": [{ "billed_charge": 327805.14, "npi": [1811727514] } ] } ] }, { "tin": { "type": "ein", "value": "851820772" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 23614.51, "providers": [{ "billed_charge": 373564.89, "npi": [1285252593] } ] } ] }, { "tin": { "type": "ein", "value": "621762545" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1672.34, "providers": [{ "billed_charge": 8119.00, "npi": [1447299649] } ] } ] } ] }, { "name": "OTHER EMER ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "459", "description": "EMERGENCY ROOM - OTHER EMERGENCY ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20369.91, "providers": [{ "billed_charge": 13231.00, "npi": [1932123247] } ] } ] } ] }, { "name": "PULMONARY FUNC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "460", "description": "PULMONARY FUNCTION - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2324.13, "providers": [{ "billed_charge": 40502.00, "npi": [1124796081] } ] } ] } ] }, { "name": "AUDIOLOGY/DX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "471", "description": "AUDIOLOGY - DIAGNOSTIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 261.93, "providers": [{ "billed_charge": 6982.80, "npi": [1124796081] } ] } ] } ] }, { "name": "CARDIOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "480", "description": "CARDIOLOGY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 325.37, "providers": [{ "billed_charge": 36725.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1600.93, "providers": [{ "billed_charge": 82921.50, "npi": [1295843787] } ] }, { "allowed_amount": 10220.77, "providers": [{ "billed_charge": 64967.00, "npi": [1982666111] } ] }, { "allowed_amount": 7850.55, "providers": [{ "billed_charge": 393560.00, "npi": [1730132234] } ] }, { "allowed_amount": 873.94, "providers": [{ "billed_charge": 5551.00, "npi": [1982666111, 1295843787, 1740233782] }, { "billed_charge": 16653.00, "npi": [1730132234] }, { "billed_charge": 24029.00, "npi": [1740233782] } ] }, { "allowed_amount": 2892.77, "providers": [{ "billed_charge": 47909.00, "npi": [1932152337] } ] } ] } ] }, { "name": "CARDIAC CATH LAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "481", "description": "CARDIOLOGY - CARDIAC CATH LAB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10370.40, "providers": [{ "billed_charge": 25472.00, "npi": [1730132234] } ] } ] } ] }, { "name": "ECHOCARDIOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "483", "description": "CARDIOLOGY - ECHOCARDIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2274.36, "providers": [{ "billed_charge": 10377.45, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1189.11, "providers": [{ "billed_charge": 96704.00, "npi": [1497871628] } ] }, { "allowed_amount": 824.78, "providers": [{ "billed_charge": 117200.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 546.21, "providers": [{ "billed_charge": 5007.01, "npi": [1477516466] } ] }, { "allowed_amount": 1349.73, "providers": [{ "billed_charge": 25771.85, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 360.17, "providers": [{ "billed_charge": 4070.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21005.35, "providers": [{ "billed_charge": 80603.00, "npi": [1205900370] } ] }, { "allowed_amount": 2386.69, "providers": [{ "billed_charge": 4530.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2832.86, "providers": [{ "billed_charge": 109874.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1092.42, "providers": [{ "billed_charge": 6446.00, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 546.21, "providers": [{ "billed_charge": 9080.00, "npi": [1679578439] } ] }, { "allowed_amount": 1629.98, "providers": [{ "billed_charge": 66427.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 546.21, "providers": [{ "billed_charge": 2619.00, "npi": [1932123247] } ] }, { "allowed_amount": 1302.33, "providers": [{ "billed_charge": 9372.00, "npi": [1932123247] } ] } ] } ] }, { "name": "AMBUL SURG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "490", "description": "AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200270605" }, "service_code": ["24"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24242.29, "providers": [{ "billed_charge": 188547.00, "npi": [1952364499] } ] } ] } ] }, { "name": "ABD PARACENTESIS W/IMAGING", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "49083", "description": "ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 372.90, "providers": [{ "billed_charge": 1622.00, "npi": [1558898049] } ] }, { "allowed_amount": 1044.12, "providers": [{ "billed_charge": 5152.00, "npi": [1558898049] } ] } ] } ] }, { "name": "CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "510", "description": "CLINIC - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1634.00, "providers": [{ "billed_charge": 2369.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1490.51, "providers": [{ "billed_charge": 3382.62, "npi": [1629089966] } ] } ] } ] }, { "name": "PEDS CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "515", "description": "CLINIC - PEDIATRIC CLINIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55918.87, "providers": [{ "billed_charge": 328696.50, "npi": [1124796081] } ] }, { "allowed_amount": 8837.43, "providers": [{ "billed_charge": 43001.20, "npi": [1548286172] } ] } ] } ] }, { "name": "AMBULANCE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "540", "description": "AMBULANCE - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18361.71, "providers": [{ "billed_charge": 35510.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "751301362" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 597.10, "providers": [{ "billed_charge": 2092.90, "npi": [1821087164] } ] } ] } ] }, { "name": "AIR AMBULANCE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "545", "description": "AMBULANCE - AIR AMBULANCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32847.86, "providers": [{ "billed_charge": 62251.25, "npi": [1982666111] } ] } ] } ] }, { "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": "272793124" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 547.50, "providers": [{ "billed_charge": 787.50, "npi": [1083934509] } ] } ] }, { "tin": { "type": "ein", "value": "204562987" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 140.00, "providers": [{ "billed_charge": 300.00, "npi": [1801912050] } ] } ] } ] }, { "name": "FETAL NON-STRESS TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "59025", "description": "FETAL NON-STRESS TEST", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1188.54, "providers": [{ "billed_charge": 4400.00, "npi": [1235225087] } ] } ] } ] }, { "name": "MRI", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "610", "description": "MRI - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1633.48, "providers": [{ "billed_charge": 26468.00, "npi": [1205900370] } ] }, { "allowed_amount": 11990.55, "providers": [{ "billed_charge": 31151.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6154.30, "providers": [{ "billed_charge": 68840.07, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 939.61, "providers": [{ "billed_charge": 24287.75, "npi": [1730132234] } ] } ] } ] }, { "name": "MRI-BRAIN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "611", "description": "MRI - BRAIN (INCLUDING BRAINSTEM)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 526.60, "providers": [{ "billed_charge": 17146.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 587.26, "providers": [{ "billed_charge": 11990.00, "npi": [1205900370] } ] }, { "allowed_amount": 360.17, "providers": [{ "billed_charge": 54196.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2929.26, "providers": [{ "billed_charge": 138025.50, "npi": [1730132234] } ] }, { "allowed_amount": 2764.09, "providers": [{ "billed_charge": 28617.00, "npi": [1982666111] } ] }, { "allowed_amount": 381.63, "providers": [{ "billed_charge": 16404.00, "npi": [1932152337] } ] } ] } ] }, { "name": "MRI-SPINE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "612", "description": "MRI - SPINAL CORD (INCLUDING SPINE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9308.76, "providers": [{ "billed_charge": 94682.72, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 763.26, "providers": [{ "billed_charge": 60778.50, "npi": [1730132234] } ] }, { "allowed_amount": 842.00, "providers": [{ "billed_charge": 19236.75, "npi": [1982666111] } ] } ] } ] }, { "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": "871142127" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.09, "providers": [{ "billed_charge": 3951.23, "npi": [1073183141] } ] } ] }, { "tin": { "type": "ein", "value": "611267229" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 796.91, "providers": [{ "billed_charge": 2656.38, "npi": [1477500015] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29067.53, "providers": [{ "billed_charge": 454148.39, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "741386053" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.15, "providers": [{ "billed_charge": 3746.50, "npi": [1720088123] } ] } ] }, { "tin": { "type": "ein", "value": "822913146" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.24, "providers": [{ "billed_charge": 5579.07, "npi": [1972517365] } ] } ] }, { "tin": { "type": "ein", "value": "451502252" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46.64, "providers": [{ "billed_charge": 35071.01, "npi": [1215296884] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.27, "providers": [{ "billed_charge": 11269.50, "npi": [1689629941] } ] }, { "allowed_amount": 3.45, "providers": [{ "billed_charge": 13333.00, "npi": [1528027786] } ] }, { "allowed_amount": 8.45, "providers": [{ "billed_charge": 10964.71, "npi": [1033165501] } ] }, { "allowed_amount": 13.08, "providers": [{ "billed_charge": 12812.50, "npi": [1275592131] } ] } ] }, { "tin": { "type": "ein", "value": "741109636" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.50, "providers": [{ "billed_charge": 2635.00, "npi": [1093708679] } ] } ] }, { "tin": { "type": "ein", "value": "820641535" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25.48, "providers": [{ "billed_charge": 371333.00, "npi": [1134783913] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.91, "providers": [{ "billed_charge": 3306.86, "npi": [1265568638] } ] } ] }, { "tin": { "type": "ein", "value": "750755367" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.71, "providers": [{ "billed_charge": 8903.05, "npi": [1396746129] } ] } ] }, { "tin": { "type": "ein", "value": "760436439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 888.52, "providers": [{ "billed_charge": 27568.97, "npi": [1689650616] } ] } ] }, { "tin": { "type": "ein", "value": "751277293" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.36, "providers": [{ "billed_charge": 389.61, "npi": [1598750721] } ] } ] }, { "tin": { "type": "ein", "value": "851978933" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 143.00, "providers": [{ "billed_charge": 1602.69, "npi": [1265044333] } ] } ] }, { "tin": { "type": "ein", "value": "741100555" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1070.50, "providers": [{ "billed_charge": 24220.07, "npi": [1477643690] } ] }, { "allowed_amount": 147753.28, "providers": [{ "billed_charge": 808221.01, "npi": [1477643690] } ] } ] }, { "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.89, "providers": [{ "billed_charge": 2090.60, "npi": [1548226988] } ] }, { "allowed_amount": 626.24, "providers": [{ "billed_charge": 44348.95, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 46000.49, "providers": [{ "billed_charge": 75628.83, "npi": [1205900370] } ] }, { "allowed_amount": 50118.50, "providers": [{ "billed_charge": 70758.82, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "832329088" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.05, "providers": [{ "billed_charge": 10671.85, "npi": [1457820995] } ] }, { "allowed_amount": 20.92, "providers": [{ "billed_charge": 2632.50, "npi": [1780436287] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2506.90, "providers": [{ "billed_charge": 33704.59, "npi": [1629089966] } ] }, { "allowed_amount": 5382.84, "providers": [{ "billed_charge": 76716.31, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 54.11, "providers": [{ "billed_charge": 24078.25, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "752682017" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9.34, "providers": [{ "billed_charge": 24318.20, "npi": [1114998911] } ] } ] }, { "tin": { "type": "ein", "value": "751301362" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.41, "providers": [{ "billed_charge": 114.70, "npi": [1821087164] } ] } ] }, { "tin": { "type": "ein", "value": "882917489" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.00, "providers": [{ "billed_charge": 1574.15, "npi": [1043942089] } ] } ] }, { "tin": { "type": "ein", "value": "736048282" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.35, "providers": [{ "billed_charge": 247.75, "npi": [1700882578] } ] } ] }, { "tin": { "type": "ein", "value": "741109643" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.98, "providers": [{ "billed_charge": 3182.00, "npi": [1124137054] } ] }, { "allowed_amount": 1.18, "providers": [{ "billed_charge": 419.25, "npi": [1164526786] } ] }, { "allowed_amount": 4.24, "providers": [{ "billed_charge": 2340.75, "npi": [1578780870] } ] }, { "allowed_amount": 12.16, "providers": [{ "billed_charge": 7853.75, "npi": [1619115383] } ] }, { "allowed_amount": 5.97, "providers": [{ "billed_charge": 7614.00, "npi": [1093810327] } ] } ] }, { "tin": { "type": "ein", "value": "841343242" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 93.71, "providers": [{ "billed_charge": 312.34, "npi": [1689624686] } ] } ] }, { "tin": { "type": "ein", "value": "371756496" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 105.45, "providers": [{ "billed_charge": 351.50, "npi": [1164821559] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 679.32, "providers": [{ "billed_charge": 115015.39, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "882931023" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 1440.00, "npi": [1740911213] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38.32, "providers": [{ "billed_charge": 54620.47, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "233069260" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.92, "providers": [{ "billed_charge": 2571.00, "npi": [1770573586] } ] } ] }, { "tin": { "type": "ein", "value": "741385192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 42224.22, "providers": [{ "billed_charge": 157511.46, "npi": [1972581940] } ] }, { "allowed_amount": 2.01, "providers": [{ "billed_charge": 2508.46, "npi": [1972581940] } ] } ] }, { "tin": { "type": "ein", "value": "454435955" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9.63, "providers": [{ "billed_charge": 2733.79, "npi": [1467897447] } ] } ] }, { "tin": { "type": "ein", "value": "203904667" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.79, "providers": [{ "billed_charge": 8496.53, "npi": [1376662296] } ] } ] }, { "tin": { "type": "ein", "value": "621762526" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 239.50, "providers": [{ "billed_charge": 798.34, "npi": [1790722346] } ] } ] }, { "tin": { "type": "ein", "value": "934242663" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 56.41, "providers": [{ "billed_charge": 592.62, "npi": [1740054436] } ] } ] }, { "tin": { "type": "ein", "value": "731662763" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 787.10, "providers": [{ "billed_charge": 6805.96, "npi": [1659352987] } ] } ] }, { "tin": { "type": "ein", "value": "741718215" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.30, "providers": [{ "billed_charge": 2.71, "npi": [1699772541] } ] } ] }, { "tin": { "type": "ein", "value": "473248194" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.60, "providers": [{ "billed_charge": 2680.00, "npi": [1588111082] } ] } ] }, { "tin": { "type": "ein", "value": "813334196" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 579.89, "providers": [{ "billed_charge": 4589.80, "npi": [1013499383] } ] } ] }, { "tin": { "type": "ein", "value": "452694620" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2638.22, "providers": [{ "billed_charge": 28029.16, "npi": [1033120423] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 132.27, "providers": [{ "billed_charge": 3087.40, "npi": [1003192311] } ] }, { "allowed_amount": 5776.18, "providers": [{ "billed_charge": 40548.00, "npi": [1003192311] } ] } ] }, { "tin": { "type": "ein", "value": "800810304" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20.21, "providers": [{ "billed_charge": 5949.72, "npi": [1295213601] } ] } ] }, { "tin": { "type": "ein", "value": "750827446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2039.58, "providers": [{ "billed_charge": 49861.72, "npi": [1528064649] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 70.71, "providers": [{ "billed_charge": 14802.82, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 717.03, "providers": [{ "billed_charge": 24023.86, "npi": [1447250253] } ] }, { "allowed_amount": 20.92, "providers": [{ "billed_charge": 766.56, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "851961472" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13.18, "providers": [{ "billed_charge": 6559.72, "npi": [1235747304] } ] } ] }, { "tin": { "type": "ein", "value": "995104341" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 293.07, "providers": [{ "billed_charge": 11136.00, "npi": [1609697242] } ] } ] }, { "tin": { "type": "ein", "value": "952126937" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 253.29, "providers": [{ "billed_charge": 844.29, "npi": [1801861190] } ] } ] }, { "tin": { "type": "ein", "value": "300885567" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 89.76, "providers": [{ "billed_charge": 299.20, "npi": [1154795581] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4250.21, "providers": [{ "billed_charge": 109045.92, "npi": [1679557888] } ] }, { "allowed_amount": 9.82, "providers": [{ "billed_charge": 3093.22, "npi": [1598749707] } ] }, { "allowed_amount": 0.78, "providers": [{ "billed_charge": 1133.22, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "831954982" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43.12, "providers": [{ "billed_charge": 20250.72, "npi": [1104381292] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 818.04, "providers": [{ "billed_charge": 130079.17, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19816.91, "providers": [{ "billed_charge": 102878.49, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "824052186" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 35.67, "providers": [{ "billed_charge": 8605.28, "npi": [1801826839] } ] } ] }, { "tin": { "type": "ein", "value": "842589283" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9.21, "providers": [{ "billed_charge": 9792.64, "npi": [1902453970] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 114.91, "providers": [{ "billed_charge": 383.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "474187773" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 180.02, "providers": [{ "billed_charge": 114313.48, "npi": [1619321742] } ] } ] }, { "tin": { "type": "ein", "value": "752865177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.30, "providers": [{ "billed_charge": 774.25, "npi": [1922002674] } ] } ] }, { "tin": { "type": "ein", "value": "331929227" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.07, "providers": [{ "billed_charge": 3973.50, "npi": [1144112129] } ] } ] }, { "tin": { "type": "ein", "value": "823463299" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24.18, "providers": [{ "billed_charge": 46736.93, "npi": [1649770488] } ] } ] }, { "tin": { "type": "ein", "value": "621692446" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.01, "providers": [{ "billed_charge": 6053.88, "npi": [1497708929] } ] } ] }, { "tin": { "type": "ein", "value": "752678857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 353.14, "providers": [{ "billed_charge": 66855.11, "npi": [1417980202] } ] } ] }, { "tin": { "type": "ein", "value": "752890358" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 24.86, "providers": [{ "billed_charge": 21180.33, "npi": [1548291883] } ] } ] }, { "tin": { "type": "ein", "value": "510064318" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 51.24, "providers": [{ "billed_charge": 170.75, "npi": [1467546135] } ] } ] }, { "tin": { "type": "ein", "value": "751777119" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 484.11, "providers": [{ "billed_charge": 18017.90, "npi": [1073511762] } ] }, { "allowed_amount": 1.44, "providers": [{ "billed_charge": 216.62, "npi": [1073511762] } ] } ] }, { "tin": { "type": "ein", "value": "260684968" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14.10, "providers": [{ "billed_charge": 19498.43, "npi": [1902047376] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.66, "providers": [{ "billed_charge": 1590.57, "npi": [1891882833] } ] }, { "allowed_amount": 390.39, "providers": [{ "billed_charge": 20343.81, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "202797853" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 542.13, "providers": [{ "billed_charge": 1177.39, "npi": [1154324952] } ] } ] }, { "tin": { "type": "ein", "value": "820756286" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.04, "providers": [{ "billed_charge": 2430.44, "npi": [1821501875] } ] } ] }, { "tin": { "type": "ein", "value": "813351512" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 61.71, "providers": [{ "billed_charge": 1103.35, "npi": [1891210639] } ] } ] }, { "tin": { "type": "ein", "value": "750818178" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.34, "providers": [{ "billed_charge": 989.00, "npi": [1760628184] } ] } ] }, { "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 241.70, "providers": [{ "billed_charge": 156439.50, "npi": [1497871628] } ] }, { "allowed_amount": 1311.37, "providers": [{ "billed_charge": 50581.50, "npi": [1629828405] } ] }, { "allowed_amount": 2268.86, "providers": [{ "billed_charge": 200569.00, "npi": [1871619254] } ] }, { "allowed_amount": 3230.61, "providers": [{ "billed_charge": 276178.00, "npi": [1083937593] } ] }, { "allowed_amount": 0.67, "providers": [{ "billed_charge": 1442.50, "npi": [1871619254] } ] }, { "allowed_amount": 76.93, "providers": [{ "billed_charge": 89143.50, "npi": [1184179194] } ] } ] }, { "tin": { "type": "ein", "value": "851931245" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 63.77, "providers": [{ "billed_charge": 4564.37, "npi": [1750909974] } ] } ] }, { "tin": { "type": "ein", "value": "464007700" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4.02, "providers": [{ "billed_charge": 1819.94, "npi": [1396138970] } ] } ] }, { "tin": { "type": "ein", "value": "831869297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1551.26, "providers": [{ "billed_charge": 18738.86, "npi": [1356960132] } ] } ] }, { "tin": { "type": "ein", "value": "746000756" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.67, "providers": [{ "billed_charge": 234.76, "npi": [1316936990] } ] } ] }, { "tin": { "type": "ein", "value": "473923087" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 257.39, "providers": [{ "billed_charge": 185044.50, "npi": [1366815144] } ] } ] }, { "tin": { "type": "ein", "value": "813562144" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2226.15, "providers": [{ "billed_charge": 12601.25, "npi": [1639663370] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.92, "providers": [{ "billed_charge": 575.79, "npi": [1003885641] } ] }, { "allowed_amount": 24.21, "providers": [{ "billed_charge": 1354.70, "npi": [1447228747] } ] }, { "allowed_amount": 1963.78, "providers": [{ "billed_charge": 18514.43, "npi": [1093783391] } ] }, { "allowed_amount": 3081.17, "providers": [{ "billed_charge": 47316.67, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "474866295" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.07, "providers": [{ "billed_charge": 18475.20, "npi": [1992172019] } ] } ] }, { "tin": { "type": "ein", "value": "582032904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 69.24, "providers": [{ "billed_charge": 230.80, "npi": [1649248626] } ] } ] }, { "tin": { "type": "ein", "value": "931617297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.51, "providers": [{ "billed_charge": 4903.51, "npi": [1417633736] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 19857.26, "providers": [{ "billed_charge": 95249.16, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "750800628" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2858.38, "providers": [{ "billed_charge": 4928.25, "npi": [1720480627] } ] }, { "allowed_amount": 1983657.85, "providers": [{ "billed_charge": 3420099.55, "npi": [1194743013] } ] }, { "allowed_amount": 189324.79, "providers": [{ "billed_charge": 333284.20, "npi": [1194743013] } ] }, { "allowed_amount": 5487.36, "providers": [{ "billed_charge": 9460.95, "npi": [1194743013] } ] }, { "allowed_amount": 304.50, "providers": [{ "billed_charge": 525.00, "npi": [1720480627] } ] }, { "allowed_amount": 8600.79, "providers": [{ "billed_charge": 14828.95, "npi": [1720480627] } ] } ] }, { "tin": { "type": "ein", "value": "540551711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 164.72, "providers": [{ "billed_charge": 549.05, "npi": [1336103738] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5277.80, "providers": [{ "billed_charge": 49447.79, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "205908627" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2206.98, "providers": [{ "billed_charge": 53218.00, "npi": [1851390967] } ] } ] }, { "tin": { "type": "ein", "value": "752428911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.33, "providers": [{ "billed_charge": 681.00, "npi": [1437171568] } ] } ] }, { "tin": { "type": "ein", "value": "851778208" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 9783.38, "npi": [1366056194] } ] } ] }, { "tin": { "type": "ein", "value": "752771569" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 126.73, "providers": [{ "billed_charge": 821.98, "npi": [1659308948] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 406.19, "providers": [{ "billed_charge": 3927.77, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "202848116" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6.70, "providers": [{ "billed_charge": 8758.61, "npi": [1629138029] } ] } ] }, { "tin": { "type": "ein", "value": "814928222" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16.07, "providers": [{ "billed_charge": 7105.00, "npi": [1710417761] } ] } ] }, { "tin": { "type": "ein", "value": "751844139" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.17, "providers": [{ "billed_charge": 4634.36, "npi": [1265430177] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1411.83, "providers": [{ "billed_charge": 93781.00, "npi": [1295843787] } ] }, { "allowed_amount": 3.73, "providers": [{ "billed_charge": 1557.50, "npi": [1982666111] } ] }, { "allowed_amount": 10722.33, "providers": [{ "billed_charge": 147550.25, "npi": [1982666111] } ] }, { "allowed_amount": 1.08, "providers": [{ "billed_charge": 1916.25, "npi": [1932152337] }, { "billed_charge": 995.75, "npi": [1740233782] } ] }, { "allowed_amount": 934.72, "providers": [{ "billed_charge": 57322.25, "npi": [1740233782] } ] }, { "allowed_amount": 612.02, "providers": [{ "billed_charge": 4374.00, "npi": [1295788735] } ] }, { "allowed_amount": 1595.06, "providers": [{ "billed_charge": 95831.50, "npi": [1932152337] } ] }, { "allowed_amount": 5061.80, "providers": [{ "billed_charge": 65279.75, "npi": [1295788735] } ] }, { "allowed_amount": 26234.90, "providers": [{ "billed_charge": 435456.00, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "992078911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 108.32, "providers": [{ "billed_charge": 4022.00, "npi": [1770333403] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 31401.82, "providers": [{ "billed_charge": 208354.70, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "465735510" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 83.57, "providers": [{ "billed_charge": 410.00, "npi": [1164827093] } ] } ] }, { "tin": { "type": "ein", "value": "751912147" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.71, "providers": [{ "billed_charge": 3027.64, "npi": [1023013448] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2295.14, "providers": [{ "billed_charge": 34827.85, "npi": [1234567893] } ] }, { "allowed_amount": 20965.82, "providers": [{ "billed_charge": 288218.45, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "720502505" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 38.67, "providers": [{ "billed_charge": 128.87, "npi": [1811973100] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.67, "providers": [{ "billed_charge": 2544.12, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "742519752" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 708.38, "providers": [{ "billed_charge": 3286.89, "npi": [1154315307] } ] } ] }, { "tin": { "type": "ein", "value": "741603120" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2070.74, "providers": [{ "billed_charge": 4940.14, "npi": [1740288505] } ] }, { "allowed_amount": 22.19, "providers": [{ "billed_charge": 79.24, "npi": [1740288505] } ] } ] }, { "tin": { "type": "ein", "value": "270036484" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12.18, "providers": [{ "billed_charge": 40.60, "npi": [1154355188] } ] } ] }, { "tin": { "type": "ein", "value": "742730328" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4324.91, "providers": [{ "billed_charge": 14367.24, "npi": [1124074273] } ] }, { "allowed_amount": 3.26, "providers": [{ "billed_charge": 22455.03, "npi": [1124074273] } ] } ] }, { "tin": { "type": "ein", "value": "752302928" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.35, "providers": [{ "billed_charge": 31.00, "npi": [1740273994] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 116.95, "providers": [{ "billed_charge": 151192.50, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "750703337" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1026.98, "providers": [{ "billed_charge": 1301.00, "npi": [1861475626] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22102.10, "providers": [{ "billed_charge": 182793.56, "npi": [1336172105] } ] } ] }, { "tin": { "type": "ein", "value": "412101361" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.73, "providers": [{ "billed_charge": 902.62, "npi": [1962504340] } ] } ] }, { "tin": { "type": "ein", "value": "920323729" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.07, "providers": [{ "billed_charge": 27615.07, "npi": [1003539073] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1203.98, "providers": [{ "billed_charge": 19077.03, "npi": [1124796081] } ] }, { "allowed_amount": 45449.17, "providers": [{ "billed_charge": 713078.71, "npi": [1548286172] } ] }, { "allowed_amount": 2.01, "providers": [{ "billed_charge": 550.55, "npi": [1548286172] } ] }, { "allowed_amount": 157032.11, "providers": [{ "billed_charge": 1305396.91, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "862533154" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 398.58, "providers": [{ "billed_charge": 8769.96, "npi": [1548847601] } ] } ] }, { "tin": { "type": "ein", "value": "390806181" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 148.29, "providers": [{ "billed_charge": 494.29, "npi": [1861447179] } ] } ] }, { "tin": { "type": "ein", "value": "472971495" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 155.73, "providers": [{ "billed_charge": 4372.72, "npi": [1659744662] } ] } ] }, { "tin": { "type": "ein", "value": "882898646" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.60, "providers": [{ "billed_charge": 1195.00, "npi": [1699406173] } ] } ] }, { "tin": { "type": "ein", "value": "760714523" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7371.98, "providers": [{ "billed_charge": 11341.50, "npi": [1598744856] } ] }, { "allowed_amount": 1850.55, "providers": [{ "billed_charge": 2847.00, "npi": [1598744856] } ] } ] }, { "tin": { "type": "ein", "value": "900220728" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 165.45, "providers": [{ "billed_charge": 551.50, "npi": [1699884858] } ] } ] }, { "tin": { "type": "ein", "value": "820551704" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20.10, "providers": [{ "billed_charge": 4347.88, "npi": [1649273434] } ] } ] }, { "tin": { "type": "ein", "value": "923209338" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 225.00, "npi": [1558132365] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 149.49, "providers": [{ "billed_charge": 8392.05, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "753175630" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.68, "providers": [{ "billed_charge": 15556.79, "npi": [1285798918] } ] }, { "allowed_amount": 5867.96, "providers": [{ "billed_charge": 18020.86, "npi": [1285798918] } ] } ] }, { "tin": { "type": "ein", "value": "756001193" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.63, "providers": [{ "billed_charge": 51.00, "npi": [1720096019] } ] } ] }, { "tin": { "type": "ein", "value": "260194016" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 137.94, "providers": [{ "billed_charge": 11655.07, "npi": [1205018439] } ] } ] }, { "tin": { "type": "ein", "value": "751584559" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3.89, "providers": [{ "billed_charge": 444.76, "npi": [1255325817] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 749.94, "providers": [{ "billed_charge": 98257.99, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "994785298" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 230.26, "providers": [{ "billed_charge": 46435.50, "npi": [1639992514] } ] } ] }, { "tin": { "type": "ein", "value": "751748586" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4665.76, "providers": [{ "billed_charge": 38264.21, "npi": [1508899204] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 84.68, "providers": [{ "billed_charge": 102198.16, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "452662980" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 596.70, "providers": [{ "billed_charge": 918.00, "npi": [1154618742] } ] } ] }, { "tin": { "type": "ein", "value": "473637912" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20.16, "providers": [{ "billed_charge": 10647.64, "npi": [1215449954] } ] } ] }, { "tin": { "type": "ein", "value": "751977850" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.02, "providers": [{ "billed_charge": 4395.17, "npi": [1396778064] } ] } ] }, { "tin": { "type": "ein", "value": "851919095" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.17, "providers": [{ "billed_charge": 6619.07, "npi": [1316617707] } ] } ] }, { "tin": { "type": "ein", "value": "301205721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 76.14, "providers": [{ "billed_charge": 13721.14, "npi": [1588215461] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5762.84, "providers": [{ "billed_charge": 67178.35, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "813040663" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.71, "providers": [{ "billed_charge": 429.47, "npi": [1902366305] } ] }, { "allowed_amount": 9.09, "providers": [{ "billed_charge": 995.14, "npi": [1144781501] } ] }, { "allowed_amount": 4.58, "providers": [{ "billed_charge": 748.54, "npi": [1346729159] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17184.43, "providers": [{ "billed_charge": 163646.93, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "481172106" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 188.34, "providers": [{ "billed_charge": 627.79, "npi": [1154314789] } ] } ] }, { "tin": { "type": "ein", "value": "742206635" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.87, "providers": [{ "billed_charge": 491.31, "npi": [1205833985] } ] } ] }, { "tin": { "type": "ein", "value": "464389870" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36.49, "providers": [{ "billed_charge": 54407.00, "npi": [1952723967] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1584.77, "providers": [{ "billed_charge": 4292.42, "npi": [1114435260] } ] } ] }, { "tin": { "type": "ein", "value": "741109665" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5.77, "providers": [{ "billed_charge": 4099.42, "npi": [1194787218] } ] }, { "allowed_amount": 4.50, "providers": [{ "billed_charge": 2028.54, "npi": [1447883301] } ] } ] }, { "tin": { "type": "ein", "value": "464084062" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.02, "providers": [{ "billed_charge": 850.32, "npi": [1669872610] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13557.70, "providers": [{ "billed_charge": 49881.21, "npi": [1992700983] } ] }, { "allowed_amount": 823.84, "providers": [{ "billed_charge": 1971.12, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 0.30, "providers": [{ "billed_charge": 8637.50, "npi": [1891789772] } ] }, { "allowed_amount": 5282.73, "providers": [{ "billed_charge": 425714.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "741595711" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 329.74, "providers": [{ "billed_charge": 992.75, "npi": [1962497800] } ] } ] }, { "tin": { "type": "ein", "value": "811708177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7.86, "providers": [{ "billed_charge": 7255.74, "npi": [1033568621] } ] } ] }, { "tin": { "type": "ein", "value": "751037591" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 21.29, "providers": [{ "billed_charge": 3285.33, "npi": [1851108765] } ] }, { "allowed_amount": 8982.54, "providers": [{ "billed_charge": 24059.61, "npi": [1124305065] } ] } ] }, { "tin": { "type": "ein", "value": "273026151" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 455.82, "providers": [{ "billed_charge": 498.00, "npi": [1326349986] } ] } ] }, { "tin": { "type": "ein", "value": "581725656" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2686.72, "providers": [{ "billed_charge": 8955.75, "npi": [1770522906] } ] } ] }, { "tin": { "type": "ein", "value": "752771437" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.86, "providers": [{ "billed_charge": 417.83, "npi": [1457382798] } ] } ] }, { "tin": { "type": "ein", "value": "621762545" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 471.58, "providers": [{ "billed_charge": 1571.94, "npi": [1447299649] } ] } ] }, { "tin": { "type": "ein", "value": "882923822" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2.54, "providers": [{ "billed_charge": 3050.00, "npi": [1770214256] } ] } ] }, { "tin": { "type": "ein", "value": "851820772" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10.11, "providers": [{ "billed_charge": 13570.67, "npi": [1285252593] } ] } ] } ] }, { "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": "742368758" }, "service_code": ["34"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2340.00, "providers": [{ "billed_charge": 3150.00, "npi": [1851590442] } ] } ] } ] }, { "name": "X-RAY EXAM OF SINUSES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "70220", "description": "RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.85, "providers": [{ "billed_charge": 220.00, "npi": [1417290511] } ] } ] } ] }, { "name": "CT HEAD/BRAIN W/O DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "70450", "description": "COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741940911" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 453.30, "providers": [{ "billed_charge": 1770.00, "npi": [1710240775] } ] } ] }, { "tin": { "type": "ein", "value": "392307067" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.13, "providers": [{ "billed_charge": 458.00, "npi": [1770739260] } ] }, { "allowed_amount": 360.59, "providers": [{ "billed_charge": 1832.00, "npi": [1770739260] } ] }, { "allowed_amount": 38.39, "providers": [{ "billed_charge": 229.00, "npi": [1770739260] } ] }, { "allowed_amount": 181.32, "providers": [{ "billed_charge": 916.00, "npi": [1366646416] } ] } ] }, { "tin": { "type": "ein", "value": "746223317" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.22, "providers": [{ "billed_charge": 717.00, "npi": [1336431352] } ] }, { "allowed_amount": 232.44, "providers": [{ "billed_charge": 1434.00, "npi": [1366947509] } ] }, { "allowed_amount": 193.70, "providers": [{ "billed_charge": 1195.00, "npi": [1336431352] } ] }, { "allowed_amount": 348.66, "providers": [{ "billed_charge": 2151.00, "npi": [1366947509] } ] }, { "allowed_amount": 38.74, "providers": [{ "billed_charge": 239.00, "npi": [1295293587] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.15, "providers": [{ "billed_charge": 149.00, "npi": [1285838862] } ] }, { "allowed_amount": 98.01, "providers": [{ "billed_charge": 447.00, "npi": [1407149941] } ] }, { "allowed_amount": 504.42, "providers": [{ "billed_charge": 1788.00, "npi": [1407149941] } ] } ] }, { "tin": { "type": "ein", "value": "751459885" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.45, "providers": [{ "billed_charge": 608.00, "npi": [1982023461] } ] }, { "allowed_amount": 30.99, "providers": [{ "billed_charge": 608.00, "npi": [1467897793] } ] }, { "allowed_amount": 157.25, "providers": [{ "billed_charge": 3040.00, "npi": [1942681549] } ] }, { "allowed_amount": 123.96, "providers": [{ "billed_charge": 2432.00, "npi": [1528599180] } ] }, { "allowed_amount": 434.38, "providers": [{ "billed_charge": 8512.00, "npi": [1528599180] } ] }, { "allowed_amount": 155.21, "providers": [{ "billed_charge": 3040.00, "npi": [1982023461] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.38, "providers": [{ "billed_charge": 686.00, "npi": [1407397847, 1871819565] } ] }, { "allowed_amount": 141.06, "providers": [{ "billed_charge": 1029.00, "npi": [1205223799] } ] }, { "allowed_amount": 40.19, "providers": [{ "billed_charge": 343.00, "npi": [1306081518, 1952696692] } ] }, { "allowed_amount": 198.05, "providers": [{ "billed_charge": 1715.00, "npi": [1952696692] } ] }, { "allowed_amount": 184.70, "providers": [{ "billed_charge": 1372.00, "npi": [1407397847, 1376991935] } ] }, { "allowed_amount": 47.02, "providers": [{ "billed_charge": 343.00, "npi": [1629631114] } ] }, { "allowed_amount": 119.12, "providers": [{ "billed_charge": 1029.00, "npi": [1376991935] } ] }, { "allowed_amount": 94.04, "providers": [{ "billed_charge": 686.00, "npi": [1871583278, 1700131760] } ] }, { "allowed_amount": 282.12, "providers": [{ "billed_charge": 2058.00, "npi": [1548823586, 1306081518] } ] }, { "allowed_amount": 137.68, "providers": [{ "billed_charge": 1029.00, "npi": [1952696692] } ] }, { "allowed_amount": 186.39, "providers": [{ "billed_charge": 1372.00, "npi": [1871819565, 1750329470] } ] }, { "allowed_amount": 937.02, "providers": [{ "billed_charge": 6860.00, "npi": [1346534120] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.38, "providers": [{ "billed_charge": 222.00, "npi": [1093759193] } ] }, { "allowed_amount": 752.32, "providers": [{ "billed_charge": 1776.00, "npi": [1093759193] } ] }, { "allowed_amount": 188.08, "providers": [{ "billed_charge": 444.00, "npi": [1679367221] } ] }, { "allowed_amount": 47.02, "providers": [{ "billed_charge": 111.00, "npi": [1538546577] } ] }, { "allowed_amount": 94.04, "providers": [{ "billed_charge": 222.00, "npi": [1164733416] } ] }, { "allowed_amount": 564.24, "providers": [{ "billed_charge": 1332.00, "npi": [1225070311] } ] }, { "allowed_amount": 235.10, "providers": [{ "billed_charge": 555.00, "npi": [1700011053] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 317.31, "providers": [{ "billed_charge": 1036.00, "npi": [1528370319] } ] }, { "allowed_amount": 498.63, "providers": [{ "billed_charge": 1628.00, "npi": [1972548139] } ] }, { "allowed_amount": 3898.38, "providers": [{ "billed_charge": 12728.00, "npi": [1417290511] } ] }, { "allowed_amount": 232.44, "providers": [{ "billed_charge": 888.00, "npi": [1417290511] } ] }, { "allowed_amount": 348.66, "providers": [{ "billed_charge": 1332.00, "npi": [1457447120] } ] }, { "allowed_amount": 426.14, "providers": [{ "billed_charge": 1628.00, "npi": [1972548139] } ] }, { "allowed_amount": 1405.23, "providers": [{ "billed_charge": 4588.00, "npi": [1538123138] } ] }, { "allowed_amount": 3535.73, "providers": [{ "billed_charge": 11544.00, "npi": [1295799088] } ] }, { "allowed_amount": 116.22, "providers": [{ "billed_charge": 444.00, "npi": [1528370319, 1972548139, 1295799088] } ] }, { "allowed_amount": 271.18, "providers": [{ "billed_charge": 1036.00, "npi": [1417290511] } ] }, { "allowed_amount": 193.70, "providers": [{ "billed_charge": 740.00, "npi": [1538123138] } ] }, { "allowed_amount": 154.96, "providers": [{ "billed_charge": 592.00, "npi": [1457447120] } ] }, { "allowed_amount": 619.84, "providers": [{ "billed_charge": 2368.00, "npi": [1295799088] } ] }, { "allowed_amount": 1450.56, "providers": [{ "billed_charge": 4736.00, "npi": [1457447120] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.48, "providers": [{ "billed_charge": 466.00, "npi": [1760200901] } ] }, { "allowed_amount": 232.96, "providers": [{ "billed_charge": 932.00, "npi": [1770739260] } ] }, { "allowed_amount": 951.93, "providers": [{ "billed_charge": 4893.00, "npi": [1760200901] } ] }, { "allowed_amount": 116.48, "providers": [{ "billed_charge": 466.00, "npi": [1396940342] } ] }, { "allowed_amount": 2970.24, "providers": [{ "billed_charge": 11883.00, "npi": [1770739260] } ] }, { "allowed_amount": 698.88, "providers": [{ "billed_charge": 2796.00, "npi": [1396940342] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2280.75, "providers": [{ "billed_charge": 25655.00, "npi": [1922121607] } ] }, { "allowed_amount": 127.84, "providers": [{ "billed_charge": 1466.00, "npi": [1679501522] } ] }, { "allowed_amount": 195.61, "providers": [{ "billed_charge": 2199.00, "npi": [1316149172] } ] }, { "allowed_amount": 258.80, "providers": [{ "billed_charge": 2932.00, "npi": [1316149172] } ] }, { "allowed_amount": 390.69, "providers": [{ "billed_charge": 4398.00, "npi": [1679501522] } ] }, { "allowed_amount": 40.19, "providers": [{ "billed_charge": 733.00, "npi": [1528293263] } ] }, { "allowed_amount": 1618.18, "providers": [{ "billed_charge": 18325.00, "npi": [1316149172] } ] }, { "allowed_amount": 393.08, "providers": [{ "billed_charge": 4398.00, "npi": [1366708000] } ] }, { "allowed_amount": 4888.76, "providers": [{ "billed_charge": 54975.00, "npi": [1679501522] } ] }, { "allowed_amount": 80.38, "providers": [{ "billed_charge": 1466.00, "npi": [1801079751] } ] }, { "allowed_amount": 191.76, "providers": [{ "billed_charge": 2199.00, "npi": [1922121607] } ] }, { "allowed_amount": 716.33, "providers": [{ "billed_charge": 8063.00, "npi": [1295837292] } ] }, { "allowed_amount": 326.77, "providers": [{ "billed_charge": 3665.00, "npi": [1528384138] } ] }, { "allowed_amount": 1219.26, "providers": [{ "billed_charge": 13927.00, "npi": [1356359335] } ] }, { "allowed_amount": 132.62, "providers": [{ "billed_charge": 1466.00, "npi": [1437112851] } ] }, { "allowed_amount": 712.07, "providers": [{ "billed_charge": 10262.00, "npi": [1528293263] } ] }, { "allowed_amount": 63.92, "providers": [{ "billed_charge": 733.00, "npi": [1467696633, 1437112851, 1801079751, 1356359335] } ] }, { "allowed_amount": 47.02, "providers": [{ "billed_charge": 733.00, "npi": [1497741714] } ] }, { "allowed_amount": 265.24, "providers": [{ "billed_charge": 2932.00, "npi": [1295837292] } ] }, { "allowed_amount": 651.88, "providers": [{ "billed_charge": 7330.00, "npi": [1467696633] } ] }, { "allowed_amount": 1691.86, "providers": [{ "billed_charge": 19058.00, "npi": [1528384138] } ] }, { "allowed_amount": 66.31, "providers": [{ "billed_charge": 733.00, "npi": [1366708000] } ] }, { "allowed_amount": 130.96, "providers": [{ "billed_charge": 1466.00, "npi": [1295837292] } ] }, { "allowed_amount": 194.15, "providers": [{ "billed_charge": 2199.00, "npi": [1528384138] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2402.49, "providers": [{ "billed_charge": 9911.00, "npi": [1093717001] } ] }, { "allowed_amount": 991.68, "providers": [{ "billed_charge": 5984.00, "npi": [1386694040] } ] }, { "allowed_amount": 498.63, "providers": [{ "billed_charge": 2057.00, "npi": [1962512269] } ] }, { "allowed_amount": 309.90, "providers": [{ "billed_charge": 1870.00, "npi": [1720280530] } ] }, { "allowed_amount": 3082.44, "providers": [{ "billed_charge": 12716.00, "npi": [1598290652] } ] }, { "allowed_amount": 232.44, "providers": [{ "billed_charge": 1122.00, "npi": [1962512269, 1811981590, 1720066749] } ] }, { "allowed_amount": 2719.80, "providers": [{ "billed_charge": 11220.00, "npi": [1720066749] } ] }, { "allowed_amount": 725.28, "providers": [{ "billed_charge": 2992.00, "npi": [1669458261, 1235422619] } ] }, { "allowed_amount": 6164.88, "providers": [{ "billed_charge": 25432.00, "npi": [1811981590] } ] }, { "allowed_amount": 362.64, "providers": [{ "billed_charge": 1496.00, "npi": [1073587788] } ] }, { "allowed_amount": 1665.82, "providers": [{ "billed_charge": 8041.00, "npi": [1720066749] } ] }, { "allowed_amount": 38.74, "providers": [{ "billed_charge": 187.00, "npi": [1295097970] } ] }, { "allowed_amount": 216.93, "providers": [{ "billed_charge": 1309.00, "npi": [1386694040] } ] }, { "allowed_amount": 1975.74, "providers": [{ "billed_charge": 9537.00, "npi": [1811981590] } ] }, { "allowed_amount": 543.96, "providers": [{ "billed_charge": 2244.00, "npi": [1295097970] } ] }, { "allowed_amount": 77.48, "providers": [{ "billed_charge": 374.00, "npi": [1073587788, 1295097970, 1669458261, 1235422619, 1093717001] } ] }, { "allowed_amount": 271.18, "providers": [{ "billed_charge": 1309.00, "npi": [1235422619] } ] }, { "allowed_amount": 2231.28, "providers": [{ "billed_charge": 13464.00, "npi": [1720280530] } ] }, { "allowed_amount": 154.95, "providers": [{ "billed_charge": 935.00, "npi": [1720280530] } ] }, { "allowed_amount": 1394.64, "providers": [{ "billed_charge": 6732.00, "npi": [1598290652] } ] }, { "allowed_amount": 774.80, "providers": [{ "billed_charge": 3740.00, "npi": [1093717001] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.26, "providers": [{ "billed_charge": 221.00, "npi": [1558937037, 1831431543] } ] }, { "allowed_amount": 217.04, "providers": [{ "billed_charge": 884.00, "npi": [1831431543] } ] } ] } ] }, { "name": "Under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "70471", "description": "Under Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 987.64, "providers": [{ "billed_charge": 11290.00, "npi": [1679501522] } ] }, { "allowed_amount": 575.40, "providers": [{ "billed_charge": 6774.00, "npi": [1679501522] } ] }, { "allowed_amount": 191.80, "providers": [{ "billed_charge": 2258.00, "npi": [1679501522] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.00, "providers": [{ "billed_charge": 349.00, "npi": [1811981590] } ] }, { "allowed_amount": 232.48, "providers": [{ "billed_charge": 698.00, "npi": [1811981590] } ] } ] } ] }, { "name": "MRI BRAIN STEM W/O DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "70551", "description": "MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 156.04, "providers": [{ "billed_charge": 518.00, "npi": [1457447120] } ] }, { "allowed_amount": 66.68, "providers": [{ "billed_charge": 259.00, "npi": [1417290511] } ] }, { "allowed_amount": 866.84, "providers": [{ "billed_charge": 3367.00, "npi": [1457447120] } ] }, { "allowed_amount": 600.12, "providers": [{ "billed_charge": 2331.00, "npi": [1457447120] } ] }, { "allowed_amount": 333.40, "providers": [{ "billed_charge": 1295.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.21, "providers": [{ "billed_charge": 1212.00, "npi": [1770739260] } ] }, { "allowed_amount": 100.07, "providers": [{ "billed_charge": 404.00, "npi": [1770739260] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 223.99, "providers": [{ "billed_charge": 2190.00, "npi": [1922121607] } ] }, { "allowed_amount": 221.31, "providers": [{ "billed_charge": 2190.00, "npi": [1528384138] } ] }, { "allowed_amount": 453.20, "providers": [{ "billed_charge": 4380.00, "npi": [1295837292] } ] }, { "allowed_amount": 901.18, "providers": [{ "billed_charge": 8760.00, "npi": [1295837292] } ] }, { "allowed_amount": 440.08, "providers": [{ "billed_charge": 4380.00, "npi": [1295837292] } ] }, { "allowed_amount": 220.04, "providers": [{ "billed_charge": 2190.00, "npi": [1528384138] } ] }, { "allowed_amount": 341.91, "providers": [{ "billed_charge": 3285.00, "npi": [1922121607] } ] }, { "allowed_amount": 227.94, "providers": [{ "billed_charge": 2190.00, "npi": [1528384138] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1533.64, "providers": [{ "billed_charge": 6348.00, "npi": [1235422619] } ] }, { "allowed_amount": 266.72, "providers": [{ "billed_charge": 1104.00, "npi": [1235422619] } ] }, { "allowed_amount": 78.02, "providers": [{ "billed_charge": 276.00, "npi": [1235422619] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 1 VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741940911" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.22, "providers": [{ "billed_charge": 41.00, "npi": [1811283930] } ] } ] }, { "tin": { "type": "ein", "value": "392307067" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.15, "providers": [{ "billed_charge": 50.00, "npi": [1770739260] } ] }, { "allowed_amount": 622.02, "providers": [{ "billed_charge": 3250.00, "npi": [1770739260] } ] }, { "allowed_amount": 270.00, "providers": [{ "billed_charge": 1650.00, "npi": [1770739260] } ] }, { "allowed_amount": 40.96, "providers": [{ "billed_charge": 250.00, "npi": [1366646416] } ] }, { "allowed_amount": 201.06, "providers": [{ "billed_charge": 1050.00, "npi": [1366646416] } ] } ] }, { "tin": { "type": "ein", "value": "814972048" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.15, "providers": [{ "billed_charge": 27.00, "npi": [1578568903] } ] }, { "allowed_amount": 32.60, "providers": [{ "billed_charge": 108.00, "npi": [1922291863] } ] }, { "allowed_amount": 171.72, "providers": [{ "billed_charge": 486.00, "npi": [1922291863] } ] }, { "allowed_amount": 95.40, "providers": [{ "billed_charge": 270.00, "npi": [1275538597] } ] }, { "allowed_amount": 114.10, "providers": [{ "billed_charge": 378.00, "npi": [1275538597] } ] }, { "allowed_amount": 28.62, "providers": [{ "billed_charge": 81.00, "npi": [1578568903] } ] } ] }, { "tin": { "type": "ein", "value": "260717903" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.52, "providers": [{ "billed_charge": 294.00, "npi": [1396940342] } ] }, { "allowed_amount": 120.66, "providers": [{ "billed_charge": 833.00, "npi": [1174574222] } ] }, { "allowed_amount": 47.41, "providers": [{ "billed_charge": 294.00, "npi": [1386694040] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.66, "providers": [{ "billed_charge": 192.00, "npi": [1285838862] } ] }, { "allowed_amount": 152.82, "providers": [{ "billed_charge": 672.00, "npi": [1285838862] } ] }, { "allowed_amount": 20.79, "providers": [{ "billed_charge": 96.00, "npi": [1356389597] } ] }, { "allowed_amount": 13.66, "providers": [{ "billed_charge": 64.00, "npi": [1134574882, 1356389597, 1316108731] } ] }, { "allowed_amount": 38.82, "providers": [{ "billed_charge": 128.00, "npi": [1588647663] } ] }, { "allowed_amount": 37.51, "providers": [{ "billed_charge": 160.00, "npi": [1831583939] } ] }, { "allowed_amount": 13.81, "providers": [{ "billed_charge": 64.00, "npi": [1407149941] } ] }, { "allowed_amount": 26.75, "providers": [{ "billed_charge": 96.00, "npi": [1487946463] } ] }, { "allowed_amount": 357.33, "providers": [{ "billed_charge": 1260.00, "npi": [1407149941] } ] }, { "allowed_amount": 184.41, "providers": [{ "billed_charge": 864.00, "npi": [1134574882] } ] }, { "allowed_amount": 30.45, "providers": [{ "billed_charge": 128.00, "npi": [1982048948] } ] }, { "allowed_amount": 138.28, "providers": [{ "billed_charge": 640.00, "npi": [1285838862] } ] }, { "allowed_amount": 61.47, "providers": [{ "billed_charge": 288.00, "npi": [1194107839] } ] }, { "allowed_amount": 43.77, "providers": [{ "billed_charge": 192.00, "npi": [1831583939] } ] }, { "allowed_amount": 177.58, "providers": [{ "billed_charge": 832.00, "npi": [1194107839] } ] }, { "allowed_amount": 194.37, "providers": [{ "billed_charge": 896.00, "npi": [1073715884] } ] }, { "allowed_amount": 63.15, "providers": [{ "billed_charge": 288.00, "npi": [1073715884] } ] }, { "allowed_amount": 57.77, "providers": [{ "billed_charge": 256.00, "npi": [1306003579] } ] }, { "allowed_amount": 6.83, "providers": [{ "billed_charge": 32.00, "npi": [1831583939, 1578820866, 1366707564, 1912232422, 1720008394] } ] }, { "allowed_amount": 54.64, "providers": [{ "billed_charge": 256.00, "npi": [1578820866] } ] }, { "allowed_amount": 97.84, "providers": [{ "billed_charge": 416.00, "npi": [1407485014] } ] }, { "allowed_amount": 189.67, "providers": [{ "billed_charge": 864.00, "npi": [1407149941] } ] }, { "allowed_amount": 98.75, "providers": [{ "billed_charge": 448.00, "npi": [1134574882] } ] }, { "allowed_amount": 34.15, "providers": [{ "billed_charge": 160.00, "npi": [1194107839, 1578820866, 1366707564] } ] }, { "allowed_amount": 155.95, "providers": [{ "billed_charge": 672.00, "npi": [1366707564] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 340.40, "providers": [{ "billed_charge": 960.00, "npi": [1174850333] } ] }, { "allowed_amount": 314.87, "providers": [{ "billed_charge": 888.00, "npi": [1487644910] } ] }, { "allowed_amount": 34.04, "providers": [{ "billed_charge": 96.00, "npi": [1790014496] } ] }, { "allowed_amount": 49.80, "providers": [{ "billed_charge": 120.00, "npi": [1760477236] } ] }, { "allowed_amount": 8.51, "providers": [{ "billed_charge": 24.00, "npi": [1760477236, 1174850333] } ] }, { "allowed_amount": 59.57, "providers": [{ "billed_charge": 168.00, "npi": [1487644910] } ] }, { "allowed_amount": 29.88, "providers": [{ "billed_charge": 72.00, "npi": [1790014496, 1487644910, 1306231733] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.44, "providers": [{ "billed_charge": 64.00, "npi": [1356667547, 1972548139] } ] }, { "allowed_amount": 156.18, "providers": [{ "billed_charge": 608.00, "npi": [1417290511] } ] }, { "allowed_amount": 115.08, "providers": [{ "billed_charge": 448.00, "npi": [1457447120] } ] }, { "allowed_amount": 90.42, "providers": [{ "billed_charge": 352.00, "npi": [1356667547, 1770842817] } ] }, { "allowed_amount": 76.96, "providers": [{ "billed_charge": 256.00, "npi": [1528370319, 1457447120] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 32.00, "npi": [1770842817] } ] }, { "allowed_amount": 73.98, "providers": [{ "billed_charge": 288.00, "npi": [1295799088] } ] }, { "allowed_amount": 1385.28, "providers": [{ "billed_charge": 4608.00, "npi": [1417290511] } ] }, { "allowed_amount": 1578.18, "providers": [{ "billed_charge": 6144.00, "npi": [1417290511] } ] }, { "allowed_amount": 378.12, "providers": [{ "billed_charge": 1472.00, "npi": [1295799088] } ] }, { "allowed_amount": 24.66, "providers": [{ "billed_charge": 96.00, "npi": [1457447120, 1538123138] } ] }, { "allowed_amount": 337.02, "providers": [{ "billed_charge": 1312.00, "npi": [1538123138] } ] }, { "allowed_amount": 41.10, "providers": [{ "billed_charge": 160.00, "npi": [1528370319] } ] }, { "allowed_amount": 468.54, "providers": [{ "billed_charge": 1824.00, "npi": [1528370319] } ] }, { "allowed_amount": 67.34, "providers": [{ "billed_charge": 224.00, "npi": [1770842817] } ] }, { "allowed_amount": 28.86, "providers": [{ "billed_charge": 96.00, "npi": [1972548139] } ] }, { "allowed_amount": 2230.44, "providers": [{ "billed_charge": 7424.00, "npi": [1295799088] } ] }, { "allowed_amount": 471.38, "providers": [{ "billed_charge": 1568.00, "npi": [1538123138] } ] } ] }, { "tin": { "type": "ein", "value": "752336860" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.44, "providers": [{ "billed_charge": 64.00, "npi": [1285195859, 1508363292] } ] }, { "allowed_amount": 41.44, "providers": [{ "billed_charge": 128.00, "npi": [1568665321] } ] }, { "allowed_amount": 57.72, "providers": [{ "billed_charge": 192.00, "npi": [1508363292] } ] }, { "allowed_amount": 38.48, "providers": [{ "billed_charge": 128.00, "npi": [1568665321] } ] }, { "allowed_amount": 105.82, "providers": [{ "billed_charge": 352.00, "npi": [1285195859] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 32.00, "npi": [1649404849] } ] }, { "allowed_amount": 26.40, "providers": [{ "billed_charge": 64.00, "npi": [1649404849] } ] } ] }, { "tin": { "type": "ein", "value": "990576438" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.66, "providers": [{ "billed_charge": 96.00, "npi": [1215198163] } ] }, { "allowed_amount": 28.86, "providers": [{ "billed_charge": 96.00, "npi": [1215198163] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.98, "providers": [{ "billed_charge": 3434.00, "npi": [1730129891] } ] }, { "allowed_amount": 124.92, "providers": [{ "billed_charge": 1818.00, "npi": [1699186775] } ] }, { "allowed_amount": 731.10, "providers": [{ "billed_charge": 10706.00, "npi": [1467440594] } ] }, { "allowed_amount": 1312.92, "providers": [{ "billed_charge": 19190.00, "npi": [1346237401] } ] }, { "allowed_amount": 54.72, "providers": [{ "billed_charge": 808.00, "npi": [1326242983] } ] }, { "allowed_amount": 166.08, "providers": [{ "billed_charge": 2424.00, "npi": [1689840076] } ] }, { "allowed_amount": 291.96, "providers": [{ "billed_charge": 4242.00, "npi": [1780624254] } ] }, { "allowed_amount": 455.91, "providers": [{ "billed_charge": 6666.00, "npi": [1689878282] } ] }, { "allowed_amount": 138.30, "providers": [{ "billed_charge": 2020.00, "npi": [1487641650] } ] }, { "allowed_amount": 166.56, "providers": [{ "billed_charge": 2424.00, "npi": [1487073474] } ] }, { "allowed_amount": 386.70, "providers": [{ "billed_charge": 5656.00, "npi": [1841287018] } ] }, { "allowed_amount": 55.02, "providers": [{ "billed_charge": 808.00, "npi": [1487641650] } ] }, { "allowed_amount": 27.27, "providers": [{ "billed_charge": 404.00, "npi": [1679501522] } ] }, { "allowed_amount": 849.24, "providers": [{ "billed_charge": 12322.00, "npi": [1780624254] } ] }, { "allowed_amount": 56.16, "providers": [{ "billed_charge": 808.00, "npi": [1730129891] } ] }, { "allowed_amount": 110.55, "providers": [{ "billed_charge": 1616.00, "npi": [1417240755] } ] }, { "allowed_amount": 81.99, "providers": [{ "billed_charge": 1212.00, "npi": [1417903618] } ] }, { "allowed_amount": 178.20, "providers": [{ "billed_charge": 2626.00, "npi": [1679501522] } ] }, { "allowed_amount": 41.31, "providers": [{ "billed_charge": 606.00, "npi": [1679501522] } ] }, { "allowed_amount": 82.80, "providers": [{ "billed_charge": 1212.00, "npi": [1609254754] } ] }, { "allowed_amount": 1706.07, "providers": [{ "billed_charge": 24846.00, "npi": [1689878282] } ] }, { "allowed_amount": 14.04, "providers": [{ "billed_charge": 202.00, "npi": [1699186775, 1609254754, 1730129891] } ] }, { "allowed_amount": 13.56, "providers": [{ "billed_charge": 202.00, "npi": [1841287018, 1467440594, 1417240755, 1316294655, 1548443542] } ] }, { "allowed_amount": 28.08, "providers": [{ "billed_charge": 404.00, "npi": [1316294655] } ] }, { "allowed_amount": 1967.77, "providers": [{ "billed_charge": 28684.00, "npi": [1689840076] } ] }, { "allowed_amount": 96.99, "providers": [{ "billed_charge": 1414.00, "npi": [1467440594] } ] }, { "allowed_amount": 290.31, "providers": [{ "billed_charge": 4242.00, "npi": [1689840076] } ] }, { "allowed_amount": 1437.63, "providers": [{ "billed_charge": 21008.00, "npi": [1326242983] } ] }, { "allowed_amount": 923.61, "providers": [{ "billed_charge": 13534.00, "npi": [1346237401] } ] }, { "allowed_amount": 55.35, "providers": [{ "billed_charge": 808.00, "npi": [1417240755] } ] }, { "allowed_amount": 83.28, "providers": [{ "billed_charge": 1212.00, "npi": [1689878282] } ] }, { "allowed_amount": 69.72, "providers": [{ "billed_charge": 1010.00, "npi": [1346237401, 1780624254] } ] }, { "allowed_amount": 263.88, "providers": [{ "billed_charge": 3838.00, "npi": [1528384138] } ] }, { "allowed_amount": 27.75, "providers": [{ "billed_charge": 404.00, "npi": [1528384138] } ] }, { "allowed_amount": 83.43, "providers": [{ "billed_charge": 1212.00, "npi": [1417903618, 1841287018] } ] }, { "allowed_amount": 263.85, "providers": [{ "billed_charge": 3838.00, "npi": [1326242983] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.44, "providers": [{ "billed_charge": 66.00, "npi": [1841440021] } ] }, { "allowed_amount": 1471.86, "providers": [{ "billed_charge": 5049.00, "npi": [1962512269] } ] }, { "allowed_amount": 105.82, "providers": [{ "billed_charge": 363.00, "npi": [1841440021] } ] }, { "allowed_amount": 443.88, "providers": [{ "billed_charge": 1782.00, "npi": [1073587788] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 33.00, "npi": [1174569842, 1811981590] } ] }, { "allowed_amount": 798.46, "providers": [{ "billed_charge": 2739.00, "npi": [1811981590] } ] }, { "allowed_amount": 830.22, "providers": [{ "billed_charge": 3333.00, "npi": [1962512269] } ] }, { "allowed_amount": 402.78, "providers": [{ "billed_charge": 1617.00, "npi": [1174569842] } ] }, { "allowed_amount": 2112.54, "providers": [{ "billed_charge": 8481.00, "npi": [1093717001] } ] }, { "allowed_amount": 24.66, "providers": [{ "billed_charge": 99.00, "npi": [1962512269] } ] }, { "allowed_amount": 740.74, "providers": [{ "billed_charge": 2541.00, "npi": [1073587788] } ] }, { "allowed_amount": 394.50, "providers": [{ "billed_charge": 1584.00, "npi": [1811981590] } ] }, { "allowed_amount": 86.58, "providers": [{ "billed_charge": 297.00, "npi": [1235422619] } ] }, { "allowed_amount": 65.76, "providers": [{ "billed_charge": 264.00, "npi": [1093717001] } ] }, { "allowed_amount": 4723.42, "providers": [{ "billed_charge": 16203.00, "npi": [1093717001] } ] }, { "allowed_amount": 471.38, "providers": [{ "billed_charge": 1617.00, "npi": [1174569842] } ] }, { "allowed_amount": 49.32, "providers": [{ "billed_charge": 198.00, "npi": [1235422619] } ] } ] }, { "tin": { "type": "ein", "value": "751375446" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.50, "providers": [{ "billed_charge": 66.00, "npi": [1649700931] } ] } ] }, { "tin": { "type": "ein", "value": "746223317" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.44, "providers": [{ "billed_charge": 100.00, "npi": [1891226114, 1942734629] } ] }, { "allowed_amount": 177.54, "providers": [{ "billed_charge": 900.00, "npi": [1740667922] } ] }, { "allowed_amount": 427.44, "providers": [{ "billed_charge": 2600.00, "npi": [1366947509] } ] }, { "allowed_amount": 172.62, "providers": [{ "billed_charge": 1050.00, "npi": [1891226114] } ] }, { "allowed_amount": 238.38, "providers": [{ "billed_charge": 1450.00, "npi": [1073018073] } ] }, { "allowed_amount": 205.50, "providers": [{ "billed_charge": 1250.00, "npi": [1336431352] } ] }, { "allowed_amount": 115.08, "providers": [{ "billed_charge": 700.00, "npi": [1295293587] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 50.00, "npi": [1336431352] } ] }, { "allowed_amount": 279.48, "providers": [{ "billed_charge": 1700.00, "npi": [1073018073] } ] }, { "allowed_amount": 106.86, "providers": [{ "billed_charge": 650.00, "npi": [1891226114] } ] }, { "allowed_amount": 189.06, "providers": [{ "billed_charge": 1150.00, "npi": [1336431352] } ] }, { "allowed_amount": 98.64, "providers": [{ "billed_charge": 600.00, "npi": [1295293587] } ] }, { "allowed_amount": 24.66, "providers": [{ "billed_charge": 150.00, "npi": [1366947509, 1073018073] } ] }, { "allowed_amount": 34.04, "providers": [{ "billed_charge": 200.00, "npi": [1740667922] } ] }, { "allowed_amount": 41.10, "providers": [{ "billed_charge": 250.00, "npi": [1942734629] } ] }, { "allowed_amount": 262.65, "providers": [{ "billed_charge": 1550.00, "npi": [1740667922] } ] }, { "allowed_amount": 320.58, "providers": [{ "billed_charge": 1950.00, "npi": [1366947509] } ] } ] }, { "tin": { "type": "ein", "value": "751459885" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.57, "providers": [{ "billed_charge": 248.00, "npi": [1528599180, 1639667660, 1366945156] } ] }, { "allowed_amount": 13.24, "providers": [{ "billed_charge": 496.00, "npi": [1639667660] } ] }, { "allowed_amount": 199.11, "providers": [{ "billed_charge": 7440.00, "npi": [1861854952] } ] }, { "allowed_amount": 72.37, "providers": [{ "billed_charge": 2728.00, "npi": [1861854952] } ] }, { "allowed_amount": 52.52, "providers": [{ "billed_charge": 1984.00, "npi": [1467897793] } ] }, { "allowed_amount": 59.44, "providers": [{ "billed_charge": 2232.00, "npi": [1457739013] } ] }, { "allowed_amount": 56.19, "providers": [{ "billed_charge": 1984.00, "npi": [1457739013] } ] }, { "allowed_amount": 231.29, "providers": [{ "billed_charge": 8680.00, "npi": [1982023461] } ] }, { "allowed_amount": 53.26, "providers": [{ "billed_charge": 1984.00, "npi": [1174936496] } ] }, { "allowed_amount": 26.38, "providers": [{ "billed_charge": 992.00, "npi": [1750815171] } ] }, { "allowed_amount": 48.68, "providers": [{ "billed_charge": 1488.00, "npi": [1376930131] } ] }, { "allowed_amount": 85.55, "providers": [{ "billed_charge": 2976.00, "npi": [1154825172] } ] }, { "allowed_amount": 43.30, "providers": [{ "billed_charge": 1488.00, "npi": [1154825172] } ] }, { "allowed_amount": 26.50, "providers": [{ "billed_charge": 992.00, "npi": [1982023461] } ] }, { "allowed_amount": 113.10, "providers": [{ "billed_charge": 4216.00, "npi": [1174936496] } ] }, { "allowed_amount": 65.43, "providers": [{ "billed_charge": 2232.00, "npi": [1790244952] } ] }, { "allowed_amount": 6.67, "providers": [{ "billed_charge": 248.00, "npi": [1740777226, 1215284898] } ] }, { "allowed_amount": 6.68, "providers": [{ "billed_charge": 248.00, "npi": [1376930131, 1457739013] } ] }, { "allowed_amount": 13.14, "providers": [{ "billed_charge": 496.00, "npi": [1861854952, 1740777226] } ] }, { "allowed_amount": 73.17, "providers": [{ "billed_charge": 2728.00, "npi": [1851667026] } ] }, { "allowed_amount": 270.49, "providers": [{ "billed_charge": 10168.00, "npi": [1013354133] } ] }, { "allowed_amount": 26.28, "providers": [{ "billed_charge": 992.00, "npi": [1013354133, 1083058317] } ] }, { "allowed_amount": 54.61, "providers": [{ "billed_charge": 1984.00, "npi": [1952854994] } ] }, { "allowed_amount": 19.71, "providers": [{ "billed_charge": 744.00, "npi": [1982023461, 1801214325] } ] }, { "allowed_amount": 166.45, "providers": [{ "billed_charge": 6200.00, "npi": [1942681549] } ] }, { "allowed_amount": 144.50, "providers": [{ "billed_charge": 5456.00, "npi": [1528599180] } ] }, { "allowed_amount": 92.71, "providers": [{ "billed_charge": 3472.00, "npi": [1467897793] } ] }, { "allowed_amount": 26.68, "providers": [{ "billed_charge": 992.00, "npi": [1851667026] } ] }, { "allowed_amount": 51.37, "providers": [{ "billed_charge": 1736.00, "npi": [1790244952] } ] }, { "allowed_amount": 172.34, "providers": [{ "billed_charge": 6448.00, "npi": [1083058317] } ] }, { "allowed_amount": 112.47, "providers": [{ "billed_charge": 4216.00, "npi": [1750815171] } ] }, { "allowed_amount": 86.57, "providers": [{ "billed_charge": 3224.00, "npi": [1942681549] } ] }, { "allowed_amount": 82.52, "providers": [{ "billed_charge": 2976.00, "npi": [1952854994] } ] }, { "allowed_amount": 190.69, "providers": [{ "billed_charge": 7192.00, "npi": [1528599180] } ] } ] }, { "tin": { "type": "ein", "value": "741671142" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.52, "providers": [{ "billed_charge": 560.00, "npi": [1801813266] } ] }, { "allowed_amount": 19.72, "providers": [{ "billed_charge": 35.00, "npi": [1063728103, 1801813266] } ] }, { "allowed_amount": 118.32, "providers": [{ "billed_charge": 210.00, "npi": [1063728103] } ] } ] }, { "tin": { "type": "ein", "value": "742620408" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.14, "providers": [{ "billed_charge": 51.66, "npi": [1114993169, 1942559349] } ] }, { "allowed_amount": 78.84, "providers": [{ "billed_charge": 309.96, "npi": [1942559349] } ] }, { "allowed_amount": 26.28, "providers": [{ "billed_charge": 103.32, "npi": [1114993169] } ] }, { "allowed_amount": 19.71, "providers": [{ "billed_charge": 77.49, "npi": [1942559349] } ] } ] }, { "tin": { "type": "ein", "value": "741548876" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.60, "providers": [{ "billed_charge": 144.00, "npi": [1831196047] } ] }, { "allowed_amount": 190.88, "providers": [{ "billed_charge": 720.00, "npi": [1831196047] } ] } ] }, { "tin": { "type": "ein", "value": "742958277" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.24, "providers": [{ "billed_charge": 82.00, "npi": [1134574882] } ] }, { "allowed_amount": 57.54, "providers": [{ "billed_charge": 287.00, "npi": [1134574882] } ] } ] }, { "tin": { "type": "ein", "value": "200376970" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.57, "providers": [{ "billed_charge": 36.00, "npi": [1285849646] } ] }, { "allowed_amount": 32.85, "providers": [{ "billed_charge": 180.00, "npi": [1285849646] } ] } ] }, { "tin": { "type": "ein", "value": "450480099" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.08, "providers": [{ "billed_charge": 156.00, "npi": [1023092442] } ] }, { "allowed_amount": 10.27, "providers": [{ "billed_charge": 39.00, "npi": [1891282885] } ] }, { "allowed_amount": 30.81, "providers": [{ "billed_charge": 117.00, "npi": [1023092442] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.12, "providers": [{ "billed_charge": 910.00, "npi": [1902868425] } ] }, { "allowed_amount": 39.16, "providers": [{ "billed_charge": 280.00, "npi": [1932199767] } ] }, { "allowed_amount": 17.02, "providers": [{ "billed_charge": 140.00, "npi": [1497744999, 1902868425, 1467672824, 1467457796, 1346534120, 1932199767] } ] }, { "allowed_amount": 8.51, "providers": [{ "billed_charge": 70.00, "npi": [1255321907, 1497744999, 1629211768, 1093030157] } ] }, { "allowed_amount": 167.62, "providers": [{ "billed_charge": 1190.00, "npi": [1346243144] } ] }, { "allowed_amount": 38.82, "providers": [{ "billed_charge": 280.00, "npi": [1578023818] } ] }, { "allowed_amount": 9.62, "providers": [{ "billed_charge": 70.00, "npi": [1770939753] } ] }, { "allowed_amount": 98.24, "providers": [{ "billed_charge": 700.00, "npi": [1437111952] } ] }, { "allowed_amount": 58.99, "providers": [{ "billed_charge": 490.00, "npi": [1538159272] } ] }, { "allowed_amount": 16.73, "providers": [{ "billed_charge": 140.00, "npi": [1932454972] } ] }, { "allowed_amount": 118.16, "providers": [{ "billed_charge": 840.00, "npi": [1629211768] } ] }, { "allowed_amount": 25.24, "providers": [{ "billed_charge": 210.00, "npi": [1578023818] } ] }, { "allowed_amount": 34.04, "providers": [{ "billed_charge": 280.00, "npi": [1235443789] } ] }, { "allowed_amount": 117.82, "providers": [{ "billed_charge": 840.00, "npi": [1538159272] } ] }, { "allowed_amount": 29.88, "providers": [{ "billed_charge": 210.00, "npi": [1093030157, 1245220102] } ] }, { "allowed_amount": 69.04, "providers": [{ "billed_charge": 490.00, "npi": [1497744999] } ] }, { "allowed_amount": 49.12, "providers": [{ "billed_charge": 350.00, "npi": [1467457796, 1295725828] } ] }, { "allowed_amount": 118.56, "providers": [{ "billed_charge": 980.00, "npi": [1346243144] } ] }, { "allowed_amount": 218.07, "providers": [{ "billed_charge": 1820.00, "npi": [1629211768] } ] }, { "allowed_amount": 176.22, "providers": [{ "billed_charge": 1260.00, "npi": [1346534120] } ] }, { "allowed_amount": 42.55, "providers": [{ "billed_charge": 350.00, "npi": [1053516898, 1295725828] } ] }, { "allowed_amount": 19.58, "providers": [{ "billed_charge": 140.00, "npi": [1457400335, 1932454972, 1053516898] } ] }, { "allowed_amount": 178.42, "providers": [{ "billed_charge": 1470.00, "npi": [1437111952] } ] }, { "allowed_amount": 9.96, "providers": [{ "billed_charge": 70.00, "npi": [1255321907, 1790050052] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 70.00, "npi": [1700857679] } ] }, { "allowed_amount": 59.76, "providers": [{ "billed_charge": 420.00, "npi": [1235443789] } ] }, { "allowed_amount": 75.72, "providers": [{ "billed_charge": 630.00, "npi": [1245220102] } ] }, { "allowed_amount": 76.30, "providers": [{ "billed_charge": 630.00, "npi": [1932199767] } ] } ] }, { "tin": { "type": "ein", "value": "751286819" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.40, "providers": [{ "billed_charge": 180.00, "npi": [1447233713] } ] }, { "allowed_amount": 32.04, "providers": [{ "billed_charge": 72.00, "npi": [1568416204] } ] }, { "allowed_amount": 161.46, "providers": [{ "billed_charge": 504.00, "npi": [1447233713] } ] } ] }, { "tin": { "type": "ein", "value": "756002868" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.66, "providers": [{ "billed_charge": 243.00, "npi": [1366460180] } ] }, { "allowed_amount": 41.10, "providers": [{ "billed_charge": 405.00, "npi": [1366460180] } ] } ] }, { "tin": { "type": "ein", "value": "752537587" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.20, "providers": [{ "billed_charge": 750.00, "npi": [1407290513] } ] }, { "allowed_amount": 134.68, "providers": [{ "billed_charge": 1050.00, "npi": [1407290513] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22", "23", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.94, "providers": [{ "billed_charge": 288.00, "npi": [1548458185] } ] }, { "allowed_amount": 22.98, "providers": [{ "billed_charge": 96.00, "npi": [1427780782, 1649411638, 1154506202] } ] }, { "allowed_amount": 91.92, "providers": [{ "billed_charge": 384.00, "npi": [1548458185] } ] }, { "allowed_amount": 114.90, "providers": [{ "billed_charge": 480.00, "npi": [1154506202, 1437197878] } ] }, { "allowed_amount": 34.47, "providers": [{ "billed_charge": 144.00, "npi": [1548458185, 1427780782, 1538368584] } ] }, { "allowed_amount": 149.37, "providers": [{ "billed_charge": 624.00, "npi": [1467139436] } ] }, { "allowed_amount": 126.39, "providers": [{ "billed_charge": 528.00, "npi": [1538368584] } ] }, { "allowed_amount": 57.45, "providers": [{ "billed_charge": 240.00, "npi": [1467841346] } ] }, { "allowed_amount": 11.49, "providers": [{ "billed_charge": 48.00, "npi": [1427780782, 1154506202, 1467139436, 1437197878, 1467841346] } ] }, { "allowed_amount": 218.31, "providers": [{ "billed_charge": 912.00, "npi": [1578065967] } ] }, { "allowed_amount": 45.96, "providers": [{ "billed_charge": 192.00, "npi": [1649411638, 1538368584] } ] } ] }, { "tin": { "type": "ein", "value": "852254487" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.22, "providers": [{ "billed_charge": 38.00, "npi": [1457399818] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1565.91, "providers": [{ "billed_charge": 6477.00, "npi": [1770739260] } ] }, { "allowed_amount": 221.94, "providers": [{ "billed_charge": 918.00, "npi": [1366646416] } ] }, { "allowed_amount": 16.44, "providers": [{ "billed_charge": 102.00, "npi": [1760200901] } ] }, { "allowed_amount": 1385.28, "providers": [{ "billed_charge": 7344.00, "npi": [1760200901] } ] }, { "allowed_amount": 3191.81, "providers": [{ "billed_charge": 13166.00, "npi": [1770739260] } ] }, { "allowed_amount": 468.54, "providers": [{ "billed_charge": 2907.00, "npi": [1760200901] } ] }, { "allowed_amount": 36.99, "providers": [{ "billed_charge": 153.00, "npi": [1770739260] } ] }, { "allowed_amount": 76.96, "providers": [{ "billed_charge": 408.00, "npi": [1023074127] } ] }, { "allowed_amount": 8.22, "providers": [{ "billed_charge": 51.00, "npi": [1023074127] } ] }, { "allowed_amount": 431.55, "providers": [{ "billed_charge": 1785.00, "npi": [1366646416] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 2 VIEWS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71046", "description": "RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746223317" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.40, "providers": [{ "billed_charge": 252.00, "npi": [1073018073] } ] }, { "allowed_amount": 9.85, "providers": [{ "billed_charge": 63.00, "npi": [1073018073] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.20, "providers": [{ "billed_charge": 39.00, "npi": [1578820866] } ] }, { "allowed_amount": 32.80, "providers": [{ "billed_charge": 156.00, "npi": [1578820866] } ] } ] }, { "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1161.01, "providers": [{ "billed_charge": 8109.00, "npi": [1447218169] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 118.71, "providers": [{ "billed_charge": 860.00, "npi": [1346534120] } ] }, { "allowed_amount": 23.82, "providers": [{ "billed_charge": 172.00, "npi": [1932454972] } ] }, { "allowed_amount": 35.73, "providers": [{ "billed_charge": 258.00, "npi": [1598772915] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.28, "providers": [{ "billed_charge": 224.00, "npi": [1760477236] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 725.76, "providers": [{ "billed_charge": 2394.00, "npi": [1417290511] } ] }, { "allowed_amount": 88.65, "providers": [{ "billed_charge": 342.00, "npi": [1295799088] } ] }, { "allowed_amount": 1241.04, "providers": [{ "billed_charge": 4788.00, "npi": [1295799088] } ] }, { "allowed_amount": 910.08, "providers": [{ "billed_charge": 3002.00, "npi": [1295799088] } ] }, { "allowed_amount": 161.28, "providers": [{ "billed_charge": 532.00, "npi": [1538123138] } ] }, { "allowed_amount": 19.70, "providers": [{ "billed_charge": 76.00, "npi": [1538123138] } ] }, { "allowed_amount": 34.56, "providers": [{ "billed_charge": 114.00, "npi": [1457447120] } ] }, { "allowed_amount": 49.25, "providers": [{ "billed_charge": 190.00, "npi": [1417290511] } ] }, { "allowed_amount": 777.97, "providers": [{ "billed_charge": 3002.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "742620408" }, "service_code": ["22", "23", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.80, "providers": [{ "billed_charge": 308.70, "npi": [1114993169] } ] }, { "allowed_amount": 31.52, "providers": [{ "billed_charge": 123.48, "npi": [1114993169] } ] }, { "allowed_amount": 7.88, "providers": [{ "billed_charge": 30.87, "npi": [1114993169] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.92, "providers": [{ "billed_charge": 240.00, "npi": [1770739260] } ] }, { "allowed_amount": 195.84, "providers": [{ "billed_charge": 1020.00, "npi": [1760200901] } ] }, { "allowed_amount": 19.70, "providers": [{ "billed_charge": 120.00, "npi": [1760200901] } ] }, { "allowed_amount": 437.17, "providers": [{ "billed_charge": 1750.00, "npi": [1770739260] } ] }, { "allowed_amount": 14.73, "providers": [{ "billed_charge": 60.00, "npi": [1770739260] } ] }, { "allowed_amount": 59.10, "providers": [{ "billed_charge": 360.00, "npi": [1760200901] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.25, "providers": [{ "billed_charge": 216.00, "npi": [1346237401] } ] }, { "allowed_amount": 16.80, "providers": [{ "billed_charge": 216.00, "npi": [1346237401] } ] }, { "allowed_amount": 115.07, "providers": [{ "billed_charge": 1512.00, "npi": [1689840076] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.40, "providers": [{ "billed_charge": 156.00, "npi": [1093717001] } ] }, { "allowed_amount": 103.68, "providers": [{ "billed_charge": 351.00, "npi": [1073587788] } ] }, { "allowed_amount": 9.85, "providers": [{ "billed_charge": 39.00, "npi": [1073587788, 1093717001] } ] }, { "allowed_amount": 679.68, "providers": [{ "billed_charge": 2301.00, "npi": [1093717001] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.96, "providers": [{ "billed_charge": 228.00, "npi": [1437197878] } ] } ] } ] }, { "name": "CT THORAX W/O DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71250", "description": "COMPUTED TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.61, "providers": [{ "billed_charge": 203.00, "npi": [1417290511] } ] }, { "allowed_amount": 227.48, "providers": [{ "billed_charge": 812.00, "npi": [1417290511] } ] }, { "allowed_amount": 194.44, "providers": [{ "billed_charge": 812.00, "npi": [1972548139] } ] }, { "allowed_amount": 97.22, "providers": [{ "billed_charge": 406.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.87, "providers": [{ "billed_charge": 204.00, "npi": [1720066749] } ] }, { "allowed_amount": 777.76, "providers": [{ "billed_charge": 3264.00, "npi": [1720066749] } ] }, { "allowed_amount": 631.93, "providers": [{ "billed_charge": 2652.00, "npi": [1720066749] } ] } ] } ] }, { "name": "CT THORAX W/DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71260", "description": "COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "450480099" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 330.30, "providers": [{ "billed_charge": 1100.00, "npi": [1538621966] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 247.32, "providers": [{ "billed_charge": 864.00, "npi": [1417290511] } ] }, { "allowed_amount": 123.66, "providers": [{ "billed_charge": 432.00, "npi": [1972548139] } ] }, { "allowed_amount": 52.85, "providers": [{ "billed_charge": 216.00, "npi": [1417290511, 1972548139] } ] }, { "allowed_amount": 211.40, "providers": [{ "billed_charge": 864.00, "npi": [1972548139] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 61.83, "providers": [{ "billed_charge": 224.00, "npi": [1720066749, 1598290652] } ] }, { "allowed_amount": 42.28, "providers": [{ "billed_charge": 224.00, "npi": [1720280530] } ] }, { "allowed_amount": 126.84, "providers": [{ "billed_charge": 672.00, "npi": [1720280530] } ] }, { "allowed_amount": 264.25, "providers": [{ "billed_charge": 1120.00, "npi": [1811981590] } ] }, { "allowed_amount": 680.13, "providers": [{ "billed_charge": 2464.00, "npi": [1811981590] } ] }, { "allowed_amount": 52.85, "providers": [{ "billed_charge": 224.00, "npi": [1598290652] } ] } ] } ] }, { "name": "CT ANGIOGRAPHY CHEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71275", "description": "COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 192.10, "providers": [{ "billed_charge": 688.00, "npi": [1598290652] } ] }, { "allowed_amount": 82.09, "providers": [{ "billed_charge": 344.00, "npi": [1811981590] } ] }, { "allowed_amount": 65.67, "providers": [{ "billed_charge": 344.00, "npi": [1720280530] } ] }, { "allowed_amount": 164.18, "providers": [{ "billed_charge": 688.00, "npi": [1720066749] } ] }, { "allowed_amount": 738.81, "providers": [{ "billed_charge": 3096.00, "npi": [1811981590] } ] }, { "allowed_amount": 1632.85, "providers": [{ "billed_charge": 5848.00, "npi": [1811981590] } ] }, { "allowed_amount": 197.01, "providers": [{ "billed_charge": 1032.00, "npi": [1720280530] } ] }, { "allowed_amount": 96.05, "providers": [{ "billed_charge": 344.00, "npi": [1720066749] } ] } ] } ] }, { "name": "X-RAY EXAM NECK SPINE 2-3 VW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72040", "description": "RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.50, "providers": [{ "billed_charge": 195.00, "npi": [1417290511] } ] }, { "allowed_amount": 91.47, "providers": [{ "billed_charge": 351.00, "npi": [1417290511] } ] } ] } ] }, { "name": "X-RAY EXAM THORAC SPINE 2VWS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72070", "description": "RADIOLOGIC EXAMINATION, SPINE; THORACIC, 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 44.56, "providers": [{ "billed_charge": 156.00, "npi": [1417290511] } ] }, { "allowed_amount": 66.64, "providers": [{ "billed_charge": 273.00, "npi": [1417290511] } ] } ] } ] }, { "name": "X-RAY EXAM L-S SPINE 2/3 VWS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72100", "description": "RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 304.21, "providers": [{ "billed_charge": 1131.00, "npi": [1417290511] } ] }, { "allowed_amount": 294.48, "providers": [{ "billed_charge": 936.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.67, "providers": [{ "billed_charge": 62.00, "npi": [1770739260] } ] }, { "allowed_amount": 24.54, "providers": [{ "billed_charge": 124.00, "npi": [1760200901] } ] }, { "allowed_amount": 219.38, "providers": [{ "billed_charge": 868.00, "npi": [1770739260] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 441.72, "providers": [{ "billed_charge": 1872.00, "npi": [1093717001] } ] } ] } ] }, { "name": "CT NECK SPINE W/O DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72125", "description": "COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 534.00, "providers": [{ "billed_charge": 1860.00, "npi": [1417290511] } ] }, { "allowed_amount": 106.80, "providers": [{ "billed_charge": 372.00, "npi": [1457447120] } ] }, { "allowed_amount": 1174.80, "providers": [{ "billed_charge": 4092.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.14, "providers": [{ "billed_charge": 830.00, "npi": [1316149172] } ] }, { "allowed_amount": 463.18, "providers": [{ "billed_charge": 4980.00, "npi": [1679501522] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1548.60, "providers": [{ "billed_charge": 6902.00, "npi": [1811981590] } ] }, { "allowed_amount": 36.51, "providers": [{ "billed_charge": 238.00, "npi": [1720280530] } ] }, { "allowed_amount": 480.60, "providers": [{ "billed_charge": 2142.00, "npi": [1598290652] } ] }, { "allowed_amount": 228.20, "providers": [{ "billed_charge": 1190.00, "npi": [1811981590] } ] }, { "allowed_amount": 91.28, "providers": [{ "billed_charge": 476.00, "npi": [1720066749] } ] }, { "allowed_amount": 620.67, "providers": [{ "billed_charge": 4046.00, "npi": [1720280530] } ] }, { "allowed_amount": 73.02, "providers": [{ "billed_charge": 476.00, "npi": [1720280530] } ] }, { "allowed_amount": 182.56, "providers": [{ "billed_charge": 952.00, "npi": [1093717001] } ] }, { "allowed_amount": 45.64, "providers": [{ "billed_charge": 238.00, "npi": [1811981590] } ] }, { "allowed_amount": 587.40, "providers": [{ "billed_charge": 2618.00, "npi": [1093717001] } ] } ] } ] }, { "name": "CT LUMBAR SPINE W/O DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72131", "description": "COMPUTED TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741680498" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.31, "providers": [{ "billed_charge": 715.00, "npi": [1528384138] } ] } ] } ] }, { "name": "X-RAY EXAM OF PELVIS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72170", "description": "RADIOLOGIC EXAMINATION, PELVIS; 1 OR 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.59, "providers": [{ "billed_charge": 44.00, "npi": [1093717001] } ] }, { "allowed_amount": 8.20, "providers": [{ "billed_charge": 44.00, "npi": [1093717001] } ] } ] } ] }, { "name": "MRI PELVIS W/O & W/DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "72197", "description": "MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1708.90, "providers": [{ "billed_charge": 20120.00, "npi": [1366767303] } ] } ] } ] }, { "name": "EKG/ECG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "730", "description": "EKG/ECG - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746000949" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 58.97, "providers": [{ "billed_charge": 234.00, "npi": [1548226988] } ] } ] }, { "tin": { "type": "ein", "value": "746002164" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55.78, "providers": [{ "billed_charge": 447.00, "npi": [1821011248] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 14.22, "providers": [{ "billed_charge": 252333.00, "npi": [1992753222] } ] }, { "allowed_amount": 88.46, "providers": [{ "billed_charge": 529.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 283.52, "providers": [{ "billed_charge": 1946.12, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 58.97, "providers": [{ "billed_charge": 567.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "751976930" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 664.94, "providers": [{ "billed_charge": 5868.00, "npi": [1952306672] } ] } ] }, { "tin": { "type": "ein", "value": "834546114" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 921.98, "providers": [{ "billed_charge": 76956.50, "npi": [1972258580] } ] } ] }, { "tin": { "type": "ein", "value": "823349983" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 128.02, "providers": [{ "billed_charge": 21412.16, "npi": [1346753118] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 378.25, "providers": [{ "billed_charge": 5193.75, "npi": [1740233782] } ] }, { "allowed_amount": 94.82, "providers": [{ "billed_charge": 1038.75, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "823280177" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 546.45, "providers": [{ "billed_charge": 1480.00, "npi": [1114435260] } ] } ] } ] }, { "name": "X-RAY EXAM OF SHOULDER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73030", "description": "RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 238.05, "providers": [{ "billed_charge": 759.00, "npi": [1417290511] } ] }, { "allowed_amount": 17.70, "providers": [{ "billed_charge": 66.00, "npi": [1417290511] } ] }, { "allowed_amount": 221.20, "providers": [{ "billed_charge": 825.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.70, "providers": [{ "billed_charge": 483.00, "npi": [1922121607] } ] }, { "allowed_amount": 74.46, "providers": [{ "billed_charge": 805.00, "npi": [1922121607] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["11", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 98.00, "npi": [1093717001] } ] }, { "allowed_amount": 8.85, "providers": [{ "billed_charge": 49.00, "npi": [1093717001] } ] }, { "allowed_amount": 351.90, "providers": [{ "billed_charge": 1666.00, "npi": [1093717001] } ] } ] } ] }, { "name": "X-RAY EXAM OF FOREARM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73090", "description": "RADIOLOGIC EXAMINATION; FOREARM, 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 44.15, "providers": [{ "billed_charge": 180.00, "npi": [1093717001] } ] } ] } ] }, { "name": "ANES UPR GI NDSC PX NOS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "731", "description": "ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260507982" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 2174.46, "providers": [{ "billed_charge": 20870.00, "npi": [1902367386] } ] } ] }, { "tin": { "type": "ein", "value": "271009253" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 970.09, "providers": [{ "billed_charge": 5760.00, "npi": [1548686710] } ] }, { "allowed_amount": 1273.26, "providers": [{ "billed_charge": 7560.00, "npi": [1548686710] } ] } ] }, { "tin": { "type": "ein", "value": "461743879" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 2206.44, "providers": [{ "billed_charge": 11520.00, "npi": [1609019892] } ] } ] } ] }, { "name": "X-RAY EXAM OF WRIST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73110", "description": "RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752848936" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 600.18, "providers": [{ "billed_charge": 1714.86, "npi": [1083623656] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.52, "providers": [{ "billed_charge": 30.00, "npi": [1417290511] } ] }, { "allowed_amount": 19.94, "providers": [{ "billed_charge": 60.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.91, "providers": [{ "billed_charge": 114.00, "npi": [1093717001] } ] }, { "allowed_amount": 8.52, "providers": [{ "billed_charge": 38.00, "npi": [1093717001] } ] } ] } ] }, { "name": "X-RAY EXAM OF HAND", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73130", "description": "RADIOLOGIC EXAMINATION, HAND; MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752848936" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 535.08, "providers": [{ "billed_charge": 1541.82, "npi": [1083623656] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.85, "providers": [{ "billed_charge": 150.00, "npi": [1417290511] } ] }, { "allowed_amount": 25.56, "providers": [{ "billed_charge": 90.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.04, "providers": [{ "billed_charge": 76.00, "npi": [1093717001] } ] }, { "allowed_amount": 249.25, "providers": [{ "billed_charge": 950.00, "npi": [1093717001] } ] } ] } ] }, { "name": "X-RAY EXAM OF KNEE 1 OR 2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73560", "description": "RADIOLOGIC EXAMINATION, KNEE; 1 OR 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853601968" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 644.53, "providers": [{ "billed_charge": 11676.00, "npi": [1326327149] } ] } ] } ] }, { "name": "X-RAY EXAM OF KNEE 3", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73562", "description": "RADIOLOGIC EXAMINATION, KNEE; 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.49, "providers": [{ "billed_charge": 495.00, "npi": [1417290511] } ] }, { "allowed_amount": 75.11, "providers": [{ "billed_charge": 231.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["11", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.17, "providers": [{ "billed_charge": 44.00, "npi": [1093717001] } ] }, { "allowed_amount": 429.20, "providers": [{ "billed_charge": 1760.00, "npi": [1093717001] } ] }, { "allowed_amount": 9.11, "providers": [{ "billed_charge": 44.00, "npi": [1093717001] } ] } ] } ] }, { "name": "X-RAY EXAM OF ANKLE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73610", "description": "RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752848936" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.24, "providers": [{ "billed_charge": 283.52, "npi": [1083623656] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.20, "providers": [{ "billed_charge": 180.00, "npi": [1417290511] } ] }, { "allowed_amount": 57.54, "providers": [{ "billed_charge": 180.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.03, "providers": [{ "billed_charge": 663.00, "npi": [1093717001] } ] } ] } ] }, { "name": "X-RAY EXAM OF FOOT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73630", "description": "RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752848936" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.67, "providers": [{ "billed_charge": 456.26, "npi": [1083623656] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.30, "providers": [{ "billed_charge": 435.00, "npi": [1417290511] } ] }, { "allowed_amount": 110.32, "providers": [{ "billed_charge": 406.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.10, "providers": [{ "billed_charge": 798.00, "npi": [1689840076] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.76, "providers": [{ "billed_charge": 82.00, "npi": [1093717001] } ] }, { "allowed_amount": 285.82, "providers": [{ "billed_charge": 1271.00, "npi": [1093717001] } ] }, { "allowed_amount": 18.44, "providers": [{ "billed_charge": 82.00, "npi": [1962512269] } ] } ] } ] }, { "name": "EEG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "740", "description": "EEG - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 347.06, "providers": [{ "billed_charge": 1741.50, "npi": [1730132234] } ] } ] } ] }, { "name": "X-RAY EXAM ABDOMEN 1 VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "74018", "description": "RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260717903" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.52, "providers": [{ "billed_charge": 69.00, "npi": [1174574222] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.07, "providers": [{ "billed_charge": 608.00, "npi": [1417290511] } ] }, { "allowed_amount": 68.24, "providers": [{ "billed_charge": 256.00, "npi": [1417290511] } ] }, { "allowed_amount": 8.53, "providers": [{ "billed_charge": 32.00, "npi": [1295799088] } ] }, { "allowed_amount": 19.96, "providers": [{ "billed_charge": 64.00, "npi": [1417290511, 1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "742620408" }, "service_code": ["22", "23", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.29, "providers": [{ "billed_charge": 258.30, "npi": [1114993169] } ] }, { "allowed_amount": 47.81, "providers": [{ "billed_charge": 180.81, "npi": [1942559349] } ] }, { "allowed_amount": 13.66, "providers": [{ "billed_charge": 51.66, "npi": [1114993169] } ] }, { "allowed_amount": 34.15, "providers": [{ "billed_charge": 129.15, "npi": [1114993169] } ] }, { "allowed_amount": 34.14, "providers": [{ "billed_charge": 129.15, "npi": [1942559349] } ] }, { "allowed_amount": 6.83, "providers": [{ "billed_charge": 25.83, "npi": [1942559349] } ] }, { "allowed_amount": 68.30, "providers": [{ "billed_charge": 258.30, "npi": [1114993169] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.13, "providers": [{ "billed_charge": 693.00, "npi": [1093717001] } ] }, { "allowed_amount": 299.40, "providers": [{ "billed_charge": 990.00, "npi": [1093717001] } ] }, { "allowed_amount": 49.90, "providers": [{ "billed_charge": 165.00, "npi": [1174569842] } ] }, { "allowed_amount": 8.53, "providers": [{ "billed_charge": 33.00, "npi": [1174569842, 1093717001] } ] }, { "allowed_amount": 19.96, "providers": [{ "billed_charge": 66.00, "npi": [1962512269] } ] }, { "allowed_amount": 76.77, "providers": [{ "billed_charge": 297.00, "npi": [1962512269] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.93, "providers": [{ "billed_charge": 48.00, "npi": [1326368739] } ] }, { "allowed_amount": 83.51, "providers": [{ "billed_charge": 336.00, "npi": [1235248964] } ] }, { "allowed_amount": 20.77, "providers": [{ "billed_charge": 96.00, "npi": [1609667245] } ] } ] } ] }, { "name": "CT ABDOMEN W/DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "74160", "description": "COMPUTED TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 605.25, "providers": [{ "billed_charge": 1989.00, "npi": [1770842817] } ] } ] } ] }, { "name": "CT ABD & PELVIS W/O CONTRAST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "74176", "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746223317" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 314.04, "providers": [{ "billed_charge": 2288.00, "npi": [1366947509] } ] }, { "allowed_amount": 157.02, "providers": [{ "billed_charge": 1144.00, "npi": [1366947509] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 255.48, "providers": [{ "billed_charge": 915.00, "npi": [1366707564] } ] }, { "allowed_amount": 130.60, "providers": [{ "billed_charge": 610.00, "npi": [1366707564] } ] }, { "allowed_amount": 471.48, "providers": [{ "billed_charge": 1830.00, "npi": [1407149941] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 643.02, "providers": [{ "billed_charge": 2121.00, "npi": [1417290511, 1295799088] } ] }, { "allowed_amount": 78.51, "providers": [{ "billed_charge": 303.00, "npi": [1417290511, 1295799088] } ] }, { "allowed_amount": 314.04, "providers": [{ "billed_charge": 1212.00, "npi": [1972548139] } ] }, { "allowed_amount": 91.86, "providers": [{ "billed_charge": 303.00, "npi": [1972548139] } ] }, { "allowed_amount": 157.02, "providers": [{ "billed_charge": 606.00, "npi": [1417290511, 1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.42, "providers": [{ "billed_charge": 950.00, "npi": [1366646416] } ] }, { "allowed_amount": 1294.81, "providers": [{ "billed_charge": 5225.00, "npi": [1770739260] } ] }, { "allowed_amount": 1929.06, "providers": [{ "billed_charge": 9975.00, "npi": [1760200901] } ] }, { "allowed_amount": 5885.50, "providers": [{ "billed_charge": 23750.00, "npi": [1770739260] } ] }, { "allowed_amount": 117.71, "providers": [{ "billed_charge": 475.00, "npi": [1366646416] } ] }, { "allowed_amount": 471.06, "providers": [{ "billed_charge": 2850.00, "npi": [1760200901] } ] }, { "allowed_amount": 157.02, "providers": [{ "billed_charge": 950.00, "npi": [1760200901] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1179.54, "providers": [{ "billed_charge": 16740.00, "npi": [1346237401] } ] }, { "allowed_amount": 263.64, "providers": [{ "billed_charge": 3720.00, "npi": [1346237401] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.53, "providers": [{ "billed_charge": 792.00, "npi": [1811981590, 1720066749] } ] }, { "allowed_amount": 1177.65, "providers": [{ "billed_charge": 3960.00, "npi": [1093717001] } ] }, { "allowed_amount": 392.55, "providers": [{ "billed_charge": 1320.00, "npi": [1235422619] } ] }, { "allowed_amount": 3766.26, "providers": [{ "billed_charge": 10824.00, "npi": [1720066749] } ] }, { "allowed_amount": 1727.22, "providers": [{ "billed_charge": 5808.00, "npi": [1720066749] } ] }, { "allowed_amount": 1413.18, "providers": [{ "billed_charge": 4752.00, "npi": [1811981590] } ] }, { "allowed_amount": 78.51, "providers": [{ "billed_charge": 264.00, "npi": [1073587788] } ] }, { "allowed_amount": 2480.22, "providers": [{ "billed_charge": 7128.00, "npi": [1598290652] } ] }, { "allowed_amount": 314.05, "providers": [{ "billed_charge": 1320.00, "npi": [1720280530] } ] }, { "allowed_amount": 314.04, "providers": [{ "billed_charge": 1056.00, "npi": [1073587788] } ] }, { "allowed_amount": 91.86, "providers": [{ "billed_charge": 264.00, "npi": [1174569842] } ] }, { "allowed_amount": 1947.11, "providers": [{ "billed_charge": 8184.00, "npi": [1720280530] } ] }, { "allowed_amount": 1194.18, "providers": [{ "billed_charge": 3432.00, "npi": [1073587788] } ] }, { "allowed_amount": 1193.39, "providers": [{ "billed_charge": 5016.00, "npi": [1386694040] } ] }, { "allowed_amount": 863.61, "providers": [{ "billed_charge": 2904.00, "npi": [1598290652] } ] }, { "allowed_amount": 6981.36, "providers": [{ "billed_charge": 20064.00, "npi": [1811981590] } ] }, { "allowed_amount": 502.48, "providers": [{ "billed_charge": 2112.00, "npi": [1386694040] } ] }, { "allowed_amount": 2847.66, "providers": [{ "billed_charge": 8184.00, "npi": [1093717001] } ] }, { "allowed_amount": 1561.62, "providers": [{ "billed_charge": 4488.00, "npi": [1235422619] } ] }, { "allowed_amount": 62.81, "providers": [{ "billed_charge": 264.00, "npi": [1386694040] } ] }, { "allowed_amount": 157.02, "providers": [{ "billed_charge": 528.00, "npi": [1174569842] } ] } ] } ] }, { "name": "CT ABD & PELV W/CONTRAST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "74177", "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741940911" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3374.70, "providers": [{ "billed_charge": 11550.00, "npi": [1710240775] } ] }, { "allowed_amount": 210.15, "providers": [{ "billed_charge": 990.00, "npi": [1174569842] } ] }, { "allowed_amount": 289.26, "providers": [{ "billed_charge": 990.00, "npi": [1114250990] } ] } ] }, { "tin": { "type": "ein", "value": "392307067" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1917.35, "providers": [{ "billed_charge": 9840.00, "npi": [1770739260] } ] }, { "allowed_amount": 328.91, "providers": [{ "billed_charge": 1968.00, "npi": [1770739260] } ] }, { "allowed_amount": 82.41, "providers": [{ "billed_charge": 492.00, "npi": [1366646416] } ] }, { "allowed_amount": 671.54, "providers": [{ "billed_charge": 3444.00, "npi": [1366646416] } ] } ] }, { "tin": { "type": "ein", "value": "450480099" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.02, "providers": [{ "billed_charge": 870.00, "npi": [1538621966] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 341.75, "providers": [{ "billed_charge": 1600.00, "npi": [1073715884] } ] }, { "allowed_amount": 1698.97, "providers": [{ "billed_charge": 7360.00, "npi": [1366707564] } ] }, { "allowed_amount": 225.64, "providers": [{ "billed_charge": 960.00, "npi": [1407149941] } ] }, { "allowed_amount": 100.08, "providers": [{ "billed_charge": 320.00, "npi": [1285838862] } ] }, { "allowed_amount": 68.35, "providers": [{ "billed_charge": 320.00, "npi": [1073715884, 1366707564] } ] }, { "allowed_amount": 1393.83, "providers": [{ "billed_charge": 5440.00, "npi": [1407149941] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.16, "providers": [{ "billed_charge": 1896.00, "npi": [1962668947] } ] }, { "allowed_amount": 396.66, "providers": [{ "billed_charge": 3792.00, "npi": [1770939753] } ] }, { "allowed_amount": 100.08, "providers": [{ "billed_charge": 948.00, "npi": [1245793397, 1851895718] } ] }, { "allowed_amount": 85.54, "providers": [{ "billed_charge": 948.00, "npi": [1598772915] } ] }, { "allowed_amount": 300.24, "providers": [{ "billed_charge": 2844.00, "npi": [1598772915] } ] } ] }, { "tin": { "type": "ein", "value": "751286819" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.69, "providers": [{ "billed_charge": 361.00, "npi": [1447233713] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12631.02, "providers": [{ "billed_charge": 41527.00, "npi": [1295799088] } ] }, { "allowed_amount": 1349.88, "providers": [{ "billed_charge": 4438.00, "npi": [1457447120] } ] }, { "allowed_amount": 576.87, "providers": [{ "billed_charge": 2219.00, "npi": [1972548139] } ] }, { "allowed_amount": 576.33, "providers": [{ "billed_charge": 2219.00, "npi": [1417290511] } ] }, { "allowed_amount": 659.28, "providers": [{ "billed_charge": 2536.00, "npi": [1972548139] } ] }, { "allowed_amount": 2024.82, "providers": [{ "billed_charge": 6657.00, "npi": [1972548139] } ] }, { "allowed_amount": 247.23, "providers": [{ "billed_charge": 951.00, "npi": [1457447120, 1538123138] } ] }, { "allowed_amount": 164.82, "providers": [{ "billed_charge": 634.00, "npi": [1538123138] } ] }, { "allowed_amount": 658.74, "providers": [{ "billed_charge": 2536.00, "npi": [1417290511] } ] }, { "allowed_amount": 771.36, "providers": [{ "billed_charge": 2536.00, "npi": [1528370319] } ] }, { "allowed_amount": 412.05, "providers": [{ "billed_charge": 1585.00, "npi": [1295799088] } ] }, { "allowed_amount": 4242.48, "providers": [{ "billed_charge": 13948.00, "npi": [1538123138] } ] }, { "allowed_amount": 988.92, "providers": [{ "billed_charge": 3804.00, "npi": [1295799088] } ] }, { "allowed_amount": 82.41, "providers": [{ "billed_charge": 317.00, "npi": [1528370319] } ] }, { "allowed_amount": 7906.44, "providers": [{ "billed_charge": 25994.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 141.14, "providers": [{ "billed_charge": 1946.00, "npi": [1144491911, 1285053546] } ] }, { "allowed_amount": 423.42, "providers": [{ "billed_charge": 5838.00, "npi": [1730129891] } ] }, { "allowed_amount": 407.94, "providers": [{ "billed_charge": 5838.00, "npi": [1346237401, 1548443542] } ] }, { "allowed_amount": 1800.18, "providers": [{ "billed_charge": 25298.00, "npi": [1548443542] } ] }, { "allowed_amount": 696.86, "providers": [{ "billed_charge": 9730.00, "npi": [1497252753] } ] }, { "allowed_amount": 5479.76, "providers": [{ "billed_charge": 77840.00, "npi": [1346237401] } ] }, { "allowed_amount": 277.12, "providers": [{ "billed_charge": 3892.00, "npi": [1497252753] } ] }, { "allowed_amount": 135.98, "providers": [{ "billed_charge": 1946.00, "npi": [1285053546, 1346237401, 1912172594, 1548443542] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6460.14, "providers": [{ "billed_charge": 21641.00, "npi": [1720066749] } ] }, { "allowed_amount": 2989.02, "providers": [{ "billed_charge": 10013.00, "npi": [1669458261] } ] }, { "allowed_amount": 482.10, "providers": [{ "billed_charge": 1615.00, "npi": [1992150221] } ] }, { "allowed_amount": 593.37, "providers": [{ "billed_charge": 2907.00, "npi": [1225003320] } ] }, { "allowed_amount": 1120.81, "providers": [{ "billed_charge": 5491.00, "npi": [1720280530] } ] }, { "allowed_amount": 1054.88, "providers": [{ "billed_charge": 5168.00, "npi": [1720280530] } ] }, { "allowed_amount": 1483.38, "providers": [{ "billed_charge": 5814.00, "npi": [1235422619] } ] }, { "allowed_amount": 247.23, "providers": [{ "billed_charge": 969.00, "npi": [1235422619, 1902034663, 1093717001] } ] }, { "allowed_amount": 771.36, "providers": [{ "billed_charge": 2584.00, "npi": [1902034663] } ] }, { "allowed_amount": 4821.00, "providers": [{ "billed_charge": 16150.00, "npi": [1235422619] } ] }, { "allowed_amount": 20522.53, "providers": [{ "billed_charge": 68799.00, "npi": [1811981590] } ] }, { "allowed_amount": 988.92, "providers": [{ "billed_charge": 3876.00, "npi": [1073587788, 1811981590] } ] }, { "allowed_amount": 289.26, "providers": [{ "billed_charge": 969.00, "npi": [1396940342] } ] }, { "allowed_amount": 82.41, "providers": [{ "billed_charge": 323.00, "npi": [1073587788, 1295097970] } ] }, { "allowed_amount": 1565.79, "providers": [{ "billed_charge": 6137.00, "npi": [1093717001] } ] }, { "allowed_amount": 3873.27, "providers": [{ "billed_charge": 15181.00, "npi": [1811981590] } ] }, { "allowed_amount": 7647.88, "providers": [{ "billed_charge": 37468.00, "npi": [1720280530] } ] }, { "allowed_amount": 395.58, "providers": [{ "billed_charge": 1938.00, "npi": [1386694040] } ] }, { "allowed_amount": 3856.80, "providers": [{ "billed_charge": 12920.00, "npi": [1073587788] } ] }, { "allowed_amount": 6131.49, "providers": [{ "billed_charge": 30039.00, "npi": [1386694040] } ] }, { "allowed_amount": 2472.30, "providers": [{ "billed_charge": 9690.00, "npi": [1720066749] } ] }, { "allowed_amount": 1384.53, "providers": [{ "billed_charge": 6783.00, "npi": [1386694040] } ] }, { "allowed_amount": 659.28, "providers": [{ "billed_charge": 2584.00, "npi": [1669458261] } ] }, { "allowed_amount": 5688.78, "providers": [{ "billed_charge": 19057.00, "npi": [1598290652] } ] }, { "allowed_amount": 741.69, "providers": [{ "billed_charge": 2907.00, "npi": [1720066749] } ] }, { "allowed_amount": 385.68, "providers": [{ "billed_charge": 1292.00, "npi": [1962512269] } ] }, { "allowed_amount": 164.82, "providers": [{ "billed_charge": 646.00, "npi": [1295097970, 1669458261, 1962512269] } ] }, { "allowed_amount": 1446.30, "providers": [{ "billed_charge": 4845.00, "npi": [1295097970] } ] }, { "allowed_amount": 2718.99, "providers": [{ "billed_charge": 10659.00, "npi": [1598290652] } ] }, { "allowed_amount": 7906.44, "providers": [{ "billed_charge": 26486.00, "npi": [1093717001] } ] }, { "allowed_amount": 131.86, "providers": [{ "billed_charge": 646.00, "npi": [1225003320] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 230.96, "providers": [{ "billed_charge": 942.00, "npi": [1437197878] } ] } ] }, { "tin": { "type": "ein", "value": "746223317" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 329.64, "providers": [{ "billed_charge": 2388.00, "npi": [1073018073] } ] }, { "allowed_amount": 659.28, "providers": [{ "billed_charge": 4776.00, "npi": [1366947509] } ] }, { "allowed_amount": 247.23, "providers": [{ "billed_charge": 1791.00, "npi": [1073018073] } ] }, { "allowed_amount": 510.11, "providers": [{ "billed_charge": 3582.00, "npi": [1740667922] } ] }, { "allowed_amount": 2060.25, "providers": [{ "billed_charge": 14925.00, "npi": [1366947509] } ] }, { "allowed_amount": 1383.45, "providers": [{ "billed_charge": 8358.00, "npi": [1740667922] } ] }, { "allowed_amount": 342.16, "providers": [{ "billed_charge": 2388.00, "npi": [1740667922] } ] } ] }, { "tin": { "type": "ein", "value": "751459885" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 662.28, "providers": [{ "billed_charge": 16710.00, "npi": [1013354133] } ] }, { "allowed_amount": 465.31, "providers": [{ "billed_charge": 11697.00, "npi": [1942681549] } ] }, { "allowed_amount": 65.93, "providers": [{ "billed_charge": 1671.00, "npi": [1013354133] } ] }, { "allowed_amount": 561.73, "providers": [{ "billed_charge": 13368.00, "npi": [1811450810] } ] }, { "allowed_amount": 66.88, "providers": [{ "billed_charge": 1671.00, "npi": [1942681549] } ] }, { "allowed_amount": 397.61, "providers": [{ "billed_charge": 10026.00, "npi": [1083058317] } ] }, { "allowed_amount": 131.86, "providers": [{ "billed_charge": 3342.00, "npi": [1083058317, 1013354133] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 496.00, "providers": [{ "billed_charge": 2008.00, "npi": [1366646416] } ] }, { "allowed_amount": 659.28, "providers": [{ "billed_charge": 4016.00, "npi": [1760200901] } ] }, { "allowed_amount": 6572.00, "providers": [{ "billed_charge": 26606.00, "npi": [1770739260] } ] }, { "allowed_amount": 1349.88, "providers": [{ "billed_charge": 7028.00, "npi": [1760200901] } ] }, { "allowed_amount": 82.41, "providers": [{ "billed_charge": 502.00, "npi": [1760200901] } ] }, { "allowed_amount": 372.00, "providers": [{ "billed_charge": 1506.00, "npi": [1770739260] } ] } ] } ] }, { "name": "MRI ABDOMEN W/O & W/DYE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "74183", "description": "MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY WITH CON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2392.46, "providers": [{ "billed_charge": 28168.00, "npi": [1366767303] } ] } ] } ] }, { "name": "GASTR-INTS SVS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "750", "description": "GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2747.96, "providers": [{ "billed_charge": 8343.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9174.27, "providers": [{ "billed_charge": 30827.00, "npi": [1730132234] } ] } ] } ] }, { "name": "TREATMENT ROOM/OBSERV ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "760", "description": "TREATMENT OR OBSERVATION ROOM - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "820641535" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1501.17, "providers": [{ "billed_charge": 39580.00, "npi": [1134783913] } ] } ] } ] }, { "name": "TREATMENT ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "761", "description": "TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741166904" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1410.85, "providers": [{ "billed_charge": 6664.90, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3037.68, "providers": [{ "billed_charge": 47473.25, "npi": [1295788735] } ] }, { "allowed_amount": 16938.80, "providers": [{ "billed_charge": 58621.63, "npi": [1740233782] } ] }, { "allowed_amount": 14128.84, "providers": [{ "billed_charge": 105681.75, "npi": [1932152337] } ] }, { "allowed_amount": 91027.64, "providers": [{ "billed_charge": 547325.75, "npi": [1730132234] } ] }, { "allowed_amount": 34086.84, "providers": [{ "billed_charge": 194319.50, "npi": [1982666111] } ] }, { "allowed_amount": 24765.51, "providers": [{ "billed_charge": 125336.00, "npi": [1295843787] } ] } ] } ] }, { "name": "OBSERVATION ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "762", "description": "TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5266.57, "providers": [{ "billed_charge": 7212.00, "npi": [1083937593] } ] }, { "allowed_amount": 2614.55, "providers": [{ "billed_charge": 4950.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13137.10, "providers": [{ "billed_charge": 165085.46, "npi": [1124796081] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7856.52, "providers": [{ "billed_charge": 12486.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2652.02, "providers": [{ "billed_charge": 9237.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4183.28, "providers": [{ "billed_charge": 7484.00, "npi": [1295843787] } ] }, { "allowed_amount": 8366.56, "providers": [{ "billed_charge": 52311.00, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2614.55, "providers": [{ "billed_charge": 495.00, "npi": [1124092036] } ] } ] } ] }, { "name": "3D RENDER W/INTRP POSTPROCES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76376", "description": "3D REND W INTERPRETATION AND RPTNG OF COMPUTED TOMOGRAPHY, NOT REQ IMG PSTPRCSNG ON AN INDEP WKSTN, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746223317" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 155.37, "providers": [{ "billed_charge": 825.00, "npi": [1740667922] } ] }, { "allowed_amount": 122.70, "providers": [{ "billed_charge": 715.00, "npi": [1740667922] } ] }, { "allowed_amount": 94.79, "providers": [{ "billed_charge": 550.00, "npi": [1740667922] } ] } ] } ] }, { "name": "ECHO EXAM OF HEAD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76506", "description": "ECHOENCEPHALOGRAPHY, REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERMINATION OF VENTRICUL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742620408" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.95, "providers": [{ "billed_charge": 89.34, "npi": [1407003015] } ] } ] } ] }, { "name": "ECHO EXAM OF EYE, THICKNESS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76514", "description": "OPHTHALMIC ULTRASOUND, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL (DETERMINATION OF COR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.20, "providers": [{ "billed_charge": 490.00, "npi": [1104203074] } ] } ] } ] }, { "name": "US EXAM OF HEAD AND NECK", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76536", "description": "ULTRASOUND, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), REAL TIME WITH IMAGE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 207.44, "providers": [{ "billed_charge": 784.00, "npi": [1972548139] } ] } ] } ] }, { "name": "ULTRASOUND BREAST COMPLETE", "billing_code_type": "CPT", "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": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1958.61, "providers": [{ "billed_charge": 18496.00, "npi": [1285876433] } ] }, { "allowed_amount": 307.59, "providers": [{ "billed_charge": 3264.00, "npi": [1912140294] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2532.72, "providers": [{ "billed_charge": 9120.00, "npi": [1407857832] } ] }, { "allowed_amount": 5231.17, "providers": [{ "billed_charge": 17290.00, "npi": [1356359384] } ] }, { "allowed_amount": 3572.80, "providers": [{ "billed_charge": 11020.00, "npi": [1477823813] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3979.20, "providers": [{ "billed_charge": 18944.00, "npi": [1295799088] } ] }, { "allowed_amount": 66.11, "providers": [{ "billed_charge": 256.00, "npi": [1295799088] } ] }, { "allowed_amount": 194.00, "providers": [{ "billed_charge": 640.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1105.48, "providers": [{ "billed_charge": 11615.00, "npi": [1770936908] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.92, "providers": [{ "billed_charge": 1920.00, "npi": [1134514896] } ] }, { "allowed_amount": 349.20, "providers": [{ "billed_charge": 1408.00, "npi": [1134514896] } ] } ] }, { "tin": { "type": "ein", "value": "943427453" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1731.96, "providers": [{ "billed_charge": 9990.00, "npi": [1881761005] } ] } ] } ] }, { "name": "ULTRASOUND BREAST LIMITED", "billing_code_type": "CPT", "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": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1177.60, "providers": [{ "billed_charge": 5520.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 585.59, "providers": [{ "billed_charge": 3969.00, "npi": [1285876433] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 771.50, "providers": [{ "billed_charge": 3689.00, "npi": [1972548139] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 152.76, "providers": [{ "billed_charge": 1551.00, "npi": [1861663924] } ] } ] } ] }, { "name": "US EXAM, ABDOM, COMPLETE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76700", "description": "ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 110.37, "providers": [{ "billed_charge": 426.00, "npi": [1417290511] } ] }, { "allowed_amount": 993.33, "providers": [{ "billed_charge": 3834.00, "npi": [1972548139] } ] }, { "allowed_amount": 43.04, "providers": [{ "billed_charge": 142.00, "npi": [1972548139] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.78, "providers": [{ "billed_charge": 554.00, "npi": [1497252753] } ] }, { "allowed_amount": 246.96, "providers": [{ "billed_charge": 2216.00, "npi": [1497252753] } ] } ] } ] }, { "name": "ECHO EXAM OF ABDOMEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76705", "description": "ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "746223317" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.86, "providers": [{ "billed_charge": 424.00, "npi": [1073018073] } ] }, { "allowed_amount": 26.93, "providers": [{ "billed_charge": 212.00, "npi": [1366947509, 1073018073] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.89, "providers": [{ "billed_charge": 104.00, "npi": [1407149941] } ] }, { "allowed_amount": 53.92, "providers": [{ "billed_charge": 208.00, "npi": [1407149941] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 457.81, "providers": [{ "billed_charge": 1751.00, "npi": [1972548139] } ] }, { "allowed_amount": 472.65, "providers": [{ "billed_charge": 1545.00, "npi": [1295799088] } ] }, { "allowed_amount": 242.37, "providers": [{ "billed_charge": 927.00, "npi": [1295799088] } ] }, { "allowed_amount": 215.44, "providers": [{ "billed_charge": 824.00, "npi": [1295799088] } ] }, { "allowed_amount": 188.51, "providers": [{ "billed_charge": 721.00, "npi": [1457447120] } ] }, { "allowed_amount": 31.51, "providers": [{ "billed_charge": 103.00, "npi": [1972548139] } ] }, { "allowed_amount": 126.04, "providers": [{ "billed_charge": 412.00, "npi": [1417290511, 1457447120] } ] }, { "allowed_amount": 107.72, "providers": [{ "billed_charge": 412.00, "npi": [1417290511, 1457447120] } ] }, { "allowed_amount": 94.53, "providers": [{ "billed_charge": 309.00, "npi": [1538123138] } ] }, { "allowed_amount": 26.93, "providers": [{ "billed_charge": 103.00, "npi": [1972548139] } ] }, { "allowed_amount": 134.65, "providers": [{ "billed_charge": 515.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1371.90, "providers": [{ "billed_charge": 5474.00, "npi": [1770739260] } ] }, { "allowed_amount": 252.08, "providers": [{ "billed_charge": 1288.00, "npi": [1760200901] } ] }, { "allowed_amount": 40.35, "providers": [{ "billed_charge": 161.00, "npi": [1770739260] } ] }, { "allowed_amount": 107.72, "providers": [{ "billed_charge": 644.00, "npi": [1760200901] } ] }, { "allowed_amount": 403.50, "providers": [{ "billed_charge": 1610.00, "npi": [1770739260] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.37, "providers": [{ "billed_charge": 2310.00, "npi": [1497252753] } ] }, { "allowed_amount": 179.28, "providers": [{ "billed_charge": 1848.00, "npi": [1497252753] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 323.16, "providers": [{ "billed_charge": 1464.00, "npi": [1174569842] } ] }, { "allowed_amount": 242.37, "providers": [{ "billed_charge": 1098.00, "npi": [1093717001] } ] }, { "allowed_amount": 188.51, "providers": [{ "billed_charge": 854.00, "npi": [1811981590] } ] }, { "allowed_amount": 630.20, "providers": [{ "billed_charge": 2440.00, "npi": [1235422619] } ] }, { "allowed_amount": 161.58, "providers": [{ "billed_charge": 732.00, "npi": [1962512269] } ] }, { "allowed_amount": 283.59, "providers": [{ "billed_charge": 1098.00, "npi": [1962512269] } ] }, { "allowed_amount": 565.53, "providers": [{ "billed_charge": 2562.00, "npi": [1073587788] } ] }, { "allowed_amount": 976.81, "providers": [{ "billed_charge": 3782.00, "npi": [1093717001] } ] }, { "allowed_amount": 1197.38, "providers": [{ "billed_charge": 4636.00, "npi": [1073587788] } ] }, { "allowed_amount": 296.23, "providers": [{ "billed_charge": 1342.00, "npi": [1235422619] } ] }, { "allowed_amount": 787.75, "providers": [{ "billed_charge": 3050.00, "npi": [1174569842] } ] }, { "allowed_amount": 441.14, "providers": [{ "billed_charge": 1708.00, "npi": [1811981590] } ] } ] } ] }, { "name": "US EXAM ABDO BACK WALL, COMP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76770", "description": "ULTRASOUND, RETROPERITONEAL (EG, RENAL, AORTA, NODES), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.50, "providers": [{ "billed_charge": 129.00, "npi": [1457447120] } ] }, { "allowed_amount": 67.00, "providers": [{ "billed_charge": 258.00, "npi": [1972548139] } ] } ] } ] }, { "name": "OB US LIMITED FETUS(S)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76815", "description": "ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, LIMITED (EG, FETAL HEART BEAT, PLAC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1023.70, "providers": [{ "billed_charge": 3306.00, "npi": [1295799088] } ] }, { "allowed_amount": 90.51, "providers": [{ "billed_charge": 342.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.84, "providers": [{ "billed_charge": 1253.00, "npi": [1770739260] } ] }, { "allowed_amount": 272.40, "providers": [{ "billed_charge": 1074.00, "npi": [1770739260] } ] } ] } ] }, { "name": "TRANSVAGINAL US, OBSTETRIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76817", "description": "ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, TRANSVAGINAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 203.45, "providers": [{ "billed_charge": 665.00, "npi": [1295799088] } ] } ] } ] }, { "name": "TRANSVAGINAL US, NON-OB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76830", "description": "ULTRASOUND, TRANSVAGINAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1351.44, "providers": [{ "billed_charge": 2976.00, "npi": [1730445628] } ] } ] } ] }, { "name": "US EXAM, PELVIC, COMPLETE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "76856", "description": "ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.15, "providers": [{ "billed_charge": 605.00, "npi": [1972548139] } ] }, { "allowed_amount": 186.20, "providers": [{ "billed_charge": 605.00, "npi": [1972548139] } ] } ] }, { "tin": { "type": "ein", "value": "990547982" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 286.98, "providers": [{ "billed_charge": 1128.00, "npi": [1770739260] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.66, "providers": [{ "billed_charge": 276.00, "npi": [1174569842, 1093717001] } ] }, { "allowed_amount": 37.24, "providers": [{ "billed_charge": 138.00, "npi": [1093717001] } ] }, { "allowed_amount": 297.92, "providers": [{ "billed_charge": 1104.00, "npi": [1235422619] } ] }, { "allowed_amount": 707.56, "providers": [{ "billed_charge": 2622.00, "npi": [1073587788] } ] }, { "allowed_amount": 446.88, "providers": [{ "billed_charge": 1656.00, "npi": [1174569842] } ] }, { "allowed_amount": 95.49, "providers": [{ "billed_charge": 414.00, "npi": [1073587788, 1235422619] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS UNI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77061", "description": "DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.50, "providers": [{ "billed_charge": 540.00, "npi": [1871989780] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS BI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77062", "description": "DIGITAL BREAST TOMOSYNTHESIS; BILATERAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 265.02, "providers": [{ "billed_charge": 630.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1092.52, "providers": [{ "billed_charge": 2880.00, "npi": [1285876433] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 330.00, "providers": [{ "billed_charge": 750.00, "npi": [1477823813] } ] }, { "allowed_amount": 1830.00, "providers": [{ "billed_charge": 4350.00, "npi": [1356359384] } ] }, { "allowed_amount": 315.00, "providers": [{ "billed_charge": 1050.00, "npi": [1407857832] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS BI", "billing_code_type": "CPT", "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": "751292603" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.27, "providers": [{ "billed_charge": 113.00, "npi": [1083666549] } ] } ] }, { "tin": { "type": "ein", "value": "751375446" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.99, "providers": [{ "billed_charge": 737.00, "npi": [1003815325] } ] } ] }, { "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2667.22, "providers": [{ "billed_charge": 19783.00, "npi": [1912140294] } ] }, { "allowed_amount": 9788.56, "providers": [{ "billed_charge": 71002.00, "npi": [1285876433] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10101.50, "providers": [{ "billed_charge": 47104.00, "npi": [1871989780] } ] }, { "allowed_amount": 90.80, "providers": [{ "billed_charge": 424.00, "npi": [1124067798] } ] }, { "allowed_amount": 2928.30, "providers": [{ "billed_charge": 13674.00, "npi": [1831517770] } ] } ] }, { "tin": { "type": "ein", "value": "204771148" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 69.24, "providers": [{ "billed_charge": 1000.00, "npi": [1952539629] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6010.80, "providers": [{ "billed_charge": 21300.00, "npi": [1578550745] } ] }, { "allowed_amount": 7254.05, "providers": [{ "billed_charge": 28200.00, "npi": [1356359384] } ] }, { "allowed_amount": 2463.46, "providers": [{ "billed_charge": 8850.00, "npi": [1790959427] } ] }, { "allowed_amount": 2664.00, "providers": [{ "billed_charge": 11100.00, "npi": [1407857832] } ] }, { "allowed_amount": 1690.73, "providers": [{ "billed_charge": 6450.00, "npi": [1477823813] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16634.71, "providers": [{ "billed_charge": 63139.00, "npi": [1295799088] } ] }, { "allowed_amount": 817.56, "providers": [{ "billed_charge": 3090.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7200.00, "providers": [{ "billed_charge": 34080.00, "npi": [1861663924] } ] }, { "allowed_amount": 558.60, "providers": [{ "billed_charge": 2556.00, "npi": [1962065573] } ] }, { "allowed_amount": 2001.65, "providers": [{ "billed_charge": 9159.00, "npi": [1770936908] } ] } ] }, { "tin": { "type": "ein", "value": "760652186" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1642.91, "providers": [{ "billed_charge": 7164.00, "npi": [1962065573] } ] }, { "allowed_amount": 2390.73, "providers": [{ "billed_charge": 11940.00, "npi": [1720367857] } ] } ] }, { "tin": { "type": "ein", "value": "943427453" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1483.80, "providers": [{ "billed_charge": 4500.00, "npi": [1881761005] } ] } ] } ] }, { "name": "DX MAMMO INCL CAD UNI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77065", "description": "DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.02, "providers": [{ "billed_charge": 683.00, "npi": [1285876433] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1230.00, "providers": [{ "billed_charge": 5720.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 185.45, "providers": [{ "billed_charge": 685.00, "npi": [1295799088] } ] } ] } ] }, { "name": "DX MAMMO INCL CAD BI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77066", "description": "DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1961.36, "providers": [{ "billed_charge": 13856.00, "npi": [1285876433] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1552.26, "providers": [{ "billed_charge": 7216.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3478.54, "providers": [{ "billed_charge": 6380.00, "npi": [1356359384] } ] }, { "allowed_amount": 598.12, "providers": [{ "billed_charge": 1100.00, "npi": [1477823813] } ] }, { "allowed_amount": 881.44, "providers": [{ "billed_charge": 1760.00, "npi": [1407857832] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1688.68, "providers": [{ "billed_charge": 5957.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 546.98, "providers": [{ "billed_charge": 3003.00, "npi": [1770936908] } ] } ] } ] }, { "name": "SCR MAMMO BI INCL CAD", "billing_code_type": "CPT", "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": "751292603" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.48, "providers": [{ "billed_charge": 138.00, "npi": [1083666549] } ] } ] }, { "tin": { "type": "ein", "value": "751375446" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 265.54, "providers": [{ "billed_charge": 935.00, "npi": [1003815325] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.68, "providers": [{ "billed_charge": 532.00, "npi": [1124067798] } ] }, { "allowed_amount": 3698.43, "providers": [{ "billed_charge": 17157.00, "npi": [1831517770] } ] }, { "allowed_amount": 12786.82, "providers": [{ "billed_charge": 59236.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "264000683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 24103.21, "providers": [{ "billed_charge": 183400.00, "npi": [1285876433] } ] }, { "allowed_amount": 6463.66, "providers": [{ "billed_charge": 51100.00, "npi": [1912140294] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4145.40, "providers": [{ "billed_charge": 9030.00, "npi": [1477823813] } ] }, { "allowed_amount": 6015.84, "providers": [{ "billed_charge": 12390.00, "npi": [1790959427] } ] }, { "allowed_amount": 6546.78, "providers": [{ "billed_charge": 15540.00, "npi": [1407857832] } ] }, { "allowed_amount": 14657.26, "providers": [{ "billed_charge": 29820.00, "npi": [1578550745] } ] }, { "allowed_amount": 17750.70, "providers": [{ "billed_charge": 39480.00, "npi": [1356359384] } ] } ] }, { "tin": { "type": "ein", "value": "204771148" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.14, "providers": [{ "billed_charge": 500.00, "npi": [1952539629] } ] }, { "allowed_amount": 84.70, "providers": [{ "billed_charge": 500.00, "npi": [1952539629] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21067.28, "providers": [{ "billed_charge": 79820.00, "npi": [1295799088] } ] }, { "allowed_amount": 1032.86, "providers": [{ "billed_charge": 3900.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2533.56, "providers": [{ "billed_charge": 13588.00, "npi": [1770936908] } ] }, { "allowed_amount": 707.04, "providers": [{ "billed_charge": 3792.00, "npi": [1962065573] } ] }, { "allowed_amount": 9159.29, "providers": [{ "billed_charge": 50876.00, "npi": [1861663924] } ] } ] }, { "tin": { "type": "ein", "value": "760652186" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4287.50, "providers": [{ "billed_charge": 19912.00, "npi": [1962065573] } ] }, { "allowed_amount": 5860.44, "providers": [{ "billed_charge": 31440.00, "npi": [1720367857] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3025.50, "providers": [{ "billed_charge": 8925.00, "npi": [1134514896] } ] }, { "allowed_amount": 241.36, "providers": [{ "billed_charge": 833.00, "npi": [1134514896] } ] } ] }, { "tin": { "type": "ein", "value": "943427453" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3629.56, "providers": [{ "billed_charge": 7200.00, "npi": [1881761005] } ] } ] } ] }, { "name": "DXA BONE DENSITY, AXIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77080", "description": "DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.56, "providers": [{ "billed_charge": 576.00, "npi": [1831517770] } ] }, { "allowed_amount": 405.98, "providers": [{ "billed_charge": 1908.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 864.62, "providers": [{ "billed_charge": 3290.00, "npi": [1417290511] } ] } ] }, { "tin": { "type": "ein", "value": "760193812" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2361.34, "providers": [{ "billed_charge": 16080.00, "npi": [1356359384] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.38, "providers": [{ "billed_charge": 388.00, "npi": [1770936908] } ] } ] } ] }, { "name": "VACCINE ADMIN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "771", "description": "PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 281.22, "providers": [{ "billed_charge": 10621.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 75.26, "providers": [{ "billed_charge": 14660.75, "npi": [1730132234] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 211.90, "providers": [{ "billed_charge": 1909.00, "npi": [1234567893] } ] }, { "allowed_amount": 1716.39, "providers": [{ "billed_charge": 15462.90, "npi": [1234567893] } ] } ] } ] }, { "name": "PET IMAGE W/CT SKULL-THIGH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "78815", "description": "POSITRON EMISSION TOMOGRAPHY (PET) W CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "450480099" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 269.60, "providers": [{ "billed_charge": 642.00, "npi": [1063907533] }, { "billed_charge": 864.00, "npi": [1275021958] } ] }, { "allowed_amount": 1752.40, "providers": [{ "billed_charge": 5061.00, "npi": [1275021958] } ] } ] } ] }, { "name": "ANESTH, SURG UPPER ABDOMEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "790", "description": "ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE SPEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271009253" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1637.02, "providers": [{ "billed_charge": 9720.00, "npi": [1447520838] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "CPT", "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": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.99, "providers": [{ "billed_charge": 329.94, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.17, "providers": [{ "billed_charge": 70.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.61, "providers": [{ "billed_charge": 118.44, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3935.60, "providers": [{ "billed_charge": 35336.38, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 952.07, "providers": [{ "billed_charge": 3621.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ELECTROLYTE PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80051", "description": "ELECTROLYTE PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CARBON DIOXIDE (BICARBONATE) (82374) CHLORI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.40, "providers": [{ "billed_charge": 452.77, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "CPT", "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": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.59, "providers": [{ "billed_charge": 96.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2290.08, "providers": [{ "billed_charge": 15173.84, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 364.32, "providers": [{ "billed_charge": 1446.72, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3247.20, "providers": [{ "billed_charge": 4923.00, "npi": [1164390605] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.80, "providers": [{ "billed_charge": 1225.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 596.64, "providers": [{ "billed_charge": 2386.56, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.28, "providers": [{ "billed_charge": 364.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1103.52, "providers": [{ "billed_charge": 3814.40, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.40, "providers": [{ "billed_charge": 623.04, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 269.28, "providers": [{ "billed_charge": 1071.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.68, "providers": [{ "billed_charge": 982.08, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 459.36, "providers": [{ "billed_charge": 4089.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "844939989" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 295.68, "providers": [{ "billed_charge": 1774.08, "npi": [1639791007] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.56, "providers": [{ "billed_charge": 52.80, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.08, "providers": [{ "billed_charge": 234.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.60, "providers": [{ "billed_charge": 700.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11647.68, "providers": [{ "billed_charge": 46587.63, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 179897.81, "providers": [{ "billed_charge": 1834155.05, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.09, "providers": [{ "billed_charge": 174.24, "npi": [1730617523] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "CPT", "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2408.70, "providers": [{ "billed_charge": 26373.03, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 281.40, "providers": [{ "billed_charge": 1111.37, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4120.50, "providers": [{ "billed_charge": 5535.00, "npi": [1164390605] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 469.00, "providers": [{ "billed_charge": 1190.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "462456505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.76, "providers": [{ "billed_charge": 220.00, "npi": [1184250524] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 361.80, "providers": [{ "billed_charge": 1446.12, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 596.30, "providers": [{ "billed_charge": 2670.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "742882192" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.80, "providers": [{ "billed_charge": 2600.00, "npi": [1033370176] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1460.60, "providers": [{ "billed_charge": 4658.65, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.60, "providers": [{ "billed_charge": 482.04, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1796.40, "providers": [{ "billed_charge": 6912.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 415.40, "providers": [{ "billed_charge": 3720.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 649.90, "providers": [{ "billed_charge": 3247.56, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1118.90, "providers": [{ "billed_charge": 4484.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13688.10, "providers": [{ "billed_charge": 114734.88, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 166041.63, "providers": [{ "billed_charge": 2009784.74, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 592.15, "providers": [{ "billed_charge": 1319.24, "npi": [1730617523] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 504.93, "providers": [{ "billed_charge": 5419.10, "npi": [1234567893] } ] } ] } ] }, { "name": "ACUTE HEPATITIS PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80074", "description": "ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.73, "providers": [{ "billed_charge": 510.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6074.10, "providers": [{ "billed_charge": 49212.45, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19133.26, "providers": [{ "billed_charge": 236521.48, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "CPT", "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": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 531.12, "providers": [{ "billed_charge": 2068.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1176.00, "providers": [{ "billed_charge": 11312.67, "npi": [1234567893] } ] } ] } ] }, { "name": "OBSTETRIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80081", "description": "OBSTETRIC PANEL (INCLUDES HIV TESTING)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15293.51, "providers": [{ "billed_charge": 160250.92, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY DIPROPYLACETIC ACD TOT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80164", "description": "VALPROIC ACID (DIPROPYLACETIC ACID); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.32, "providers": [{ "billed_charge": 769.68, "npi": [1234567893] } ] } ] } ] }, { "name": "DRUG SCRN QUAN LEVETIRACETAM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80177", "description": "LEVETIRACETAM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 59.43, "providers": [{ "billed_charge": 1069.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF LITHIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80178", "description": "LITHIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.04, "providers": [{ "billed_charge": 544.85, "npi": [1234567893] } ] } ] } ] }, { "name": "DRUG TEST PRSMV DIR OPT OBS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80305", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "470988250" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.80, "providers": [{ "billed_charge": 800.00, "npi": [1083621023] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "CPT", "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": "464163620" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7065.94, "providers": [{ "billed_charge": 150252.80, "npi": [1265854855] } ] } ] }, { "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15562.50, "providers": [{ "billed_charge": 258750.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 124.28, "providers": [{ "billed_charge": 396.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1584.57, "providers": [{ "billed_charge": 6338.28, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "843172409" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.21, "providers": [{ "billed_charge": 3900.00, "npi": [1306739909] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3666.26, "providers": [{ "billed_charge": 14665.04, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6089.72, "providers": [{ "billed_charge": 29350.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "830973361" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7518.94, "providers": [{ "billed_charge": 60151.52, "npi": [1447814272] } ] } ] }, { "tin": { "type": "ein", "value": "471489220" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 466.05, "providers": [{ "billed_charge": 2330.25, "npi": [1861895500] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.56, "providers": [{ "billed_charge": 600.00, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "464460776" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 93.21, "providers": [{ "billed_charge": 1800.00, "npi": [1235665175] } ] } ] }, { "tin": { "type": "ein", "value": "472177895" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 497.12, "providers": [{ "billed_charge": 2123.64, "npi": [1477925188] } ] } ] }, { "tin": { "type": "ein", "value": "880241758" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1988.48, "providers": [{ "billed_charge": 15488.00, "npi": [1699782722] } ] } ] }, { "tin": { "type": "ein", "value": "800686939" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 434.98, "providers": [{ "billed_charge": 952.00, "npi": [1699045674] } ] } ] }, { "tin": { "type": "ein", "value": "611803788" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 932.10, "providers": [{ "billed_charge": 3484.28, "npi": [1053841023] } ] } ] }, { "tin": { "type": "ein", "value": "994142539" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1336.01, "providers": [{ "billed_charge": 4194.45, "npi": [1164257499] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.07, "providers": [{ "billed_charge": 124.28, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 605.95, "providers": [{ "billed_charge": 2145.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1460.29, "providers": [{ "billed_charge": 7449.50, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 33872.75, "providers": [{ "billed_charge": 230658.93, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 62.14, "providers": [{ "billed_charge": 6591.86, "npi": [1063011898] } ] } ] } ] }, { "name": "DRUG SCREEN AMPHETAMINES 1/2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80324", "description": "AMPHETAMINES; 1 OR 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 90.96, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 1101.60, "npi": [1164017422] } ] } ] } ] }, { "name": "ANTIDEPRESSANTS CLASS 1 OR 2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80332", "description": "ANTIDEPRESSANTS, SEROTONERGIC CLASS; 1 OR 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] } ] }, { "name": "ANTIDEPRESSANT TRICYCLIC 1/2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80335", "description": "ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYCLICALS; 1 OR 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] } ] }, { "name": "ANTIDEPRESSANT NOT SPECIFIED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80338", "description": "ANTIDEPRESSANTS, NOT OTHERWISE SPECIFIED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.96, "providers": [{ "billed_charge": 76.50, "npi": [1720448061] } ] } ] } ] }, { "name": "ANTIPSYCHOTICS NOS 1-3", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80342", "description": "ANTIPSYCHOTICS, NOT OTHERWISE SPECIFIED; 1-3", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] } ] }, { "name": "DRUG SCREENING BARBITURATES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80345", "description": "BARBITURATES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] } ] }, { "name": "BENZODIAZEPINES1-12", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80346", "description": "BENZODIAZEPINES; 1-12", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 98.16, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 1118.16, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.30, "providers": [{ "billed_charge": 18122.40, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING BUPRENORPHINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80348", "description": "BUPRENORPHINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.44, "providers": [{ "billed_charge": 98.16, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.16, "providers": [{ "billed_charge": 1377.36, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3423.40, "providers": [{ "billed_charge": 11411.36, "npi": [1962190819] } ] } ] } ] }, { "name": "CANNABINOIDS, NATURAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80349", "description": "CANNABINOIDS, NATURAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 80.52, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 939.60, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 376.53, "providers": [{ "billed_charge": 3236.64, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING COCAINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80353", "description": "COCAINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 73.20, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 988.56, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 387.94, "providers": [{ "billed_charge": 2804.32, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING FENTANYL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80354", "description": "FENTANYL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 91.50, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 399.35, "providers": [{ "billed_charge": 3707.20, "npi": [1962190819] } ] } ] } ] }, { "name": "GABAPENTIN, NON-BLOOD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80355", "description": "GABAPENTIN, NON-BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 55.08, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 365.12, "providers": [{ "billed_charge": 2307.84, "npi": [1962190819] } ] } ] } ] }, { "name": "HEROIN METABOLITE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80356", "description": "HEROIN METABOLITE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 95.40, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.48, "providers": [{ "billed_charge": 2965.76, "npi": [1962190819] } ] } ] } ] }, { "name": "KETAMINE AND NORKETAMINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80357", "description": "KETAMINE AND NORKETAMINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 73.80, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] } ] }, { "name": "DRUG SCREENING METHADONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80358", "description": "METHADONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 395.28, "providers": [{ "billed_charge": 1150.56, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.48, "providers": [{ "billed_charge": 5671.68, "npi": [1962190819] } ] } ] } ] }, { "name": "METHYLENEDIOXYAMPHETAMINES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80359", "description": "METHYLENEDIOXYAMPHETAMINES (MDA, MDEA, MDMA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 60.72, "npi": [1720448061] } ] } ] } ] }, { "name": "METHYLPHENIDATE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80360", "description": "METHYLPHENIDATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.28, "providers": [{ "billed_charge": 1101.60, "npi": [1164017422] } ] } ] } ] }, { "name": "OPIATES, 1 OR MORE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80361", "description": "OPIATES, 1 OR MORE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 102.00, "npi": [1720448061] } ] } ] } ] }, { "name": "OPIOIDS & OPIATE ANALOGS 1/2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80362", "description": "OPIOIDS AND OPIATE ANALOGS; 1 OR 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 82.80, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.28, "providers": [{ "billed_charge": 1377.36, "npi": [1164017422] } ] } ] } ] }, { "name": "OPIOIDS & OPIATE ANALOGS 3/4", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80363", "description": "OPIOIDS AND OPIATE ANALOGS; 3 OR 4", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3177.50, "providers": [{ "billed_charge": 10592.00, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING OXYCODONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80365", "description": "OXYCODONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 1377.36, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.30, "providers": [{ "billed_charge": 3389.44, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING PREGABALIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80366", "description": "PREGABALIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 365.12, "providers": [{ "billed_charge": 2385.92, "npi": [1962190819] } ] } ] } ] }, { "name": "SEDATIVE HYPNOTICS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80368", "description": "SEDATIVE HYPNOTICS (NON-BENZODIAZEPINES)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 63.00, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 296.66, "providers": [{ "billed_charge": 2753.92, "npi": [1962190819] } ] } ] } ] }, { "name": "SKELETAL MUSCLE RELAXANT 1/2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80369", "description": "SKELETAL MUSCLE RELAXANTS; 1 OR 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 80.10, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 296.66, "providers": [{ "billed_charge": 10553.40, "npi": [1962190819] } ] } ] } ] }, { "name": "STIMULANTS, SYNTHETIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80371", "description": "STIMULANTS, SYNTHETIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 296.66, "providers": [{ "billed_charge": 5344.30, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING TAPENTADOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80372", "description": "TAPENTADOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.28, "providers": [{ "billed_charge": 2138.40, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 399.35, "providers": [{ "billed_charge": 3707.20, "npi": [1962190819] } ] } ] } ] }, { "name": "DRUG SCREENING TRAMADOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80373", "description": "TRAMADOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.88, "providers": [{ "billed_charge": 73.80, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 398.28, "providers": [{ "billed_charge": 1377.36, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "923508707" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.48, "providers": [{ "billed_charge": 2662.80, "npi": [1962190819] } ] } ] } ] }, { "name": "PATH CLIN CONSLTJ SF 5-20", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80503", "description": "PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742922218" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.07, "providers": [{ "billed_charge": 90.00, "npi": [1669462388] } ] }, { "allowed_amount": 54.42, "providers": [{ "billed_charge": 540.00, "npi": [1669462388] } ] } ] }, { "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6858.00, "providers": [{ "billed_charge": 11184.00, "npi": [1164390605] } ] } ] } ] }, { "name": "PATH CLIN CONSLTJ HIGH 41-60", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80505", "description": "PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823763668" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6114.56, "providers": [{ "billed_charge": 19456.00, "npi": [1689633711] } ] } ] } ] }, { "name": "URINALYSIS NONAUTO W/SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81000", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.13, "providers": [{ "billed_charge": 221.00, "npi": [1891855656] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.55, "providers": [{ "billed_charge": 1023.75, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "200537948" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.13, "providers": [{ "billed_charge": 208.00, "npi": [1831383355] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 265.32, "providers": [{ "billed_charge": 528.00, "npi": [1972519544] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "CPT", "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.60, "providers": [{ "billed_charge": 2278.38, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.95, "providers": [{ "billed_charge": 75.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.50, "providers": [{ "billed_charge": 500.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 634.41, "providers": [{ "billed_charge": 5302.71, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.19, "providers": [{ "billed_charge": 105.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18270.81, "providers": [{ "billed_charge": 366857.31, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.60, "providers": [{ "billed_charge": 50.77, "npi": [1730617523] } ] } ] } ] }, { "name": "URINALYSIS NONAUTO W/O SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81002", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.58, "providers": [{ "billed_charge": 510.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.92, "providers": [{ "billed_charge": 40.00, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.70, "providers": [{ "billed_charge": 125.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.92, "providers": [{ "billed_charge": 80.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.40, "providers": [{ "billed_charge": 75.05, "npi": [1942535828] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.98, "providers": [{ "billed_charge": 404.25, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "752719502" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.84, "providers": [{ "billed_charge": 200.00, "npi": [1205477908] } ] } ] }, { "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.44, "providers": [{ "billed_charge": 1400.00, "npi": [1730445628] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "CPT", "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.04, "providers": [{ "billed_charge": 330.75, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "752302928" }, "service_code": ["11", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.26, "providers": [{ "billed_charge": 44.00, "npi": [1578265302] } ] }, { "allowed_amount": 4.52, "providers": [{ "billed_charge": 88.00, "npi": [1578265302] } ] } ] }, { "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.88, "providers": [{ "billed_charge": 168.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.13, "providers": [{ "billed_charge": 10.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.64, "providers": [{ "billed_charge": 225.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "862433458" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.84, "providers": [{ "billed_charge": 80.00, "npi": [1982278800] } ] } ] }, { "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 170.63, "providers": [{ "billed_charge": 4379.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 796.65, "providers": [{ "billed_charge": 6641.10, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.88, "providers": [{ "billed_charge": 15.00, "npi": [1234567893] } ] }, { "allowed_amount": 7008.60, "providers": [{ "billed_charge": 178637.12, "npi": [1234567893] } ] } ] } ] }, { "name": "URINALYSIS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81005", "description": "URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT IMMUNOASSAYS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 44.08, "providers": [{ "billed_charge": 380.00, "npi": [1861913576] } ] } ] } ] }, { "name": "URINE SCREEN FOR BACTERIA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81007", "description": "URINALYSIS; BACTERIURIA SCREEN, EXCEPT BY CULTURE OR DIPSTICK", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883769862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 509.66, "providers": [{ "billed_charge": 1528.98, "npi": [1811688104] } ] } ] } ] }, { "name": "MICROSCOPIC EXAM OF URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81015", "description": "URINALYSIS; MICROSCOPIC ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 127.83, "providers": [{ "billed_charge": 1781.70, "npi": [1234567893] } ] } ] } ] }, { "name": "URINE PREGNANCY TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81025", "description": "URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.10, "providers": [{ "billed_charge": 400.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 673.53, "providers": [{ "billed_charge": 8371.43, "npi": [1234567893] } ] }, { "allowed_amount": 7.32, "providers": [{ "billed_charge": 50.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "752719502" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.20, "providers": [{ "billed_charge": 800.00, "npi": [1205477908] } ] } ] }, { "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.44, "providers": [{ "billed_charge": 160.00, "npi": [1730445628] } ] } ] } ] }, { "name": "ANES LWR INTST NDSC NOS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "811", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; NOT ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260507982" }, "service_code": ["22", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.89, "providers": [{ "billed_charge": 610.00, "npi": [1902367386] } ] }, { "allowed_amount": 1002.74, "providers": [{ "billed_charge": 9390.00, "npi": [1902367386] } ] } ] }, { "tin": { "type": "ein", "value": "461743879" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 7048.35, "providers": [{ "billed_charge": 39660.00, "npi": [1609019892] } ] } ] }, { "tin": { "type": "ein", "value": "842647146" }, "service_code": ["11", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 5005.00, "providers": [{ "billed_charge": 6120.00, "npi": [1720806342] } ] }, { "allowed_amount": 390.00, "providers": [{ "billed_charge": 540.00, "npi": [1720806342] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "CPT", "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": "320293376" }, "service_code": ["22", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 919.80, "providers": [{ "billed_charge": 25500.00, "npi": [1114138377] } ] }, { "allowed_amount": 977.67, "providers": [{ "billed_charge": 25500.00, "npi": [1114138377] } ] } ] }, { "tin": { "type": "ein", "value": "260507982" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 2670.60, "providers": [{ "billed_charge": 30360.00, "npi": [1902367386] } ] }, { "allowed_amount": 221.67, "providers": [{ "billed_charge": 2370.00, "npi": [1700681525] } ] } ] }, { "tin": { "type": "ein", "value": "273821065" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 669.90, "providers": [{ "billed_charge": 9800.00, "npi": [1750741583] } ] } ] }, { "tin": { "type": "ein", "value": "461743879" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 10235.43, "providers": [{ "billed_charge": 59475.00, "npi": [1609019892] } ] } ] }, { "tin": { "type": "ein", "value": "201218565" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1078.00, "providers": [{ "billed_charge": 18349.00, "npi": [1790636983] } ] } ] }, { "tin": { "type": "ein", "value": "760462852" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 7117.50, "providers": [{ "billed_charge": 35541.00, "npi": [1235128042] } ] }, { "allowed_amount": 455.00, "providers": [{ "billed_charge": 2436.00, "npi": [1578558599] } ] }, { "allowed_amount": 422.50, "providers": [{ "billed_charge": 1809.00, "npi": [1962788836] } ] } ] } ] }, { "name": "CALR GENE COM VARIANTS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81219", "description": "CALR (CALRETICULIN) (EG, MYELOPROLIFERATIVE DISORDERS), GENE ANALYSIS, COMMON VARIANTS IN EXON 9", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 321.10, "providers": [{ "billed_charge": 1277.13, "npi": [1841375094] } ] } ] } ] }, { "name": "CFTR GENE COM VARIANTS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81220", "description": "CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14532.20, "providers": [{ "billed_charge": 163950.27, "npi": [1598314437] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12677.00, "providers": [{ "billed_charge": 149855.63, "npi": [1234567893] } ] } ] } ] }, { "name": "FMR1 GENE DETECTION", "billing_code_type": "CPT", "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": 336.81, "providers": [{ "billed_charge": 5019.52, "npi": [1598314437] } ] } ] } ] }, { "name": "HBA1/HBA2 GENE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81257", "description": "HBA1/HBA2 (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) (EG, ALPHA THALASSEMIA, HB BART HYDROPS FETALIS SYNDRO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1736.28, "providers": [{ "billed_charge": 19790.20, "npi": [1598314437] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 674.22, "providers": [{ "billed_charge": 2449.32, "npi": [1234567893] } ] } ] } ] }, { "name": "JAK2 GENE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81270", "description": "JAK2 (JANUS KINASE 2) (EG, MYELOPROLIFERATIVE DISORDER) GENE ANALYSIS, P.VAL617PHE (V617F) VARIANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.74, "providers": [{ "billed_charge": 962.43, "npi": [1841375094] } ] } ] } ] }, { "name": "JAK2 GENE TRGT SEQUENCE ALYS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81279", "description": "JAK2 TARGETED SEQUENCE ANALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 383.36, "providers": [{ "billed_charge": 1944.60, "npi": [1841375094] } ] } ] } ] }, { "name": "ANES UPR LWR GI NDSC PX", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "813", "description": "ANESTHESIA FOR COMBINED UPPER AND LOWER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842830378" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 455.00, "providers": [{ "billed_charge": 2450.00, "npi": [1346480134] } ] } ] }, { "tin": { "type": "ein", "value": "260507982" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 2424.08, "providers": [{ "billed_charge": 23000.00, "npi": [1902367386] } ] } ] }, { "tin": { "type": "ein", "value": "760462852" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 650.00, "providers": [{ "billed_charge": 3480.00, "npi": [1235128042] } ] } ] } ] }, { "name": "SMN1 GENE DOS/DELETION ALYS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81329", "description": "SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3698.42, "providers": [{ "billed_charge": 41575.01, "npi": [1598314437] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4379.52, "providers": [{ "billed_charge": 20043.77, "npi": [1234567893] } ] } ] } ] }, { "name": "MPL GENE COMMON VARIANTS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81338", "description": "MPL GENE ANALYSIS COMMON VARIANTS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.87, "providers": [{ "billed_charge": 1578.48, "npi": [1841375094] } ] } ] } ] }, { "name": "HBB GENE COM VARIANTS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81361", "description": "HBB (HEMOGLOBIN, SUBUNIT BETA) (EG, SICKLE CELL ANEMIA, BETA THALASSEMIA, HEMOGLOBINOPATHY); COMMON ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2755.88, "providers": [{ "billed_charge": 32666.64, "npi": [1598314437] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 934.24, "providers": [{ "billed_charge": 2800.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HBB FULL GENE SEQUENCE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81364", "description": "HBB (HEMOGLOBIN, SUBUNIT BETA) (EG, SICKLE CELL ANEMIA, BETA THALASSEMIA, HEMOGLOBINOPATHY); FULL GE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1951.38, "providers": [{ "billed_charge": 5400.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MOPATH PROCEDURE LEVEL 7", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81406", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 7", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1836.42, "providers": [{ "billed_charge": 5040.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MOPATH PROCEDURE LEVEL 8", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81407", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 8", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4805.05, "providers": [{ "billed_charge": 13515.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MOPATH PROCEDURE LEVEL 9", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81408", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 9", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 60410.00, "providers": [{ "billed_charge": 189765.00, "npi": [1234567893] } ] }, { "allowed_amount": 668.00, "providers": [{ "billed_charge": 2225.00, "npi": [1234567893] } ] } ] } ] }, { "name": "FETAL CHRMOML ANEUPLOIDY", "billing_code_type": "CPT", "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": 71421.89, "providers": [{ "billed_charge": 500973.00, "npi": [1598314437] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1518.12, "providers": [{ "billed_charge": 10000.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 112026.25, "providers": [{ "billed_charge": 1094775.48, "npi": [1234567893] } ] } ] } ] }, { "name": "FETAL CHRMOML MICRODELTJ", "billing_code_type": "CPT", "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": 57787.51, "providers": [{ "billed_charge": 394706.00, "npi": [1598314437] } ] } ] } ] }, { "name": "HRDTRY BRST CA-RLATD DSORDRS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81432", "description": "HEREDITARY BREAST CANCER-RELATED DISORDERS (EG, HEREDITARY BREAST CANCER, HEREDITARY OVARIAN CANCER,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 49442.31, "providers": [{ "billed_charge": 324619.00, "npi": [1234567893] } ] } ] } ] }, { "name": "GENETIC TSTG SEVERE INH COND", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81443", "description": "GENETIC TESTING FOR SEVERE INHERITED CONDITIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32291.64, "providers": [{ "billed_charge": 346298.20, "npi": [1234567893] } ] }, { "allowed_amount": 817.82, "providers": [{ "billed_charge": 12969.00, "npi": [1234567893] } ] } ] } ] }, { "name": "SO/HL 51/>GSAP RNA ALYS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81456", "description": "SO/HEMATOLYMPHOID NEO/DO 51/>RNA ANALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 132271.63, "providers": [{ "billed_charge": 178600.00, "npi": [1740733708] } ] } ] } ] }, { "name": "Under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81459", "description": "Under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30187.70, "providers": [{ "billed_charge": 38000.00, "npi": [1740733708] } ] } ] } ] }, { "name": "Under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81464", "description": "Under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96306.10, "providers": [{ "billed_charge": 110200.00, "npi": [1740733708] } ] } ] } ] }, { "name": "NFCT DS BV RNA VAG FLU ALG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81513", "description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1640.36, "providers": [{ "billed_charge": 4922.00, "npi": [1992709356] } ] }, { "allowed_amount": 998.48, "providers": [{ "billed_charge": 2996.00, "npi": [1023104528] } ] } ] } ] }, { "name": "NFCT DS BV&VAGINITIS DNA ALG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81514", "description": "NFCT DS BCT VAGINOSIS&VAGINITIS DNA VAG FLU ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 42579.36, "providers": [{ "billed_charge": 246988.47, "npi": [1234567893] } ] } ] } ] }, { "name": "ONCOLOGY COLORECTAL SCR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81528", "description": "ONCOLOGY (COLORECTAL) SCREENING, QUANTITATIVE REAL-TIME TARGET AND SIGNAL AMPL OF 10 DNA MARKERS (KR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 100247.39, "providers": [{ "billed_charge": 134157.00, "npi": [1234567893] } ] } ] } ] }, { "name": "NFCT DS CHRNC HCV 6 ASSAYS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81596", "description": "NFCT DS CHRNC HCV 6 BIOCHEM ASSAY SRM ALG LVR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10638.30, "providers": [{ "billed_charge": 95938.50, "npi": [1234567893] } ] } ] } ] }, { "name": "UNLISTED MAAA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81599", "description": "UNLISTED MULTIANALYTE ASSAY WITH ALGORITHMIC ANALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472289700" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10594.80, "providers": [{ "billed_charge": 35316.00, "npi": [1871220764] } ] } ] } ] }, { "name": "ASSAY OF ACTH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82024", "description": "ADRENOCORTICOTROPIC HORMONE (ACTH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1381.68, "providers": [{ "billed_charge": 14836.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF SERUM ALBUMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82040", "description": "ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2789.38, "providers": [{ "billed_charge": 4735.16, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 312.78, "providers": [{ "billed_charge": 6665.77, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.91, "providers": [{ "billed_charge": 312.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.58, "providers": [{ "billed_charge": 254.32, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1060.63, "providers": [{ "billed_charge": 6547.28, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "883769862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.37, "providers": [{ "billed_charge": 286.11, "npi": [1811688104] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25627.68, "providers": [{ "billed_charge": 637999.74, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF ALDOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82088", "description": "ALDOSTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 780.74, "providers": [{ "billed_charge": 4861.56, "npi": [1234567893] } ] } ] } ] }, { "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": "853213313" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7600.00, "providers": [{ "billed_charge": 229358.50, "npi": [1437756772] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 63842.73, "providers": [{ "billed_charge": 479742.00, "npi": [1234567893] } ] }, { "allowed_amount": 5908990.80, "providers": [{ "billed_charge": 41083513.04, "npi": [1234567893] } ] } ] } ] }, { "name": "ALPHA-1-ANTITRYPSIN, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82103", "description": "ALPHA-1-ANTITRYPSIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.59, "providers": [{ "billed_charge": 2622.03, "npi": [1234567893] } ] } ] } ] }, { "name": "ALPHA-FETOPROTEIN, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82105", "description": "ALPHA-FETOPROTEIN (AFP); SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.58, "providers": [{ "billed_charge": 1547.04, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3076.05, "providers": [{ "billed_charge": 44082.98, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF AMMONIA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82140", "description": "AMMONIA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 86.56, "providers": [{ "billed_charge": 1238.18, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF AMYLASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82150", "description": "AMYLASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 169.65, "providers": [{ "billed_charge": 485.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1688.90, "providers": [{ "billed_charge": 28507.64, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1058.76, "providers": [{ "billed_charge": 4575.00, "npi": [1174172845] } ] } ] } ] }, { "name": "chemistry test for anti-mullerian hormone (AMH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82166", "description": "chemistry test for anti-mullerian hormone (AMH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2698.68, "providers": [{ "billed_charge": 18337.58, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 242.54, "providers": [{ "billed_charge": 485.07, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 474.75, "providers": [{ "billed_charge": 2922.75, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2237.53, "providers": [{ "billed_charge": 9219.90, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1657.39, "providers": [{ "billed_charge": 5840.00, "npi": [1174172845] } ] } ] } ] }, { "name": "BILIRUBIN, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82247", "description": "BILIRUBIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2655.28, "providers": [{ "billed_charge": 3317.01, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 682.50, "providers": [{ "billed_charge": 2805.00, "npi": [1174172845] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 131.56, "providers": [{ "billed_charge": 390.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1020.94, "providers": [{ "billed_charge": 3157.16, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 819.98, "providers": [{ "billed_charge": 3648.00, "npi": [1174172845] } ] } ] } ] }, { "name": "OCCULT BLOOD FECES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82270", "description": "BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; FECES, CONSECUTIVE COLLECTED SPECIM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.50, "providers": [{ "billed_charge": 5310.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY TEST FOR BLOOD, FECAL", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5474.60, "providers": [{ "billed_charge": 77355.86, "npi": [1234567893] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2919.52, "providers": [{ "billed_charge": 34470.32, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 720.05, "providers": [{ "billed_charge": 1644.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.40, "providers": [{ "billed_charge": 1716.80, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 828.80, "providers": [{ "billed_charge": 2072.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 636.40, "providers": [{ "billed_charge": 2545.60, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1776.00, "providers": [{ "billed_charge": 7104.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.40, "providers": [{ "billed_charge": 4630.30, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 251.60, "providers": [{ "billed_charge": 503.20, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3956.40, "providers": [{ "billed_charge": 14940.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 177.60, "providers": [{ "billed_charge": 1584.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1361.60, "providers": [{ "billed_charge": 6808.00, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2619.60, "providers": [{ "billed_charge": 8636.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.80, "providers": [{ "billed_charge": 99.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13349.60, "providers": [{ "billed_charge": 111920.16, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 236484.54, "providers": [{ "billed_charge": 2320080.51, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1534.67, "providers": [{ "billed_charge": 3714.80, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF CALCIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82310", "description": "CALCIUM; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2365.85, "providers": [{ "billed_charge": 3167.86, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF CALCIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82330", "description": "CALCIUM; IONIZED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1060.35, "providers": [{ "billed_charge": 7293.74, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2185.80, "providers": [{ "billed_charge": 8428.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY, BLOOD CARBON DIOXIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82374", "description": "CARBON DIOXIDE (BICARBONATE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 293.80, "providers": [{ "billed_charge": 350.35, "npi": [1234567893] } ] } ] } ] }, { "name": "CARCINOEMBRYONIC ANTIGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82378", "description": "CARCINOEMBRYONIC ANTIGEN (CEA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3505.97, "providers": [{ "billed_charge": 47648.19, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF CERULOPLASMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82390", "description": "CERULOPLASMIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.36, "providers": [{ "billed_charge": 3075.40, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF BLOOD CHLORIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82435", "description": "CHLORIDE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2165.42, "providers": [{ "billed_charge": 2351.07, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY, OTHER FLUID CHLORIDES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82438", "description": "CHLORIDE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 205.00, "providers": [{ "billed_charge": 820.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY, BLD/SERUM CHOLESTEROL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82465", "description": "CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.09, "providers": [{ "billed_charge": 116.55, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF COPPER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82525", "description": "COPPER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.54, "providers": [{ "billed_charge": 329.90, "npi": [1234567893] } ] } ] } ] }, { "name": "TOTAL CORTISOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82533", "description": "CORTISOL; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 418.85, "providers": [{ "billed_charge": 1001.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 285.25, "providers": [{ "billed_charge": 735.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.25, "providers": [{ "billed_charge": 1025.10, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3092.04, "providers": [{ "billed_charge": 34854.45, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1993.45, "providers": [{ "billed_charge": 9988.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 166.50, "providers": [{ "billed_charge": 366.75, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF CK (CPK)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE (CK), (CPK); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.78, "providers": [{ "billed_charge": 48.84, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.69, "providers": [{ "billed_charge": 450.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.46, "providers": [{ "billed_charge": 573.30, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1868.27, "providers": [{ "billed_charge": 27190.21, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 843.06, "providers": [{ "billed_charge": 3555.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF CPK IN BLOOD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82552", "description": "CREATINE KINASE (CK), (CPK); ISOENZYMES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.68, "providers": [{ "billed_charge": 880.31, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF CREATININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82565", "description": "CREATININE; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2684.13, "providers": [{ "billed_charge": 5622.08, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.79, "providers": [{ "billed_charge": 6222.82, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.21, "providers": [{ "billed_charge": 390.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.98, "providers": [{ "billed_charge": 227.92, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 771.82, "providers": [{ "billed_charge": 6463.62, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "883769862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.47, "providers": [{ "billed_charge": 256.41, "npi": [1811688104] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23489.40, "providers": [{ "billed_charge": 566525.85, "npi": [1234567893] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 544.44, "providers": [{ "billed_charge": 6115.97, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 389.88, "providers": [{ "billed_charge": 940.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 361.92, "providers": [{ "billed_charge": 723.84, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 716.30, "providers": [{ "billed_charge": 2865.20, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.12, "providers": [{ "billed_charge": 844.48, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 346.84, "providers": [{ "billed_charge": 874.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 414.70, "providers": [{ "billed_charge": 2210.48, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2021.14, "providers": [{ "billed_charge": 8398.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 701.22, "providers": [{ "billed_charge": 3506.10, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 64.09, "providers": [{ "billed_charge": 273.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4802.98, "providers": [{ "billed_charge": 40245.66, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47228.97, "providers": [{ "billed_charge": 638184.40, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 379.62, "providers": [{ "billed_charge": 836.94, "npi": [1730617523] } ] } ] } ] }, { "name": "CYSTATIN C", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82610", "description": "CYSTATIN C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1313.35, "providers": [{ "billed_charge": 23759.95, "npi": [1234567893] } ] } ] } ] }, { "name": "DEHYDROEPIANDROSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82626", "description": "DEHYDROEPIANDROSTERONE (DHEA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.64, "providers": [{ "billed_charge": 105.93, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.47, "providers": [{ "billed_charge": 6261.30, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2867.04, "providers": [{ "billed_charge": 10750.00, "npi": [1174172845] } ] } ] } ] }, { "name": "DEHYDROEPIANDROSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82627", "description": "DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 566.92, "providers": [{ "billed_charge": 1304.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 478.16, "providers": [{ "billed_charge": 1204.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 266.88, "providers": [{ "billed_charge": 2237.04, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7165.99, "providers": [{ "billed_charge": 111780.33, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 656.08, "providers": [{ "billed_charge": 2950.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.95, "providers": [{ "billed_charge": 500.25, "npi": [1730617523] } ] } ] } ] }, { "name": "PANCREATIC ELASTASE, FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82656", "description": "ELASTASE, PANCREATIC (EL-1), FECAL, QUALITATIVE OR SEMI-QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.31, "providers": [{ "billed_charge": 90.00, "npi": [1346472859] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 135.80, "providers": [{ "billed_charge": 1288.12, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 679.32, "providers": [{ "billed_charge": 1487.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.97, "providers": [{ "billed_charge": 69.85, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 377.19, "providers": [{ "billed_charge": 1508.76, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 628.65, "providers": [{ "billed_charge": 1575.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1732.28, "providers": [{ "billed_charge": 14522.88, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 181.61, "providers": [{ "billed_charge": 1209.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20453.78, "providers": [{ "billed_charge": 237549.34, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3185.64, "providers": [{ "billed_charge": 12096.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 323.17, "providers": [{ "billed_charge": 712.47, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF ESTROGENS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82671", "description": "ESTROGENS; FRACTIONATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.05, "providers": [{ "billed_charge": 947.73, "npi": [1235186800] } ] } ] } ] }, { "name": "ASSAY OF ESTROGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82672", "description": "ESTROGENS; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2628.41, "providers": [{ "billed_charge": 28681.67, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.34, "providers": [{ "billed_charge": 1752.37, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 259.16, "providers": [{ "billed_charge": 517.94, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 225.06, "providers": [{ "billed_charge": 1124.64, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.74, "providers": [{ "billed_charge": 190.82, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.76, "providers": [{ "billed_charge": 490.68, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.34, "providers": [{ "billed_charge": 666.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 422.84, "providers": [{ "billed_charge": 2170.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1234.42, "providers": [{ "billed_charge": 10333.29, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 28124.30, "providers": [{ "billed_charge": 308821.64, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1499.28, "providers": [{ "billed_charge": 5616.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.36, "providers": [{ "billed_charge": 1868.42, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 322.22, "providers": [{ "billed_charge": 940.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 279.30, "providers": [{ "billed_charge": 558.60, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 565.95, "providers": [{ "billed_charge": 2263.80, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.35, "providers": [{ "billed_charge": 617.40, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 316.05, "providers": [{ "billed_charge": 817.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 404.25, "providers": [{ "billed_charge": 2216.40, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.70, "providers": [{ "billed_charge": 29.40, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1919.30, "providers": [{ "billed_charge": 8262.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 308.70, "providers": [{ "billed_charge": 1543.50, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4160.10, "providers": [{ "billed_charge": 34876.92, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29673.49, "providers": [{ "billed_charge": 369178.64, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.16, "providers": [{ "billed_charge": 352.80, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID, RBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82747", "description": "FOLIC ACID; RBC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1007.93, "providers": [{ "billed_charge": 12379.57, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1852.81, "providers": [{ "billed_charge": 24931.19, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF IGE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82785", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 677.22, "providers": [{ "billed_charge": 7571.73, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742882192" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.61, "providers": [{ "billed_charge": 650.00, "npi": [1033370176] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1864.60, "providers": [{ "billed_charge": 4343.44, "npi": [1234567893] } ] } ] } ] }, { "name": "REAGENT STRIP/BLOOD GLUCOSE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82948", "description": "GLUCOSE; BLOOD, REAGENT STRIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742882192" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.68, "providers": [{ "billed_charge": 860.00, "npi": [1033370176] } ] } ] }, { "tin": { "type": "ein", "value": "300198705" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.98, "providers": [{ "billed_charge": 35.00, "npi": [1538526702] } ] }, { "allowed_amount": 89.88, "providers": [{ "billed_charge": 210.00, "npi": [1003273731] } ] }, { "allowed_amount": 29.96, "providers": [{ "billed_charge": 70.00, "npi": [1669082723] } ] } ] } ] }, { "name": "GLUCOSE TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82950", "description": "GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.38, "providers": [{ "billed_charge": 16.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 869.58, "providers": [{ "billed_charge": 10739.20, "npi": [1234567893] } ] } ] } ] }, { "name": "GLUCOSE TOLERANCE TEST (GTT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82951", "description": "GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 551.67, "providers": [{ "billed_charge": 5910.51, "npi": [1234567893] } ] } ] } ] }, { "name": "GTT-ADDED SAMPLES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82952", "description": "GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 132.79, "providers": [{ "billed_charge": 1406.94, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF G6PD ENZYME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82955", "description": "GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 107.68, "providers": [{ "billed_charge": 1345.68, "npi": [1234567893] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "CPT", "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": "752354465" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.00, "providers": [{ "billed_charge": 10.00, "npi": [1144282989] } ] }, { "allowed_amount": 54.00, "providers": [{ "billed_charge": 180.00, "npi": [1144282989] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.64, "providers": [{ "billed_charge": 15.00, "npi": [1942400601] } ] } ] }, { "tin": { "type": "ein", "value": "756002868" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.08, "providers": [{ "billed_charge": 24.00, "npi": [1326017872] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.72, "providers": [{ "billed_charge": 288.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF GGT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82977", "description": "GLUTAMYLTRANSFERASE, GAMMA (GGT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 129.60, "providers": [{ "billed_charge": 324.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.40, "providers": [{ "billed_charge": 1327.92, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4194.58, "providers": [{ "billed_charge": 36886.88, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1165.20, "providers": [{ "billed_charge": 4848.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.74, "providers": [{ "billed_charge": 1924.93, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 253.00, "providers": [{ "billed_charge": 610.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.19, "providers": [{ "billed_charge": 408.76, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.06, "providers": [{ "billed_charge": 868.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1727.94, "providers": [{ "billed_charge": 14491.26, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16837.48, "providers": [{ "billed_charge": 191585.99, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2561.92, "providers": [{ "billed_charge": 10922.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 215.05, "providers": [{ "billed_charge": 473.79, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.72, "providers": [{ "billed_charge": 272.46, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 450.26, "providers": [{ "billed_charge": 1072.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.52, "providers": [{ "billed_charge": 124.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1676.06, "providers": [{ "billed_charge": 14052.84, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13140.98, "providers": [{ "billed_charge": 141660.35, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2515.74, "providers": [{ "billed_charge": 10668.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 214.20, "providers": [{ "billed_charge": 472.26, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY, GROWTH HORMONE (HGH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83003", "description": "GROWTH HORMONE, HUMAN (HGH) (SOMATOTROPIN)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.29, "providers": [{ "billed_charge": 1012.00, "npi": [1760897755] } ] } ] } ] }, { "name": "ASSAY OF HAPTOGLOBIN, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83010", "description": "HAPTOGLOBIN; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 161.15, "providers": [{ "billed_charge": 2228.01, "npi": [1234567893] } ] } ] } ] }, { "name": "H PYLORI (C-13), BREATH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83013", "description": "HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3738.48, "providers": [{ "billed_charge": 31338.63, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23807.38, "providers": [{ "billed_charge": 218807.27, "npi": [1234567893] } ] } ] } ] }, { "name": "H PYLORI DRUG ADMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83014", "description": "HELICOBACTER PYLORI; DRUG ADMINISTRATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 334.05, "providers": [{ "billed_charge": 2799.90, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 618.02, "providers": [{ "billed_charge": 10264.31, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMOGLOBIN ELECTROPHORESIS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83020", "description": "HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.42, "providers": [{ "billed_charge": 21534.99, "npi": [1234567893] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1529.98, "providers": [{ "billed_charge": 17631.62, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 306.18, "providers": [{ "billed_charge": 611.73, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 325.62, "providers": [{ "billed_charge": 871.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.72, "providers": [{ "billed_charge": 1009.84, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 349.92, "providers": [{ "billed_charge": 1800.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "742882192" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.78, "providers": [{ "billed_charge": 2650.00, "npi": [1033370176] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 442.26, "providers": [{ "billed_charge": 1590.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 87.48, "providers": [{ "billed_charge": 174.78, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1471.08, "providers": [{ "billed_charge": 5680.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.30, "providers": [{ "billed_charge": 145.65, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.82, "providers": [{ "billed_charge": 1628.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.58, "providers": [{ "billed_charge": 222.00, "npi": [1942400601] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 456.84, "providers": [{ "billed_charge": 2282.32, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 792.18, "providers": [{ "billed_charge": 2772.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9195.12, "providers": [{ "billed_charge": 76966.56, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.64, "providers": [{ "billed_charge": 768.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "751414940" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.02, "providers": [{ "billed_charge": 135.00, "npi": [1578897765] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 108950.28, "providers": [{ "billed_charge": 1528575.42, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "300198705" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.60, "providers": [{ "billed_charge": 500.00, "npi": [1003273731] } ] }, { "allowed_amount": 12.39, "providers": [{ "billed_charge": 75.00, "npi": [1669082723] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 436.26, "providers": [{ "billed_charge": 971.33, "npi": [1730617523] } ] } ] } ] }, { "name": "GLYCOSYLATED HB, HOME DEVICE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83037", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C) BY DEVICE CLEARED BY FDA FOR HOME USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 155.52, "providers": [{ "billed_charge": 1856.00, "npi": [1235225087] } ] } ] } ] }, { "name": "ASSAY OF HOMOCYSTINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83090", "description": "HOMOCYSTEINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 617.60, "providers": [{ "billed_charge": 2480.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE 17-D", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83498", "description": "HYDROXYPROGESTERONE, 17-D", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2568.63, "providers": [{ "billed_charge": 22285.24, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY NONANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83516", "description": "IMMUNOASSAY FOR ANALYTE OTH THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 236.51, "providers": [{ "billed_charge": 8036.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3399.25, "providers": [{ "billed_charge": 85785.08, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY QUANT NOS NONAB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83520", "description": "IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.56, "providers": [{ "billed_charge": 172.00, "npi": [1346472859] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1486.20, "providers": [{ "billed_charge": 23810.40, "npi": [1234567893] } ] } ] } ] }, { "name": "IG LIGHT CHAINS FREE EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83521", "description": "IMMUNOGLOBULIN LIGHT CHAINS FREE EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 713.24, "providers": [{ "billed_charge": 8919.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF INSULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83525", "description": "INSULIN; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 278.02, "providers": [{ "billed_charge": 702.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 234.52, "providers": [{ "billed_charge": 615.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 852.28, "providers": [{ "billed_charge": 7143.06, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4786.26, "providers": [{ "billed_charge": 83270.22, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2824.61, "providers": [{ "billed_charge": 10672.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 124.48, "providers": [{ "billed_charge": 274.40, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF INSULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83527", "description": "INSULIN; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 238.45, "providers": [{ "billed_charge": 4293.32, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.91, "providers": [{ "billed_charge": 584.68, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 132.84, "providers": [{ "billed_charge": 265.27, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 281.88, "providers": [{ "billed_charge": 1407.66, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.36, "providers": [{ "billed_charge": 181.16, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.32, "providers": [{ "billed_charge": 232.92, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 132.84, "providers": [{ "billed_charge": 369.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.68, "providers": [{ "billed_charge": 1138.23, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 638.28, "providers": [{ "billed_charge": 5348.55, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12845.24, "providers": [{ "billed_charge": 133589.96, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 727.44, "providers": [{ "billed_charge": 3150.00, "npi": [1174172845] } ] } ] } ] }, { "name": "IRON BINDING TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83550", "description": "IRON BINDING CAPACITY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.91, "providers": [{ "billed_charge": 605.93, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 183.54, "providers": [{ "billed_charge": 462.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.66, "providers": [{ "billed_charge": 314.64, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.02, "providers": [{ "billed_charge": 1684.98, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13324.50, "providers": [{ "billed_charge": 151849.41, "npi": [1234567893] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.00, "providers": [{ "billed_charge": 456.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.78, "providers": [{ "billed_charge": 312.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1935.45, "providers": [{ "billed_charge": 8520.22, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 977.96, "providers": [{ "billed_charge": 3952.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF LEAD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83655", "description": "LEAD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 541.29, "providers": [{ "billed_charge": 6081.51, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2549.59, "providers": [{ "billed_charge": 49124.14, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 977.70, "providers": [{ "billed_charge": 4050.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 214.80, "providers": [{ "billed_charge": 1800.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5190.05, "providers": [{ "billed_charge": 86996.82, "npi": [1234567893] } ] } ] } ] }, { "name": "LIPOPROTEIN BLD QUAN PART", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 656.40, "providers": [{ "billed_charge": 7482.52, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83718", "description": "LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 326.10, "providers": [{ "billed_charge": 1235.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF BLOOD LIPOPROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83721", "description": "LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.75, "providers": [{ "billed_charge": 1659.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.72, "providers": [{ "billed_charge": 78.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.42, "providers": [{ "billed_charge": 481.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.75, "providers": [{ "billed_charge": 301.50, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 231.15, "providers": [{ "billed_charge": 1155.75, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.70, "providers": [{ "billed_charge": 840.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.75, "providers": [{ "billed_charge": 405.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.25, "providers": [{ "billed_charge": 421.20, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7015.35, "providers": [{ "billed_charge": 87131.74, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.80, "providers": [{ "billed_charge": 432.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF METANEPHRINES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83835", "description": "METANEPHRINES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.26, "providers": [{ "billed_charge": 280.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF NATRIURETIC PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83880", "description": "NATRIURETIC PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11165.55, "providers": [{ "billed_charge": 105042.58, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4192.15, "providers": [{ "billed_charge": 8778.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ORGANIC ACID SINGLE QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83921", "description": "ORGANIC ACID, SINGLE, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.94, "providers": [{ "billed_charge": 3181.84, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 247.68, "providers": [{ "billed_charge": 2076.12, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 61.92, "providers": [{ "billed_charge": 371.52, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12222.55, "providers": [{ "billed_charge": 95422.46, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5125.40, "providers": [{ "billed_charge": 13200.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 421.35, "providers": [{ "billed_charge": 928.80, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY FOR PHENCYCLIDINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83992", "description": "PHENCYCLIDINE (PCP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.50, "providers": [{ "billed_charge": 100.80, "npi": [1720448061] } ] } ] } ] }, { "name": "ASSAY FOR CALPROTECTIN FECAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83993", "description": "CALPROTECTIN, FECAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263844242" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.92, "providers": [{ "billed_charge": 588.00, "npi": [1346472859] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.84, "providers": [{ "billed_charge": 618.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ANESTH, SURG LOWER ABDOMEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "840", "description": "ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWER ABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE SPEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742569713" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2394.89, "providers": [{ "billed_charge": 9100.00, "npi": [1063041523] } ] } ] } ] }, { "name": "ASSAY ALKALINE PHOSPHATASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84075", "description": "PHOSPHATASE, ALKALINE;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2683.49, "providers": [{ "billed_charge": 3468.48, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY ALKALINE PHOSPHATASES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84080", "description": "PHOSPHATASE, ALKALINE; ISOENZYMES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.89, "providers": [{ "billed_charge": 736.25, "npi": [1234567893] } ] } ] } ] }, { "name": "CAPD/COMPOSIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "841", "description": "CONT AMBULATORY PERITONEAL DIALYSIS - CAPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 61368.30, "providers": [{ "billed_charge": 510030.00, "npi": [1234567893] } ] }, { "allowed_amount": 7273.36, "providers": [{ "billed_charge": 71712.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 124.25, "providers": [{ "billed_charge": 371.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2099.63, "providers": [{ "billed_charge": 10244.28, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.76, "providers": [{ "billed_charge": 528.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.68, "providers": [{ "billed_charge": 113.76, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF SERUM POTASSIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84132", "description": "POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1999.27, "providers": [{ "billed_charge": 4915.45, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PREALBUMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84134", "description": "PREALBUMIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.39, "providers": [{ "billed_charge": 352.08, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 511.20, "providers": [{ "billed_charge": 1224.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.86, "providers": [{ "billed_charge": 104.30, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.01, "providers": [{ "billed_charge": 292.04, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 198.17, "providers": [{ "billed_charge": 513.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.73, "providers": [{ "billed_charge": 770.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 719.67, "providers": [{ "billed_charge": 6034.05, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10957.23, "providers": [{ "billed_charge": 127510.06, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2403.16, "providers": [{ "billed_charge": 10368.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.40, "providers": [{ "billed_charge": 219.03, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.84, "providers": [{ "billed_charge": 561.65, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.34, "providers": [{ "billed_charge": 1110.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 930.24, "providers": [{ "billed_charge": 7799.04, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10284.42, "providers": [{ "billed_charge": 131778.87, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2230.28, "providers": [{ "billed_charge": 9504.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 92.33, "providers": [{ "billed_charge": 203.49, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF PSA, COMPLEXED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84152", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); COMPLEXED (DIRECT MEASUREMENT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 595.20, "providers": [{ "billed_charge": 2268.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 92.00, "providers": [{ "billed_charge": 459.80, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.80, "providers": [{ "billed_charge": 421.02, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3072.80, "providers": [{ "billed_charge": 25751.40, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29400.32, "providers": [{ "billed_charge": 365664.28, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PSA, FREE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84154", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.00, "providers": [{ "billed_charge": 385.50, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5065.17, "providers": [{ "billed_charge": 63842.03, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84155", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2216.68, "providers": [{ "billed_charge": 4341.33, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 980.51, "providers": [{ "billed_charge": 16590.51, "npi": [1234567893] } ] } ] } ] }, { "name": "PROTEIN E-PHORESIS, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84165", "description": "PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 647.72, "providers": [{ "billed_charge": 7757.50, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN B-6", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84207", "description": "PYRIDOXAL PHOSPHATE (VITAMIN B-6)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2686.14, "providers": [{ "billed_charge": 30046.57, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF QUININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84228", "description": "QUININE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880241758" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.46, "providers": [{ "billed_charge": 144.00, "npi": [1699782722] } ] } ] } ] }, { "name": "ASSAY OF RENIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84244", "description": "RENIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 400.40, "providers": [{ "billed_charge": 2920.04, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 558.10, "providers": [{ "billed_charge": 1282.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.87, "providers": [{ "billed_charge": 54.33, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 434.80, "providers": [{ "billed_charge": 1120.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.74, "providers": [{ "billed_charge": 86.92, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 608.72, "providers": [{ "billed_charge": 2433.76, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.70, "providers": [{ "billed_charge": 720.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 423.93, "providers": [{ "billed_charge": 3552.12, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12916.94, "providers": [{ "billed_charge": 118071.47, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2500.44, "providers": [{ "billed_charge": 10584.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.90, "providers": [{ "billed_charge": 326.00, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF SERUM SODIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84295", "description": "SODIUM; SERUM, PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2213.10, "providers": [{ "billed_charge": 2358.27, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF SOMATOMEDIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84305", "description": "SOMATOMEDIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 362.23, "providers": [{ "billed_charge": 7026.73, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.07, "providers": [{ "billed_charge": 628.89, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.66, "providers": [{ "billed_charge": 765.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7398.38, "providers": [{ "billed_charge": 85606.47, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2915.54, "providers": [{ "billed_charge": 11150.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 340.67, "providers": [{ "billed_charge": 3587.53, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 667.66, "providers": [{ "billed_charge": 1535.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.64, "providers": [{ "billed_charge": 103.24, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.82, "providers": [{ "billed_charge": 129.06, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.64, "providers": [{ "billed_charge": 206.48, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 735.87, "providers": [{ "billed_charge": 2942.34, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 555.13, "providers": [{ "billed_charge": 1419.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.92, "providers": [{ "billed_charge": 1032.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3279.14, "providers": [{ "billed_charge": 27492.96, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35835.85, "providers": [{ "billed_charge": 394113.60, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3031.29, "providers": [{ "billed_charge": 11373.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 281.12, "providers": [{ "billed_charge": 619.52, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN B-1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84425", "description": "THIAMINE (VITAMIN B-1)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.96, "providers": [{ "billed_charge": 360.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 420.35, "providers": [{ "billed_charge": 4001.64, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF THYROGLOBULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84432", "description": "THYROGLOBULIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 254.55, "providers": [{ "billed_charge": 3293.11, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1866.48, "providers": [{ "billed_charge": 7260.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF TOTAL THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84436", "description": "THYROXINE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.31, "providers": [{ "billed_charge": 142.03, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8590.78, "providers": [{ "billed_charge": 93195.91, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 363.08, "providers": [{ "billed_charge": 5486.50, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.22, "providers": [{ "billed_charge": 198.44, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 144.32, "providers": [{ "billed_charge": 577.28, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 279.62, "providers": [{ "billed_charge": 744.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 171.38, "providers": [{ "billed_charge": 685.52, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.22, "providers": [{ "billed_charge": 334.12, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.02, "providers": [{ "billed_charge": 18.04, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1188.95, "providers": [{ "billed_charge": 5229.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 423.94, "providers": [{ "billed_charge": 2119.70, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.24, "providers": [{ "billed_charge": 720.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 834.35, "providers": [{ "billed_charge": 6993.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32746.80, "providers": [{ "billed_charge": 623415.63, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 331.56, "providers": [{ "billed_charge": 739.64, "npi": [1730617523] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2439.03, "providers": [{ "billed_charge": 25140.09, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 302.40, "providers": [{ "billed_charge": 1192.80, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5166.00, "providers": [{ "billed_charge": 6777.00, "npi": [1164390605] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.40, "providers": [{ "billed_charge": 546.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.40, "providers": [{ "billed_charge": 1713.60, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 285.60, "providers": [{ "billed_charge": 996.90, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.80, "providers": [{ "billed_charge": 403.20, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2463.20, "providers": [{ "billed_charge": 9452.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.20, "providers": [{ "billed_charge": 151.20, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.60, "providers": [{ "billed_charge": 1050.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1192.80, "providers": [{ "billed_charge": 4968.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15002.40, "providers": [{ "billed_charge": 125710.55, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 378.00, "providers": [{ "billed_charge": 2520.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 155578.72, "providers": [{ "billed_charge": 1734151.78, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TSI GLOBULIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84445", "description": "THYROID STIMULATING IMMUNE GLOBULINS (TSI)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.97, "providers": [{ "billed_charge": 525.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1814.07, "providers": [{ "billed_charge": 19866.61, "npi": [1234567893] } ] } ] } ] }, { "name": "TRANSFERASE (AST) (SGOT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84450", "description": "TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2728.24, "providers": [{ "billed_charge": 3689.79, "npi": [1234567893] } ] } ] } ] }, { "name": "ALANINE AMINO (ALT) (SGPT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84460", "description": "TRANSFERASE; ALANINE AMINO (ALT) (SGPT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1755.17, "providers": [{ "billed_charge": 2791.37, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.42, "providers": [{ "billed_charge": 229.68, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 599.72, "providers": [{ "billed_charge": 4951.92, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.50, "providers": [{ "billed_charge": 875.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 720.62, "providers": [{ "billed_charge": 11788.67, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1440.66, "providers": [{ "billed_charge": 6330.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF TRIGLYCERIDES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84478", "description": "TRIGLYCERIDES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.23, "providers": [{ "billed_charge": 390.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF THYROID (T3 OR T4)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84479", "description": "THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6702.24, "providers": [{ "billed_charge": 72087.92, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84480", "description": "TRIIODOTHYRONINE T3; TOTAL (TT-3)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9311.34, "providers": [{ "billed_charge": 133626.74, "npi": [1234567893] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.52, "providers": [{ "billed_charge": 514.50, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 412.02, "providers": [{ "billed_charge": 944.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.82, "providers": [{ "billed_charge": 101.64, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 787.71, "providers": [{ "billed_charge": 3938.55, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 372.68, "providers": [{ "billed_charge": 968.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 279.51, "providers": [{ "billed_charge": 1118.04, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 186.34, "providers": [{ "billed_charge": 745.36, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 728.42, "providers": [{ "billed_charge": 6106.86, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26627.21, "providers": [{ "billed_charge": 591612.39, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.93, "providers": [{ "billed_charge": 321.86, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2296.09, "providers": [{ "billed_charge": 8602.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 392.02, "providers": [{ "billed_charge": 880.88, "npi": [1730617523] } ] } ] } ] }, { "name": "T3 REVERSE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84482", "description": "TRIIODOTHYRONINE T3; REVERSE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.94, "providers": [{ "billed_charge": 3683.89, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84484", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 456.92, "providers": [{ "billed_charge": 7863.78, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF UREA NITROGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84520", "description": "UREA NITROGEN; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2160.58, "providers": [{ "billed_charge": 2972.79, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.45, "providers": [{ "billed_charge": 405.58, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.30, "providers": [{ "billed_charge": 374.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.72, "providers": [{ "billed_charge": 248.60, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 92.66, "providers": [{ "billed_charge": 246.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1089.32, "providers": [{ "billed_charge": 9124.26, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7033.02, "providers": [{ "billed_charge": 91833.30, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.78, "providers": [{ "billed_charge": 2266.00, "npi": [1174172845] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN A", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84590", "description": "VITAMIN A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.20, "providers": [{ "billed_charge": 415.55, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF VITAMIN K", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84597", "description": "VITAMIN K", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1011.60, "providers": [{ "billed_charge": 25818.60, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF ZINC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84630", "description": "ZINC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 237.81, "providers": [{ "billed_charge": 3329.80, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF C-PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84681", "description": "C-PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1290.84, "providers": [{ "billed_charge": 10814.04, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1184.64, "providers": [{ "billed_charge": 18602.09, "npi": [1234567893] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.83, "providers": [{ "billed_charge": 552.09, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5397.33, "providers": [{ "billed_charge": 76949.47, "npi": [1234567893] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN ASSAY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84703", "description": "GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 451.72, "providers": [{ "billed_charge": 9228.19, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMATOCRIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85014", "description": "BLOOD COUNT; HEMATOCRIT (HCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 118.85, "providers": [{ "billed_charge": 1596.11, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMOGLOBIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85018", "description": "BLOOD COUNT; HEMOGLOBIN (HGB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.85, "providers": [{ "billed_charge": 300.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.42, "providers": [{ "billed_charge": 1726.21, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "CPT", "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": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.80, "providers": [{ "billed_charge": 90.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1175.02, "providers": [{ "billed_charge": 7260.84, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.61, "providers": [{ "billed_charge": 753.69, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2392.35, "providers": [{ "billed_charge": 6155.00, "npi": [1164390605] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 132.26, "providers": [{ "billed_charge": 1190.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 101.14, "providers": [{ "billed_charge": 260.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 521.26, "providers": [{ "billed_charge": 2082.36, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 793.56, "providers": [{ "billed_charge": 2775.99, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "872633751" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.58, "providers": [{ "billed_charge": 341.88, "npi": [1821749896] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1167.53, "providers": [{ "billed_charge": 4245.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 198.39, "providers": [{ "billed_charge": 1188.81, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "742854030" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.80, "providers": [{ "billed_charge": 325.00, "npi": [1083256879] } ] } ] }, { "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.89, "providers": [{ "billed_charge": 65.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 820.79, "providers": [{ "billed_charge": 15825.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 334.54, "providers": [{ "billed_charge": 3010.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.67, "providers": [{ "billed_charge": 58.29, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 594.50, "providers": [{ "billed_charge": 2200.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 112.81, "providers": [{ "billed_charge": 899.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6974.77, "providers": [{ "billed_charge": 27844.93, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 851.91, "providers": [{ "billed_charge": 5037.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96914.78, "providers": [{ "billed_charge": 813080.60, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "260834681" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.79, "providers": [{ "billed_charge": 396.00, "npi": [1033290077] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1048.95, "providers": [{ "billed_charge": 1620.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.89, "providers": [{ "billed_charge": 55.00, "npi": [1093920399] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "CPT", "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": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.10, "providers": [{ "billed_charge": 40.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.36, "providers": [{ "billed_charge": 379.68, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4634.25, "providers": [{ "billed_charge": 35522.53, "npi": [1234567893] } ] } ] } ] }, { "name": "AUTOMATED RETICULOCYTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85045", "description": "BLOOD COUNT; RETICULOCYTE, AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260834681" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.00, "providers": [{ "billed_charge": 288.00, "npi": [1033290077] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 939.21, "providers": [{ "billed_charge": 15233.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 608.00, "providers": [{ "billed_charge": 2288.00, "npi": [1174172845] } ] } ] } ] }, { "name": "AUTOMATED PLATELET COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85049", "description": "BLOOD COUNT; PLATELET, AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.01, "providers": [{ "billed_charge": 757.03, "npi": [1234567893] } ] } ] } ] }, { "name": "BLOOD SMEAR INTERPRETATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85060", "description": "BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.28, "providers": [{ "billed_charge": 1104.53, "npi": [1234567893] } ] } ] } ] }, { "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": "750800628" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 39699.84, "providers": [{ "billed_charge": 68448.00, "npi": [1194743013] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20910.91, "providers": [{ "billed_charge": 206172.00, "npi": [1234567893] } ] }, { "allowed_amount": 917262.01, "providers": [{ "billed_charge": 8054409.00, "npi": [1234567893] } ] } ] } ] }, { "name": "FIBRIN DEGRADATION, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85379", "description": "FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 435.92, "providers": [{ "billed_charge": 13549.50, "npi": [1234567893] } ] } ] } ] }, { "name": "FIBRINOLYSINS SCREEN I&R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85390", "description": "FIBRINOLYSINS OR COAGULOPATHY SCREEN, INTERPRETATION AND REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741720245" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 451.50, "providers": [{ "billed_charge": 3175.00, "npi": [1518254309] } ] }, { "allowed_amount": 1408.57, "providers": [{ "billed_charge": 9680.00, "npi": [1518254309] } ] } ] } ] }, { "name": "BLOOD PLATELET AGGREGATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85576", "description": "PLATELET, AGGREGATION (IN VITRO), EACH AGENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741720245" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 250.32, "providers": [{ "billed_charge": 2352.00, "npi": [1518254309] } ] }, { "allowed_amount": 929.93, "providers": [{ "billed_charge": 8736.00, "npi": [1518254309] } ] }, { "allowed_amount": 98.35, "providers": [{ "billed_charge": 924.00, "npi": [1003132663] } ] } ] }, { "tin": { "type": "ein", "value": "760421006" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 131.74, "providers": [{ "billed_charge": 131.74, "npi": [1487652293] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823021953" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.65, "providers": [{ "billed_charge": 141.57, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1188.59, "providers": [{ "billed_charge": 18840.90, "npi": [1234567893] } ] } ] } ] }, { "name": "RUSSELL VIPER VENOM, DILUTED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85613", "description": "RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 86.90, "providers": [{ "billed_charge": 1817.51, "npi": [1234567893] } ] } ] } ] }, { "name": "RBC SED RATE, NONAUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85651", "description": "SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.70, "providers": [{ "billed_charge": 42.70, "npi": [1558717827] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.60, "providers": [{ "billed_charge": 154.30, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.10, "providers": [{ "billed_charge": 67.86, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2597.28, "providers": [{ "billed_charge": 56982.39, "npi": [1234567893] } ] } ] } ] }, { "name": "RBC SICKLE CELL TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85660", "description": "SICKLING OF RBC, REDUCTION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.08, "providers": [{ "billed_charge": 3165.28, "npi": [1234567893] } ] } ] } ] }, { "name": "THROMBOPLASTIN TIME, PARTIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85730", "description": "THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1335.37, "providers": [{ "billed_charge": 21241.89, "npi": [1234567893] } ] } ] } ] }, { "name": "ALLERGEN SPECIFIC IGE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86003", "description": "ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843210939" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16443.00, "providers": [{ "billed_charge": 206955.00, "npi": [1851917207] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3158.63, "providers": [{ "billed_charge": 28510.16, "npi": [1234567893] } ] } ] } ] }, { "name": "ACTIN ANTIBODY EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86015", "description": "ACTIN SMOOTH MUSCLE ANTIBODY EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 420.83, "providers": [{ "billed_charge": 5785.28, "npi": [1234567893] } ] } ] } ] }, { "name": "ANCA SCREEN EACH ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86036", "description": "ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.68, "providers": [{ "billed_charge": 614.55, "npi": [1234567893] } ] } ] } ] }, { "name": "ANCA TITER EACH ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86037", "description": "ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.53, "providers": [{ "billed_charge": 110.14, "npi": [1234567893] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.60, "providers": [{ "billed_charge": 1621.44, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9591.98, "providers": [{ "billed_charge": 147901.45, "npi": [1234567893] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES (ANA)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86039", "description": "ANTINUCLEAR ANTIBODIES (ANA); TITER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1084.82, "providers": [{ "billed_charge": 22951.38, "npi": [1234567893] } ] } ] } ] }, { "name": "ANTISTREPTOLYSIN O, TITER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86060", "description": "ANTISTREPTOLYSIN 0; TITER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 358.76, "providers": [{ "billed_charge": 4777.74, "npi": [1234567893] } ] } ] } ] }, { "name": "PHYS BLOOD BANK SERV XMATCH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86077", "description": "BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR ANTIBODY(S), INT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760421006" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.31, "providers": [{ "billed_charge": 326.25, "npi": [1487652293] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.51, "providers": [{ "billed_charge": 403.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.95, "providers": [{ "billed_charge": 64.75, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.49, "providers": [{ "billed_charge": 113.96, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.19, "providers": [{ "billed_charge": 889.29, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3624.64, "providers": [{ "billed_charge": 73949.27, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.32, "providers": [{ "billed_charge": 124.32, "npi": [1730617523] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN, HS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86141", "description": "C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.32, "providers": [{ "billed_charge": 116.55, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "822704194" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 246.24, "providers": [{ "billed_charge": 646.00, "npi": [1487429874] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1192.32, "providers": [{ "billed_charge": 9985.68, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2065.54, "providers": [{ "billed_charge": 22228.66, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1702.80, "providers": [{ "billed_charge": 7230.00, "npi": [1174172845] } ] } ] } ] }, { "name": "BETA-2 GLYCOPROTEIN ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86146", "description": "BETA 2 GLYCOPROTEIN I ANTIBODY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 489.18, "providers": [{ "billed_charge": 3502.58, "npi": [1234567893] } ] } ] } ] }, { "name": "CARDIOLIPIN ANTIBODY EA IG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86147", "description": "CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1898.61, "providers": [{ "billed_charge": 18005.02, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPLEMENT, ANTIGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86160", "description": "COMPLEMENT; ANTIGEN, EACH COMPONENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.00, "providers": [{ "billed_charge": 1524.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4211.75, "providers": [{ "billed_charge": 64176.48, "npi": [1234567893] } ] } ] } ] }, { "name": "CCP ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86200", "description": "CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.44, "providers": [{ "billed_charge": 270.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2962.55, "providers": [{ "billed_charge": 42042.13, "npi": [1234567893] } ] } ] } ] }, { "name": "DNA ANTIBODY NATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86225", "description": "DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.14, "providers": [{ "billed_charge": 1267.20, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2949.12, "providers": [{ "billed_charge": 62112.06, "npi": [1234567893] } ] } ] } ] }, { "name": "NUCLEAR ANTIGEN ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86235", "description": "EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1210.37, "providers": [{ "billed_charge": 10149.30, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24776.06, "providers": [{ "billed_charge": 175039.76, "npi": [1234567893] } ] } ] } ] }, { "name": "FLUORESCENT ANTIBODY, TITER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86256", "description": "FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.56, "providers": [{ "billed_charge": 228.50, "npi": [1234567893] } ] } ] } ] }, { "name": "DGP ANTIBODY EACH IG CLASS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86258", "description": "GLIADIN ANTIBODY EACH IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 606.69, "providers": [{ "billed_charge": 15120.69, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 15-3", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86300", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2616.48, "providers": [{ "billed_charge": 26769.10, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 19-9", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86301", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 19-9", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 934.35, "providers": [{ "billed_charge": 16709.02, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY, TUMOR, CA 125", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86304", "description": "IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1567.94, "providers": [{ "billed_charge": 20603.07, "npi": [1234567893] } ] } ] } ] }, { "name": "HETEROPHILE ANTIBODY SCREEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86308", "description": "HETEROPHILE ANTIBODIES; SCREENING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.57, "providers": [{ "billed_charge": 181.70, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOASSAY INFECTIOUS AGENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86317", "description": "IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1834.25, "providers": [{ "billed_charge": 15949.92, "npi": [1234567893] } ] } ] } ] }, { "name": "IA INFECTIOUS AGENT ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86318", "description": "IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.10, "providers": [{ "billed_charge": 80.00, "npi": [1336758952] } ] } ] } ] }, { "name": "IMMUNOFIX E-PHORESIS, SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86334", "description": "IMMUNOFIXATION ELECTROPHORESIS; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 316.32, "providers": [{ "billed_charge": 3310.64, "npi": [1234567893] } ] } ] } ] }, { "name": "ISLET CELL ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86341", "description": "ISLET CELL ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 484.58, "providers": [{ "billed_charge": 7183.19, "npi": [1234567893] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT/RATIO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86360", "description": "T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6432.37, "providers": [{ "billed_charge": 60466.54, "npi": [1234567893] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86361", "description": "T CELLS; ABSOLUTE CD4 COUNT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1626.92, "providers": [{ "billed_charge": 16333.45, "npi": [1234567893] } ] } ] } ] }, { "name": "TISS TRNSGLTMNASE EA IG CLAS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86364", "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 651.48, "providers": [{ "billed_charge": 16673.17, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROSOMAL ANTIBODY EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86376", "description": "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.16, "providers": [{ "billed_charge": 640.20, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 101.92, "providers": [{ "billed_charge": 407.40, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.12, "providers": [{ "billed_charge": 1768.71, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9696.57, "providers": [{ "billed_charge": 113935.40, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1570.16, "providers": [{ "billed_charge": 6834.00, "npi": [1174172845] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 326.70, "providers": [{ "billed_charge": 734.94, "npi": [1730617523] } ] } ] } ] }, { "name": "MITOCHONDRIAL ANTIBODY EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86381", "description": "MITOCHONDRIAL ANTIBODY EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 817.10, "providers": [{ "billed_charge": 7550.26, "npi": [1234567893] } ] } ] } ] }, { "name": "RHEUMATOID FACTOR, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86431", "description": "RHEUMATOID FACTOR; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463663879" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 149.52, "providers": [{ "billed_charge": 429.00, "npi": [1760897755] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.40, "providers": [{ "billed_charge": 141.80, "npi": [1740715333] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.52, "providers": [{ "billed_charge": 666.12, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3680.26, "providers": [{ "billed_charge": 61037.08, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 722.04, "providers": [{ "billed_charge": 2607.00, "npi": [1174172845] } ] } ] } ] }, { "name": "TB TEST CELL IMMUN MEASURE", "billing_code_type": "CPT", "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": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 123.96, "providers": [{ "billed_charge": 1040.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20282.32, "providers": [{ "billed_charge": 106446.41, "npi": [1234567893] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "CPT", "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.64, "providers": [{ "billed_charge": 503.26, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 87.74, "providers": [{ "billed_charge": 704.79, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9873.46, "providers": [{ "billed_charge": 151247.72, "npi": [1234567893] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86593", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 365.68, "providers": [{ "billed_charge": 4812.84, "npi": [1234567893] } ] } ] } ] }, { "name": "CHLAMYDIA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86631", "description": "ANTIBODY; CHLAMYDIA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1630.81, "providers": [{ "billed_charge": 22437.76, "npi": [1234567893] } ] } ] } ] }, { "name": "CHLAMYDIA IGM ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86632", "description": "ANTIBODY; CHLAMYDIA, IGM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 869.29, "providers": [{ "billed_charge": 12186.06, "npi": [1234567893] } ] } ] } ] }, { "name": "EPSTEIN-BARR NUCLEAR ANTIGEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86664", "description": "ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 64.50, "providers": [{ "billed_charge": 651.85, "npi": [1234567893] } ] } ] } ] }, { "name": "EPSTEIN-BARR CAPSID VCA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86665", "description": "ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 436.88, "providers": [{ "billed_charge": 4269.68, "npi": [1234567893] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 1 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86695", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 1", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.00, "providers": [{ "billed_charge": 1382.25, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7591.99, "providers": [{ "billed_charge": 89140.48, "npi": [1234567893] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 2 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86696", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 300.08, "providers": [{ "billed_charge": 2515.65, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12018.28, "providers": [{ "billed_charge": 138207.67, "npi": [1234567893] } ] } ] } ] }, { "name": "HEP B CORE ANTIBODY, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86704", "description": "HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 253.26, "providers": [{ "billed_charge": 2121.84, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7422.24, "providers": [{ "billed_charge": 100472.49, "npi": [1234567893] } ] } ] } ] }, { "name": "HEP B CORE ANTIBODY, IGM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86705", "description": "HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 868.09, "providers": [{ "billed_charge": 12407.59, "npi": [1234567893] } ] } ] } ] }, { "name": "HEP B SURFACE ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86706", "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 306.09, "providers": [{ "billed_charge": 2566.71, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7480.28, "providers": [{ "billed_charge": 111983.78, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS BE ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86707", "description": "HEPATITIS BE ANTIBODY (HBEAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 419.05, "providers": [{ "billed_charge": 8179.78, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS A ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86708", "description": "HEPATITIS A ANTIBODY (HAAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.80, "providers": [{ "billed_charge": 2146.32, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3322.70, "providers": [{ "billed_charge": 48003.31, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS A IGM ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86709", "description": "HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2204.80, "providers": [{ "billed_charge": 47360.70, "npi": [1234567893] } ] } ] } ] }, { "name": "MUMPS ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86735", "description": "ANTIBODY; MUMPS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 737.90, "providers": [{ "billed_charge": 8779.11, "npi": [1234567893] } ] } ] } ] }, { "name": "RUBELLA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86762", "description": "ANTIBODY; RUBELLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1675.80, "providers": [{ "billed_charge": 16694.94, "npi": [1234567893] } ] } ] } ] }, { "name": "RUBEOLA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86765", "description": "ANTIBODY; RUBEOLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1015.18, "providers": [{ "billed_charge": 12630.19, "npi": [1234567893] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.26, "providers": [{ "billed_charge": 150.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.92, "providers": [{ "billed_charge": 704.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.46, "providers": [{ "billed_charge": 1677.27, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4646.36, "providers": [{ "billed_charge": 55101.11, "npi": [1234567893] } ] } ] } ] }, { "name": "VARICELLA-ZOSTER ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86787", "description": "ANTIBODY; VARICELLA-ZOSTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1619.97, "providers": [{ "billed_charge": 18788.21, "npi": [1234567893] } ] } ] } ] }, { "name": "THYROGLOBULIN ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86800", "description": "THYROGLOBULIN ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5482.96, "providers": [{ "billed_charge": 59868.24, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1855.44, "providers": [{ "billed_charge": 8284.00, "npi": [1174172845] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.40, "providers": [{ "billed_charge": 3589.20, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23405.82, "providers": [{ "billed_charge": 338886.27, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.42, "providers": [{ "billed_charge": 42.82, "npi": [1730617523] } ] } ] } ] }, { "name": "HLA TYPING, A, B, OR C", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86812", "description": "HLA TYPING; A, B, OR C (EG, A10, B7, B27), SINGLE ANTIGEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.17, "providers": [{ "billed_charge": 681.75, "npi": [1234567893] } ] } ] } ] }, { "name": "RBC ANTIBODY SCREEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86850", "description": "ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 607.22, "providers": [{ "billed_charge": 5388.51, "npi": [1234567893] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC ABO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86900", "description": "BLOOD TYPING, SEROLOGIC; ABO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.50, "providers": [{ "billed_charge": 30.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.50, "providers": [{ "billed_charge": 15.00, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 443.20, "providers": [{ "billed_charge": 6871.35, "npi": [1234567893] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC RH(D)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86901", "description": "BLOOD TYPING, SEROLOGIC; RH (D)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.50, "providers": [{ "billed_charge": 30.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 353.28, "providers": [{ "billed_charge": 5974.12, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPATIBILITY TEST, ELECTRIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86923", "description": "COMPATIBILITY TEST EACH UNIT; ELECTRONIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741720245" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 268.65, "providers": [{ "billed_charge": 644.00, "npi": [1518254309] } ] }, { "allowed_amount": 2497.45, "providers": [{ "billed_charge": 5947.00, "npi": [1518254309] } ] } ] } ] }, { "name": "SPECIMEN INFECT AGNT CONCNTJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87015", "description": "CONCENTRATION (ANY TYPE), FOR INFECTIOUS AGENTS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842769317" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1550.76, "providers": [{ "billed_charge": 5964.00, "npi": [1174172845] } ] } ] } ] }, { "name": "BLOOD CULTURE FOR BACTERIA", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.77, "providers": [{ "billed_charge": 1224.92, "npi": [1234567893] } ] } ] } ] }, { "name": "FECES CULTURE AEROBIC BACT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87045", "description": "CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 376.11, "providers": [{ "billed_charge": 4213.89, "npi": [1234567893] } ] } ] } ] }, { "name": "STOOL CULTR AEROBIC BACT EA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87046", "description": "CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRESUMPTIVE IDENTIFICATION O", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 382.20, "providers": [{ "billed_charge": 4243.46, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTURE OTHR SPECIMN AEROBIC", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1606.82, "providers": [{ "billed_charge": 25479.12, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTR BACTERIA, EXCEPT BLOOD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87075", "description": "CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 313.48, "providers": [{ "billed_charge": 6259.32, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "CPT", "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": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.08, "providers": [{ "billed_charge": 72.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.88, "providers": [{ "billed_charge": 1591.89, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4557.99, "providers": [{ "billed_charge": 22666.14, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTURE SCREEN ONLY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87081", "description": "CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1213.14, "providers": [{ "billed_charge": 14928.77, "npi": [1234567893] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.47, "providers": [{ "billed_charge": 1553.83, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.48, "providers": [{ "billed_charge": 432.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.54, "providers": [{ "billed_charge": 400.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.32, "providers": [{ "billed_charge": 240.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 937.28, "providers": [{ "billed_charge": 7850.91, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21328.12, "providers": [{ "billed_charge": 299951.32, "npi": [1234567893] } ] } ] } ] }, { "name": "URINE BACTERIA CULTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87088", "description": "CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.10, "providers": [{ "billed_charge": 72.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.70, "providers": [{ "billed_charge": 350.00, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3915.82, "providers": [{ "billed_charge": 22614.41, "npi": [1234567893] } ] } ] } ] }, { "name": "FUNGI IDENTIFICATION, YEAST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87106", "description": "CULTURE, FUNGI, DEFINITIVE IDENTIFICATION, EACH ORGANISM; YEAST", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.40, "providers": [{ "billed_charge": 38.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MYCOPLASMA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87109", "description": "CULTURE, MYCOPLASMA, ANY SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 318.19, "providers": [{ "billed_charge": 4817.80, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTURE TYPE IMMUNOLOGIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87147", "description": "CULTURE, TYPING; IMMUNOLOGIC METHOD, OTHER THAN IMMUNOFLUORESCENCE (EG, AGGLUTINATION GROUPING), PER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.91, "providers": [{ "billed_charge": 2448.40, "npi": [1234567893] } ] } ] } ] }, { "name": "DNA/RNA AMPLIFIED PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87150", "description": "CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (Dna or Rna) PROBE, AMPLIFIED PROBE TECHNIQUE, PER C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1895.28, "providers": [{ "billed_charge": 11988.70, "npi": [1234567893] } ] } ] } ] }, { "name": "OVA AND PARASITES SMEARS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87177", "description": "OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 578.79, "providers": [{ "billed_charge": 3509.93, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE, DISK", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87184", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR FEWER AGENTS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.05, "providers": [{ "billed_charge": 453.06, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE MIC", "billing_code_type": "CPT", "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": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.66, "providers": [{ "billed_charge": 78.00, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.56, "providers": [{ "billed_charge": 1159.68, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6430.87, "providers": [{ "billed_charge": 83914.56, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 675.68, "providers": [{ "billed_charge": 3650.00, "npi": [1861913576] } ] } ] } ] }, { "name": "SMEAR, GRAM STAIN", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.93, "providers": [{ "billed_charge": 184.53, "npi": [1234567893] } ] } ] } ] }, { "name": "SMEAR, COMPLEX STAIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87209", "description": "SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1197.82, "providers": [{ "billed_charge": 8525.86, "npi": [1234567893] } ] } ] } ] }, { "name": "GIARDIA AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87329", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, GIARDIA; (EG, ENZYME IMMUNOASSAY [EIA],", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 186.21, "providers": [{ "billed_charge": 1540.66, "npi": [1234567893] } ] } ] } ] }, { "name": "HPYLORI STOOL IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87338", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HELICOBACTER PYLORI, STOOL; (EG, ENZYME", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 228.84, "providers": [{ "billed_charge": 5219.96, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "CPT", "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": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.18, "providers": [{ "billed_charge": 88.25, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.51, "providers": [{ "billed_charge": 102.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 196.46, "providers": [{ "billed_charge": 1301.28, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13067.41, "providers": [{ "billed_charge": 171657.66, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87341", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG) NEU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 322.40, "providers": [{ "billed_charge": 6272.50, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS BE AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87350", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS BE ANTIGEN (HBEAG); (EG, ENZY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 469.88, "providers": [{ "billed_charge": 9170.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HIV-1 AG W/HIV-1 & HIV-2 AB", "billing_code_type": "CPT", "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": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.08, "providers": [{ "billed_charge": 178.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.32, "providers": [{ "billed_charge": 1070.96, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "810576059" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3708.32, "providers": [{ "billed_charge": 19980.31, "npi": [1235186800] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 313.04, "providers": [{ "billed_charge": 2080.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 52109.12, "providers": [{ "billed_charge": 530586.25, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 458.92, "providers": [{ "billed_charge": 1011.36, "npi": [1730617523] } ] } ] } ] }, { "name": "INFLUENZA A/B AG IA", "billing_code_type": "CPT", "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": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.05, "providers": [{ "billed_charge": 140.00, "npi": [1831544808] } ] } ] } ] }, { "name": "CORONAVIRUS AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87426", "description": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.10, "providers": [{ "billed_charge": 355.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 229.71, "providers": [{ "billed_charge": 3900.00, "npi": [1093920399] } ] } ] } ] }, { "name": "SHIGA-LIKE TOXIN AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87427", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, SHIGA-LIKE TOXIN; (EG, ENZYME IMMUNOASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 275.48, "providers": [{ "billed_charge": 2941.28, "npi": [1234567893] } ] } ] } ] }, { "name": "SARSCOV & INF VIR A&B AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87428", "description": "IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.00, "providers": [{ "billed_charge": 66.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3584.79, "providers": [{ "billed_charge": 5100.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2284.75, "providers": [{ "billed_charge": 19500.00, "npi": [1093920399] } ] } ] } ] }, { "name": "CANDIDA, DNA, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87480", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna CANDIDA SPECIES, DIRECT PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5572.00, "providers": [{ "billed_charge": 45380.67, "npi": [1234567893] } ] } ] } ] }, { "name": "CANDIDA, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3316.49, "providers": [{ "billed_charge": 10017.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 263.25, "providers": [{ "billed_charge": 795.00, "npi": [1023104528] } ] }, { "allowed_amount": 930.15, "providers": [{ "billed_charge": 2809.00, "npi": [1992709356] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 754.44, "providers": [{ "billed_charge": 3017.74, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 754.65, "providers": [{ "billed_charge": 6450.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 236.87, "providers": [{ "billed_charge": 455.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "812532457" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 228.15, "providers": [{ "billed_charge": 1950.00, "npi": [1295331221] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11057.28, "providers": [{ "billed_charge": 15600.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 562.56, "providers": [{ "billed_charge": 4785.33, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.40, "providers": [{ "billed_charge": 336.88, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7158.43, "providers": [{ "billed_charge": 16397.52, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10746.00, "providers": [{ "billed_charge": 31581.00, "npi": [1689639544] } ] }, { "allowed_amount": 614.15, "providers": [{ "billed_charge": 2456.30, "npi": [1104631415] } ] } ] } ] }, { "name": "CHYLMD PNEUM, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 1431.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2674.56, "providers": [{ "billed_charge": 7860.16, "npi": [1689639544] } ] }, { "allowed_amount": 3878.55, "providers": [{ "billed_charge": 15509.78, "npi": [1104631415] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.88, "providers": [{ "billed_charge": 480.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 219.33, "providers": [{ "billed_charge": 1222.55, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 52.65, "providers": [{ "billed_charge": 159.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 4050.00, "npi": [1992709356] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.80, "providers": [{ "billed_charge": 1122.88, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1965.04, "providers": [{ "billed_charge": 3006.00, "npi": [1326484569] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 421.08, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.00, "providers": [{ "billed_charge": 12000.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 98.25, "providers": [{ "billed_charge": 195.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81298.41, "providers": [{ "billed_charge": 473774.27, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1719.90, "providers": [{ "billed_charge": 3938.62, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5516.28, "providers": [{ "billed_charge": 16211.58, "npi": [1689639544] } ] }, { "allowed_amount": 7651.80, "providers": [{ "billed_charge": 30598.48, "npi": [1104631415] } ] } ] } ] }, { "name": "CYTOMEG, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87496", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna CYTOMEGALOVIRUS, AMPLIFIED PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 421.08, "npi": [1972117349] } ] } ] } ] }, { "name": "ENTEROVIRUS PROBE&REVRS TRNS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87498", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna ENTEROVIRUS, AMPLIFIED PROBE TECHNIQUE, INC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 614.25, "providers": [{ "billed_charge": 2456.30, "npi": [1972117349] } ] } ] } ] }, { "name": "VANOMYCIN DNA AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87500", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1123.20, "providers": [{ "billed_charge": 3392.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1912.95, "providers": [{ "billed_charge": 7649.62, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.05, "providers": [{ "billed_charge": 463.21, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.75, "providers": [{ "billed_charge": 1325.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2445.36, "providers": [{ "billed_charge": 3450.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 252.66, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1632.15, "providers": [{ "billed_charge": 3737.67, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3567.25, "providers": [{ "billed_charge": 16625.00, "npi": [1861913576] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 210.00, "npi": [1659031433] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.64, "providers": [{ "billed_charge": 157.92, "npi": [1730617523] } ] } ] } ] }, { "name": "INFLUENZA DNA AMP PROBE", "billing_code_type": "CPT", "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": "882565848" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 335.30, "providers": [{ "billed_charge": 1050.00, "npi": [1548999451] } ] } ] } ] }, { "name": "GARDNER VAG, DNA, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87510", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2883.51, "providers": [{ "billed_charge": 22795.99, "npi": [1234567893] } ] } ] } ] }, { "name": "GARDNER VAG, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.05, "providers": [{ "billed_charge": 1650.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2658.00, "providers": [{ "billed_charge": 3750.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.32, "providers": [{ "billed_charge": 681.25, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 982.80, "providers": [{ "billed_charge": 2250.64, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2772.90, "providers": [{ "billed_charge": 11088.44, "npi": [1104631415] } ] }, { "allowed_amount": 1528.32, "providers": [{ "billed_charge": 4491.52, "npi": [1689639544] } ] } ] } ] }, { "name": "HEPATITIS B, DNA, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87517", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HEPATITIS B VIRUS, QUANTIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.84, "providers": [{ "billed_charge": 359.10, "npi": [1942526447] } ] }, { "allowed_amount": 835.38, "providers": [{ "billed_charge": 7002.45, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4486.61, "providers": [{ "billed_charge": 77639.33, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS C PROBE&RVRS TRNSC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87521", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HEPATITIS C, AMPLIFIED PROBE TECHNIQUE, INC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 596.70, "providers": [{ "billed_charge": 1366.46, "npi": [1134559685] } ] } ] } ] }, { "name": "HEPATITIS C REVRS TRNSCRPJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87522", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HEPATITIS C, QUANTIFICATION, INCLUDES REVER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6094.14, "providers": [{ "billed_charge": 114258.67, "npi": [1234567893] } ] } ] } ] }, { "name": "HSV, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 649.17, "providers": [{ "billed_charge": 2596.66, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1789.59, "providers": [{ "billed_charge": 2703.00, "npi": [1326484569] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1266.33, "providers": [{ "billed_charge": 14388.65, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1386.45, "providers": [{ "billed_charge": 3175.01, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1649.66, "providers": [{ "billed_charge": 6596.92, "npi": [1104631415] } ] }, { "allowed_amount": 644.76, "providers": [{ "billed_charge": 1894.86, "npi": [1689639544] } ] } ] } ] }, { "name": "HIV-1 PROBE&REVERSE TRNSCRPJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87535", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HIV-1, AMPLIFIED PROBE TECHNIQUE, INCLUDES ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3014.35, "providers": [{ "billed_charge": 50966.15, "npi": [1234567893] } ] } ] } ] }, { "name": "HIV-1 QUANT&REVRSE TRNSCRPJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87536", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HIV-1, QUANTIFICATION, INCLUDES REVERSE TRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17578.80, "providers": [{ "billed_charge": 155024.35, "npi": [1234567893] } ] } ] } ] }, { "name": "LEGION PNEUMO, DNA, AMP PROB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87541", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna LEGIONELLA PNEUMOPHILA, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 1431.00, "npi": [1619488418] } ] } ] } ] }, { "name": "M.TUBERCULO, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87556", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna MYCOBACTERIA TUBERCULOSIS, AMPLIFIED PROBE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 229.24, "providers": [{ "billed_charge": 463.21, "npi": [1558150078] } ] } ] } ] }, { "name": "M. GENITALIUM AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87563", "description": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1948.05, "providers": [{ "billed_charge": 5883.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1824.68, "providers": [{ "billed_charge": 2784.50, "npi": [1326484569] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2421.90, "providers": [{ "billed_charge": 9684.84, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.50, "providers": [{ "billed_charge": 421.10, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 331.59, "providers": [{ "billed_charge": 1260.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12094.39, "providers": [{ "billed_charge": 86677.60, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3604.80, "providers": [{ "billed_charge": 8421.12, "npi": [1861913576] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1368.90, "providers": [{ "billed_charge": 3134.82, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4879.20, "providers": [{ "billed_charge": 10667.36, "npi": [1689639544] } ] }, { "allowed_amount": 4141.80, "providers": [{ "billed_charge": 16562.48, "npi": [1104631415] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.21, "providers": [{ "billed_charge": 157.92, "npi": [1730617523] } ] } ] } ] }, { "name": "M.PNEUMON, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 1431.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2793.96, "providers": [{ "billed_charge": 8211.06, "npi": [1689639544] } ] }, { "allowed_amount": 3931.20, "providers": [{ "billed_charge": 15720.32, "npi": [1104631415] } ] } ] } ] }, { "name": "N.GONORRHOEAE, DNA, AMP PROB", "billing_code_type": "CPT", "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": "541882269" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.88, "providers": [{ "billed_charge": 480.00, "npi": [1912903717] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.70, "providers": [{ "billed_charge": 1289.44, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 52.65, "providers": [{ "billed_charge": 159.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.80, "providers": [{ "billed_charge": 1122.88, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1965.04, "providers": [{ "billed_charge": 2987.00, "npi": [1326484569] } ] } ] }, { "tin": { "type": "ein", "value": "843731229" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 421.08, "npi": [1336758952] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1719.90, "providers": [{ "billed_charge": 3938.62, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5373.00, "providers": [{ "billed_charge": 15790.50, "npi": [1689639544] } ] }, { "allowed_amount": 7511.40, "providers": [{ "billed_charge": 30037.04, "npi": [1104631415] } ] } ] }, { "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 4050.00, "npi": [1992709356] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.50, "providers": [{ "billed_charge": 421.10, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1386.45, "providers": [{ "billed_charge": 11850.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 121.05, "providers": [{ "billed_charge": 195.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 80141.93, "providers": [{ "billed_charge": 467501.36, "npi": [1234567893] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "CPT", "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": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.85, "providers": [{ "billed_charge": 5158.08, "npi": [1023104528] } ] }, { "allowed_amount": 719.55, "providers": [{ "billed_charge": 7832.64, "npi": [1992709356] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3316.95, "providers": [{ "billed_charge": 20790.00, "npi": [1093753303] } ] }, { "allowed_amount": 245.70, "providers": [{ "billed_charge": 1540.00, "npi": [1093753303] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2790.45, "providers": [{ "billed_charge": 23055.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 707.10, "providers": [{ "billed_charge": 1690.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 60039.59, "providers": [{ "billed_charge": 433483.57, "npi": [1234567893] } ] } ] } ] }, { "name": "HPV TYPES 16 & 18 ONLY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87625", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna HUMAN PAPILLOMAVIRUS (HPV), TYPES 16 AND 18", "allowed_amounts": [{ "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.56, "providers": [{ "billed_charge": 97.32, "npi": [1558150078] } ] } ] } ] }, { "name": "Infectious Agent Antigen Detection", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87626", "description": "the detection of human papillomavirus (HPV) by nucleic acid (Dna or Rna) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.59, "providers": [{ "billed_charge": 140.40, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.50, "providers": [{ "billed_charge": 1500.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32824.40, "providers": [{ "billed_charge": 157431.64, "npi": [1234567893] } ] } ] } ] }, { "name": "RESP VIRUS 3-5 TARGETS", "billing_code_type": "CPT", "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": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11839.12, "providers": [{ "billed_charge": 16600.00, "npi": [1164390605] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10474.80, "providers": [{ "billed_charge": 34231.20, "npi": [1689639544] } ] }, { "allowed_amount": 20682.80, "providers": [{ "billed_charge": 82725.40, "npi": [1104631415] } ] } ] } ] }, { "name": "RESP VIRUS 12-25 TARGETS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87633", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6043.31, "providers": [{ "billed_charge": 18125.00, "npi": [1619488418] } ] } ] } ] }, { "name": "SARS-COV-2 COVID-19 AMP PRB", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 692.82, "providers": [{ "billed_charge": 2079.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2155.44, "providers": [{ "billed_charge": 8620.08, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 631.09, "providers": [{ "billed_charge": 2325.00, "npi": [1234567893] } ] } ] } ] }, { "name": "STAPH A, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1439.10, "providers": [{ "billed_charge": 4346.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.00, "providers": [{ "billed_charge": 5614.40, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 87.75, "providers": [{ "billed_charge": 350.90, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2693.44, "providers": [{ "billed_charge": 3800.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 750.08, "providers": [{ "billed_charge": 8221.08, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4966.65, "providers": [{ "billed_charge": 19860.94, "npi": [1104631415] } ] }, { "allowed_amount": 4967.04, "providers": [{ "billed_charge": 14597.44, "npi": [1689639544] } ] } ] } ] }, { "name": "MR-STAPH DNA AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87641", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 614.25, "providers": [{ "billed_charge": 1855.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.05, "providers": [{ "billed_charge": 463.21, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.75, "providers": [{ "billed_charge": 1325.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 252.66, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1210.95, "providers": [{ "billed_charge": 2773.11, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 210.00, "npi": [1659031433] } ] } ] }, { "tin": { "type": "ein", "value": "821606706" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.64, "providers": [{ "billed_charge": 157.92, "npi": [1730617523] } ] } ] } ] }, { "name": "STREP A, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1790.10, "providers": [{ "billed_charge": 5406.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "854205837" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.20, "providers": [{ "billed_charge": 280.72, "npi": [1164017422] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 193.05, "providers": [{ "billed_charge": 463.21, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.75, "providers": [{ "billed_charge": 1325.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.40, "providers": [{ "billed_charge": 336.88, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1386.45, "providers": [{ "billed_charge": 3175.01, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1552.20, "providers": [{ "billed_charge": 4561.70, "npi": [1689639544] } ] }, { "allowed_amount": 544.05, "providers": [{ "billed_charge": 2175.58, "npi": [1104631415] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 120.00, "npi": [1659031433] } ] } ] } ] }, { "name": "STREP A, DNA, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87652", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna STREPTOCOCCUS, GROUP A, QUANTIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4199.92, "providers": [{ "billed_charge": 13630.00, "npi": [1861913576] } ] } ] } ] }, { "name": "STREP B, DNA, AMP PROBE", "billing_code_type": "CPT", "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": "474579289" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 210.54, "npi": [1720448061] } ] } ] }, { "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.00, "providers": [{ "billed_charge": 4240.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.30, "providers": [{ "billed_charge": 592.68, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1614.60, "providers": [{ "billed_charge": 6456.56, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.50, "providers": [{ "billed_charge": 421.10, "npi": [1558150078] } ] } ] }, { "tin": { "type": "ein", "value": "760182737" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 649.35, "providers": [{ "billed_charge": 1961.00, "npi": [1104839380] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2728.88, "providers": [{ "billed_charge": 3850.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.40, "providers": [{ "billed_charge": 336.88, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1455.50, "providers": [{ "billed_charge": 15667.53, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2018.25, "providers": [{ "billed_charge": 4621.85, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35.10, "providers": [{ "billed_charge": 210.00, "npi": [1659031433] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5349.12, "providers": [{ "billed_charge": 15720.32, "npi": [1689639544] } ] }, { "allowed_amount": 6616.35, "providers": [{ "billed_charge": 26457.86, "npi": [1104631415] } ] } ] } ] }, { "name": "TRICHOMONAS VAGIN, DIR PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87660", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID Dna or Rna TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5307.33, "providers": [{ "billed_charge": 43062.97, "npi": [1234567893] } ] } ] } ] }, { "name": "TRICHOMONAS VAGINALIS AMPLIF", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 52.65, "providers": [{ "billed_charge": 159.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1175.85, "providers": [{ "billed_charge": 9715.00, "npi": [1992709356] } ] }, { "allowed_amount": 403.65, "providers": [{ "billed_charge": 3335.00, "npi": [1023104528] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1965.04, "providers": [{ "billed_charge": 2987.00, "npi": [1326484569] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2421.90, "providers": [{ "billed_charge": 9684.84, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1035.45, "providers": [{ "billed_charge": 8850.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.70, "providers": [{ "billed_charge": 130.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29974.24, "providers": [{ "billed_charge": 177127.30, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1719.90, "providers": [{ "billed_charge": 3938.62, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4919.28, "providers": [{ "billed_charge": 14457.08, "npi": [1689639544] } ] }, { "allowed_amount": 7528.95, "providers": [{ "billed_charge": 30107.22, "npi": [1104631415] } ] } ] } ] }, { "name": "DETECT AGENT NOS, DNA, AMP", "billing_code_type": "CPT", "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": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3403.80, "providers": [{ "billed_charge": 10282.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "851486076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3509.08, "providers": [{ "billed_charge": 14036.00, "npi": [1972117349] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 263.25, "providers": [{ "billed_charge": 2250.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 34094.02, "providers": [{ "billed_charge": 89100.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "812532457" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.20, "providers": [{ "billed_charge": 600.00, "npi": [1295331221] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.40, "providers": [{ "billed_charge": 336.88, "npi": [1518325562] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8021.87, "providers": [{ "billed_charge": 75955.71, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 877.25, "providers": [{ "billed_charge": 2009.50, "npi": [1134559685] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 167.16, "providers": [{ "billed_charge": 491.26, "npi": [1689639544] } ] }, { "allowed_amount": 859.89, "providers": [{ "billed_charge": 3438.82, "npi": [1104631415] } ] } ] } ] }, { "name": "DETECT AGNT MULT, DNA, DIREC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87800", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (Dna or Rna), MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1404.32, "providers": [{ "billed_charge": 18542.25, "npi": [1234567893] } ] } ] } ] }, { "name": "DETECT AGNT MULT, DNA, AMPLI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87801", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (Dna or Rna), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821936336" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1053.00, "providers": [{ "billed_charge": 3150.00, "npi": [1619488418] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.40, "providers": [{ "billed_charge": 5704.60, "npi": [1093753303] } ] }, { "allowed_amount": 3194.10, "providers": [{ "billed_charge": 36349.50, "npi": [1093753303] } ] }, { "allowed_amount": 631.80, "providers": [{ "billed_charge": 6713.30, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1863.81, "providers": [{ "billed_charge": 10227.65, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10635.50, "providers": [{ "billed_charge": 15000.00, "npi": [1508594136] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47503.65, "providers": [{ "billed_charge": 464526.55, "npi": [1234567893] } ] } ] } ] }, { "name": "INFLUENZA ASSAY W/OPTIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87804", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1573.20, "providers": [{ "billed_charge": 10450.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "760423386" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.45, "providers": [{ "billed_charge": 840.00, "npi": [1659025328] } ] } ] } ] }, { "name": "SARS-COV-2 COVID19 W/OPTIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87811", "description": "IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "394764139" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2813.84, "providers": [{ "billed_charge": 5776.00, "npi": [1164390605] } ] } ] } ] }, { "name": "STREP A ASSAY W/OPTIC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87880", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742854030" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.10, "providers": [{ "billed_charge": 50.00, "npi": [1083256879] } ] } ] }, { "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.89, "providers": [{ "billed_charge": 385.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.03, "providers": [{ "billed_charge": 33.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.03, "providers": [{ "billed_charge": 25.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2363.79, "providers": [{ "billed_charge": 5005.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1306.66, "providers": [{ "billed_charge": 8690.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "760423386" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.18, "providers": [{ "billed_charge": 510.00, "npi": [1659025328] } ] } ] } ] }, { "name": "PHENOTYPE, INFECT AGENT DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87900", "description": "INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATED GENOTYPIC BIOINFOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471358089" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13389.12, "providers": [{ "billed_charge": 19200.00, "npi": [1861913576] } ] } ] } ] }, { "name": "GENOTYPE DNA/RNA HEP C", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87902", "description": "INFECTIOUS AGENT GENOTYPE ANALYSIS BY NUCLEIC ACID Dna or Rna HEPATITIS C VIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4819.62, "providers": [{ "billed_charge": 10374.00, "npi": [1234567893] } ] } ] } ] }, { "name": "DIALY/ULTRAFILT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "881", "description": "MISC DIALYSIS - ULTRAFILTRATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32221.49, "providers": [{ "billed_charge": 221184.00, "npi": [1234567893] } ] } ] } ] }, { "name": "CYTOPATH, CONCENTRATE TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88108", "description": "CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742922218" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.00, "providers": [{ "billed_charge": 900.00, "npi": [1669462388] } ] }, { "allowed_amount": 21.00, "providers": [{ "billed_charge": 450.00, "npi": [1669462388] } ] } ] }, { "tin": { "type": "ein", "value": "751784456" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.16, "providers": [{ "billed_charge": 450.00, "npi": [1750313904] } ] } ] } ] }, { "name": "CYTOPATH CELL ENHANCE TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88112", "description": "CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113272376" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 467.07, "providers": [{ "billed_charge": 1902.00, "npi": [1215921549] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 230.97, "providers": [{ "billed_charge": 1461.73, "npi": [1234567893] } ] } ] } ] }, { "name": "CYTP URINE 3-5 PROBES CMPTR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88121", "description": "CYTOPATHOLOGY, IN SITU HYBRIDIZATION (EG, FISH), URINARY TRACT SPECIMEN W MORPHOMETRIC ANALYSIS, 3-5", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113272376" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1036.65, "providers": [{ "billed_charge": 4175.00, "npi": [1215921549] } ] } ] } ] }, { "name": "CYTOPATH, C/V, INTERPRET", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88141", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING INTERPRETATION BY PHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 432.36, "providers": [{ "billed_charge": 3420.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 63.64, "providers": [{ "billed_charge": 232.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2737.59, "providers": [{ "billed_charge": 14138.92, "npi": [1234567893] } ] } ] } ] }, { "name": "CYTOPATH C/V THIN LAYER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88142", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.11, "providers": [{ "billed_charge": 1173.75, "npi": [1234567893] } ] } ] } ] }, { "name": "CYTOPATH EVAL, FNA, REPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88173", "description": "CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; INTERPRETATION AND REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "205455398" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2717.97, "providers": [{ "billed_charge": 12530.00, "npi": [1134438427] } ] } ] } ] }, { "name": "CYTOPATH C/V AUTO FLUID REDO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88175", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3859.90, "providers": [{ "billed_charge": 27260.00, "npi": [1093753303] } ] }, { "allowed_amount": 146.41, "providers": [{ "billed_charge": 1034.00, "npi": [1093753303] } ] } ] }, { "tin": { "type": "ein", "value": "741761309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 425.92, "providers": [{ "billed_charge": 2560.00, "npi": [1023104528] } ] }, { "allowed_amount": 998.25, "providers": [{ "billed_charge": 6000.00, "npi": [1992709356] } ] } ] }, { "tin": { "type": "ein", "value": "752526006" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.24, "providers": [{ "billed_charge": 322.00, "npi": [1023066412] } ] }, { "allowed_amount": 79.86, "providers": [{ "billed_charge": 483.00, "npi": [1023066412] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3287.57, "providers": [{ "billed_charge": 29640.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 406.98, "providers": [{ "billed_charge": 2890.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "812532457" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.62, "providers": [{ "billed_charge": 240.00, "npi": [1295331221] } ] } ] }, { "tin": { "type": "ein", "value": "752956384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 669.35, "providers": [{ "billed_charge": 2160.00, "npi": [1154345841] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27132.78, "providers": [{ "billed_charge": 195300.76, "npi": [1234567893] } ] } ] } ] }, { "name": "FLOWCYTOMETRY/ TC, 1 MARKER", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88184", "description": "FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5502.77, "providers": [{ "billed_charge": 22968.75, "npi": [1841375094] } ] } ] } ] }, { "name": "FLOWCYTOMETRY/TC ADD-ON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88185", "description": "FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40243.69, "providers": [{ "billed_charge": 167076.00, "npi": [1841375094] } ] } ] } ] }, { "name": "FLOWCYTOMETRY/READ, 16 & >", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88189", "description": "FLOW CYTOMETRY, INTERPRETATION; 16 OR MORE MARKERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911789357" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5368.08, "providers": [{ "billed_charge": 21478.50, "npi": [1841375094] } ] } ] }, { "tin": { "type": "ein", "value": "760421006" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.45, "providers": [{ "billed_charge": 520.00, "npi": [1003131038] } ] }, { "allowed_amount": 40.17, "providers": [{ "billed_charge": 520.00, "npi": [1003131038] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88304", "description": "LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752526006" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 320.55, "providers": [{ "billed_charge": 2589.62, "npi": [1023066412] } ] } ] }, { "tin": { "type": "ein", "value": "863024305" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.78, "providers": [{ "billed_charge": 576.00, "npi": [1245234616] } ] }, { "allowed_amount": 5.26, "providers": [{ "billed_charge": 192.00, "npi": [1841488202] } ] }, { "allowed_amount": 10.52, "providers": [{ "billed_charge": 384.00, "npi": [1245234616, 1841488202] } ] } ] }, { "tin": { "type": "ein", "value": "371925902" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.00, "providers": [{ "billed_charge": 192.00, "npi": [1538149406] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "CPT", "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": "640899072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26133.52, "providers": [{ "billed_charge": 196500.00, "npi": [1225142920] } ] } ] }, { "tin": { "type": "ein", "value": "741209207" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.52, "providers": [{ "billed_charge": 580.00, "npi": [1316123987] } ] } ] }, { "tin": { "type": "ein", "value": "454486874" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3522.06, "providers": [{ "billed_charge": 6860.00, "npi": [1831169762] } ] }, { "allowed_amount": 5171.11, "providers": [{ "billed_charge": 10010.00, "npi": [1164955928] } ] }, { "allowed_amount": 8867.36, "providers": [{ "billed_charge": 16730.00, "npi": [1003073628] } ] } ] }, { "tin": { "type": "ein", "value": "751049190" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7358.85, "providers": [{ "billed_charge": 62109.00, "npi": [1104855717] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9105.21, "providers": [{ "billed_charge": 75004.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "752290938" }, "service_code": ["11", "22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.26, "providers": [{ "billed_charge": 230.00, "npi": [1447442165] } ] }, { "allowed_amount": 120.80, "providers": [{ "billed_charge": 1610.00, "npi": [1447442165] } ] }, { "allowed_amount": 103.56, "providers": [{ "billed_charge": 1600.00, "npi": [1215930649] } ] }, { "allowed_amount": 86.28, "providers": [{ "billed_charge": 1150.00, "npi": [1447442165] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["22", "81", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 28633.03, "providers": [{ "billed_charge": 157411.91, "npi": [1234567893] } ] }, { "allowed_amount": 50.16, "providers": [{ "billed_charge": 182.10, "npi": [1234567893] } ] }, { "allowed_amount": 66.88, "providers": [{ "billed_charge": 242.80, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1433.20, "providers": [{ "billed_charge": 9020.00, "npi": [1366421927] } ] }, { "allowed_amount": 281.12, "providers": [{ "billed_charge": 2800.00, "npi": [1245454149] } ] } ] }, { "tin": { "type": "ein", "value": "742079362" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 271.12, "providers": [{ "billed_charge": 1160.00, "npi": [1619957560] } ] } ] }, { "tin": { "type": "ein", "value": "752526006" }, "service_code": ["11", "24", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.79, "providers": [{ "billed_charge": 1368.00, "npi": [1023066412] } ] }, { "allowed_amount": 16.63, "providers": [{ "billed_charge": 228.00, "npi": [1023066412] } ] }, { "allowed_amount": 1297.33, "providers": [{ "billed_charge": 17784.00, "npi": [1023066412] } ] } ] }, { "tin": { "type": "ein", "value": "760421006" }, "service_code": ["22", "11", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 810.59, "providers": [{ "billed_charge": 5474.00, "npi": [1356788517] } ] }, { "allowed_amount": 1096.67, "providers": [{ "billed_charge": 7406.00, "npi": [1033613922] } ] }, { "allowed_amount": 850.62, "providers": [{ "billed_charge": 5796.00, "npi": [1366447690] } ] }, { "allowed_amount": 476.80, "providers": [{ "billed_charge": 3220.00, "npi": [1265870406] } ] }, { "allowed_amount": 381.45, "providers": [{ "billed_charge": 2576.00, "npi": [1124293873] } ] }, { "allowed_amount": 143.05, "providers": [{ "billed_charge": 966.00, "npi": [1417419375, 1740620384] } ] }, { "allowed_amount": 381.44, "providers": [{ "billed_charge": 2576.00, "npi": [1265870406] } ] }, { "allowed_amount": 1897.25, "providers": [{ "billed_charge": 9760.00, "npi": [1154427201] } ] }, { "allowed_amount": 139.77, "providers": [{ "billed_charge": 966.00, "npi": [1740620384] } ] }, { "allowed_amount": 333.77, "providers": [{ "billed_charge": 2254.00, "npi": [1124293873] } ] }, { "allowed_amount": 1382.77, "providers": [{ "billed_charge": 9338.00, "npi": [1417419375] } ] }, { "allowed_amount": 564.96, "providers": [{ "billed_charge": 6118.00, "npi": [1083034227] } ] }, { "allowed_amount": 47.68, "providers": [{ "billed_charge": 322.00, "npi": [1366447690] } ] }, { "allowed_amount": 748.71, "providers": [{ "billed_charge": 5152.00, "npi": [1609810696] } ] } ] }, { "tin": { "type": "ein", "value": "581910975" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2592.97, "providers": [{ "billed_charge": 9165.00, "npi": [1295085686] } ] }, { "allowed_amount": 1137.21, "providers": [{ "billed_charge": 8256.00, "npi": [1003919531] } ] } ] }, { "tin": { "type": "ein", "value": "871005967" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1862.33, "providers": [{ "billed_charge": 10335.00, "npi": [1043539687] } ] }, { "allowed_amount": 1440.64, "providers": [{ "billed_charge": 7995.00, "npi": [1043539687] } ] } ] }, { "tin": { "type": "ein", "value": "746106575" }, "service_code": ["22", "11", "81", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.26, "providers": [{ "billed_charge": 280.00, "npi": [1487918603, 1710217971, 1629259056] } ] }, { "allowed_amount": 362.39, "providers": [{ "billed_charge": 5880.00, "npi": [1265412928] } ] }, { "allowed_amount": 276.14, "providers": [{ "billed_charge": 4480.00, "npi": [1710217971] } ] }, { "allowed_amount": 2433.10, "providers": [{ "billed_charge": 39480.00, "npi": [1487918603] } ] }, { "allowed_amount": 51.77, "providers": [{ "billed_charge": 840.00, "npi": [1487918603, 1265412928] } ] }, { "allowed_amount": 189.84, "providers": [{ "billed_charge": 3080.00, "npi": [1629259056] } ] }, { "allowed_amount": 86.30, "providers": [{ "billed_charge": 1400.00, "npi": [1699979294] } ] }, { "allowed_amount": 465.92, "providers": [{ "billed_charge": 7560.00, "npi": [1699979294] } ] } ] }, { "tin": { "type": "ein", "value": "751435000" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.00, "providers": [{ "billed_charge": 3240.00, "npi": [1174109979] } ] } ] }, { "tin": { "type": "ein", "value": "863024305" }, "service_code": ["22", "23", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.00, "providers": [{ "billed_charge": 1040.00, "npi": [1588985956] } ] }, { "allowed_amount": 812.36, "providers": [{ "billed_charge": 11960.00, "npi": [1841488202] } ] }, { "allowed_amount": 41.32, "providers": [{ "billed_charge": 260.00, "npi": [1841488202] } ] }, { "allowed_amount": 278.90, "providers": [{ "billed_charge": 4160.00, "npi": [1164493706] } ] }, { "allowed_amount": 317.88, "providers": [{ "billed_charge": 4680.00, "npi": [1841488202] } ] }, { "allowed_amount": 35.32, "providers": [{ "billed_charge": 520.00, "npi": [1427469352] } ] }, { "allowed_amount": 70.64, "providers": [{ "billed_charge": 1040.00, "npi": [1689636276, 1699270702] } ] }, { "allowed_amount": 105.96, "providers": [{ "billed_charge": 1560.00, "npi": [1679981658] } ] }, { "allowed_amount": 364.00, "providers": [{ "billed_charge": 6760.00, "npi": [1487057626] } ] }, { "allowed_amount": 52.98, "providers": [{ "billed_charge": 780.00, "npi": [1245234616, 1164493706] } ] }, { "allowed_amount": 112.00, "providers": [{ "billed_charge": 2080.00, "npi": [1588985956] } ] }, { "allowed_amount": 935.17, "providers": [{ "billed_charge": 13780.00, "npi": [1427469352] } ] }, { "allowed_amount": 176.60, "providers": [{ "billed_charge": 2600.00, "npi": [1679981658] } ] }, { "allowed_amount": 742.00, "providers": [{ "billed_charge": 13780.00, "npi": [1346650371] } ] }, { "allowed_amount": 158.94, "providers": [{ "billed_charge": 2340.00, "npi": [1811283591] } ] }, { "allowed_amount": 600.44, "providers": [{ "billed_charge": 8840.00, "npi": [1699270702] } ] }, { "allowed_amount": 84.00, "providers": [{ "billed_charge": 1560.00, "npi": [1487057626] } ] }, { "allowed_amount": 194.26, "providers": [{ "billed_charge": 2860.00, "npi": [1245234616] } ] }, { "allowed_amount": 88.30, "providers": [{ "billed_charge": 1300.00, "npi": [1689636276] } ] } ] }, { "tin": { "type": "ein", "value": "462288983" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 278.12, "providers": [{ "billed_charge": 1200.00, "npi": [1528300837] } ] } ] }, { "tin": { "type": "ein", "value": "460543096" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12939.42, "providers": [{ "billed_charge": 159140.00, "npi": [1588840706] } ] }, { "allowed_amount": 17619.41, "providers": [{ "billed_charge": 222796.00, "npi": [1225142920] } ] }, { "allowed_amount": 10599.39, "providers": [{ "billed_charge": 133416.00, "npi": [1831294883] } ] } ] }, { "tin": { "type": "ein", "value": "205455398" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 991.48, "providers": [{ "billed_charge": 6208.00, "npi": [1134438427] } ] } ] }, { "tin": { "type": "ein", "value": "760182525" }, "service_code": ["22", "11", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 847.68, "providers": [{ "billed_charge": 13440.00, "npi": [1861478711] } ] }, { "allowed_amount": 423.84, "providers": [{ "billed_charge": 6720.00, "npi": [1659464857] } ] }, { "allowed_amount": 1006.62, "providers": [{ "billed_charge": 15960.00, "npi": [1275021255] } ] }, { "allowed_amount": 247.24, "providers": [{ "billed_charge": 3920.00, "npi": [1275021255] } ] }, { "allowed_amount": 17.66, "providers": [{ "billed_charge": 280.00, "npi": [1275021255, 1205812674] } ] }, { "allowed_amount": 176.60, "providers": [{ "billed_charge": 2800.00, "npi": [1659464857] } ] }, { "allowed_amount": 971.30, "providers": [{ "billed_charge": 15400.00, "npi": [1659464857] } ] }, { "allowed_amount": 229.58, "providers": [{ "billed_charge": 3640.00, "npi": [1275021255] } ] }, { "allowed_amount": 141.28, "providers": [{ "billed_charge": 2240.00, "npi": [1861478711] } ] }, { "allowed_amount": 123.62, "providers": [{ "billed_charge": 1960.00, "npi": [1205812674] } ] } ] }, { "tin": { "type": "ein", "value": "760611317" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1454.56, "providers": [{ "billed_charge": 18720.00, "npi": [1699744144] } ] } ] }, { "tin": { "type": "ein", "value": "392970380" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15859.83, "providers": [{ "billed_charge": 93600.00, "npi": [1972966265] } ] } ] }, { "tin": { "type": "ein", "value": "371925902" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1036.00, "providers": [{ "billed_charge": 19240.00, "npi": [1144367426] } ] }, { "allowed_amount": 238.00, "providers": [{ "billed_charge": 4420.00, "npi": [1538149406] } ] }, { "allowed_amount": 1053.03, "providers": [{ "billed_charge": 15860.00, "npi": [1952324956] } ] }, { "allowed_amount": 280.00, "providers": [{ "billed_charge": 5200.00, "npi": [1144367426] } ] }, { "allowed_amount": 140.00, "providers": [{ "billed_charge": 2600.00, "npi": [1538149406] } ] }, { "allowed_amount": 155.32, "providers": [{ "billed_charge": 2340.00, "npi": [1952324956] } ] }, { "allowed_amount": 34.51, "providers": [{ "billed_charge": 520.00, "npi": [1629605399] } ] } ] }, { "tin": { "type": "ein", "value": "751784456" }, "service_code": ["22", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 440.00, "providers": [{ "billed_charge": 6625.00, "npi": [1750313904] } ] }, { "allowed_amount": 193.61, "providers": [{ "billed_charge": 2915.00, "npi": [1801178371] } ] }, { "allowed_amount": 17.60, "providers": [{ "billed_charge": 265.00, "npi": [1750313904] } ] }, { "allowed_amount": 422.40, "providers": [{ "billed_charge": 6360.00, "npi": [1750313904] } ] }, { "allowed_amount": 52.80, "providers": [{ "billed_charge": 795.00, "npi": [1801178371] } ] } ] }, { "tin": { "type": "ein", "value": "752005254" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2785.74, "providers": [{ "billed_charge": 22240.00, "npi": [1427376557] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88307", "description": "LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ADRENAL, RESECTION BONE - BIOPSY/CUR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752526006" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1719.70, "providers": [{ "billed_charge": 5987.34, "npi": [1023066412] } ] } ] }, { "tin": { "type": "ein", "value": "863024305" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.12, "providers": [{ "billed_charge": 936.00, "npi": [1841488202] } ] } ] }, { "tin": { "type": "ein", "value": "371925902" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 28.00, "providers": [{ "billed_charge": 936.00, "npi": [1538149406] } ] } ] }, { "tin": { "type": "ein", "value": "751784456" }, "service_code": ["22", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 230.16, "providers": [{ "billed_charge": 2910.00, "npi": [1750313904] } ] }, { "allowed_amount": 230.15, "providers": [{ "billed_charge": 2910.00, "npi": [1750313904] } ] }, { "allowed_amount": 115.08, "providers": [{ "billed_charge": 1455.00, "npi": [1750313904] } ] } ] } ] }, { "name": "SPECIAL STAINS GROUP 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88312", "description": "SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "640899072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5892.00, "providers": [{ "billed_charge": 17640.00, "npi": [1225142920] } ] } ] }, { "tin": { "type": "ein", "value": "460543096" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 548.85, "providers": [{ "billed_charge": 5248.00, "npi": [1588840706] } ] }, { "allowed_amount": 1122.03, "providers": [{ "billed_charge": 11648.00, "npi": [1225142920] } ] }, { "allowed_amount": 406.89, "providers": [{ "billed_charge": 4224.00, "npi": [1831294883] } ] } ] }, { "tin": { "type": "ein", "value": "454486874" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 873.60, "providers": [{ "billed_charge": 1600.00, "npi": [1003073628] } ] } ] }, { "tin": { "type": "ein", "value": "871005967" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.88, "providers": [{ "billed_charge": 1280.00, "npi": [1043539687] } ] } ] }, { "tin": { "type": "ein", "value": "392970380" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4926.65, "providers": [{ "billed_charge": 18800.00, "npi": [1972966265] } ] } ] }, { "tin": { "type": "ein", "value": "452815598" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.17, "providers": [{ "billed_charge": 532.00, "npi": [1366421927] } ] } ] } ] }, { "name": "SPECIAL STAINS GROUP 2", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88313", "description": "SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460543096" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1410.82, "providers": [{ "billed_charge": 21315.00, "npi": [1588840706] } ] }, { "allowed_amount": 1721.79, "providers": [{ "billed_charge": 26883.00, "npi": [1225142920] } ] }, { "allowed_amount": 942.44, "providers": [{ "billed_charge": 14703.00, "npi": [1831294883] } ] } ] }, { "tin": { "type": "ein", "value": "640899072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15088.71, "providers": [{ "billed_charge": 50380.00, "npi": [1225142920] } ] } ] }, { "tin": { "type": "ein", "value": "454486874" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1951.20, "providers": [{ "billed_charge": 4443.00, "npi": [1003073628] } ] }, { "allowed_amount": 1971.72, "providers": [{ "billed_charge": 4848.00, "npi": [1164955928] } ] }, { "allowed_amount": 1695.82, "providers": [{ "billed_charge": 4207.00, "npi": [1831169762] } ] } ] }, { "tin": { "type": "ein", "value": "392970380" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5086.62, "providers": [{ "billed_charge": 26400.00, "npi": [1972966265] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.74, "providers": [{ "billed_charge": 244.00, "npi": [1234567893] } ] }, { "allowed_amount": 53.62, "providers": [{ "billed_charge": 194.80, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOHISTO ANTIBODY SLIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88341", "description": "IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY STAIN PRO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "393155066" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1982.40, "providers": [{ "billed_charge": 19120.00, "npi": [1114807153] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 625.08, "providers": [{ "billed_charge": 3240.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2343.95, "providers": [{ "billed_charge": 7400.00, "npi": [1740733708] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["22", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3085.14, "providers": [{ "billed_charge": 16193.60, "npi": [1234567893] } ] }, { "allowed_amount": 12.71, "providers": [{ "billed_charge": 50.57, "npi": [1234567893] } ] } ] } ] }, { "name": "IMMUNOHISTO ANTB 1ST STAIN", "billing_code_type": "CPT", "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": "640899072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7458.86, "providers": [{ "billed_charge": 17255.00, "npi": [1225142920] } ] } ] }, { "tin": { "type": "ein", "value": "752526006" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 441.12, "providers": [{ "billed_charge": 1253.64, "npi": [1023066412] } ] } ] }, { "tin": { "type": "ein", "value": "454486874" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2909.72, "providers": [{ "billed_charge": 7446.00, "npi": [1003073628] } ] }, { "allowed_amount": 1626.02, "providers": [{ "billed_charge": 4161.00, "npi": [1831169762] } ] }, { "allowed_amount": 2310.66, "providers": [{ "billed_charge": 5913.00, "npi": [1164955928] } ] } ] }, { "tin": { "type": "ein", "value": "581910975" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.82, "providers": [{ "billed_charge": 496.00, "npi": [1003919531] } ] } ] }, { "tin": { "type": "ein", "value": "871005967" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 258.63, "providers": [{ "billed_charge": 1375.75, "npi": [1043539687] } ] }, { "allowed_amount": 77.08, "providers": [{ "billed_charge": 284.24, "npi": [1043539687] } ] } ] }, { "tin": { "type": "ein", "value": "393155066" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4088.29, "providers": [{ "billed_charge": 37299.00, "npi": [1114807153] } ] }, { "allowed_amount": 661.70, "providers": [{ "billed_charge": 5040.00, "npi": [1548973167] } ] } ] }, { "tin": { "type": "ein", "value": "746106575" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.20, "providers": [{ "billed_charge": 362.00, "npi": [1487918603] } ] } ] }, { "tin": { "type": "ein", "value": "460543096" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2077.45, "providers": [{ "billed_charge": 21027.00, "npi": [1588840706] } ] }, { "allowed_amount": 2060.39, "providers": [{ "billed_charge": 20864.00, "npi": [1225142920] } ] }, { "allowed_amount": 1013.64, "providers": [{ "billed_charge": 10269.00, "npi": [1831294883] } ] } ] }, { "tin": { "type": "ein", "value": "760182525" }, "service_code": ["22", "24", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.49, "providers": [{ "billed_charge": 200.00, "npi": [1659464857, 1275021255] } ] }, { "allowed_amount": 65.95, "providers": [{ "billed_charge": 800.00, "npi": [1275021255] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1663.04, "providers": [{ "billed_charge": 8100.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 766.53, "providers": [{ "billed_charge": 1800.00, "npi": [1740733708] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["22", "81", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.80, "providers": [{ "billed_charge": 151.71, "npi": [1234567893] } ] }, { "allowed_amount": 31.20, "providers": [{ "billed_charge": 101.14, "npi": [1234567893] } ] }, { "allowed_amount": 5347.58, "providers": [{ "billed_charge": 26733.80, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "371925902" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.61, "providers": [{ "billed_charge": 1560.00, "npi": [1952324956] } ] }, { "allowed_amount": 28.00, "providers": [{ "billed_charge": 520.00, "npi": [1144367426] } ] }, { "allowed_amount": 98.00, "providers": [{ "billed_charge": 1820.00, "npi": [1144367426] } ] }, { "allowed_amount": 16.10, "providers": [{ "billed_charge": 260.00, "npi": [1952324956] } ] } ] }, { "tin": { "type": "ein", "value": "752005254" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.05, "providers": [{ "billed_charge": 3906.00, "npi": [1427376557] } ] } ] } ] }, { "name": "TUMOR IMMUNOHISTOCHEM/MANUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88360", "description": "MORPHOMETRIC ANALYSIS, TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN RECEPTOR/PROGESTERONE REC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113272376" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 935.34, "providers": [{ "billed_charge": 3573.00, "npi": [1215921549] } ] } ] }, { "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 14332.64, "providers": [{ "billed_charge": 22400.00, "npi": [1740733708] } ] } ] } ] }, { "name": "MICRODISSECTION, MANUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88381", "description": "MICRODISSECTION (IE, SAMPLE PREPARATION OF MICROSCOPICALLY IDENTIFIED TARGET); MANUAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "743126687" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 644.24, "providers": [{ "billed_charge": 3754.20, "npi": [1013973866] } ] } ] }, { "tin": { "type": "ein", "value": "474903308" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1273.47, "providers": [{ "billed_charge": 2750.00, "npi": [1740733708] } ] } ] } ] }, { "name": "PSTAY TREATMENT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "900", "description": "PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "861790384" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4408.60, "providers": [{ "billed_charge": 49620.00, "npi": [1912670068] } ] } ] } ] }, { "name": "IM ADMIN 1ST/ONLY COMPONENT", "billing_code_type": "CPT", "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": "473975088" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.51, "providers": [{ "billed_charge": 165.00, "npi": [1497225478] } ] } ] }, { "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 541.20, "providers": [{ "billed_charge": 1440.00, "npi": [1265546287] } ] } ] }, { "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 225.50, "providers": [{ "billed_charge": 300.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "752252866" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.65, "providers": [{ "billed_charge": 150.06, "npi": [1235154824] } ] } ] } ] }, { "name": "IM ADMIN EACH ADDL COMPONENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90461", "description": "IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, W COUNSELING BY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.82, "providers": [{ "billed_charge": 1440.00, "npi": [1265546287] } ] } ] } ] }, { "name": "IMMUNIZATION ADMIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90471", "description": "IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760549240" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.32, "providers": [{ "billed_charge": 200.00, "npi": [1053772129] } ] } ] }, { "tin": { "type": "ein", "value": "752252866" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.38, "providers": [{ "billed_charge": 100.04, "npi": [1235154824] } ] } ] } ] }, { "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": "832064561" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 353.20, "providers": [{ "billed_charge": 10472.00, "npi": [1942966502] } ] } ] }, { "tin": { "type": "ein", "value": "844582670" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3524.05, "providers": [{ "billed_charge": 80600.00, "npi": [1447848577] } ] } ] } ] }, { "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": "631198286" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 104.63, "providers": [{ "billed_charge": 1000.00, "npi": [1356624506] } ] } ] }, { "tin": { "type": "ein", "value": "742664821" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4008.00, "providers": [{ "billed_charge": 9600.00, "npi": [1073654737] } ] } ] }, { "tin": { "type": "ein", "value": "861790384" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 394350.00, "providers": [{ "billed_charge": 7287588.00, "npi": [1912670068] } ] } ] }, { "tin": { "type": "ein", "value": "471323448" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 13000.00, "providers": [{ "billed_charge": 13000.00, "npi": [1922408517] } ] } ] } ] }, { "name": "PSYCH DIAG EVAL W/MED SRVCS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90792", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832104126" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2627.04, "providers": [{ "billed_charge": 5044.00, "npi": [1013614668] } ] } ] }, { "tin": { "type": "ein", "value": "201020949" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 592.09, "providers": [{ "billed_charge": 1182.00, "npi": [1679958557] } ] }, { "allowed_amount": 2208.73, "providers": [{ "billed_charge": 4334.00, "npi": [1457457665] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["11", "55", "02", "57"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.81, "providers": [{ "billed_charge": 403.00, "npi": [1255388203] } ] }, { "allowed_amount": 6790.76, "providers": [{ "billed_charge": 13842.00, "npi": [1255388203] } ] }, { "allowed_amount": 319.62, "providers": [{ "billed_charge": 820.00, "npi": [1255388203] } ] }, { "allowed_amount": 403.63, "providers": [{ "billed_charge": 813.00, "npi": [1255388203] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 202.08, "providers": [{ "billed_charge": 394.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PSYTX W PT 30 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90832", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.88, "providers": [{ "billed_charge": 314.40, "npi": [1437720323] } ] } ] }, { "tin": { "type": "ein", "value": "743001674" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1767.20, "providers": [{ "billed_charge": 2520.00, "npi": [1063896124] } ] }, { "allowed_amount": 417.72, "providers": [{ "billed_charge": 720.00, "npi": [1063896124] } ] }, { "allowed_amount": 1110.52, "providers": [{ "billed_charge": 1920.00, "npi": [1063896124] } ] } ] }, { "tin": { "type": "ein", "value": "874431096" }, "service_code": ["22", "61"], "billing_class": "professional", "payments": [{ "allowed_amount": 274.42, "providers": [{ "billed_charge": 600.00, "npi": [1265218176] } ] }, { "allowed_amount": 276.88, "providers": [{ "billed_charge": 600.00, "npi": [1033308747] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 30 MIN", "billing_code_type": "CPT", "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": "264621796" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1497.42, "providers": [{ "billed_charge": 3915.00, "npi": [1215516992] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 195.75, "providers": [{ "billed_charge": 1086.60, "npi": [1952012189] } ] }, { "allowed_amount": 1755.54, "providers": [{ "billed_charge": 9779.40, "npi": [1124012067] } ] }, { "allowed_amount": 160.30, "providers": [{ "billed_charge": 724.40, "npi": [1952012189] } ] }, { "allowed_amount": 400.75, "providers": [{ "billed_charge": 1811.00, "npi": [1124012067] } ] } ] }, { "tin": { "type": "ein", "value": "990521596" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 332.76, "providers": [{ "billed_charge": 1200.00, "npi": [1235652280] } ] } ] } ] }, { "name": "PSYTX W PT 45 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90834", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832104126" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2050.20, "providers": [{ "billed_charge": 4680.00, "npi": [1861749715] } ] } ] }, { "tin": { "type": "ein", "value": "201020949" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 341.72, "providers": [{ "billed_charge": 800.00, "npi": [1801491659] } ] }, { "allowed_amount": 256.29, "providers": [{ "billed_charge": 600.00, "npi": [1043701147] } ] }, { "allowed_amount": 598.01, "providers": [{ "billed_charge": 1400.00, "npi": [1790108801] } ] }, { "allowed_amount": 939.73, "providers": [{ "billed_charge": 2200.00, "npi": [1528414307] } ] }, { "allowed_amount": 170.86, "providers": [{ "billed_charge": 400.00, "npi": [1891908513, 1164029054, 1922631126] } ] }, { "allowed_amount": 768.87, "providers": [{ "billed_charge": 1800.00, "npi": [1710611819] } ] }, { "allowed_amount": 327.10, "providers": [{ "billed_charge": 800.00, "npi": [1306218789] } ] }, { "allowed_amount": 85.43, "providers": [{ "billed_charge": 200.00, "npi": [1629595699, 1265657084, 1336536069] } ] }, { "allowed_amount": 5115.76, "providers": [{ "billed_charge": 9000.00, "npi": [1144297086] } ] }, { "allowed_amount": 925.11, "providers": [{ "billed_charge": 2200.00, "npi": [1578189635] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 622.24, "providers": [{ "billed_charge": 1368.00, "npi": [1619288024] } ] }, { "allowed_amount": 173.34, "providers": [{ "billed_charge": 342.00, "npi": [1609490069] } ] }, { "allowed_amount": 155.56, "providers": [{ "billed_charge": 342.00, "npi": [1649079179] } ] } ] }, { "tin": { "type": "ein", "value": "743001674" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1375.62, "providers": [{ "billed_charge": 2175.00, "npi": [1063896124] } ] }, { "allowed_amount": 2479.60, "providers": [{ "billed_charge": 3190.00, "npi": [1063896124] } ] }, { "allowed_amount": 549.78, "providers": [{ "billed_charge": 870.00, "npi": [1063896124] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4186.07, "providers": [{ "billed_charge": 9800.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PSYTX W PT 60 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90837", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853966442" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.34, "providers": [{ "billed_charge": 300.00, "npi": [1487305975] } ] } ] }, { "tin": { "type": "ein", "value": "854159267" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2176.64, "providers": [{ "billed_charge": 2572.00, "npi": [1043811441] } ] }, { "allowed_amount": 2362.36, "providers": [{ "billed_charge": 2387.98, "npi": [1043811441] } ] } ] }, { "tin": { "type": "ein", "value": "113762050" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 742.02, "providers": [{ "billed_charge": 3312.00, "npi": [1447775895] } ] } ] }, { "tin": { "type": "ein", "value": "832104126" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1169.00, "providers": [{ "billed_charge": 2457.00, "npi": [1154821296, 1033855317] } ] }, { "allowed_amount": 6834.29, "providers": [{ "billed_charge": 14391.00, "npi": [1598225575] } ] }, { "allowed_amount": 1002.00, "providers": [{ "billed_charge": 2106.00, "npi": [1962018143] } ] }, { "allowed_amount": 501.00, "providers": [{ "billed_charge": 1053.00, "npi": [1598396780, 1861043713] } ] }, { "allowed_amount": 1991.29, "providers": [{ "billed_charge": 4212.00, "npi": [1386203883] } ] }, { "allowed_amount": 835.00, "providers": [{ "billed_charge": 1755.00, "npi": [1215485776] } ] }, { "allowed_amount": 4843.00, "providers": [{ "billed_charge": 10179.00, "npi": [1427418102] } ] }, { "allowed_amount": 4008.00, "providers": [{ "billed_charge": 8424.00, "npi": [1194281741] } ] }, { "allowed_amount": 1837.00, "providers": [{ "billed_charge": 3861.00, "npi": [1164764676] } ] }, { "allowed_amount": 2171.00, "providers": [{ "billed_charge": 4563.00, "npi": [1508624479] } ] }, { "allowed_amount": 3982.58, "providers": [{ "billed_charge": 8424.00, "npi": [1679230379] } ] } ] }, { "tin": { "type": "ein", "value": "742944931" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1415.26, "providers": [{ "billed_charge": 3483.12, "npi": [1184353708] } ] }, { "allowed_amount": 371.01, "providers": [{ "billed_charge": 760.44, "npi": [1184353708] } ] }, { "allowed_amount": 123.67, "providers": [{ "billed_charge": 245.28, "npi": [1740517218, 1821886409] } ] } ] }, { "tin": { "type": "ein", "value": "264621796" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1752.14, "providers": [{ "billed_charge": 5070.00, "npi": [1447325618] } ] } ] }, { "tin": { "type": "ein", "value": "883332622" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 841.02, "providers": [{ "billed_charge": 1350.00, "npi": [1396522561] } ] }, { "allowed_amount": 1947.52, "providers": [{ "billed_charge": 3750.00, "npi": [1396522561] } ] } ] }, { "tin": { "type": "ein", "value": "863875777" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2965.16, "providers": [{ "billed_charge": 4400.00, "npi": [1639690472] } ] }, { "allowed_amount": 17974.10, "providers": [{ "billed_charge": 21800.00, "npi": [1639690472] } ] } ] }, { "tin": { "type": "ein", "value": "334407237" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 458.24, "providers": [{ "billed_charge": 700.00, "npi": [1649906082] } ] }, { "allowed_amount": 2943.57, "providers": [{ "billed_charge": 3675.00, "npi": [1649906082] } ] } ] }, { "tin": { "type": "ein", "value": "882960420" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1886.92, "providers": [{ "billed_charge": 2520.00, "npi": [1003157165] } ] }, { "allowed_amount": 824.50, "providers": [{ "billed_charge": 900.00, "npi": [1003157165] } ] } ] }, { "tin": { "type": "ein", "value": "871776521" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 875.00, "providers": [{ "billed_charge": 875.00, "npi": [1154187730] } ] } ] }, { "tin": { "type": "ein", "value": "822069193" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 566.82, "providers": [{ "billed_charge": 1200.00, "npi": [1639690472] } ] }, { "allowed_amount": 2928.57, "providers": [{ "billed_charge": 6200.00, "npi": [1639690472] } ] } ] }, { "tin": { "type": "ein", "value": "871883530" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1261.53, "providers": [{ "billed_charge": 1350.00, "npi": [1952946865] } ] }, { "allowed_amount": 229.12, "providers": [{ "billed_charge": 300.00, "npi": [1952946865] } ] } ] }, { "tin": { "type": "ein", "value": "611676787" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2473.40, "providers": [{ "billed_charge": 3500.00, "npi": [1285979286] } ] }, { "allowed_amount": 101.09, "providers": [{ "billed_charge": 175.00, "npi": [1285979286] } ] }, { "allowed_amount": 202.18, "providers": [{ "billed_charge": 350.00, "npi": [1285979286] } ] } ] }, { "tin": { "type": "ein", "value": "922142691" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1832.96, "providers": [{ "billed_charge": 2080.00, "npi": [1174261853] } ] }, { "allowed_amount": 2714.56, "providers": [{ "billed_charge": 2730.00, "npi": [1174261853] } ] } ] }, { "tin": { "type": "ein", "value": "862493019" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.25, "providers": [{ "billed_charge": 125.25, "npi": [1316303183] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1336.00, "providers": [{ "billed_charge": 2802.00, "npi": [1234567893] } ] } ] } ] }, { "name": "GROUP PSYCHOTHERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90853", "description": "GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261240810" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.36, "providers": [{ "billed_charge": 2495.00, "npi": [1639998420] } ] } ] } ] }, { "name": "TCRANIAL MAGN STIM TX DELI", "billing_code_type": "CPT", "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": "465717265" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1800.20, "providers": [{ "billed_charge": 5225.00, "npi": [1740505957] } ] } ] }, { "tin": { "type": "ein", "value": "393466163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6554.24, "providers": [{ "billed_charge": 16542.24, "npi": [1740546209] } ] }, { "allowed_amount": 5064.64, "providers": [{ "billed_charge": 12782.64, "npi": [1114969300] } ] } ] }, { "tin": { "type": "ein", "value": "465718339" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 592.16, "providers": [{ "billed_charge": 2400.00, "npi": [1548231806] } ] } ] }, { "tin": { "type": "ein", "value": "823841127" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3480.00, "providers": [{ "billed_charge": 11600.00, "npi": [1689995649] } ] } ] } ] }, { "name": "DIALYSIS ONE EVALUATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90945", "description": "DIALYSIS PROC OTH THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTH CONTINUOUS RENA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261104730" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 756.70, "providers": [{ "billed_charge": 3530.00, "npi": [1164804225] } ] } ] } ] }, { "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": "621864265" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 960.00, "providers": [{ "billed_charge": 3750.00, "npi": [1598764359] } ] } ] }, { "tin": { "type": "ein", "value": "832064561" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6086.08, "providers": [{ "billed_charge": 105112.00, "npi": [1942966502] } ] } ] }, { "tin": { "type": "ein", "value": "921353734" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2500.00, "providers": [{ "billed_charge": 15627.20, "npi": [1104538461] } ] } ] }, { "tin": { "type": "ein", "value": "823470979" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 524.00, "providers": [{ "billed_charge": 3300.00, "npi": [1265447015] } ] } ] } ] }, { "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": "861790384" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 163800.00, "providers": [{ "billed_charge": 2194920.00, "npi": [1912670068] } ] } ] }, { "tin": { "type": "ein", "value": "471323448" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 62100.00, "providers": [{ "billed_charge": 62100.00, "npi": [1922408517] } ] } ] }, { "tin": { "type": "ein", "value": "461281853" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1463.23, "providers": [{ "billed_charge": 19975.00, "npi": [1457232589] } ] } ] } ] }, { "name": "PSTAY/INDIV RX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "914", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - INDIVIDUAL THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "861790384" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 27587.91, "providers": [{ "billed_charge": 339740.00, "npi": [1912670068] } ] } ] } ] }, { "name": "OTHER DX SVS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "920", "description": "OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7677.82, "providers": [{ "billed_charge": 54732.75, "npi": [1730132234] } ] } ] } ] }, { "name": "EYE EXAM NEW PATIENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92004", "description": "OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION W INITIATION OF DIAGNOSTIC AND TRTMNT ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 30313.36, "providers": [{ "billed_charge": 54340.00, "npi": [1104203074] } ] } ] } ] }, { "name": "EYE EXAM ESTABLISH PATIENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92012", "description": "OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, W INITIATION OR CONTINUATION OF DIAGN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6906.18, "providers": [{ "billed_charge": 12640.00, "npi": [1104203074] } ] } ] } ] }, { "name": "EYE EXAM&TX ESTAB PT 1/>VST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92014", "description": "OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION, W INITIATION OR CONTINUATION OF DIAGN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1723.68, "providers": [{ "billed_charge": 4001.20, "npi": [1326043506] } ] } ] }, { "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12188.88, "providers": [{ "billed_charge": 21780.00, "npi": [1104203074] } ] } ] } ] }, { "name": "DETERMINE REFRACTIVE STATE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92015", "description": "DETERMINATION OF REFRACTIVE STATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2536.22, "providers": [{ "billed_charge": 4760.00, "npi": [1104203074] } ] } ] } ] }, { "name": "PERI VASCUL LAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "921", "description": "OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1870.33, "providers": [{ "billed_charge": 54470.00, "npi": [1184179194] } ] }, { "allowed_amount": 3456.72, "providers": [{ "billed_charge": 102855.00, "npi": [1083937593] } ] }, { "allowed_amount": 3468.05, "providers": [{ "billed_charge": 111045.00, "npi": [1497871628] } ] }, { "allowed_amount": 9193.09, "providers": [{ "billed_charge": 215287.00, "npi": [1871619254] } ] } ] }, { "tin": { "type": "ein", "value": "756000439" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2284.02, "providers": [{ "billed_charge": 12048.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "741109836" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4912.93, "providers": [{ "billed_charge": 54299.00, "npi": [1689641680] } ] } ] }, { "tin": { "type": "ein", "value": "750800661" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 358.29, "providers": [{ "billed_charge": 6036.00, "npi": [1275592131] } ] }, { "allowed_amount": 179.00, "providers": [{ "billed_charge": 2294.00, "npi": [1689629941] } ] }, { "allowed_amount": 178.71, "providers": [{ "billed_charge": 8330.00, "npi": [1033165501] } ] }, { "allowed_amount": 357.42, "providers": [{ "billed_charge": 5312.00, "npi": [1528027786] } ] } ] }, { "tin": { "type": "ein", "value": "274434451" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 596.19, "providers": [{ "billed_charge": 2832.16, "npi": [1265772362] } ] } ] }, { "tin": { "type": "ein", "value": "432008974" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1202.88, "providers": [{ "billed_charge": 9025.00, "npi": [1003883158] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3462.90, "providers": [{ "billed_charge": 14114.28, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "741166904" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2354.85, "providers": [{ "billed_charge": 14906.51, "npi": [1477516466] } ] } ] }, { "tin": { "type": "ein", "value": "760591590" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1712.87, "providers": [{ "billed_charge": 24462.00, "npi": [1679557888] } ] } ] }, { "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 50466.78, "providers": [{ "billed_charge": 707642.50, "npi": [1730132234] } ] }, { "allowed_amount": 21705.43, "providers": [{ "billed_charge": 275816.75, "npi": [1295843787] } ] }, { "allowed_amount": 8504.56, "providers": [{ "billed_charge": 100630.25, "npi": [1982666111] } ] }, { "allowed_amount": 9627.52, "providers": [{ "billed_charge": 111367.50, "npi": [1740233782] } ] }, { "allowed_amount": 11653.80, "providers": [{ "billed_charge": 135842.50, "npi": [1932152337] } ] } ] }, { "tin": { "type": "ein", "value": "750972805" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5034.78, "providers": [{ "billed_charge": 29682.75, "npi": [1174533343] } ] } ] }, { "tin": { "type": "ein", "value": "750818167" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 969.89, "providers": [{ "billed_charge": 26529.00, "npi": [1679578439] } ] } ] }, { "tin": { "type": "ein", "value": "756004221" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 868.22, "providers": [{ "billed_charge": 10000.00, "npi": [1932123247] } ] } ] }, { "tin": { "type": "ein", "value": "751438726" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4670.48, "providers": [{ "billed_charge": 26982.00, "npi": [1104845015] } ] } ] }, { "tin": { "type": "ein", "value": "752770738" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 627.06, "providers": [{ "billed_charge": 7067.25, "npi": [1770514077] } ] } ] }, { "tin": { "type": "ein", "value": "741536936" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17654.54, "providers": [{ "billed_charge": 114119.00, "npi": [1205900370] } ] } ] }, { "tin": { "type": "ein", "value": "742225672" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 884.10, "providers": [{ "billed_charge": 8539.17, "npi": [1629089966] } ] }, { "allowed_amount": 1217.73, "providers": [{ "billed_charge": 12318.51, "npi": [1629089966] } ] } ] }, { "tin": { "type": "ein", "value": "751008430" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 962.22, "providers": [{ "billed_charge": 6017.88, "npi": [1669472387] } ] } ] }, { "tin": { "type": "ein", "value": "750974351" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 217.38, "providers": [{ "billed_charge": 10199.00, "npi": [1124092036] } ] } ] }, { "tin": { "type": "ein", "value": "741161944" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3051.51, "providers": [{ "billed_charge": 12340.06, "npi": [1891882833] } ] } ] }, { "tin": { "type": "ein", "value": "752586857" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5929.78, "providers": [{ "billed_charge": 29572.31, "npi": [1992700983] } ] } ] }, { "tin": { "type": "ein", "value": "741287015" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6312.47, "providers": [{ "billed_charge": 165279.00, "npi": [1891789772] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 385.65, "providers": [{ "billed_charge": 5349.00, "npi": [1407191984] } ] } ] }, { "tin": { "type": "ein", "value": "741180155" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1627.75, "providers": [{ "billed_charge": 27716.00, "npi": [1548387418] } ] } ] }, { "tin": { "type": "ein", "value": "751047527" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 190.21, "providers": [{ "billed_charge": 1130.50, "npi": [1396779948] } ] } ] }, { "tin": { "type": "ein", "value": "756001743" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6862.52, "providers": [{ "billed_charge": 37387.25, "npi": [1336172105] } ] } ] } ] }, { "name": "CMPTR OPHTH IMG OPTIC NERVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92133", "description": "SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERPRETATION AND RPT, UN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 652.08, "providers": [{ "billed_charge": 2200.00, "npi": [1104203074] } ] } ] } ] }, { "name": "CPTR OPHTH DX IMG POST SEGMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92134", "description": "SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERPRETATION AND RPT, UN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3044.01, "providers": [{ "billed_charge": 10670.00, "npi": [1104203074] } ] } ] } ] }, { "name": "EYE PHOTOGRAPHY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92285", "description": "EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742868879" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 767.04, "providers": [{ "billed_charge": 4080.00, "npi": [1104203074] } ] } ] } ] }, { "name": "SPEECH/HEARING THERAPY", "billing_code_type": "CPT", "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": "270960116" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2000.00, "providers": [{ "billed_charge": 3900.00, "npi": [1306170576] } ] } ] }, { "tin": { "type": "ein", "value": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2164.96, "providers": [{ "billed_charge": 3360.00, "npi": [1215122056] } ] } ] }, { "tin": { "type": "ein", "value": "470944519" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1444.44, "providers": [{ "billed_charge": 7956.00, "npi": [1194889659] } ] } ] }, { "tin": { "type": "ein", "value": "832421583" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 64.79, "providers": [{ "billed_charge": 180.00, "npi": [1346564622] } ] }, { "allowed_amount": 453.53, "providers": [{ "billed_charge": 1070.00, "npi": [1346564622] } ] }, { "allowed_amount": 4405.72, "providers": [{ "billed_charge": 10210.00, "npi": [1346564622] } ] } ] }, { "tin": { "type": "ein", "value": "830379784" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 404.53, "providers": [{ "billed_charge": 875.00, "npi": [1740392729] } ] } ] }, { "tin": { "type": "ein", "value": "760645849" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2706.20, "providers": [{ "billed_charge": 6300.00, "npi": [1841204898] } ] } ] }, { "tin": { "type": "ein", "value": "741679824" }, "service_code": ["12", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 2752.26, "providers": [{ "billed_charge": 5880.00, "npi": [1942665823] } ] }, { "allowed_amount": 720.83, "providers": [{ "billed_charge": 1540.00, "npi": [1942665823] } ] } ] } ] }, { "name": "PURE TONE AUDIOMETRY, AIR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92552", "description": "PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 641.70, "providers": [{ "billed_charge": 1440.00, "npi": [1437203676] } ] } ] } ] }, { "name": "USE OF SPEECH DEVICE SERVICE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92609", "description": "THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING PROGRAMMING AND MODIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "813743218" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 446.96, "providers": [{ "billed_charge": 1200.00, "npi": [1568885309] } ] } ] } ] }, { "name": "AEP SCR AUDITORY POTENTIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92650", "description": "AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "650578395" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8410.80, "providers": [{ "billed_charge": 28036.00, "npi": [1780642041] } ] }, { "allowed_amount": 195.60, "providers": [{ "billed_charge": 652.00, "npi": [1770548190] } ] }, { "allowed_amount": 1564.80, "providers": [{ "billed_charge": 5216.00, "npi": [1043211394] } ] } ] }, { "tin": { "type": "ein", "value": "752740653" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5183.40, "providers": [{ "billed_charge": 17278.00, "npi": [1174547608] } ] }, { "allowed_amount": 953.84, "providers": [{ "billed_charge": 5542.00, "npi": [1699087429] } ] } ] } ] }, { "name": "ELECTROCARDIOGRAM, COMPLETE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93000", "description": "ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.44, "providers": [{ "billed_charge": 108.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.61, "providers": [{ "billed_charge": 45.01, "npi": [1942535828] } ] } ] } ] }, { "name": "ELECTROCARDIOGRAM REPORT", "billing_code_type": "CPT", "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": "920192097" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.85, "providers": [{ "billed_charge": 66.00, "npi": [1467441428] } ] }, { "allowed_amount": 584.99, "providers": [{ "billed_charge": 1342.00, "npi": [1023007085] } ] }, { "allowed_amount": 47.70, "providers": [{ "billed_charge": 132.00, "npi": [1336660984] } ] }, { "allowed_amount": 38.36, "providers": [{ "billed_charge": 88.00, "npi": [1700061736] } ] }, { "allowed_amount": 15.90, "providers": [{ "billed_charge": 44.00, "npi": [1700061736] } ] }, { "allowed_amount": 419.00, "providers": [{ "billed_charge": 968.00, "npi": [1336660984] } ] }, { "allowed_amount": 55.65, "providers": [{ "billed_charge": 154.00, "npi": [1336660984, 1023007085] } ] }, { "allowed_amount": 153.44, "providers": [{ "billed_charge": 352.00, "npi": [1467441428] } ] }, { "allowed_amount": 111.30, "providers": [{ "billed_charge": 308.00, "npi": [1023007085] } ] } ] }, { "tin": { "type": "ein", "value": "352526373" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 88.88, "providers": [{ "billed_charge": 183.26, "npi": [1477754190] } ] }, { "allowed_amount": 46.60, "providers": [{ "billed_charge": 83.30, "npi": [1407086705] } ] }, { "allowed_amount": 129.28, "providers": [{ "billed_charge": 266.56, "npi": [1417974155] } ] }, { "allowed_amount": 19.50, "providers": [{ "billed_charge": 33.32, "npi": [1104092741] } ] }, { "allowed_amount": 80.80, "providers": [{ "billed_charge": 166.60, "npi": [1477754190, 1417974155] } ] }, { "allowed_amount": 9.75, "providers": [{ "billed_charge": 16.66, "npi": [1477754190] } ] }, { "allowed_amount": 139.80, "providers": [{ "billed_charge": 249.90, "npi": [1407086705] } ] }, { "allowed_amount": 282.80, "providers": [{ "billed_charge": 578.62, "npi": [1104092741] } ] }, { "allowed_amount": 64.64, "providers": [{ "billed_charge": 132.64, "npi": [1104092741] } ] } ] }, { "tin": { "type": "ein", "value": "814094395" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.68, "providers": [{ "billed_charge": 72.00, "npi": [1457395360] } ] }, { "allowed_amount": 10.66, "providers": [{ "billed_charge": 36.00, "npi": [1649272923] } ] }, { "allowed_amount": 130.08, "providers": [{ "billed_charge": 432.00, "npi": [1457395360] } ] }, { "allowed_amount": 138.58, "providers": [{ "billed_charge": 468.00, "npi": [1649272923] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 177.34, "providers": [{ "billed_charge": 810.00, "npi": [1215321476] } ] }, { "allowed_amount": 231.00, "providers": [{ "billed_charge": 1260.00, "npi": [1235591389] } ] }, { "allowed_amount": 308.45, "providers": [{ "billed_charge": 1395.00, "npi": [1295811099] } ] }, { "allowed_amount": 8.25, "providers": [{ "billed_charge": 45.00, "npi": [1780905810] } ] }, { "allowed_amount": 1084.55, "providers": [{ "billed_charge": 4905.00, "npi": [1235591389] } ] }, { "allowed_amount": 49.50, "providers": [{ "billed_charge": 270.00, "npi": [1821403775] } ] }, { "allowed_amount": 348.25, "providers": [{ "billed_charge": 1575.00, "npi": [1780905810] } ] }, { "allowed_amount": 318.40, "providers": [{ "billed_charge": 1440.00, "npi": [1821403775] } ] }, { "allowed_amount": 41.25, "providers": [{ "billed_charge": 225.00, "npi": [1780905810] } ] }, { "allowed_amount": 78.72, "providers": [{ "billed_charge": 360.00, "npi": [1215321476] } ] }, { "allowed_amount": 16.50, "providers": [{ "billed_charge": 90.00, "npi": [1215321476] } ] }, { "allowed_amount": 57.75, "providers": [{ "billed_charge": 315.00, "npi": [1295811099] } ] } ] }, { "tin": { "type": "ein", "value": "872457837" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 309.96, "providers": [{ "billed_charge": 1323.00, "npi": [1306596697] } ] } ] }, { "tin": { "type": "ein", "value": "752616977" }, "service_code": ["22", "11", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.18, "providers": [{ "billed_charge": 38.00, "npi": [1902817992] } ] }, { "allowed_amount": 9.50, "providers": [{ "billed_charge": 19.00, "npi": [1770019549] } ] }, { "allowed_amount": 177.12, "providers": [{ "billed_charge": 304.00, "npi": [1326038159] } ] }, { "allowed_amount": 44.28, "providers": [{ "billed_charge": 76.00, "npi": [1619114659] } ] }, { "allowed_amount": 109.22, "providers": [{ "billed_charge": 190.00, "npi": [1831261809] } ] }, { "allowed_amount": 22.14, "providers": [{ "billed_charge": 38.00, "npi": [1639344310, 1811987654, 1033537873] } ] }, { "allowed_amount": 124.67, "providers": [{ "billed_charge": 247.00, "npi": [1679990527] } ] }, { "allowed_amount": 33.21, "providers": [{ "billed_charge": 57.00, "npi": [1831261809, 1568751196] } ] }, { "allowed_amount": 77.42, "providers": [{ "billed_charge": 133.00, "npi": [1033537873] } ] }, { "allowed_amount": 15.74, "providers": [{ "billed_charge": 38.00, "npi": [1730186610, 1376955492] } ] }, { "allowed_amount": 332.59, "providers": [{ "billed_charge": 665.00, "npi": [1376955492] } ] }, { "allowed_amount": 110.70, "providers": [{ "billed_charge": 190.00, "npi": [1811987654] } ] }, { "allowed_amount": 123.50, "providers": [{ "billed_charge": 247.00, "npi": [1730186610] } ] }, { "allowed_amount": 54.80, "providers": [{ "billed_charge": 95.00, "npi": [1982701652] } ] }, { "allowed_amount": 31.48, "providers": [{ "billed_charge": 76.00, "npi": [1730186610] } ] }, { "allowed_amount": 77.49, "providers": [{ "billed_charge": 133.00, "npi": [1568751196] } ] }, { "allowed_amount": 11.07, "providers": [{ "billed_charge": 19.00, "npi": [1639344310, 1578004859, 1326038159, 1831261809, 1578935268, 1033537873, 1568751196, 1770019549] } ] }, { "allowed_amount": 164.40, "providers": [{ "billed_charge": 285.00, "npi": [1982701652] } ] }, { "allowed_amount": 66.42, "providers": [{ "billed_charge": 114.00, "npi": [1578935268] } ] }, { "allowed_amount": 157.56, "providers": [{ "billed_charge": 380.00, "npi": [1376955492] } ] }, { "allowed_amount": 31.80, "providers": [{ "billed_charge": 76.00, "npi": [1679990527] } ] } ] }, { "tin": { "type": "ein", "value": "332241086" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.00, "providers": [{ "billed_charge": 200.00, "npi": [1871538165] } ] }, { "allowed_amount": 517.40, "providers": [{ "billed_charge": 2600.00, "npi": [1225267081] } ] }, { "allowed_amount": 239.25, "providers": [{ "billed_charge": 1450.00, "npi": [1164499240] } ] }, { "allowed_amount": 8.25, "providers": [{ "billed_charge": 50.00, "npi": [1881945236, 1841546157, 1922478841] } ] }, { "allowed_amount": 19.90, "providers": [{ "billed_charge": 100.00, "npi": [1205350428] } ] }, { "allowed_amount": 368.15, "providers": [{ "billed_charge": 1850.00, "npi": [1134475239] } ] }, { "allowed_amount": 960.11, "providers": [{ "billed_charge": 4850.00, "npi": [1164499240] } ] }, { "allowed_amount": 149.25, "providers": [{ "billed_charge": 750.00, "npi": [1841546157] } ] }, { "allowed_amount": 198.00, "providers": [{ "billed_charge": 1200.00, "npi": [1356590970] } ] }, { "allowed_amount": 24.75, "providers": [{ "billed_charge": 150.00, "npi": [1205350428, 1881945236] } ] }, { "allowed_amount": 675.52, "providers": [{ "billed_charge": 3400.00, "npi": [1356590970] } ] }, { "allowed_amount": 79.60, "providers": [{ "billed_charge": 400.00, "npi": [1881945236] } ] }, { "allowed_amount": 159.00, "providers": [{ "billed_charge": 420.00, "npi": [1902843949] } ] }, { "allowed_amount": 206.25, "providers": [{ "billed_charge": 1250.00, "npi": [1134475239] } ] }, { "allowed_amount": 173.25, "providers": [{ "billed_charge": 1050.00, "npi": [1225267081] } ] }, { "allowed_amount": 69.65, "providers": [{ "billed_charge": 350.00, "npi": [1922478841] } ] }, { "allowed_amount": 16.50, "providers": [{ "billed_charge": 100.00, "npi": [1356590970, 1225267081] } ] }, { "allowed_amount": 89.07, "providers": [{ "billed_charge": 450.00, "npi": [1871538165] } ] }, { "allowed_amount": 82.50, "providers": [{ "billed_charge": 500.00, "npi": [1164499240] } ] }, { "allowed_amount": 383.60, "providers": [{ "billed_charge": 840.00, "npi": [1902843949] } ] }, { "allowed_amount": 29.85, "providers": [{ "billed_charge": 150.00, "npi": [1639161011] } ] } ] }, { "tin": { "type": "ein", "value": "760324613" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.38, "providers": [{ "billed_charge": 612.00, "npi": [1750709895] } ] }, { "allowed_amount": 7.91, "providers": [{ "billed_charge": 34.00, "npi": [1487948436] } ] }, { "allowed_amount": 197.75, "providers": [{ "billed_charge": 850.00, "npi": [1740569227] } ] }, { "allowed_amount": 134.47, "providers": [{ "billed_charge": 578.00, "npi": [1487948436, 1750709895] } ] }, { "allowed_amount": 79.10, "providers": [{ "billed_charge": 340.00, "npi": [1740569227] } ] }, { "allowed_amount": 126.56, "providers": [{ "billed_charge": 544.00, "npi": [1497242382] } ] }, { "allowed_amount": 87.01, "providers": [{ "billed_charge": 374.00, "npi": [1487948436] } ] }, { "allowed_amount": 102.83, "providers": [{ "billed_charge": 442.00, "npi": [1497242382] } ] }, { "allowed_amount": 15.82, "providers": [{ "billed_charge": 68.00, "npi": [1497242382] } ] } ] }, { "tin": { "type": "ein", "value": "831838607" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.00, "providers": [{ "billed_charge": 26.00, "npi": [1225020522] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.75, "providers": [{ "billed_charge": 200.00, "npi": [1144315417] } ] } ] }, { "tin": { "type": "ein", "value": "822018496" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.40, "providers": [{ "billed_charge": 420.00, "npi": [1609131929] } ] }, { "allowed_amount": 82.50, "providers": [{ "billed_charge": 350.00, "npi": [1609131929] } ] } ] }, { "tin": { "type": "ein", "value": "851164952" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.89, "providers": [{ "billed_charge": 770.00, "npi": [1982047676] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.00, "providers": [{ "billed_charge": 133.00, "npi": [1427201375] } ] }, { "allowed_amount": 40.05, "providers": [{ "billed_charge": 82.00, "npi": [1457324592] } ] }, { "allowed_amount": 278.10, "providers": [{ "billed_charge": 549.00, "npi": [1811158983] } ] }, { "allowed_amount": 39.75, "providers": [{ "billed_charge": 80.00, "npi": [1124254784] }, { "billed_charge": 81.00, "npi": [1548524812] } ] }, { "allowed_amount": 676.60, "providers": [{ "billed_charge": 1105.00, "npi": [1164685277] } ] }, { "allowed_amount": 49.75, "providers": [{ "billed_charge": 83.00, "npi": [1285012518] } ] }, { "allowed_amount": 24.75, "providers": [{ "billed_charge": 48.00, "npi": [1902024987] } ] }, { "allowed_amount": 23.85, "providers": [{ "billed_charge": 48.00, "npi": [1174753917] } ] }, { "allowed_amount": 159.20, "providers": [{ "billed_charge": 261.00, "npi": [1770878670] } ] }, { "allowed_amount": 49.50, "providers": [{ "billed_charge": 96.00, "npi": [1508253402] } ] }, { "allowed_amount": 288.75, "providers": [{ "billed_charge": 571.00, "npi": [1417278714] } ] }, { "allowed_amount": 87.39, "providers": [{ "billed_charge": 145.00, "npi": [1073847042] } ] }, { "allowed_amount": 82.50, "providers": [{ "billed_charge": 169.00, "npi": [1982893129] } ] }, { "allowed_amount": 88.05, "providers": [{ "billed_charge": 179.00, "npi": [1548524812] } ] }, { "allowed_amount": 577.10, "providers": [{ "billed_charge": 947.00, "npi": [1417278714] } ] }, { "allowed_amount": 48.67, "providers": [{ "billed_charge": 85.00, "npi": [1376569061] } ] }, { "allowed_amount": 191.70, "providers": [{ "billed_charge": 392.00, "npi": [1609851377] } ] }, { "allowed_amount": 248.75, "providers": [{ "billed_charge": 423.00, "npi": [1982893129] } ] }, { "allowed_amount": 805.46, "providers": [{ "billed_charge": 1324.00, "npi": [1811158983] } ] }, { "allowed_amount": 29.85, "providers": [{ "billed_charge": 48.00, "npi": [1467895078] } ] }, { "allowed_amount": 375.09, "providers": [{ "billed_charge": 641.00, "npi": [1609851377] } ] }, { "allowed_amount": 58.62, "providers": [{ "billed_charge": 96.00, "npi": [1174753917] } ] }, { "allowed_amount": 8.25, "providers": [{ "billed_charge": 16.00, "npi": [1285012518, 1508253402, 1326579277] }, { "billed_charge": 17.00, "npi": [1376569061, 1124281118] } ] }, { "allowed_amount": 9.59, "providers": [{ "billed_charge": 16.00, "npi": [1609131762] } ] }, { "allowed_amount": 38.36, "providers": [{ "billed_charge": 64.00, "npi": [1124254784] } ] }, { "allowed_amount": 134.26, "providers": [{ "billed_charge": 227.00, "npi": [1053706804] } ] }, { "allowed_amount": 364.78, "providers": [{ "billed_charge": 617.00, "npi": [1548524812] } ] }, { "allowed_amount": 41.25, "providers": [{ "billed_charge": 80.00, "npi": [1770878670] }, { "billed_charge": 81.00, "npi": [1164685277] } ] }, { "allowed_amount": 39.80, "providers": [{ "billed_charge": 65.00, "npi": [1902024987] } ] }, { "allowed_amount": 7.95, "providers": [{ "billed_charge": 17.00, "npi": [1710364377] } ] }, { "allowed_amount": 124.67, "providers": [{ "billed_charge": 209.00, "npi": [1982895850] } ] }, { "allowed_amount": 9.95, "providers": [{ "billed_charge": 16.00, "npi": [1710364377, 1326579277, 1497733018] } ] }, { "allowed_amount": 74.25, "providers": [{ "billed_charge": 148.00, "npi": [1417278714] } ] }, { "allowed_amount": 57.75, "providers": [{ "billed_charge": 115.00, "npi": [1427201375] } ] }, { "allowed_amount": 105.85, "providers": [{ "billed_charge": 181.00, "npi": [1457324592] } ] }, { "allowed_amount": 222.75, "providers": [{ "billed_charge": 440.00, "npi": [1164685277] } ] }, { "allowed_amount": 140.25, "providers": [{ "billed_charge": 276.00, "npi": [1770878670] } ] }, { "allowed_amount": 32.10, "providers": [{ "billed_charge": 65.00, "npi": [1073539755] } ] }, { "allowed_amount": 15.90, "providers": [{ "billed_charge": 33.00, "npi": [1073847042] }, { "billed_charge": 34.00, "npi": [1073847042, 1053706804] }, { "billed_charge": 32.00, "npi": [1174753917] } ] }, { "allowed_amount": 16.50, "providers": [{ "billed_charge": 33.00, "npi": [1467895078] }, { "billed_charge": 34.00, "npi": [1982893129] }, { "billed_charge": 32.00, "npi": [1467895078, 1124281118] } ] }, { "allowed_amount": 143.40, "providers": [{ "billed_charge": 294.00, "npi": [1609851377] } ] }, { "allowed_amount": 117.96, "providers": [{ "billed_charge": 199.00, "npi": [1073539755] } ] }, { "allowed_amount": 99.50, "providers": [{ "billed_charge": 166.00, "npi": [1427201375] }, { "billed_charge": 162.00, "npi": [1508253402] } ] }, { "allowed_amount": 31.80, "providers": [{ "billed_charge": 66.00, "npi": [1982895850] }, { "billed_charge": 64.00, "npi": [1053706804] } ] }, { "allowed_amount": 88.35, "providers": [{ "billed_charge": 176.00, "npi": [1811158983] } ] } ] }, { "tin": { "type": "ein", "value": "260856658" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.50, "providers": [{ "billed_charge": 60.00, "npi": [1952391161] } ] }, { "allowed_amount": 74.25, "providers": [{ "billed_charge": 270.00, "npi": [1952391161] } ] } ] }, { "tin": { "type": "ein", "value": "742958277" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.59, "providers": [{ "billed_charge": 41.00, "npi": [1578640884] } ] }, { "allowed_amount": 134.26, "providers": [{ "billed_charge": 574.00, "npi": [1902867146] } ] }, { "allowed_amount": 7.95, "providers": [{ "billed_charge": 41.00, "npi": [1659639433, 1245597400, 1821058512] } ] }, { "allowed_amount": 76.72, "providers": [{ "billed_charge": 328.00, "npi": [1659639433] } ] }, { "allowed_amount": 297.29, "providers": [{ "billed_charge": 1271.00, "npi": [1578586715] } ] }, { "allowed_amount": 57.54, "providers": [{ "billed_charge": 246.00, "npi": [1245597400] } ] }, { "allowed_amount": 55.60, "providers": [{ "billed_charge": 287.00, "npi": [1619405784] } ] }, { "allowed_amount": 47.95, "providers": [{ "billed_charge": 205.00, "npi": [1386808723] } ] }, { "allowed_amount": 23.85, "providers": [{ "billed_charge": 123.00, "npi": [1902867146, 1386808723] } ] }, { "allowed_amount": 47.71, "providers": [{ "billed_charge": 246.00, "npi": [1578586715] } ] }, { "allowed_amount": 166.95, "providers": [{ "billed_charge": 861.00, "npi": [1821058512] } ] }, { "allowed_amount": 15.90, "providers": [{ "billed_charge": 82.00, "npi": [1336533637, 1619405784] } ] }, { "allowed_amount": 632.97, "providers": [{ "billed_charge": 2706.00, "npi": [1821058512] } ] }, { "allowed_amount": 326.06, "providers": [{ "billed_charge": 1394.00, "npi": [1619405784] } ] }, { "allowed_amount": 67.13, "providers": [{ "billed_charge": 287.00, "npi": [1336533637] } ] } ] }, { "tin": { "type": "ein", "value": "751277293" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.10, "providers": [{ "billed_charge": 72.00, "npi": [1821260670] } ] }, { "allowed_amount": 15.90, "providers": [{ "billed_charge": 48.00, "npi": [1821260670] } ] }, { "allowed_amount": 162.89, "providers": [{ "billed_charge": 432.00, "npi": [1821260670] } ] } ] }, { "tin": { "type": "ein", "value": "274468883" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.38, "providers": [{ "billed_charge": 44.00, "npi": [1194769133] } ] } ] }, { "tin": { "type": "ein", "value": "232238976" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.18, "providers": [{ "billed_charge": 210.00, "npi": [1710996194, 1417113945] } ] }, { "allowed_amount": 86.31, "providers": [{ "billed_charge": 945.00, "npi": [1760649289] } ] }, { "allowed_amount": 198.77, "providers": [{ "billed_charge": 2625.00, "npi": [1932175981] } ] }, { "allowed_amount": 105.49, "providers": [{ "billed_charge": 1155.00, "npi": [1659312775] } ] }, { "allowed_amount": 79.51, "providers": [{ "billed_charge": 1050.00, "npi": [1487628293, 1013949601] } ] }, { "allowed_amount": 7.95, "providers": [{ "billed_charge": 105.00, "npi": [1245234293] } ] }, { "allowed_amount": 71.56, "providers": [{ "billed_charge": 945.00, "npi": [1760649289] } ] }, { "allowed_amount": 143.11, "providers": [{ "billed_charge": 1890.00, "npi": [1447424007] } ] }, { "allowed_amount": 39.76, "providers": [{ "billed_charge": 525.00, "npi": [1710996194] } ] }, { "allowed_amount": 39.75, "providers": [{ "billed_charge": 525.00, "npi": [1659312775] } ] }, { "allowed_amount": 239.75, "providers": [{ "billed_charge": 2625.00, "npi": [1447424007] } ] }, { "allowed_amount": 238.52, "providers": [{ "billed_charge": 3150.00, "npi": [1932175981] } ] }, { "allowed_amount": 119.28, "providers": [{ "billed_charge": 1575.00, "npi": [1659312775] } ] }, { "allowed_amount": 47.95, "providers": [{ "billed_charge": 525.00, "npi": [1245234293] } ] }, { "allowed_amount": 354.84, "providers": [{ "billed_charge": 3885.00, "npi": [1932175981] } ] }, { "allowed_amount": 28.77, "providers": [{ "billed_charge": 315.00, "npi": [1568465094] } ] }, { "allowed_amount": 47.71, "providers": [{ "billed_charge": 630.00, "npi": [1760649289, 1245234293] } ] }, { "allowed_amount": 105.50, "providers": [{ "billed_charge": 1155.00, "npi": [1013949601] } ] }, { "allowed_amount": 159.00, "providers": [{ "billed_charge": 2100.00, "npi": [1487628293] } ] }, { "allowed_amount": 335.66, "providers": [{ "billed_charge": 3675.00, "npi": [1487628293] } ] }, { "allowed_amount": 111.32, "providers": [{ "billed_charge": 1470.00, "npi": [1447424007] } ] }, { "allowed_amount": 23.80, "providers": [{ "billed_charge": 315.00, "npi": [1568465094] } ] }, { "allowed_amount": 31.80, "providers": [{ "billed_charge": 420.00, "npi": [1568465094, 1013949601] } ] } ] }, { "tin": { "type": "ein", "value": "300520570" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.00, "providers": [{ "billed_charge": 400.00, "npi": [1164499240] } ] }, { "allowed_amount": 8.25, "providers": [{ "billed_charge": 50.00, "npi": [1457555021] } ] }, { "allowed_amount": 168.43, "providers": [{ "billed_charge": 850.00, "npi": [1356590970] } ] }, { "allowed_amount": 16.50, "providers": [{ "billed_charge": 100.00, "npi": [1164499240, 1356590970, 1134475239] } ] }, { "allowed_amount": 82.50, "providers": [{ "billed_charge": 500.00, "npi": [1356590970] } ] }, { "allowed_amount": 198.28, "providers": [{ "billed_charge": 1000.00, "npi": [1164499240] } ] }, { "allowed_amount": 149.25, "providers": [{ "billed_charge": 750.00, "npi": [1134475239] } ] } ] }, { "tin": { "type": "ein", "value": "844504483" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.95, "providers": [{ "billed_charge": 280.00, "npi": [1346982444] } ] }, { "allowed_amount": 9.59, "providers": [{ "billed_charge": 56.00, "npi": [1437310562] } ] } ] }, { "tin": { "type": "ein", "value": "510598546" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 134.27, "providers": [{ "billed_charge": 346.08, "npi": [1316172067] } ] } ] }, { "tin": { "type": "ein", "value": "831325073" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.91, "providers": [{ "billed_charge": 17.66, "npi": [1003257999] } ] }, { "allowed_amount": 47.46, "providers": [{ "billed_charge": 105.96, "npi": [1003257999] } ] } ] }, { "tin": { "type": "ein", "value": "760010407" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.00, "providers": [{ "billed_charge": 60.00, "npi": [1447200308] } ] }, { "allowed_amount": 16.60, "providers": [{ "billed_charge": 60.00, "npi": [1972763159] } ] }, { "allowed_amount": 8.32, "providers": [{ "billed_charge": 30.00, "npi": [1447200308] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22", "23", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.12, "providers": [{ "billed_charge": 176.00, "npi": [1255524179, 1194925040] } ] }, { "allowed_amount": 156.48, "providers": [{ "billed_charge": 704.00, "npi": [1942644703] } ] }, { "allowed_amount": 107.58, "providers": [{ "billed_charge": 484.00, "npi": [1265840334, 1447320585] } ] }, { "allowed_amount": 440.10, "providers": [{ "billed_charge": 1980.00, "npi": [1326088592] } ] }, { "allowed_amount": 78.24, "providers": [{ "billed_charge": 352.00, "npi": [1699825299, 1235162215, 1326010208, 1447320585, 1588817340] } ] }, { "allowed_amount": 166.26, "providers": [{ "billed_charge": 748.00, "npi": [1386616613, 1497756654] } ] }, { "allowed_amount": 166.25, "providers": [{ "billed_charge": 748.00, "npi": [1245263284] } ] }, { "allowed_amount": 254.28, "providers": [{ "billed_charge": 1144.00, "npi": [1609220656] } ] }, { "allowed_amount": 36.06, "providers": [{ "billed_charge": 176.00, "npi": [1710187646] } ] }, { "allowed_amount": 48.90, "providers": [{ "billed_charge": 220.00, "npi": [1235162215] } ] }, { "allowed_amount": 195.60, "providers": [{ "billed_charge": 880.00, "npi": [1124462650] } ] }, { "allowed_amount": 997.56, "providers": [{ "billed_charge": 4488.00, "npi": [1316033962] } ] }, { "allowed_amount": 88.02, "providers": [{ "billed_charge": 396.00, "npi": [1699825299, 1366457921, 1609220656, 1245263284] } ] }, { "allowed_amount": 283.62, "providers": [{ "billed_charge": 1276.00, "npi": [1952629685] } ] }, { "allowed_amount": 753.06, "providers": [{ "billed_charge": 3388.00, "npi": [1588817340] } ] }, { "allowed_amount": 322.74, "providers": [{ "billed_charge": 1452.00, "npi": [1124090469] } ] }, { "allowed_amount": 264.06, "providers": [{ "billed_charge": 1188.00, "npi": [1124462650] } ] }, { "allowed_amount": 58.68, "providers": [{ "billed_charge": 264.00, "npi": [1386616613, 1316033962, 1881946739] } ] }, { "allowed_amount": 361.86, "providers": [{ "billed_charge": 1628.00, "npi": [1194925040] } ] }, { "allowed_amount": 19.56, "providers": [{ "billed_charge": 88.00, "npi": [1023458080, 1396904215, 1326010208, 1780613257, 1265840334] } ] }, { "allowed_amount": 127.14, "providers": [{ "billed_charge": 572.00, "npi": [1952629685, 1588004733, 1780613257, 1255562138] } ] }, { "allowed_amount": 9.78, "providers": [{ "billed_charge": 44.00, "npi": [1124090469, 1477086031, 1255524179, 1437578713, 1326088592, 1588004733, 1609220656] } ] }, { "allowed_amount": 185.82, "providers": [{ "billed_charge": 836.00, "npi": [1609042001] } ] }, { "allowed_amount": 97.80, "providers": [{ "billed_charge": 440.00, "npi": [1851733950, 1124090469] } ] }, { "allowed_amount": 29.34, "providers": [{ "billed_charge": 132.00, "npi": [1851733950, 1477086031, 1437578713, 1497756654] } ] }, { "allowed_amount": 117.36, "providers": [{ "billed_charge": 528.00, "npi": [1023458080, 1780613257] } ] }, { "allowed_amount": 146.70, "providers": [{ "billed_charge": 660.00, "npi": [1609042001, 1326088592, 1255562138] } ] }, { "allowed_amount": 332.86, "providers": [{ "billed_charge": 1496.00, "npi": [1710187646] } ] }, { "allowed_amount": 762.84, "providers": [{ "billed_charge": 3432.00, "npi": [1255524179] } ] }, { "allowed_amount": 68.46, "providers": [{ "billed_charge": 308.00, "npi": [1366457921, 1942644703] } ] }, { "allowed_amount": 224.94, "providers": [{ "billed_charge": 1012.00, "npi": [1588004733] } ] } ] }, { "tin": { "type": "ein", "value": "752613493" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.20, "providers": [{ "billed_charge": 28.00, "npi": [1760508592] } ] }, { "allowed_amount": 32.80, "providers": [{ "billed_charge": 112.00, "npi": [1760508592] } ] } ] }, { "tin": { "type": "ein", "value": "760446083" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.73, "providers": [{ "billed_charge": 105.00, "npi": [1881672103] } ] }, { "allowed_amount": 450.87, "providers": [{ "billed_charge": 1995.00, "npi": [1649456336] } ] }, { "allowed_amount": 7.91, "providers": [{ "billed_charge": 35.00, "npi": [1881672103] } ] }, { "allowed_amount": 656.53, "providers": [{ "billed_charge": 2905.00, "npi": [1881672103] } ] } ] }, { "tin": { "type": "ein", "value": "474649080" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.95, "providers": [{ "billed_charge": 368.55, "npi": [1326400714] } ] }, { "allowed_amount": 28.77, "providers": [{ "billed_charge": 221.13, "npi": [1790866242] } ] }, { "allowed_amount": 9.59, "providers": [{ "billed_charge": 73.71, "npi": [1326280058] } ] }, { "allowed_amount": 57.54, "providers": [{ "billed_charge": 442.26, "npi": [1114069895] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.18, "providers": [{ "billed_charge": 68.00, "npi": [1548257900] } ] }, { "allowed_amount": 23.85, "providers": [{ "billed_charge": 102.00, "npi": [1548257900] } ] }, { "allowed_amount": 9.59, "providers": [{ "billed_charge": 34.00, "npi": [1013949601] } ] }, { "allowed_amount": 47.70, "providers": [{ "billed_charge": 204.00, "npi": [1568465094] } ] }, { "allowed_amount": 38.36, "providers": [{ "billed_charge": 136.00, "npi": [1568465094] } ] }, { "allowed_amount": 7.95, "providers": [{ "billed_charge": 34.00, "npi": [1013949601] } ] } ] }, { "tin": { "type": "ein", "value": "752536818" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.85, "providers": [{ "billed_charge": 450.00, "npi": [1194783274] } ] }, { "allowed_amount": 16.78, "providers": [{ "billed_charge": 60.00, "npi": [1932514817] } ] }, { "allowed_amount": 75.51, "providers": [{ "billed_charge": 270.00, "npi": [1194783274] } ] }, { "allowed_amount": 8.09, "providers": [{ "billed_charge": 30.00, "npi": [1427292705] } ] }, { "allowed_amount": 40.04, "providers": [{ "billed_charge": 120.00, "npi": [1467654764] } ] }, { "allowed_amount": 8.39, "providers": [{ "billed_charge": 30.00, "npi": [1194783274, 1932514817] } ] }, { "allowed_amount": 25.17, "providers": [{ "billed_charge": 90.00, "npi": [1427292705] } ] }, { "allowed_amount": 50.05, "providers": [{ "billed_charge": 150.00, "npi": [1003816745] } ] }, { "allowed_amount": 10.01, "providers": [{ "billed_charge": 30.00, "npi": [1467654764, 1508251265] } ] }, { "allowed_amount": 41.95, "providers": [{ "billed_charge": 150.00, "npi": [1932514817] } ] } ] }, { "tin": { "type": "ein", "value": "471158090" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.85, "providers": [{ "billed_charge": 51.00, "npi": [1053373902] } ] }, { "allowed_amount": 7.95, "providers": [{ "billed_charge": 17.00, "npi": [1053373902] } ] } ] } ] }, { "name": "REMOTE 30 DAY ECG TECH SUPP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93229", "description": "EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY W ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT COMPUTERIZED R", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23004.92, "providers": [{ "billed_charge": 216000.00, "npi": [1234567893] } ] } ] } ] }, { "name": "EXT ECG>48HR<7D SCAN A/R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93243", "description": "EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208149544" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3956.13, "providers": [{ "billed_charge": 10710.00, "npi": [1710130539] } ] } ] } ] }, { "name": "EXT ECG>7D<15D SCAN A/R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93247", "description": "EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208149544" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17831.69, "providers": [{ "billed_charge": 42840.00, "npi": [1710130539] } ] } ] } ] }, { "name": "PM/ICD REMOTE TECH SERV", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93296", "description": "INTERROGATION DEVICE EVALUATION(S) (REMOTE), UP TO 90 DAYS; SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842922023" }, "service_code": ["49"], "billing_class": "professional", "payments": [{ "allowed_amount": 1696.75, "providers": [{ "billed_charge": 1750.00, "npi": [1124678263] } ] } ] } ] }, { "name": "ICM DEVICE INTERROGAT REMOTE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93297", "description": "INTERROGATION DEVICE EVALUATION(S), (REMOTE) UP TO 30 DAYS; IMPLANTABLE CARDIOVASCULAR MONITOR SYSTE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844519944" }, "service_code": ["49"], "billing_class": "professional", "payments": [{ "allowed_amount": 422.28, "providers": [{ "billed_charge": 1920.00, "npi": [1659401974] } ] } ] }, { "tin": { "type": "ein", "value": "842922023" }, "service_code": ["49"], "billing_class": "professional", "payments": [{ "allowed_amount": 719.40, "providers": [{ "billed_charge": 730.00, "npi": [1124678263] } ] } ] } ] }, { "name": "TTE W/DOPPLER COMPLETE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93306", "description": "ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741613878" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 132.60, "providers": [{ "billed_charge": 770.00, "npi": [1770875338] } ] }, { "allowed_amount": 198.90, "providers": [{ "billed_charge": 1155.00, "npi": [1770875338] } ] } ] }, { "tin": { "type": "ein", "value": "831325073" }, "service_code": ["11", "22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 765.52, "providers": [{ "billed_charge": 6041.84, "npi": [1003257999] } ] }, { "allowed_amount": 1419.03, "providers": [{ "billed_charge": 3884.04, "npi": [1003257999] } ] }, { "allowed_amount": 164.04, "providers": [{ "billed_charge": 1294.68, "npi": [1003257999] } ] } ] }, { "tin": { "type": "ein", "value": "272996872" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 65.40, "providers": [{ "billed_charge": 234.00, "npi": [1487867172] } ] } ] } ] }, { "name": "BIS XTRACELL FLUID ANALYSIS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93702", "description": "BIOIMPEDANCE SPECTROSCOPY (BIS), EXTRACELLULAR FLUID ANALYSIS FOR LYMPHEDEMA ASSESSMENT(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "933500990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3950.43, "providers": [{ "billed_charge": 11379.00, "npi": [1770999377] } ] } ] } ] }, { "name": "UPR/L XTREMITY ART 2 LEVELS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93922", "description": "LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2750.55, "providers": [{ "billed_charge": 3300.00, "npi": [1447447545] } ] } ] } ] }, { "name": "EXTREMITY STUDY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93970", "description": "DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "332241086" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.88, "providers": [{ "billed_charge": 432.00, "npi": [1023387339] } ] } ] }, { "tin": { "type": "ein", "value": "272008627" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 91.65, "providers": [{ "billed_charge": 435.00, "npi": [1093717001] } ] } ] } ] }, { "name": "EXTREMITY STUDY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93971", "description": "DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.44, "providers": [{ "billed_charge": 78.00, "npi": [1295799088] } ] }, { "allowed_amount": 93.80, "providers": [{ "billed_charge": 312.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.39, "providers": [{ "billed_charge": 417.00, "npi": [1780624254] } ] } ] } ] }, { "name": "VASCULAR STUDY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93976", "description": "DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "990547982" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.86, "providers": [{ "billed_charge": 218.00, "npi": [1770739260] } ] } ] } ] }, { "name": "OTHER RX SVS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "940", "description": "OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "756000439" }, "service_code": ["22", "23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 102.68, "providers": [{ "billed_charge": 854.00, "npi": [1992753222] } ] }, { "allowed_amount": 107.96, "providers": [{ "billed_charge": 221.00, "npi": [1992753222] } ] }, { "allowed_amount": 83059.63, "providers": [{ "billed_charge": 738473.00, "npi": [1992753222] } ] } ] }, { "tin": { "type": "ein", "value": "452750258" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3851.05, "providers": [{ "billed_charge": 12750.00, "npi": [1003192311] } ] } ] } ] }, { "name": "EDUC/TRAINING", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "942", "description": "OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741152597" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 42.56, "providers": [{ "billed_charge": 43.75, "npi": [1740233782] } ] }, { "allowed_amount": 41.49, "providers": [{ "billed_charge": 43.75, "npi": [1295788735] } ] }, { "allowed_amount": 2692.22, "providers": [{ "billed_charge": 5346.50, "npi": [1730132234] } ] }, { "allowed_amount": 124.47, "providers": [{ "billed_charge": 131.25, "npi": [1932152337] } ] }, { "allowed_amount": 255.36, "providers": [{ "billed_charge": 262.50, "npi": [1295843787] } ] }, { "allowed_amount": 308.00, "providers": [{ "billed_charge": 745.25, "npi": [1982666111] } ] } ] } ] }, { "name": "ANTIGEN THERAPY SERVICES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95144", "description": "PROFESSIONAL SERVICES FOR THE SUPERVISION OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "854247861" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10028.17, "providers": [{ "billed_charge": 12040.00, "npi": [1093144560] } ] } ] } ] }, { "name": "GLUC MONITOR, CONT, PHYS I&R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95251", "description": "AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBCUTANEOUS SENSOR FOR ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.44, "providers": [{ "billed_charge": 400.00, "npi": [1508068438] } ] } ] } ] }, { "name": "SLP STDY UNATTENDED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95800", "description": "SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; HEART RATE, OXYGEN SATURATION, RESPIRATORY ANALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "262531558" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7927.04, "providers": [{ "billed_charge": 58800.00, "npi": [1861655961] } ] } ] } ] }, { "name": "MUSC TEST DONE W/N TEST COMP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95886", "description": "NEEDLE ELECTROMYOGRAPHY, EACH EXTREM, W RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE W NERVE CONDU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6598.02, "providers": [{ "billed_charge": 9900.00, "npi": [1447447545] } ] } ] } ] }, { "name": "NRV CNDJ TEST 13/> STUDIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95913", "description": "NERVE CONDUCTION STUDIES; 13 OR MORE STUDIES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9953.79, "providers": [{ "billed_charge": 49500.00, "npi": [1447447545] } ] } ] } ] }, { "name": "AUTONOMIC NRV PARASYM INERVJ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95921", "description": "TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPATHETIC FUNCTION), IN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2986.50, "providers": [{ "billed_charge": 3350.00, "npi": [1447447545] } ] } ] } ] }, { "name": "AUTONOMIC NRV SYST FUNJ TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95923", "description": "TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING 1 OR MORE OF THE FOLLOWING: QUANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4052.40, "providers": [{ "billed_charge": 6600.00, "npi": [1447447545] } ] } ] } ] }, { "name": "NEUROMUSCULAR JUNCTION TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95937", "description": "NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY 1 METHOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300106470" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7037.58, "providers": [{ "billed_charge": 9900.00, "npi": [1447447545] } ] } ] } ] }, { "name": "BRIEF EMOTIONAL/BEHAV ASSMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96127", "description": "BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760540476" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.66, "providers": [{ "billed_charge": 396.00, "npi": [1609288208] } ] } ] }, { "tin": { "type": "ein", "value": "863745753" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.30, "providers": [{ "billed_charge": 300.00, "npi": [1831561158] } ] } ] }, { "tin": { "type": "ein", "value": "462456505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.22, "providers": [{ "billed_charge": 48.00, "npi": [1164865762] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.70, "providers": [{ "billed_charge": 75.00, "npi": [1508068438] } ] }, { "allowed_amount": 4.74, "providers": [{ "billed_charge": 15.00, "npi": [1508068438] } ] } ] } ] }, { "name": "HLTH BHV ASSMT/REASSESSMENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96156", "description": "HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 583.65, "providers": [{ "billed_charge": 990.00, "npi": [1265079396] } ] }, { "allowed_amount": 259.40, "providers": [{ "billed_charge": 440.00, "npi": [1972124824, 1548866213, 1932679677] } ] }, { "allowed_amount": 453.95, "providers": [{ "billed_charge": 770.00, "npi": [1093556680] } ] }, { "allowed_amount": 3820.32, "providers": [{ "billed_charge": 5280.00, "npi": [1932679677] } ] }, { "allowed_amount": 8436.54, "providers": [{ "billed_charge": 11660.00, "npi": [1972124824] } ] }, { "allowed_amount": 3183.60, "providers": [{ "billed_charge": 4400.00, "npi": [1548866213] } ] }, { "allowed_amount": 2387.70, "providers": [{ "billed_charge": 3300.00, "npi": [1093556680] } ] }, { "allowed_amount": 4536.63, "providers": [{ "billed_charge": 6270.00, "npi": [1265079396] } ] }, { "allowed_amount": 194.55, "providers": [{ "billed_charge": 330.00, "npi": [1093556680] } ] }, { "allowed_amount": 64.85, "providers": [{ "billed_charge": 110.00, "npi": [1396411104] } ] }, { "allowed_amount": 324.25, "providers": [{ "billed_charge": 550.00, "npi": [1265079396, 1932679677] } ] }, { "allowed_amount": 397.95, "providers": [{ "billed_charge": 550.00, "npi": [1396411104] } ] }, { "allowed_amount": 389.10, "providers": [{ "billed_charge": 660.00, "npi": [1548866213] } ] } ] } ] }, { "name": "HLTH BHV IVNTJ INDIV 1ST 30", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96158", "description": "HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 89.32, "providers": [{ "billed_charge": 220.00, "npi": [1972124824, 1932679677] } ] }, { "allowed_amount": 178.64, "providers": [{ "billed_charge": 440.00, "npi": [1265079396, 1972124824] } ] }, { "allowed_amount": 312.62, "providers": [{ "billed_charge": 770.00, "npi": [1265079396] } ] }, { "allowed_amount": 625.24, "providers": [{ "billed_charge": 1540.00, "npi": [1396411104] } ] }, { "allowed_amount": 535.92, "providers": [{ "billed_charge": 1320.00, "npi": [1932679677] } ] }, { "allowed_amount": 2131.35, "providers": [{ "billed_charge": 4290.00, "npi": [1932679677] } ] }, { "allowed_amount": 1429.12, "providers": [{ "billed_charge": 3520.00, "npi": [1396411104] } ] }, { "allowed_amount": 7596.35, "providers": [{ "billed_charge": 15290.00, "npi": [1093556680] } ] }, { "allowed_amount": 273.25, "providers": [{ "billed_charge": 550.00, "npi": [1558903542] } ] }, { "allowed_amount": 4809.20, "providers": [{ "billed_charge": 9680.00, "npi": [1396411104] } ] }, { "allowed_amount": 3115.05, "providers": [{ "billed_charge": 6270.00, "npi": [1548866213] } ] }, { "allowed_amount": 133.98, "providers": [{ "billed_charge": 330.00, "npi": [1548866213] } ] }, { "allowed_amount": 1803.45, "providers": [{ "billed_charge": 3630.00, "npi": [1265079396] } ] }, { "allowed_amount": 4535.95, "providers": [{ "billed_charge": 9130.00, "npi": [1972124824] } ] }, { "allowed_amount": 267.96, "providers": [{ "billed_charge": 660.00, "npi": [1558903542] } ] } ] } ] }, { "name": "PT-FOCUSED HLTH RISK ASSMT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96160", "description": "ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760537608" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.55, "providers": [{ "billed_charge": 45.00, "npi": [1770583411] } ] } ] }, { "tin": { "type": "ein", "value": "760549240" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.12, "providers": [{ "billed_charge": 306.00, "npi": [1770998999] } ] }, { "allowed_amount": 47.20, "providers": [{ "billed_charge": 360.00, "npi": [1053772129] } ] } ] } ] }, { "name": "THER/PROPH/DIAG IV INF INIT", "billing_code_type": "CPT", "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": "815097602" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1664.20, "providers": [{ "billed_charge": 3042.00, "npi": [1649235490] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.06, "providers": [{ "billed_charge": 1152.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1085.60, "providers": [{ "billed_charge": 1392.00, "npi": [1972519544] } ] } ] } ] }, { "name": "THER/PROPH/DIAG IV INF ADDON", "billing_code_type": "CPT", "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": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 288.12, "providers": [{ "billed_charge": 868.00, "npi": [1497716401] } ] } ] } ] }, { "name": "TX/PROPH/DG ADDL SEQ IV INF", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96367", "description": "INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4220.96, "providers": [{ "billed_charge": 12728.00, "npi": [1497716401] } ] } ] } ] }, { "name": "THER/DIAG CONCURRENT INF", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96368", "description": "INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); CONCURRENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "815097602" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 518.18, "providers": [{ "billed_charge": 1144.00, "npi": [1649235490] } ] } ] } ] }, { "name": "THER/PROPH/DIAG INJ SC/IM", "billing_code_type": "CPT", "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": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.25, "providers": [{ "billed_charge": 54.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 312.06, "providers": [{ "billed_charge": 735.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 861.88, "providers": [{ "billed_charge": 3016.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "994843175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.19, "providers": [{ "billed_charge": 325.00, "npi": [1992003552] } ] } ] }, { "tin": { "type": "ein", "value": "833128725" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.56, "providers": [{ "billed_charge": 120.00, "npi": [1841497393] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 401.22, "providers": [{ "billed_charge": 783.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 643.96, "providers": [{ "billed_charge": 1447.38, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1362.26, "providers": [{ "billed_charge": 4060.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "461454134" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.70, "providers": [{ "billed_charge": 286.60, "npi": [1194883272] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.63, "providers": [{ "billed_charge": 40.01, "npi": [1942535828] } ] }, { "allowed_amount": 252.55, "providers": [{ "billed_charge": 800.20, "npi": [1942535828] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 713.28, "providers": [{ "billed_charge": 2160.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1795.19, "providers": [{ "billed_charge": 2850.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.04, "providers": [{ "billed_charge": 490.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 6041.45, "providers": [{ "billed_charge": 18380.00, "npi": [1093920399] } ] } ] } ] }, { "name": "TX/PRO/DX INJ NEW DRUG ADDON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96375", "description": "THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); EACH ADDNL SEQUENTIA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "815097602" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1565.22, "providers": [{ "billed_charge": 3016.00, "npi": [1649235490] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 446.80, "providers": [{ "billed_charge": 840.00, "npi": [1972519544] } ] } ] } ] }, { "name": "CHEMO, IV INFUSION, 1 HR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96413", "description": "CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO 1 HOUR, SINGLE OR INITIAL SUBSTAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7356.72, "providers": [{ "billed_charge": 22098.00, "npi": [1497716401] } ] } ] } ] }, { "name": "CHEMO IV INFUSION ADDL HR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96415", "description": "CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL HOUR (LIST SEPARATELY I", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 953.35, "providers": [{ "billed_charge": 2870.00, "npi": [1497716401] } ] } ] } ] }, { "name": "CHEMO IV INFUS EACH ADDL SEQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96417", "description": "CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL SEQUENTIAL INFUSION (DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1267.80, "providers": [{ "billed_charge": 3800.00, "npi": [1497716401] } ] } ] } ] }, { "name": "MECHANICAL TRACTION THERAPY", "billing_code_type": "CPT", "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": "542110302" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.82, "providers": [{ "billed_charge": 22.00, "npi": [1639985294] } ] } ] } ] }, { "name": "ELECTRIC STIMULATION THERAPY", "billing_code_type": "CPT", "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": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 614.40, "providers": [{ "billed_charge": 1200.00, "npi": [1578748083] } ] } ] }, { "tin": { "type": "ein", "value": "542110302" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.34, "providers": [{ "billed_charge": 16.00, "npi": [1639985294] } ] } ] } ] }, { "name": "ULTRASOUND THERAPY", "billing_code_type": "CPT", "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": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.47, "providers": [{ "billed_charge": 25.00, "npi": [1578748083] } ] } ] } ] }, { "name": "THERAPEUTIC EXERCISES", "billing_code_type": "CPT", "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": "812070461" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.03, "providers": [{ "billed_charge": 60.00, "npi": [1003828492] } ] } ] }, { "tin": { "type": "ein", "value": "813180280" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2402.34, "providers": [{ "billed_charge": 4000.00, "npi": [1194482059] } ] } ] }, { "tin": { "type": "ein", "value": "465292740" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 838.43, "providers": [{ "billed_charge": 3145.00, "npi": [1528474046] } ] } ] }, { "tin": { "type": "ein", "value": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 187.86, "providers": [{ "billed_charge": 300.00, "npi": [1659383214] } ] }, { "allowed_amount": 11240.29, "providers": [{ "billed_charge": 18100.00, "npi": [1578748083] } ] }, { "allowed_amount": 532.27, "providers": [{ "billed_charge": 850.00, "npi": [1932472644] } ] } ] }, { "tin": { "type": "ein", "value": "822119231" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 691.45, "providers": [{ "billed_charge": 2448.00, "npi": [1912748963] } ] } ] }, { "tin": { "type": "ein", "value": "542110302" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.83, "providers": [{ "billed_charge": 20.00, "npi": [1639985294] } ] } ] } ] }, { "name": "NEUROMUSCULAR REEDUCATION", "billing_code_type": "CPT", "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": "813180280" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4158.47, "providers": [{ "billed_charge": 7011.00, "npi": [1194482059] } ] } ] }, { "tin": { "type": "ein", "value": "263501523" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 403.65, "providers": [{ "billed_charge": 825.00, "npi": [1952900607] } ] } ] }, { "tin": { "type": "ein", "value": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1939.80, "providers": [{ "billed_charge": 3000.00, "npi": [1578748083] } ] } ] }, { "tin": { "type": "ein", "value": "822119231" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.49, "providers": [{ "billed_charge": 1190.00, "npi": [1912748963] } ] } ] }, { "tin": { "type": "ein", "value": "721531238" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10920.00, "providers": [{ "billed_charge": 21146.00, "npi": [1750128773] } ] }, { "allowed_amount": 2940.00, "providers": [{ "billed_charge": 5432.00, "npi": [1477111219] } ] } ] } ] }, { "name": "GAIT TRAINING THERAPY", "billing_code_type": "CPT", "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": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 633.88, "providers": [{ "billed_charge": 1380.00, "npi": [1578748083] } ] } ] } ] }, { "name": "MANUAL THERAPY 1/> REGIONS", "billing_code_type": "CPT", "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": "813180280" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2521.05, "providers": [{ "billed_charge": 4136.00, "npi": [1194482059] } ] } ] }, { "tin": { "type": "ein", "value": "465292740" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1189.10, "providers": [{ "billed_charge": 4455.00, "npi": [1528474046] } ] } ] }, { "tin": { "type": "ein", "value": "741359405" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 753.22, "providers": [{ "billed_charge": 1430.00, "npi": [1578748083] } ] } ] }, { "tin": { "type": "ein", "value": "843153496" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2421.43, "providers": [{ "billed_charge": 11520.00, "npi": [1265633440] } ] } ] }, { "tin": { "type": "ein", "value": "822119231" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.04, "providers": [{ "billed_charge": 260.00, "npi": [1912748963] } ] } ] } ] }, { "name": "ADAPTIVE BEHAVIOR TX BY TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824718695" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10111.01, "providers": [{ "billed_charge": 11992.50, "npi": [1376885525] } ] } ] }, { "tin": { "type": "ein", "value": "842938165" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 15648.72, "providers": [{ "billed_charge": 40896.00, "npi": [1548905870] } ] }, { "allowed_amount": 21687.67, "providers": [{ "billed_charge": 57312.00, "npi": [1043715238] } ] } ] }, { "tin": { "type": "ein", "value": "392725248" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4381.52, "providers": [{ "billed_charge": 10560.00, "npi": [1093070229] } ] } ] }, { "tin": { "type": "ein", "value": "931694360" }, "service_code": ["12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 4174.31, "providers": [{ "billed_charge": 15400.00, "npi": [1972960680] } ] }, { "allowed_amount": 591.01, "providers": [{ "billed_charge": 2100.00, "npi": [1972960680] } ] } ] }, { "tin": { "type": "ein", "value": "262657184" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28411.38, "providers": [{ "billed_charge": 59400.00, "npi": [1295224046] } ] }, { "allowed_amount": 18711.00, "providers": [{ "billed_charge": 49500.00, "npi": [1124299706] } ] } ] }, { "tin": { "type": "ein", "value": "812214687" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 43374.26, "providers": [{ "billed_charge": 131909.44, "npi": [1336758366] } ] }, { "allowed_amount": 32820.46, "providers": [{ "billed_charge": 122674.24, "npi": [1386205060] } ] }, { "allowed_amount": 19755.50, "providers": [{ "billed_charge": 58720.48, "npi": [1225844848] } ] }, { "allowed_amount": 1729.56, "providers": [{ "billed_charge": 6464.64, "npi": [1134951783] } ] }, { "allowed_amount": 20281.67, "providers": [{ "billed_charge": 64800.32, "npi": [1912634361] } ] }, { "allowed_amount": 8346.35, "providers": [{ "billed_charge": 26397.28, "npi": [1497219828] } ] }, { "allowed_amount": 10621.90, "providers": [{ "billed_charge": 24627.20, "npi": [1841654050] } ] }, { "allowed_amount": 22300.75, "providers": [{ "billed_charge": 76498.24, "npi": [1447802848] } ] }, { "allowed_amount": 11432.25, "providers": [{ "billed_charge": 38480.00, "npi": [1730703075] } ] }, { "allowed_amount": 13850.31, "providers": [{ "billed_charge": 44252.00, "npi": [1386528867] } ] }, { "allowed_amount": 15654.97, "providers": [{ "billed_charge": 47407.36, "npi": [1184180473] } ] }, { "allowed_amount": 69225.52, "providers": [{ "billed_charge": 184473.12, "npi": [1740886712] } ] }, { "allowed_amount": 38801.12, "providers": [{ "billed_charge": 126368.32, "npi": [1548871569] } ] }, { "allowed_amount": 10646.69, "providers": [{ "billed_charge": 34016.32, "npi": [1134888043] } ] }, { "allowed_amount": 4838.65, "providers": [{ "billed_charge": 18085.60, "npi": [1710629209] } ] }, { "allowed_amount": 19245.93, "providers": [{ "billed_charge": 61491.04, "npi": [1316690589] } ] }, { "allowed_amount": 21567.96, "providers": [{ "billed_charge": 63338.08, "npi": [1255297578] } ] }, { "allowed_amount": 8339.59, "providers": [{ "billed_charge": 27628.64, "npi": [1659037828] } ] }, { "allowed_amount": 46960.21, "providers": [{ "billed_charge": 143453.44, "npi": [1174254387] } ] }, { "allowed_amount": 63265.05, "providers": [{ "billed_charge": 176546.24, "npi": [1164099651] } ] }, { "allowed_amount": 34739.80, "providers": [{ "billed_charge": 112900.32, "npi": [1841048915] } ] }, { "allowed_amount": 45736.24, "providers": [{ "billed_charge": 141067.68, "npi": [1679140503] } ] }, { "allowed_amount": 15586.63, "providers": [{ "billed_charge": 58258.72, "npi": [1184452401] } ] } ] }, { "tin": { "type": "ein", "value": "465720011" }, "service_code": ["49"], "billing_class": "professional", "payments": [{ "allowed_amount": 7824.59, "providers": [{ "billed_charge": 9990.00, "npi": [1710496609] } ] } ] } ] }, { "name": "ADAPT BEHAVIOR TX PHYS/QHP", "billing_code_type": "CPT", "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": "824718695" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 107.20, "providers": [{ "billed_charge": 250.00, "npi": [1376885525] } ] } ] }, { "tin": { "type": "ein", "value": "842938165" }, "service_code": ["12", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2193.09, "providers": [{ "billed_charge": 8720.00, "npi": [1548905870] } ] }, { "allowed_amount": 3144.31, "providers": [{ "billed_charge": 12495.00, "npi": [1548905870] } ] } ] }, { "tin": { "type": "ein", "value": "262657184" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.00, "providers": [{ "billed_charge": 525.00, "npi": [1124299706] } ] } ] }, { "tin": { "type": "ein", "value": "812214687" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4488.55, "providers": [{ "billed_charge": 18738.72, "npi": [1174254387] } ] }, { "allowed_amount": 684.72, "providers": [{ "billed_charge": 1801.28, "npi": [1447802848] } ] }, { "allowed_amount": 1697.42, "providers": [{ "billed_charge": 7619.04, "npi": [1841048915] } ] }, { "allowed_amount": 963.39, "providers": [{ "billed_charge": 4272.32, "npi": [1912634361] } ] }, { "allowed_amount": 1911.20, "providers": [{ "billed_charge": 8236.80, "npi": [1386205060] } ] }, { "allowed_amount": 673.03, "providers": [{ "billed_charge": 2882.88, "npi": [1679140503] } ] }, { "allowed_amount": 3688.23, "providers": [{ "billed_charge": 10912.72, "npi": [1164099651] } ] } ] }, { "tin": { "type": "ein", "value": "465720011" }, "service_code": ["49"], "billing_class": "professional", "payments": [{ "allowed_amount": 1146.90, "providers": [{ "billed_charge": 1562.50, "npi": [1710496609] } ] } ] } ] }, { "name": "PT EVAL LOW COMPLEX 20 MIN", "billing_code_type": "CPT", "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": "721531238" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.00, "providers": [{ "billed_charge": 524.00, "npi": [1750128773] } ] } ] } ] }, { "name": "PT EVAL MOD COMPLEX 30 MIN", "billing_code_type": "CPT", "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": "721531238" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 420.00, "providers": [{ "billed_charge": 1256.00, "npi": [1477111219] } ] } ] } ] }, { "name": "THERAPEUTIC ACTIVITIES", "billing_code_type": "CPT", "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": "813180280" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1874.84, "providers": [{ "billed_charge": 3432.00, "npi": [1194482059] } ] } ] }, { "tin": { "type": "ein", "value": "263501523" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 347.76, "providers": [{ "billed_charge": 660.00, "npi": [1952900607] } ] } ] }, { "tin": { "type": "ein", "value": "760384227" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 735.00, "providers": [{ "billed_charge": 2033.00, "npi": [1639109812] } ] } ] }, { "tin": { "type": "ein", "value": "721531238" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 630.00, "providers": [{ "billed_charge": 1155.00, "npi": [1114776036] } ] }, { "allowed_amount": 6720.00, "providers": [{ "billed_charge": 13335.00, "npi": [1477111219] } ] }, { "allowed_amount": 4725.00, "providers": [{ "billed_charge": 7770.00, "npi": [1750128773] } ] } ] }, { "tin": { "type": "ein", "value": "760645849" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2152.32, "providers": [{ "billed_charge": 5760.00, "npi": [1841204898] } ] } ] } ] }, { "name": "SELF CARE MNGMENT TRAINING", "billing_code_type": "CPT", "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": "843153496" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1212.75, "providers": [{ "billed_charge": 3850.00, "npi": [1265633440] } ] } ] } ] }, { "name": "WOUND(S) CARE NON-SELECTIVE", "billing_code_type": "CPT", "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": "993423266" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.00, "providers": [{ "billed_charge": 250.00, "npi": [1730144718] } ] } ] } ] }, { "name": "Brief Synchronous Communication Technology Evaluation and Management Service", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98016", "description": "a brief synchronous communication technology evaluation and management service", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 475.46, "providers": [{ "billed_charge": 825.33, "npi": [1942535828] } ] } ] } ] }, { "name": "CHIROPRACT MANJ 3-4 REGIONS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98941", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844109654" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8647.71, "providers": [{ "billed_charge": 11935.00, "npi": [1518233303] } ] } ] }, { "tin": { "type": "ein", "value": "542110302" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.61, "providers": [{ "billed_charge": 91.00, "npi": [1639985294] } ] } ] } ] }, { "name": "CHIROPRACT MANJ XTRSPINL 1/>", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98943", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844109654" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4858.27, "providers": [{ "billed_charge": 8010.00, "npi": [1518233303] } ] } ] } ] }, { "name": "MED SERV EVE/WKEND/HOLIDAY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99051", "description": "SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.00, "providers": [{ "billed_charge": 550.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "273844473" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.39, "providers": [{ "billed_charge": 50.00, "npi": [1205344561] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1656.00, "providers": [{ "billed_charge": 5520.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "200537948" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 468.45, "providers": [{ "billed_charge": 1377.00, "npi": [1831383355] } ] } ] } ] }, { "name": "MOD SED SAME PHYS/QHP 5/>YRS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99152", "description": "MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYS OR OTH QUAL HEALTH CARE PROF PERFORMING THE DIA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.17, "providers": [{ "billed_charge": 129.00, "npi": [1952863110] } ] }, { "allowed_amount": 10.39, "providers": [{ "billed_charge": 43.00, "npi": [1952863110] } ] } ] } ] }, { "name": "VISUAL ACUITY SCREEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99173", "description": "SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11.72, "providers": [{ "billed_charge": 200.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "311756818" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.30, "providers": [{ "billed_charge": 50.00, "npi": [1073140737] } ] } ] } ] }, { "name": "HYPERBARIC OXYGEN THERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99183", "description": "PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208033976" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1398.38, "providers": [{ "billed_charge": 5358.64, "npi": [1619408325] } ] }, { "allowed_amount": 714.18, "providers": [{ "billed_charge": 2679.32, "npi": [1497893754] } ] } ] }, { "tin": { "type": "ein", "value": "463175783" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1365.30, "providers": [{ "billed_charge": 4905.00, "npi": [1508558180] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99202", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 5811.00, "providers": [{ "billed_charge": 14146.00, "npi": [1234567893] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "CPT", "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": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3586.74, "providers": [{ "billed_charge": 6475.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1199.00, "providers": [{ "billed_charge": 1199.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2961.29, "providers": [{ "billed_charge": 4250.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 9694.25, "providers": [{ "billed_charge": 41912.00, "npi": [1093920399] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "CPT", "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": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1378.80, "providers": [{ "billed_charge": 3480.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 5515.84, "providers": [{ "billed_charge": 10752.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 689.48, "providers": [{ "billed_charge": 1336.00, "npi": [1730445628] } ] } ] }, { "tin": { "type": "ein", "value": "853601968" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9824.31, "providers": [{ "billed_charge": 78375.00, "npi": [1326327149] } ] } ] }, { "tin": { "type": "ein", "value": "824472878" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4886.73, "providers": [{ "billed_charge": 11205.00, "npi": [1477916708] } ] } ] }, { "tin": { "type": "ein", "value": "202798379" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3068.33, "providers": [{ "billed_charge": 9167.28, "npi": [1740849520] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.85, "providers": [{ "billed_charge": 230.01, "npi": [1942535828] } ] } ] }, { "tin": { "type": "ein", "value": "611643282" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 4856.22, "providers": [{ "billed_charge": 5750.00, "npi": [1184882573] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14616.77, "providers": [{ "billed_charge": 19692.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "823426999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 249.94, "providers": [{ "billed_charge": 390.00, "npi": [1780174110] } ] } ] }, { "tin": { "type": "ein", "value": "463969440" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 586.50, "providers": [{ "billed_charge": 2348.00, "npi": [1124360987] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 8963.24, "providers": [{ "billed_charge": 33488.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "461105510" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5962.75, "providers": [{ "billed_charge": 29280.00, "npi": [1184991564] } ] }, { "allowed_amount": 293.02, "providers": [{ "billed_charge": 960.00, "npi": [1184991564] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99205", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824472878" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9182.70, "providers": [{ "billed_charge": 19798.00, "npi": [1477916708] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99211", "description": "OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208271258" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.29, "providers": [{ "billed_charge": 150.00, "npi": [1417944943] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6021.00, "providers": [{ "billed_charge": 6021.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "742512591" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 187.44, "providers": [{ "billed_charge": 520.00, "npi": [1669470043] } ] } ] } ] }, { "name": "OFFICE OR OTH OUTPATIENT VISIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99212", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208271258" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3206.06, "providers": [{ "billed_charge": 11800.00, "npi": [1457729287] } ] } ] }, { "tin": { "type": "ein", "value": "742944931" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1070.30, "providers": [{ "billed_charge": 2371.95, "npi": [1770763666] } ] }, { "allowed_amount": 77.97, "providers": [{ "billed_charge": 238.86, "npi": [1871115261] } ] } ] }, { "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2444.50, "providers": [{ "billed_charge": 5687.00, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "863998689" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.52, "providers": [{ "billed_charge": 114.00, "npi": [1962509901] } ] } ] }, { "tin": { "type": "ein", "value": "862433458" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 342.23, "providers": [{ "billed_charge": 840.00, "npi": [1982278800] } ] } ] }, { "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 345.12, "providers": [{ "billed_charge": 660.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2650.00, "providers": [{ "billed_charge": 5161.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "475489256" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 12941.58, "providers": [{ "billed_charge": 22275.00, "npi": [1902223217] } ] }, { "allowed_amount": 1131.46, "providers": [{ "billed_charge": 3732.00, "npi": [1902223217] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "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": "932115414" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3220.22, "providers": [{ "billed_charge": 7234.04, "npi": [1013444892] } ] }, { "allowed_amount": 96.22, "providers": [{ "billed_charge": 352.88, "npi": [1013444892] } ] } ] }, { "tin": { "type": "ein", "value": "273418492" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1099.70, "providers": [{ "billed_charge": 3221.68, "npi": [1457747347] } ] }, { "allowed_amount": 432.99, "providers": [{ "billed_charge": 2071.08, "npi": [1457747347] } ] } ] }, { "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 831.69, "providers": [{ "billed_charge": 2115.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 14600.78, "providers": [{ "billed_charge": 23700.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "300491632" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1694.88, "providers": [{ "billed_charge": 4266.00, "npi": [1518365253] } ] } ] }, { "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5451.80, "providers": [{ "billed_charge": 7493.00, "npi": [1891855656] } ] }, { "allowed_amount": 462.05, "providers": [{ "billed_charge": 635.00, "npi": [1801874763] } ] } ] }, { "tin": { "type": "ein", "value": "833128725" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 233.15, "providers": [{ "billed_charge": 720.00, "npi": [1841497393] } ] }, { "allowed_amount": 192.66, "providers": [{ "billed_charge": 360.00, "npi": [1841497393] } ] } ] }, { "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 817.19, "providers": [{ "billed_charge": 3086.52, "npi": [1942832191] } ] }, { "allowed_amount": 10368.27, "providers": [{ "billed_charge": 23965.92, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "273993262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.23, "providers": [{ "billed_charge": 306.00, "npi": [1407863939] } ] }, { "allowed_amount": 831.69, "providers": [{ "billed_charge": 918.00, "npi": [1659386001] } ] } ] }, { "tin": { "type": "ein", "value": "752723993" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 549.85, "providers": [{ "billed_charge": 1904.00, "npi": [1609132521] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 9738.88, "providers": [{ "billed_charge": 17980.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "854247861" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 646.87, "providers": [{ "billed_charge": 955.50, "npi": [1093144560] } ] } ] }, { "tin": { "type": "ein", "value": "742620408" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1016.51, "providers": [{ "billed_charge": 2122.89, "npi": [1902804123] } ] }, { "allowed_amount": 92.41, "providers": [{ "billed_charge": 192.99, "npi": [1619149762] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2957.12, "providers": [{ "billed_charge": 8864.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 744.00, "providers": [{ "billed_charge": 1868.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 19682.94, "providers": [{ "billed_charge": 63900.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "742699762" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 942.60, "providers": [{ "billed_charge": 1824.00, "npi": [1689186413] } ] } ] }, { "tin": { "type": "ein", "value": "452298151" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 324.24, "providers": [{ "billed_charge": 636.00, "npi": [1457727885] } ] } ] }, { "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2120.52, "providers": [{ "billed_charge": 3240.00, "npi": [1831544808] } ] }, { "allowed_amount": 240.21, "providers": [{ "billed_charge": 600.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "760549240" }, "service_code": ["02", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 481.65, "providers": [{ "billed_charge": 848.40, "npi": [1982790143] } ] }, { "allowed_amount": 250.10, "providers": [{ "billed_charge": 848.40, "npi": [1053772129] } ] }, { "allowed_amount": 2210.76, "providers": [{ "billed_charge": 4581.36, "npi": [1053772129] } ] }, { "allowed_amount": 1228.20, "providers": [{ "billed_charge": 2545.20, "npi": [1770998999] } ] } ] }, { "tin": { "type": "ein", "value": "742553409" }, "service_code": ["02", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 15706.19, "providers": [{ "billed_charge": 30430.00, "npi": [1225471303] } ] }, { "allowed_amount": 169.80, "providers": [{ "billed_charge": 537.00, "npi": [1568542090] } ] }, { "allowed_amount": 5821.44, "providers": [{ "billed_charge": 11277.00, "npi": [1568542090] } ] } ] }, { "tin": { "type": "ein", "value": "201020949" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 306.00, "providers": [{ "billed_charge": 1092.00, "npi": [1457457665] } ] } ] }, { "tin": { "type": "ein", "value": "862433458" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 549.85, "providers": [{ "billed_charge": 1400.00, "npi": [1982278800] } ] } ] }, { "tin": { "type": "ein", "value": "200981834" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.02, "providers": [{ "billed_charge": 143.00, "npi": [1467273995] } ] }, { "allowed_amount": 736.92, "providers": [{ "billed_charge": 1287.00, "npi": [1467273995] } ] } ] }, { "tin": { "type": "ein", "value": "881290586" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1021.15, "providers": [{ "billed_charge": 2236.00, "npi": [1588210660] } ] } ] }, { "tin": { "type": "ein", "value": "200537948" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15153.29, "providers": [{ "billed_charge": 24272.00, "npi": [1831383355] } ] } ] }, { "tin": { "type": "ein", "value": "460741987" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2867.08, "providers": [{ "billed_charge": 4800.00, "npi": [1366531691] } ] } ] }, { "tin": { "type": "ein", "value": "853601968" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5543.82, "providers": [{ "billed_charge": 44640.00, "npi": [1326327149] } ] } ] }, { "tin": { "type": "ein", "value": "742663370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3419.17, "providers": [{ "billed_charge": 4625.00, "npi": [1437203676] } ] } ] }, { "tin": { "type": "ein", "value": "760453250" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 598.20, "providers": [{ "billed_charge": 3120.00, "npi": [1407596448] } ] } ] }, { "tin": { "type": "ein", "value": "760540476" }, "service_code": ["22", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.60, "providers": [{ "billed_charge": 98.00, "npi": [1609288208] } ] }, { "allowed_amount": 1292.96, "providers": [{ "billed_charge": 1372.00, "npi": [1609288208] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 628.40, "providers": [{ "billed_charge": 1396.80, "npi": [1760857379] } ] }, { "allowed_amount": 1535.16, "providers": [{ "billed_charge": 2968.20, "npi": [1942400601] } ] }, { "allowed_amount": 156.77, "providers": [{ "billed_charge": 349.20, "npi": [1922636612] } ] }, { "allowed_amount": 2828.41, "providers": [{ "billed_charge": 5412.60, "npi": [1255893798] } ] }, { "allowed_amount": 1016.12, "providers": [{ "billed_charge": 1920.60, "npi": [1861494130] } ] }, { "allowed_amount": 3197.27, "providers": [{ "billed_charge": 6111.00, "npi": [1265495998] } ] } ] }, { "tin": { "type": "ein", "value": "933500990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.30, "providers": [{ "billed_charge": 1375.00, "npi": [1770999377] } ] } ] }, { "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17365.28, "providers": [{ "billed_charge": 41924.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "743016407" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1848.20, "providers": [{ "billed_charge": 2200.00, "npi": [1841310695] } ] } ] }, { "tin": { "type": "ein", "value": "760423386" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 314.20, "providers": [{ "billed_charge": 768.00, "npi": [1659025328] } ] } ] }, { "tin": { "type": "ein", "value": "752252866" }, "service_code": ["11", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1755.79, "providers": [{ "billed_charge": 5158.50, "npi": [1235154824] } ] }, { "allowed_amount": 92.41, "providers": [{ "billed_charge": 271.50, "npi": [1235154824] } ] } ] }, { "tin": { "type": "ein", "value": "741394418" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 462.00, "providers": [{ "billed_charge": 462.00, "npi": [1164835971] } ] } ] }, { "tin": { "type": "ein", "value": "260845489" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 660.00, "providers": [{ "billed_charge": 1680.00, "npi": [1366098915] } ] } ] }, { "tin": { "type": "ein", "value": "273656127" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1492.45, "providers": [{ "billed_charge": 3895.00, "npi": [1659984441] } ] }, { "allowed_amount": 48.11, "providers": [{ "billed_charge": 205.00, "npi": [1659984441] } ] } ] }, { "tin": { "type": "ein", "value": "813843305" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.55, "providers": [{ "billed_charge": 260.00, "npi": [1780865857] } ] } ] }, { "tin": { "type": "ein", "value": "475489256" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 7392.02, "providers": [{ "billed_charge": 13371.00, "npi": [1902223217] } ] }, { "allowed_amount": 1132.00, "providers": [{ "billed_charge": 3360.00, "npi": [1902223217] } ] } ] }, { "tin": { "type": "ein", "value": "841777691" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1256.80, "providers": [{ "billed_charge": 2108.00, "npi": [1659859759] } ] } ] }, { "tin": { "type": "ein", "value": "463847386" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4620.50, "providers": [{ "billed_charge": 10000.00, "npi": [1164442778] } ] } ] }, { "tin": { "type": "ein", "value": "742944931" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2830.00, "providers": [{ "billed_charge": 5128.20, "npi": [1669887865] } ] }, { "allowed_amount": 1291.03, "providers": [{ "billed_charge": 2286.53, "npi": [1770763666] } ] }, { "allowed_amount": 288.66, "providers": [{ "billed_charge": 646.80, "npi": [1821721697] } ] }, { "allowed_amount": 1806.65, "providers": [{ "billed_charge": 2378.25, "npi": [1821721697] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 12521.56, "providers": [{ "billed_charge": 25237.00, "npi": [1134828494] } ] }, { "allowed_amount": 849.00, "providers": [{ "billed_charge": 2775.00, "npi": [1134828494] } ] }, { "allowed_amount": 11829.40, "providers": [{ "billed_charge": 38665.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "756176121" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 143.88, "providers": [{ "billed_charge": 143.88, "npi": [1467436014] } ] } ] }, { "tin": { "type": "ein", "value": "760226835" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 7071.09, "providers": [{ "billed_charge": 10920.00, "npi": [1376584789] } ] } ] }, { "tin": { "type": "ein", "value": "461105510" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.55, "providers": [{ "billed_charge": 261.00, "npi": [1184991564] } ] }, { "allowed_amount": 529.21, "providers": [{ "billed_charge": 2871.00, "npi": [1184991564] } ] } ] }, { "tin": { "type": "ein", "value": "208271258" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6468.52, "providers": [{ "billed_charge": 11850.00, "npi": [1457729287] } ] }, { "allowed_amount": 100.04, "providers": [{ "billed_charge": 300.00, "npi": [1457729287] } ] }, { "allowed_amount": 12445.76, "providers": [{ "billed_charge": 22800.00, "npi": [1699156612] } ] } ] }, { "tin": { "type": "ein", "value": "752931720" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 462.08, "providers": [{ "billed_charge": 1108.00, "npi": [1477296648] } ] } ] }, { "tin": { "type": "ein", "value": "200187041" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 924.10, "providers": [{ "billed_charge": 1300.00, "npi": [1790784288] } ] } ] }, { "tin": { "type": "ein", "value": "462456505" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 678.81, "providers": [{ "billed_charge": 2664.00, "npi": [1164865762] } ] }, { "allowed_amount": 314.20, "providers": [{ "billed_charge": 888.00, "npi": [1184250524] } ] } ] }, { "tin": { "type": "ein", "value": "994843175" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6362.22, "providers": [{ "billed_charge": 8100.00, "npi": [1992003552] } ] }, { "allowed_amount": 288.66, "providers": [{ "billed_charge": 600.00, "npi": [1992003552] } ] } ] }, { "tin": { "type": "ein", "value": "741794256" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 2041.97, "providers": [{ "billed_charge": 3510.00, "npi": [1518249150] } ] } ] }, { "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.60, "providers": [{ "billed_charge": 151.00, "npi": [1730445628] } ] }, { "allowed_amount": 12382.94, "providers": [{ "billed_charge": 20234.00, "npi": [1730445628] } ] }, { "allowed_amount": 283.00, "providers": [{ "billed_charge": 755.00, "npi": [1730445628] } ] } ] }, { "tin": { "type": "ein", "value": "742854030" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2749.25, "providers": [{ "billed_charge": 4200.00, "npi": [1083256879] } ] } ] }, { "tin": { "type": "ein", "value": "752403687" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 549.85, "providers": [{ "billed_charge": 1225.00, "npi": [1033892245] } ] } ] }, { "tin": { "type": "ein", "value": "264621796" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.82, "providers": [{ "billed_charge": 400.00, "npi": [1124221965] } ] }, { "allowed_amount": 92.31, "providers": [{ "billed_charge": 200.00, "npi": [1427494871] } ] }, { "allowed_amount": 288.66, "providers": [{ "billed_charge": 990.00, "npi": [1215516992] } ] }, { "allowed_amount": 396.20, "providers": [{ "billed_charge": 1400.00, "npi": [1124221965] } ] }, { "allowed_amount": 622.60, "providers": [{ "billed_charge": 2200.00, "npi": [1427494871] } ] } ] }, { "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 255.00, "providers": [{ "billed_charge": 255.00, "npi": [1265546287] } ] } ] }, { "tin": { "type": "ein", "value": "934354270" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.22, "providers": [{ "billed_charge": 460.00, "npi": [1083845218] } ] }, { "allowed_amount": 864.05, "providers": [{ "billed_charge": 2530.00, "npi": [1083845218] } ] } ] }, { "tin": { "type": "ein", "value": "274716160" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4064.77, "providers": [{ "billed_charge": 8800.00, "npi": [1922027838] } ] } ] }, { "tin": { "type": "ein", "value": "851746454" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1256.80, "providers": [{ "billed_charge": 3274.14, "npi": [1154917896] } ] } ] }, { "tin": { "type": "ein", "value": "863745753" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2551.52, "providers": [{ "billed_charge": 4125.00, "npi": [1831561158] } ] }, { "allowed_amount": 625.43, "providers": [{ "billed_charge": 1625.00, "npi": [1831561158] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 14296.07, "providers": [{ "billed_charge": 25823.00, "npi": [1972519544] } ] }, { "allowed_amount": 2999.50, "providers": [{ "billed_charge": 9029.00, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 31943.82, "providers": [{ "billed_charge": 52896.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "752719502" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1256.80, "providers": [{ "billed_charge": 3200.00, "npi": [1205477908] } ] } ] }, { "tin": { "type": "ein", "value": "300198705" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1108.92, "providers": [{ "billed_charge": 2724.00, "npi": [1598105546] } ] }, { "allowed_amount": 7532.96, "providers": [{ "billed_charge": 20884.00, "npi": [1538526702] } ] }, { "allowed_amount": 4912.80, "providers": [{ "billed_charge": 13620.00, "npi": [1003273731] } ] }, { "allowed_amount": 6433.72, "providers": [{ "billed_charge": 18387.00, "npi": [1669082723] } ] }, { "allowed_amount": 1570.58, "providers": [{ "billed_charge": 3859.00, "npi": [1245432038] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "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": "742867580" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 263.50, "providers": [{ "billed_charge": 540.00, "npi": [1366024606] } ] } ] }, { "tin": { "type": "ein", "value": "811123403" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 196.41, "providers": [{ "billed_charge": 1435.50, "npi": [1750739405] } ] }, { "allowed_amount": 973.61, "providers": [{ "billed_charge": 5263.50, "npi": [1750739405] } ] } ] }, { "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 20284.28, "providers": [{ "billed_charge": 51690.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 36890.00, "providers": [{ "billed_charge": 61600.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "921468472" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3807.66, "providers": [{ "billed_charge": 8738.00, "npi": [1679827604] } ] } ] }, { "tin": { "type": "ein", "value": "760458535" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 474.30, "providers": [{ "billed_charge": 783.00, "npi": [1215790845] } ] }, { "allowed_amount": 3003.90, "providers": [{ "billed_charge": 5282.00, "npi": [1841828548] } ] } ] }, { "tin": { "type": "ein", "value": "833128725" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 19862.39, "providers": [{ "billed_charge": 29000.00, "npi": [1841497393] } ] }, { "allowed_amount": 3466.80, "providers": [{ "billed_charge": 8000.00, "npi": [1841497393] } ] } ] }, { "tin": { "type": "ein", "value": "475121236" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.76, "providers": [{ "billed_charge": 225.00, "npi": [1932138575] } ] } ] }, { "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26313.15, "providers": [{ "billed_charge": 60343.30, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1567.36, "providers": [{ "billed_charge": 2450.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "854247861" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7772.67, "providers": [{ "billed_charge": 11346.88, "npi": [1093144560] } ] } ] }, { "tin": { "type": "ein", "value": "202798379" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 824.46, "providers": [{ "billed_charge": 2307.78, "npi": [1740849520] } ] } ] }, { "tin": { "type": "ein", "value": "752600873" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 592.89, "providers": [{ "billed_charge": 747.00, "npi": [1295350999] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["11", "57", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 5152.91, "providers": [{ "billed_charge": 12285.00, "npi": [1255388203] } ] }, { "allowed_amount": 85.01, "providers": [{ "billed_charge": 265.00, "npi": [1255388203] } ] } ] }, { "tin": { "type": "ein", "value": "611643282" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 969.48, "providers": [{ "billed_charge": 1050.00, "npi": [1184882573] } ] } ] }, { "tin": { "type": "ein", "value": "741951476" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2497.50, "providers": [{ "billed_charge": 8214.96, "npi": [1982267787] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11857.50, "providers": [{ "billed_charge": 35550.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "742897231" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7378.00, "providers": [{ "billed_charge": 14000.00, "npi": [1003934365] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 395.25, "providers": [{ "billed_charge": 1935.00, "npi": [1952012189] } ] }, { "allowed_amount": 2671.91, "providers": [{ "billed_charge": 21285.00, "npi": [1124012067] } ] }, { "allowed_amount": 666.00, "providers": [{ "billed_charge": 5160.00, "npi": [1952012189] } ] }, { "allowed_amount": 545.28, "providers": [{ "billed_charge": 4515.00, "npi": [1952012189] } ] }, { "allowed_amount": 658.75, "providers": [{ "billed_charge": 3225.00, "npi": [1124012067] } ] } ] }, { "tin": { "type": "ein", "value": "746001573" }, "service_code": ["71"], "billing_class": "professional", "payments": [{ "allowed_amount": 671.94, "providers": [{ "billed_charge": 728.82, "npi": [1982722401] } ] }, { "allowed_amount": 2127.81, "providers": [{ "billed_charge": 2307.93, "npi": [1144326521] } ] } ] }, { "tin": { "type": "ein", "value": "752472510" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6943.38, "providers": [{ "billed_charge": 15396.00, "npi": [1336976984] } ] } ] }, { "tin": { "type": "ein", "value": "742699762" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 895.92, "providers": [{ "billed_charge": 1816.00, "npi": [1689186413] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 23649.35, "providers": [{ "billed_charge": 73748.00, "npi": [1093920399] } ] } ] }, { "tin": { "type": "ein", "value": "452578435" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 395.25, "providers": [{ "billed_charge": 615.00, "npi": [1760170401] } ] }, { "allowed_amount": 131.75, "providers": [{ "billed_charge": 205.00, "npi": [1417277435] } ] } ] }, { "tin": { "type": "ein", "value": "200719874" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10162.85, "providers": [{ "billed_charge": 14220.00, "npi": [1932785854] } ] } ] }, { "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1273.68, "providers": [{ "billed_charge": 2520.00, "npi": [1831544808] } ] }, { "allowed_amount": 31465.25, "providers": [{ "billed_charge": 39340.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "760549240" }, "service_code": ["02", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1648.92, "providers": [{ "billed_charge": 3105.96, "npi": [1982790143] } ] }, { "allowed_amount": 7358.40, "providers": [{ "billed_charge": 16306.29, "npi": [1053772129] } ] }, { "allowed_amount": 221.01, "providers": [{ "billed_charge": 776.49, "npi": [1053772129] } ] }, { "allowed_amount": 86.67, "providers": [{ "billed_charge": 258.83, "npi": [1982790143] } ] } ] }, { "tin": { "type": "ein", "value": "756064033" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.00, "providers": [{ "billed_charge": 1084.00, "npi": [1518068709] } ] } ] }, { "tin": { "type": "ein", "value": "923290009" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 395.25, "providers": [{ "billed_charge": 525.00, "npi": [1538165162] } ] }, { "allowed_amount": 83.25, "providers": [{ "billed_charge": 175.00, "npi": [1538165162] } ] } ] }, { "tin": { "type": "ein", "value": "200537948" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12383.34, "providers": [{ "billed_charge": 20116.00, "npi": [1831383355] } ] } ] }, { "tin": { "type": "ein", "value": "881290586" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6607.41, "providers": [{ "billed_charge": 14337.00, "npi": [1588210660] } ] } ] }, { "tin": { "type": "ein", "value": "760453250" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1155.30, "providers": [{ "billed_charge": 5505.00, "npi": [1184038598] } ] } ] }, { "tin": { "type": "ein", "value": "760540476" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2765.01, "providers": [{ "billed_charge": 2898.00, "npi": [1609288208] } ] } ] }, { "tin": { "type": "ein", "value": "760009637" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 333.00, "providers": [{ "billed_charge": 1031.20, "npi": [1295988855] } ] }, { "allowed_amount": 3799.92, "providers": [{ "billed_charge": 8765.20, "npi": [1174771679] } ] }, { "allowed_amount": 1791.23, "providers": [{ "billed_charge": 4124.80, "npi": [1760857379] } ] }, { "allowed_amount": 658.75, "providers": [{ "billed_charge": 1289.00, "npi": [1184687394] } ] }, { "allowed_amount": 527.00, "providers": [{ "billed_charge": 1031.20, "npi": [1245897602] } ] }, { "allowed_amount": 3454.50, "providers": [{ "billed_charge": 9796.40, "npi": [1730760364] } ] }, { "allowed_amount": 83.25, "providers": [{ "billed_charge": 257.80, "npi": [1427317239] } ] }, { "allowed_amount": 131.75, "providers": [{ "billed_charge": 257.80, "npi": [1528475845] } ] }, { "allowed_amount": 263.50, "providers": [{ "billed_charge": 515.60, "npi": [1942400601] } ] } ] }, { "tin": { "type": "ein", "value": "824472878" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 352.77, "providers": [{ "billed_charge": 810.00, "npi": [1659617827] } ] }, { "allowed_amount": 25731.24, "providers": [{ "billed_charge": 50220.00, "npi": [1477916708] } ] } ] }, { "tin": { "type": "ein", "value": "933500990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.00, "providers": [{ "billed_charge": 1520.00, "npi": [1770999377] } ] } ] }, { "tin": { "type": "ein", "value": "830358685" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7769.77, "providers": [{ "billed_charge": 15694.00, "npi": [1235225087] } ] } ] }, { "tin": { "type": "ein", "value": "823426999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4685.91, "providers": [{ "billed_charge": 10310.00, "npi": [1083596118] } ] } ] }, { "tin": { "type": "ein", "value": "990521596" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 424.56, "providers": [{ "billed_charge": 1800.00, "npi": [1235652280] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 12321.00, "providers": [{ "billed_charge": 53648.00, "npi": [1386297356] } ] } ] }, { "tin": { "type": "ein", "value": "760423386" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4479.27, "providers": [{ "billed_charge": 11320.00, "npi": [1679263834] } ] }, { "allowed_amount": 1448.09, "providers": [{ "billed_charge": 3113.00, "npi": [1356920193] } ] }, { "allowed_amount": 6271.33, "providers": [{ "billed_charge": 17048.00, "npi": [1568244358] } ] }, { "allowed_amount": 83.33, "providers": [{ "billed_charge": 283.00, "npi": [1356920193] } ] } ] }, { "tin": { "type": "ein", "value": "882648776" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1231.89, "providers": [{ "billed_charge": 3476.00, "npi": [1194436147] } ] }, { "allowed_amount": 424.56, "providers": [{ "billed_charge": 1896.00, "npi": [1194436147] } ] } ] }, { "tin": { "type": "ein", "value": "752252866" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 17117.84, "providers": [{ "billed_charge": 49918.70, "npi": [1235154824] } ] }, { "allowed_amount": 166.50, "providers": [{ "billed_charge": 767.98, "npi": [1235154824] } ] } ] }, { "tin": { "type": "ein", "value": "273656127" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1679.35, "providers": [{ "billed_charge": 4350.00, "npi": [1952657025] } ] }, { "allowed_amount": 70.76, "providers": [{ "billed_charge": 290.00, "npi": [1952657025] } ] }, { "allowed_amount": 13662.28, "providers": [{ "billed_charge": 35380.00, "npi": [1659984441] } ] } ] }, { "tin": { "type": "ein", "value": "743001674" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 593.31, "providers": [{ "billed_charge": 1624.00, "npi": [1063896124] } ] }, { "allowed_amount": 131.75, "providers": [{ "billed_charge": 232.00, "npi": [1063896124] } ] }, { "allowed_amount": 168.26, "providers": [{ "billed_charge": 464.00, "npi": [1063896124] } ] } ] }, { "tin": { "type": "ein", "value": "934659393" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3293.75, "providers": [{ "billed_charge": 4700.00, "npi": [1417344953] } ] } ] }, { "tin": { "type": "ein", "value": "833527998" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2652.74, "providers": [{ "billed_charge": 8550.00, "npi": [1275508848] } ] } ] }, { "tin": { "type": "ein", "value": "760151142" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 549.64, "providers": [{ "billed_charge": 924.00, "npi": [1326676362] } ] }, { "allowed_amount": 86.67, "providers": [{ "billed_charge": 231.00, "npi": [1326676362] } ] } ] }, { "tin": { "type": "ein", "value": "841777691" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2127.81, "providers": [{ "billed_charge": 3544.26, "npi": [1659859759] } ] } ] }, { "tin": { "type": "ein", "value": "463847386" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 790.50, "providers": [{ "billed_charge": 1500.00, "npi": [1164442778] } ] } ] }, { "tin": { "type": "ein", "value": "742512591" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1185.75, "providers": [{ "billed_charge": 1575.00, "npi": [1669470043] } ] }, { "allowed_amount": 582.17, "providers": [{ "billed_charge": 1225.00, "npi": [1669470043] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 166.50, "providers": [{ "billed_charge": 450.00, "npi": [1508068438] } ] }, { "allowed_amount": 666.00, "providers": [{ "billed_charge": 1800.00, "npi": [1508068438] } ] }, { "allowed_amount": 21865.34, "providers": [{ "billed_charge": 37350.00, "npi": [1508068438] } ] } ] }, { "tin": { "type": "ein", "value": "742944931" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3829.50, "providers": [{ "billed_charge": 6604.89, "npi": [1669887865] } ] }, { "allowed_amount": 3163.50, "providers": [{ "billed_charge": 5460.57, "npi": [1205005519] } ] }, { "allowed_amount": 566.08, "providers": [{ "billed_charge": 1144.32, "npi": [1386125979] } ] }, { "allowed_amount": 3679.52, "providers": [{ "billed_charge": 7563.33, "npi": [1114698289] } ] }, { "allowed_amount": 559.95, "providers": [{ "billed_charge": 715.20, "npi": [1386125979] } ] }, { "allowed_amount": 2239.80, "providers": [{ "billed_charge": 3011.10, "npi": [1821721697] } ] }, { "allowed_amount": 141.52, "providers": [{ "billed_charge": 336.18, "npi": [1821721697] } ] } ] }, { "tin": { "type": "ein", "value": "832104126" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1616.89, "providers": [{ "billed_charge": 3624.00, "npi": [1679117063] } ] }, { "allowed_amount": 1762.93, "providers": [{ "billed_charge": 3926.00, "npi": [1013614668] } ] } ] }, { "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 582.75, "providers": [{ "billed_charge": 1834.00, "npi": [1134828494] } ] }, { "allowed_amount": 20917.13, "providers": [{ "billed_charge": 41920.00, "npi": [1134828494] } ] }, { "allowed_amount": 4079.25, "providers": [{ "billed_charge": 12838.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "412273820" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1882.86, "providers": [{ "billed_charge": 4928.00, "npi": [1578730818] } ] } ] }, { "tin": { "type": "ein", "value": "873147341" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 671.94, "providers": [{ "billed_charge": 1158.00, "npi": [1780108175] } ] } ] }, { "tin": { "type": "ein", "value": "651255384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4874.17, "providers": [{ "billed_charge": 9324.00, "npi": [1942390273] } ] } ] }, { "tin": { "type": "ein", "value": "746003411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 480.00, "providers": [{ "billed_charge": 480.00, "npi": [1629005418] } ] } ] }, { "tin": { "type": "ein", "value": "861467380" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1222.64, "providers": [{ "billed_charge": 1343.82, "npi": [1174668933] } ] } ] }, { "tin": { "type": "ein", "value": "760226835" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 7755.60, "providers": [{ "billed_charge": 12360.00, "npi": [1376584789] } ] } ] }, { "tin": { "type": "ein", "value": "461105510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 9198.80, "providers": [{ "billed_charge": 47970.00, "npi": [1184991564] } ] } ] }, { "tin": { "type": "ein", "value": "208271258" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1051.20, "providers": [{ "billed_charge": 2300.00, "npi": [1699156612] } ] } ] }, { "tin": { "type": "ein", "value": "752931720" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 329.21, "providers": [{ "billed_charge": 460.00, "npi": [1629480017] } ] }, { "allowed_amount": 104.06, "providers": [{ "billed_charge": 357.00, "npi": [1477296648] } ] }, { "allowed_amount": 2963.52, "providers": [{ "billed_charge": 6426.00, "npi": [1477296648] } ] } ] }, { "tin": { "type": "ein", "value": "432016287" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 790.50, "providers": [{ "billed_charge": 1772.34, "npi": [1043741275] } ] } ] }, { "tin": { "type": "ein", "value": "453508803" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 559.95, "providers": [{ "billed_charge": 1990.00, "npi": [1467226316] } ] } ] }, { "tin": { "type": "ein", "value": "822312224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1567.86, "providers": [{ "billed_charge": 3697.68, "npi": [1053568014] } ] } ] }, { "tin": { "type": "ein", "value": "752848936" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3425.50, "providers": [{ "billed_charge": 6851.00, "npi": [1780200816] } ] }, { "allowed_amount": 1712.75, "providers": [{ "billed_charge": 3425.50, "npi": [1861004913] } ] } ] }, { "tin": { "type": "ein", "value": "821661889" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2330.58, "providers": [{ "billed_charge": 7868.00, "npi": [1619087111] } ] }, { "allowed_amount": 131.75, "providers": [{ "billed_charge": 281.00, "npi": [1619087111] } ] } ] }, { "tin": { "type": "ein", "value": "741659064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 708.08, "providers": [{ "billed_charge": 1000.00, "npi": [1861915266] } ] } ] }, { "tin": { "type": "ein", "value": "462456505" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 895.92, "providers": [{ "billed_charge": 2640.00, "npi": [1710577788] } ] }, { "allowed_amount": 658.75, "providers": [{ "billed_charge": 1650.00, "npi": [1104278464] } ] }, { "allowed_amount": 921.67, "providers": [{ "billed_charge": 2310.00, "npi": [1164865762] } ] }, { "allowed_amount": 249.75, "providers": [{ "billed_charge": 990.00, "npi": [1164865762] } ] }, { "allowed_amount": 131.75, "providers": [{ "billed_charge": 330.00, "npi": [1821671504] } ] }, { "allowed_amount": 263.50, "providers": [{ "billed_charge": 660.00, "npi": [1396852240] } ] } ] }, { "tin": { "type": "ein", "value": "742882192" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 18837.35, "providers": [{ "billed_charge": 44030.00, "npi": [1033370176] } ] } ] }, { "tin": { "type": "ein", "value": "994843175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.99, "providers": [{ "billed_charge": 125.00, "npi": [1992003552] } ] } ] }, { "tin": { "type": "ein", "value": "460796181" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1099.28, "providers": [{ "billed_charge": 3297.84, "npi": [1811557333] } ] }, { "allowed_amount": 274.82, "providers": [{ "billed_charge": 796.86, "npi": [1497956734] } ] }, { "allowed_amount": 961.87, "providers": [{ "billed_charge": 2720.01, "npi": [1457235830] } ] } ] }, { "tin": { "type": "ein", "value": "741794256" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 11758.45, "providers": [{ "billed_charge": 18900.00, "npi": [1518249150] } ] } ] }, { "tin": { "type": "ein", "value": "811830612" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 131.75, "providers": [{ "billed_charge": 375.00, "npi": [1316044050] } ] } ] }, { "tin": { "type": "ein", "value": "811795980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4347.75, "providers": [{ "billed_charge": 7293.00, "npi": [1730445628] } ] } ] }, { "tin": { "type": "ein", "value": "812513596" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 327.35, "providers": [{ "billed_charge": 1050.00, "npi": [1437666591] } ] } ] }, { "tin": { "type": "ein", "value": "264621796" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 582.75, "providers": [{ "billed_charge": 1855.00, "npi": [1902918675] } ] }, { "allowed_amount": 19525.49, "providers": [{ "billed_charge": 73140.00, "npi": [1043828544] } ] }, { "allowed_amount": 1119.90, "providers": [{ "billed_charge": 2650.00, "npi": [1043828544] } ] }, { "allowed_amount": 749.25, "providers": [{ "billed_charge": 2385.00, "npi": [1427494871] } ] }, { "allowed_amount": 1007.91, "providers": [{ "billed_charge": 2385.00, "npi": [1336774801] } ] }, { "allowed_amount": 1054.00, "providers": [{ "billed_charge": 2120.00, "npi": [1124221965] } ] }, { "allowed_amount": 283.04, "providers": [{ "billed_charge": 1060.00, "npi": [1336774801] } ] }, { "allowed_amount": 527.00, "providers": [{ "billed_charge": 1060.00, "npi": [1427494871] } ] }, { "allowed_amount": 111.99, "providers": [{ "billed_charge": 265.00, "npi": [1780290106, 1740360213] } ] }, { "allowed_amount": 141.52, "providers": [{ "billed_charge": 530.00, "npi": [1285198911, 1780290106, 1740360213] } ] }, { "allowed_amount": 4408.93, "providers": [{ "billed_charge": 14045.00, "npi": [1124221965] } ] } ] }, { "tin": { "type": "ein", "value": "842426702" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3162.00, "providers": [{ "billed_charge": 5108.64, "npi": [1396475455] } ] } ] }, { "tin": { "type": "ein", "value": "851746454" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8063.28, "providers": [{ "billed_charge": 18101.72, "npi": [1154917896] } ] } ] }, { "tin": { "type": "ein", "value": "751368151" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 111.99, "providers": [{ "billed_charge": 375.00, "npi": [1558995092] } ] } ] }, { "tin": { "type": "ein", "value": "274716160" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5664.67, "providers": [{ "billed_charge": 10750.00, "npi": [1922027838] } ] } ] }, { "tin": { "type": "ein", "value": "863745753" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 335.97, "providers": [{ "billed_charge": 675.00, "npi": [1831561158] } ] } ] }, { "tin": { "type": "ein", "value": "461454134" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2693.00, "providers": [{ "billed_charge": 7760.00, "npi": [1194883272] } ] }, { "allowed_amount": 758.34, "providers": [{ "billed_charge": 3492.00, "npi": [1194883272] } ] } ] }, { "tin": { "type": "ein", "value": "464725163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 36386.25, "providers": [{ "billed_charge": 47128.25, "npi": [1942535828] } ] } ] }, { "tin": { "type": "ein", "value": "751414940" }, "service_code": ["11", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 638.95, "providers": [{ "billed_charge": 1220.00, "npi": [1578897765] } ] }, { "allowed_amount": 3066.96, "providers": [{ "billed_charge": 5906.00, "npi": [1578897765] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6265.75, "providers": [{ "billed_charge": 14592.78, "npi": [1972519544] } ] }, { "allowed_amount": 100403.50, "providers": [{ "billed_charge": 138218.67, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12911.51, "providers": [{ "billed_charge": 21879.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "300198705" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1051.20, "providers": [{ "billed_charge": 2970.00, "npi": [1003273731] } ] }, { "allowed_amount": 1635.20, "providers": [{ "billed_charge": 4620.00, "npi": [1538526702] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "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": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2431.26, "providers": [{ "billed_charge": 6110.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "824472878" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6872.95, "providers": [{ "billed_charge": 12740.00, "npi": [1477916708] } ] } ] }, { "tin": { "type": "ein", "value": "463951057" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8415.90, "providers": [{ "billed_charge": 23040.00, "npi": [1144330762] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["57"], "billing_class": "professional", "payments": [{ "allowed_amount": 1112.79, "providers": [{ "billed_charge": 2758.00, "npi": [1194386094] } ] } ] }, { "tin": { "type": "ein", "value": "832419554" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 585.39, "providers": [{ "billed_charge": 1833.00, "npi": [1134516032] } ] } ] }, { "tin": { "type": "ein", "value": "995025033" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1305.10, "providers": [{ "billed_charge": 1370.00, "npi": [1891289310] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 26333.19, "providers": [{ "billed_charge": 95947.00, "npi": [1386297356] } ] } ] } ] }, { "name": "INITIAL HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99221", "description": "INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883517085" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 606.73, "providers": [{ "billed_charge": 2475.00, "npi": [1356821284] } ] } ] }, { "tin": { "type": "ein", "value": "753129210" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1389.78, "providers": [{ "billed_charge": 4950.00, "npi": [1215925185] } ] } ] } ] }, { "name": "INITIAL HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99222", "description": "INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271368002" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6367.41, "providers": [{ "billed_charge": 31350.00, "npi": [1306048277] } ] } ] }, { "tin": { "type": "ein", "value": "510602325" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.01, "providers": [{ "billed_charge": 205.00, "npi": [1720068174] } ] } ] }, { "tin": { "type": "ein", "value": "395004203" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.02, "providers": [{ "billed_charge": 325.00, "npi": [1902216740] } ] }, { "allowed_amount": 581.90, "providers": [{ "billed_charge": 1625.00, "npi": [1902216740] } ] } ] }, { "tin": { "type": "ein", "value": "611648898" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 933.76, "providers": [{ "billed_charge": 2000.00, "npi": [1275532046] } ] } ] }, { "tin": { "type": "ein", "value": "753129210" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5535.18, "providers": [{ "billed_charge": 13800.00, "npi": [1215925185] } ] }, { "allowed_amount": 5192.73, "providers": [{ "billed_charge": 13800.00, "npi": [1235363862] } ] }, { "allowed_amount": 10337.52, "providers": [{ "billed_charge": 26700.00, "npi": [1184041436] } ] }, { "allowed_amount": 8914.95, "providers": [{ "billed_charge": 23100.00, "npi": [1316279326] } ] } ] }, { "tin": { "type": "ein", "value": "260822356" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1140.01, "providers": [{ "billed_charge": 2340.00, "npi": [1053929729] } ] } ] }, { "tin": { "type": "ein", "value": "760123983" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 700.32, "providers": [{ "billed_charge": 1260.00, "npi": [1538154042] } ] } ] }, { "tin": { "type": "ein", "value": "842068606" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 805.14, "providers": [{ "billed_charge": 2954.00, "npi": [1427478965] } ] }, { "allowed_amount": 690.12, "providers": [{ "billed_charge": 2532.00, "npi": [1427478965] } ] } ] }, { "tin": { "type": "ein", "value": "463847386" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.02, "providers": [{ "billed_charge": 200.00, "npi": [1164442778] } ] } ] }, { "tin": { "type": "ein", "value": "824004052" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 892.56, "providers": [{ "billed_charge": 3200.00, "npi": [1891943098] } ] } ] }, { "tin": { "type": "ein", "value": "270794018" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4715.82, "providers": [{ "billed_charge": 8200.00, "npi": [1932300779] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.85, "providers": [{ "billed_charge": 1302.00, "npi": [1326173386] } ] }, { "allowed_amount": 223.14, "providers": [{ "billed_charge": 520.00, "npi": [1225775182] } ] }, { "allowed_amount": 334.71, "providers": [{ "billed_charge": 782.00, "npi": [1225775182] } ] } ] }, { "tin": { "type": "ein", "value": "10681320" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 584.30, "providers": [{ "billed_charge": 1023.20, "npi": [1477618429] } ] }, { "allowed_amount": 111.57, "providers": [{ "billed_charge": 204.64, "npi": [1477618429] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["55", "51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 575.10, "providers": [{ "billed_charge": 1292.00, "npi": [1255388203] } ] }, { "allowed_amount": 230.04, "providers": [{ "billed_charge": 509.00, "npi": [1255388203] } ] }, { "allowed_amount": 345.06, "providers": [{ "billed_charge": 822.00, "npi": [1255388203] } ] } ] }, { "tin": { "type": "ein", "value": "861395398" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 4370.76, "providers": [{ "billed_charge": 17100.00, "npi": [1063546844] } ] } ] }, { "tin": { "type": "ein", "value": "742177317" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 233.44, "providers": [{ "billed_charge": 500.00, "npi": [1518997477] } ] } ] } ] }, { "name": "INITIAL HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99223", "description": "INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472401409" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3270.54, "providers": [{ "billed_charge": 7308.00, "npi": [1407879489] } ] } ] }, { "tin": { "type": "ein", "value": "470964891" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 2024.62, "providers": [{ "billed_charge": 3900.00, "npi": [1710025515] } ] } ] }, { "tin": { "type": "ein", "value": "992536327" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1692.68, "providers": [{ "billed_charge": 9544.15, "npi": [1447309208] } ] } ] }, { "tin": { "type": "ein", "value": "421708103" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 934.44, "providers": [{ "billed_charge": 2250.00, "npi": [1861486482] } ] } ] }, { "tin": { "type": "ein", "value": "205036495" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 467.22, "providers": [{ "billed_charge": 3126.00, "npi": [1548296429] } ] }, { "allowed_amount": 151.24, "providers": [{ "billed_charge": 1042.00, "npi": [1659886455] } ] } ] }, { "tin": { "type": "ein", "value": "753129210" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4810.12, "providers": [{ "billed_charge": 10500.00, "npi": [1215925185] } ] } ] }, { "tin": { "type": "ein", "value": "760434450" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1557.40, "providers": [{ "billed_charge": 3380.00, "npi": [1366436263] } ] } ] }, { "tin": { "type": "ein", "value": "461224002" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 335.26, "providers": [{ "billed_charge": 582.00, "npi": [1649470931] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 298.52, "providers": [{ "billed_charge": 759.49, "npi": [1659950160] } ] }, { "allowed_amount": 460.74, "providers": [{ "billed_charge": 1140.98, "npi": [1669712980] } ] }, { "allowed_amount": 149.26, "providers": [{ "billed_charge": 378.00, "npi": [1669712980, 1336113323] }, { "billed_charge": 381.49, "npi": [1891721700] } ] }, { "allowed_amount": 622.96, "providers": [{ "billed_charge": 1515.49, "npi": [1699809483] } ] }, { "allowed_amount": 447.78, "providers": [{ "billed_charge": 1134.00, "npi": [1891721700] } ] }, { "allowed_amount": 155.74, "providers": [{ "billed_charge": 381.49, "npi": [1689969974] }, { "billed_charge": 378.00, "npi": [1780941070] } ] }, { "allowed_amount": 311.48, "providers": [{ "billed_charge": 756.00, "npi": [1689969974] } ] } ] }, { "tin": { "type": "ein", "value": "832962661" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1940.38, "providers": [{ "billed_charge": 8125.00, "npi": [1346436276] } ] } ] }, { "tin": { "type": "ein", "value": "752387191" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 326.22, "providers": [{ "billed_charge": 1006.00, "npi": [1760529515] } ] } ] }, { "tin": { "type": "ein", "value": "873385999" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1384.92, "providers": [{ "billed_charge": 3600.00, "npi": [1710942727] } ] } ] }, { "tin": { "type": "ein", "value": "10681320" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 149.26, "providers": [{ "billed_charge": 262.84, "npi": [1881954030] } ] }, { "allowed_amount": 2238.90, "providers": [{ "billed_charge": 3942.60, "npi": [1881954030] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["22", "61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 746.30, "providers": [{ "billed_charge": 3095.00, "npi": [1174987820] } ] }, { "allowed_amount": 3432.98, "providers": [{ "billed_charge": 14237.00, "npi": [1174987820] } ] }, { "allowed_amount": 1343.34, "providers": [{ "billed_charge": 5571.00, "npi": [1841547759] } ] }, { "allowed_amount": 298.52, "providers": [{ "billed_charge": 1238.00, "npi": [1952663916] } ] }, { "allowed_amount": 2686.68, "providers": [{ "billed_charge": 11142.00, "npi": [1710333620] } ] }, { "allowed_amount": 16717.12, "providers": [{ "billed_charge": 69328.00, "npi": [1710333620] } ] }, { "allowed_amount": 149.26, "providers": [{ "billed_charge": 619.00, "npi": [1841547759] } ] }, { "allowed_amount": 447.78, "providers": [{ "billed_charge": 1857.00, "npi": [1952663916] } ] } ] }, { "tin": { "type": "ein", "value": "651287824" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 963.36, "providers": [{ "billed_charge": 3090.00, "npi": [1417069246] } ] } ] }, { "tin": { "type": "ein", "value": "202231203" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 467.22, "providers": [{ "billed_charge": 1155.00, "npi": [1447454012] } ] } ] }, { "tin": { "type": "ein", "value": "813904483" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.56, "providers": [{ "billed_charge": 554.85, "npi": [1386903037] } ] } ] }, { "tin": { "type": "ein", "value": "845003224" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 261.58, "providers": [{ "billed_charge": 678.00, "npi": [1235880717] } ] } ] }, { "tin": { "type": "ein", "value": "814005993" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1538.80, "providers": [{ "billed_charge": 3290.00, "npi": [1154393817] } ] }, { "allowed_amount": 4462.52, "providers": [{ "billed_charge": 9541.00, "npi": [1215076229] } ] } ] }, { "tin": { "type": "ein", "value": "843372323" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2959.06, "providers": [{ "billed_charge": 11970.00, "npi": [1588911390] } ] } ] }, { "tin": { "type": "ein", "value": "842068606" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3077.60, "providers": [{ "billed_charge": 12380.00, "npi": [1427478965] } ] }, { "allowed_amount": 461.64, "providers": [{ "billed_charge": 1857.00, "npi": [1881027126] } ] }, { "allowed_amount": 923.28, "providers": [{ "billed_charge": 3714.00, "npi": [1083136360, 1942863170] } ] }, { "allowed_amount": 307.76, "providers": [{ "billed_charge": 1238.00, "npi": [1922685866] } ] }, { "allowed_amount": 10463.84, "providers": [{ "billed_charge": 42092.00, "npi": [1881027126] } ] }, { "allowed_amount": 1384.92, "providers": [{ "billed_charge": 5571.00, "npi": [1942863170] } ] }, { "allowed_amount": 5539.68, "providers": [{ "billed_charge": 22284.00, "npi": [1427478965] } ] } ] }, { "tin": { "type": "ein", "value": "271463889" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5013.84, "providers": [{ "billed_charge": 19890.00, "npi": [1912096694] } ] } ] }, { "tin": { "type": "ein", "value": "371868760" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 746.30, "providers": [{ "billed_charge": 5455.00, "npi": [1497068233, 1063040020] } ] }, { "allowed_amount": 1194.08, "providers": [{ "billed_charge": 8728.00, "npi": [1205571692] } ] }, { "allowed_amount": 2089.64, "providers": [{ "billed_charge": 15274.00, "npi": [1043705528] } ] }, { "allowed_amount": 597.04, "providers": [{ "billed_charge": 4364.00, "npi": [1043705528] } ] }, { "allowed_amount": 298.52, "providers": [{ "billed_charge": 2182.00, "npi": [1497068233, 1063040020] } ] }, { "allowed_amount": 7909.76, "providers": [{ "billed_charge": 57823.00, "npi": [1992454797] } ] }, { "allowed_amount": 2835.94, "providers": [{ "billed_charge": 20729.00, "npi": [1992454797] } ] }, { "allowed_amount": 148.24, "providers": [{ "billed_charge": 1091.00, "npi": [1952798001] } ] } ] }, { "tin": { "type": "ein", "value": "760187419" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1245.92, "providers": [{ "billed_charge": 2400.00, "npi": [1366440265] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2154.32, "providers": [{ "billed_charge": 6964.00, "npi": [1790123495] } ] }, { "allowed_amount": 457.02, "providers": [{ "billed_charge": 1548.00, "npi": [1356637227] } ] }, { "allowed_amount": 6607.60, "providers": [{ "billed_charge": 21252.00, "npi": [1356637227] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99231", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460820928" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 383.94, "providers": [{ "billed_charge": 720.00, "npi": [1083600456] } ] } ] }, { "tin": { "type": "ein", "value": "134236446" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1805.44, "providers": [{ "billed_charge": 8400.00, "npi": [1043396211] } ] } ] }, { "tin": { "type": "ein", "value": "992536327" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1736.80, "providers": [{ "billed_charge": 9968.00, "npi": [1265953137] } ] } ] }, { "tin": { "type": "ein", "value": "200036985" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 589.68, "providers": [{ "billed_charge": 1036.00, "npi": [1265424980] } ] } ] }, { "tin": { "type": "ein", "value": "269983488" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.32, "providers": [{ "billed_charge": 176.80, "npi": [1770556995] } ] } ] }, { "tin": { "type": "ein", "value": "852260461" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2665.32, "providers": [{ "billed_charge": 7537.96, "npi": [1891944708] } ] } ] }, { "tin": { "type": "ein", "value": "760434450" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 922.95, "providers": [{ "billed_charge": 2268.00, "npi": [1366436263] } ] } ] }, { "tin": { "type": "ein", "value": "821243813" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 768.56, "providers": [{ "billed_charge": 3600.00, "npi": [1619175239] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 156.30, "providers": [{ "billed_charge": 309.00, "npi": [1649854498] } ] } ] }, { "tin": { "type": "ein", "value": "883517085" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3689.80, "providers": [{ "billed_charge": 7725.00, "npi": [1356821284] } ] } ] }, { "tin": { "type": "ein", "value": "991682710" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 130.26, "providers": [{ "billed_charge": 237.81, "npi": [1417935826] } ] }, { "allowed_amount": 824.98, "providers": [{ "billed_charge": 1506.13, "npi": [1417935826] } ] } ] }, { "tin": { "type": "ein", "value": "202706713" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1367.85, "providers": [{ "billed_charge": 2480.00, "npi": [1417972688] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["55", "22", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 86.84, "providers": [{ "billed_charge": 212.00, "npi": [1255388203] } ] }, { "allowed_amount": 1432.86, "providers": [{ "billed_charge": 3090.00, "npi": [1255388203] } ] }, { "allowed_amount": 43.42, "providers": [{ "billed_charge": 106.00, "npi": [1255388203] } ] } ] }, { "tin": { "type": "ein", "value": "471158090" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.36, "providers": [{ "billed_charge": 264.00, "npi": [1588061030] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.12, "providers": [{ "billed_charge": 121.00, "npi": [1841547759] } ] } ] }, { "tin": { "type": "ein", "value": "742177317" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 835.05, "providers": [{ "billed_charge": 4750.00, "npi": [1518997477] } ] } ] }, { "tin": { "type": "ein", "value": "873018884" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 681.76, "providers": [{ "billed_charge": 1568.00, "npi": [1366437865] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "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": "273852113" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5423.25, "providers": [{ "billed_charge": 15000.00, "npi": [1053366351] } ] } ] }, { "tin": { "type": "ein", "value": "202992162" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2827.44, "providers": [{ "billed_charge": 6300.00, "npi": [1841309341] } ] } ] }, { "tin": { "type": "ein", "value": "830807354" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.64, "providers": [{ "billed_charge": 460.00, "npi": [1043238553] } ] } ] }, { "tin": { "type": "ein", "value": "752616977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1539.16, "providers": [{ "billed_charge": 4071.00, "npi": [1376955492] } ] }, { "allowed_amount": 66.92, "providers": [{ "billed_charge": 177.00, "npi": [1376955492] } ] }, { "allowed_amount": 201.96, "providers": [{ "billed_charge": 531.00, "npi": [1447505243] } ] }, { "allowed_amount": 80.86, "providers": [{ "billed_charge": 177.00, "npi": [1366790990] } ] } ] }, { "tin": { "type": "ein", "value": "830594617" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 490.98, "providers": [{ "billed_charge": 1572.69, "npi": [1497918155] } ] } ] }, { "tin": { "type": "ein", "value": "760537362" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 981.96, "providers": [{ "billed_charge": 1750.00, "npi": [1588667778] } ] } ] }, { "tin": { "type": "ein", "value": "461202759" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1022.10, "providers": [{ "billed_charge": 1800.00, "npi": [1720225816] } ] } ] }, { "tin": { "type": "ein", "value": "752387191" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2354.24, "providers": [{ "billed_charge": 7328.00, "npi": [1760529515] } ] }, { "allowed_amount": 1695.09, "providers": [{ "billed_charge": 5496.00, "npi": [1346828704] } ] }, { "allowed_amount": 588.56, "providers": [{ "billed_charge": 1832.00, "npi": [1881816437] } ] }, { "allowed_amount": 435.99, "providers": [{ "billed_charge": 1374.00, "npi": [1407318470] } ] } ] }, { "tin": { "type": "ein", "value": "371737462" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1710.71, "providers": [{ "billed_charge": 5510.00, "npi": [1356808950] } ] } ] }, { "tin": { "type": "ein", "value": "202798379" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 430.29, "providers": [{ "billed_charge": 1538.10, "npi": [1144052804] } ] } ] }, { "tin": { "type": "ein", "value": "10681320" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1615.22, "providers": [{ "billed_charge": 2328.00, "npi": [1477618429] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 97.00, "npi": [1477618429] } ] }, { "allowed_amount": 1481.04, "providers": [{ "billed_charge": 2134.00, "npi": [1881954030] } ] } ] }, { "tin": { "type": "ein", "value": "475401520" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 589.90, "providers": [{ "billed_charge": 1800.00, "npi": [1649512591] } ] } ] }, { "tin": { "type": "ein", "value": "742958277" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 134.64, "providers": [{ "billed_charge": 278.00, "npi": [1760610182] } ] } ] }, { "tin": { "type": "ein", "value": "882064487" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 831.96, "providers": [{ "billed_charge": 1920.00, "npi": [1437531126] } ] } ] }, { "tin": { "type": "ein", "value": "461184208" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3016.02, "providers": [{ "billed_charge": 8600.00, "npi": [1659469609] } ] } ] }, { "tin": { "type": "ein", "value": "463932661" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 423.15, "providers": [{ "billed_charge": 1029.00, "npi": [1780198622] } ] } ] }, { "tin": { "type": "ein", "value": "760123983" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12414.78, "providers": [{ "billed_charge": 19470.00, "npi": [1538154042] } ] } ] }, { "tin": { "type": "ein", "value": "824140982" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.52, "providers": [{ "billed_charge": 1650.00, "npi": [1821385618] } ] } ] }, { "tin": { "type": "ein", "value": "752511572" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1569.06, "providers": [{ "billed_charge": 4485.00, "npi": [1467475244] } ] } ] }, { "tin": { "type": "ein", "value": "823224794" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7577.36, "providers": [{ "billed_charge": 31364.00, "npi": [1285924142] } ] }, { "allowed_amount": 72.31, "providers": [{ "billed_charge": 292.00, "npi": [1043251044] } ] } ] }, { "tin": { "type": "ein", "value": "921613687" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 485.87, "providers": [{ "billed_charge": 971.74, "npi": [1598984791, 1881661593] } ] }, { "allowed_amount": 277.64, "providers": [{ "billed_charge": 555.28, "npi": [1619139672] } ] } ] }, { "tin": { "type": "ein", "value": "752905110" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.66, "providers": [{ "billed_charge": 240.00, "npi": [1144457649] } ] } ] }, { "tin": { "type": "ein", "value": "752943993" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.14, "providers": [{ "billed_charge": 282.00, "npi": [1093209140] } ] } ] }, { "tin": { "type": "ein", "value": "883737728" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1023.30, "providers": [{ "billed_charge": 2100.00, "npi": [1932391844] } ] } ] }, { "tin": { "type": "ein", "value": "991626483" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.44, "providers": [{ "billed_charge": 350.00, "npi": [1245867274] } ] } ] }, { "tin": { "type": "ein", "value": "760532341" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 911.82, "providers": [{ "billed_charge": 1950.00, "npi": [1548292980] } ] } ] }, { "tin": { "type": "ein", "value": "471158090" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.24, "providers": [{ "billed_charge": 980.00, "npi": [1588061030] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 140.00, "npi": [1588061030] } ] } ] }, { "tin": { "type": "ein", "value": "843838788" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 701.40, "providers": [{ "billed_charge": 2169.30, "npi": [1528019023] } ] } ] }, { "tin": { "type": "ein", "value": "823426999" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1005.71, "providers": [{ "billed_charge": 2115.00, "npi": [1811639636] } ] } ] }, { "tin": { "type": "ein", "value": "850803569" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1211.76, "providers": [{ "billed_charge": 2970.00, "npi": [1720090988] } ] } ] }, { "tin": { "type": "ein", "value": "992536327" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2568.17, "providers": [{ "billed_charge": 14618.70, "npi": [1447309208] } ] } ] }, { "tin": { "type": "ein", "value": "510602325" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8246.04, "providers": [{ "billed_charge": 14950.00, "npi": [1720068174] } ] } ] }, { "tin": { "type": "ein", "value": "833693670" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 286.15, "providers": [{ "billed_charge": 1065.00, "npi": [1972350346] } ] } ] }, { "tin": { "type": "ein", "value": "844058518" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5760.55, "providers": [{ "billed_charge": 16185.00, "npi": [1932470689] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 701.40, "providers": [{ "billed_charge": 1990.00, "npi": [1073848396] } ] }, { "allowed_amount": 1122.24, "providers": [{ "billed_charge": 3184.00, "npi": [1467980433] } ] }, { "allowed_amount": 490.98, "providers": [{ "billed_charge": 1393.00, "npi": [1962603563] } ] }, { "allowed_amount": 981.96, "providers": [{ "billed_charge": 2786.00, "npi": [1780027136] } ] }, { "allowed_amount": 912.80, "providers": [{ "billed_charge": 2587.00, "npi": [1114036373] } ] } ] }, { "tin": { "type": "ein", "value": "332241086" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1122.24, "providers": [{ "billed_charge": 2528.00, "npi": [1700815479] } ] }, { "allowed_amount": 1683.00, "providers": [{ "billed_charge": 3950.00, "npi": [1952562407] } ] }, { "allowed_amount": 471.24, "providers": [{ "billed_charge": 1106.00, "npi": [1295175784] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 158.00, "npi": [1952562407] } ] } ] }, { "tin": { "type": "ein", "value": "760324613" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 307.35, "providers": [{ "billed_charge": 1472.32, "npi": [1851883128] }, { "billed_charge": 1446.20, "npi": [1477123719] } ] } ] }, { "tin": { "type": "ein", "value": "352635512" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.54, "providers": [{ "billed_charge": 2044.00, "npi": [1326023862] } ] }, { "allowed_amount": 1432.62, "providers": [{ "billed_charge": 6132.00, "npi": [1720037443] } ] } ] }, { "tin": { "type": "ein", "value": "831944931" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 3137.90, "providers": [{ "billed_charge": 7875.00, "npi": [1013265677] } ] } ] }, { "tin": { "type": "ein", "value": "845048280" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 2104.20, "providers": [{ "billed_charge": 10500.00, "npi": [1902255102] } ] } ] }, { "tin": { "type": "ein", "value": "992442600" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5136.34, "providers": [{ "billed_charge": 10212.00, "npi": [1730209719] } ] } ] }, { "tin": { "type": "ein", "value": "760672320" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5716.71, "providers": [{ "billed_charge": 10230.00, "npi": [1164989075] } ] } ] }, { "tin": { "type": "ein", "value": "472354281" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1192.38, "providers": [{ "billed_charge": 3502.00, "npi": [1376779140] } ] } ] }, { "tin": { "type": "ein", "value": "760681269" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1874.07, "providers": [{ "billed_charge": 5076.00, "npi": [1649591835] } ] }, { "allowed_amount": 1665.84, "providers": [{ "billed_charge": 4512.00, "npi": [1154680320] } ] } ] }, { "tin": { "type": "ein", "value": "842068606" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 416.46, "providers": [{ "billed_charge": 1326.00, "npi": [1780264317] } ] }, { "allowed_amount": 347.05, "providers": [{ "billed_charge": 1105.00, "npi": [1922685866] } ] }, { "allowed_amount": 138.82, "providers": [{ "billed_charge": 442.00, "npi": [1861769663, 1942863170] } ] }, { "allowed_amount": 1249.38, "providers": [{ "billed_charge": 3978.00, "npi": [1255952057] } ] }, { "allowed_amount": 1110.56, "providers": [{ "billed_charge": 3536.00, "npi": [1427478965] } ] }, { "allowed_amount": 277.64, "providers": [{ "billed_charge": 884.00, "npi": [1518198407] } ] }, { "allowed_amount": 2012.89, "providers": [{ "billed_charge": 6409.00, "npi": [1922685866] } ] }, { "allowed_amount": 3817.55, "providers": [{ "billed_charge": 12155.00, "npi": [1942863170] } ] }, { "allowed_amount": 1944.67, "providers": [{ "billed_charge": 7293.00, "npi": [1790890929] } ] }, { "allowed_amount": 1665.84, "providers": [{ "billed_charge": 5304.00, "npi": [1861769663] } ] }, { "allowed_amount": 4787.07, "providers": [{ "billed_charge": 15249.00, "npi": [1518198407] } ] } ] }, { "tin": { "type": "ein", "value": "760499311" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.70, "providers": [{ "billed_charge": 570.00, "npi": [1558423103] } ] } ] }, { "tin": { "type": "ein", "value": "270271587" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 757.50, "providers": [{ "billed_charge": 3300.00, "npi": [1912037417] } ] } ] }, { "tin": { "type": "ein", "value": "264717662" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1041.15, "providers": [{ "billed_charge": 3420.00, "npi": [1770516510] } ] } ] }, { "tin": { "type": "ein", "value": "471197805" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 551.10, "providers": [{ "billed_charge": 1200.00, "npi": [1770726309] } ] }, { "allowed_amount": 3820.47, "providers": [{ "billed_charge": 8250.00, "npi": [1770726309] } ] } ] }, { "tin": { "type": "ein", "value": "273888895" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.91, "providers": [{ "billed_charge": 160.00, "npi": [1508505892] } ] } ] }, { "tin": { "type": "ein", "value": "812513596" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 3109.33, "providers": [{ "billed_charge": 11180.00, "npi": [1366860447] } ] }, { "allowed_amount": 1475.28, "providers": [{ "billed_charge": 6240.00, "npi": [1730900754] } ] } ] }, { "tin": { "type": "ein", "value": "752452610" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1705.50, "providers": [{ "billed_charge": 3534.00, "npi": [1841653706] } ] } ] }, { "tin": { "type": "ein", "value": "472815347" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4418.82, "providers": [{ "billed_charge": 8190.00, "npi": [1699784819] } ] } ] }, { "tin": { "type": "ein", "value": "742634091" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.42, "providers": [{ "billed_charge": 302.00, "npi": [1780615732] } ] } ] }, { "tin": { "type": "ein", "value": "710892430" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5971.08, "providers": [{ "billed_charge": 12172.00, "npi": [1467427054] } ] } ] }, { "tin": { "type": "ein", "value": "464065241" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.24, "providers": [{ "billed_charge": 3549.00, "npi": [1952558769] } ] } ] }, { "tin": { "type": "ein", "value": "742177317" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1332.66, "providers": [{ "billed_charge": 3800.00, "npi": [1518997477] } ] } ] }, { "tin": { "type": "ein", "value": "853148201" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 817.68, "providers": [{ "billed_charge": 2100.00, "npi": [1376652206] } ] }, { "allowed_amount": 1297.20, "providers": [{ "billed_charge": 3325.00, "npi": [1376652206] } ] } ] }, { "tin": { "type": "ein", "value": "760665593" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1472.94, "providers": [{ "billed_charge": 11025.00, "npi": [1750325601] } ] } ] }, { "tin": { "type": "ein", "value": "472459031" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 763.51, "providers": [{ "billed_charge": 1738.00, "npi": [1235374224] } ] } ] }, { "tin": { "type": "ein", "value": "200978270" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 555.28, "providers": [{ "billed_charge": 1272.00, "npi": [1376747303] } ] } ] }, { "tin": { "type": "ein", "value": "844480979" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 538.56, "providers": [{ "billed_charge": 856.00, "npi": [1932307766] } ] } ] }, { "tin": { "type": "ein", "value": "460692925" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1066.80, "providers": [{ "billed_charge": 3000.00, "npi": [1942216460] } ] } ] }, { "tin": { "type": "ein", "value": "743099730" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2672.54, "providers": [{ "billed_charge": 5396.00, "npi": [1134165988] } ] } ] }, { "tin": { "type": "ein", "value": "272656129" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1262.52, "providers": [{ "billed_charge": 1987.20, "npi": [1124016829] } ] } ] }, { "tin": { "type": "ein", "value": "273378639" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 492.31, "providers": [{ "billed_charge": 1050.00, "npi": [1982870416] } ] } ] }, { "tin": { "type": "ein", "value": "861395398" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 9162.12, "providers": [{ "billed_charge": 52800.00, "npi": [1063546844] } ] } ] }, { "tin": { "type": "ein", "value": "205768117" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.14, "providers": [{ "billed_charge": 292.00, "npi": [1457333775] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": ["02", "51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.96, "providers": [{ "billed_charge": 1185.30, "npi": [1275152985] } ] }, { "allowed_amount": 624.06, "providers": [{ "billed_charge": 3555.90, "npi": [1689023152] } ] }, { "allowed_amount": 208.23, "providers": [{ "billed_charge": 1185.30, "npi": [1669615944] } ] }, { "allowed_amount": 3244.45, "providers": [{ "billed_charge": 21730.50, "npi": [1528604063] } ] }, { "allowed_amount": 277.64, "providers": [{ "billed_charge": 1580.40, "npi": [1669615944] } ] }, { "allowed_amount": 2493.00, "providers": [{ "billed_charge": 14223.60, "npi": [1669615944] } ] }, { "allowed_amount": 2524.25, "providers": [{ "billed_charge": 16989.30, "npi": [1821632712] } ] }, { "allowed_amount": 2779.30, "providers": [{ "billed_charge": 15804.00, "npi": [1689023152] } ] } ] }, { "tin": { "type": "ein", "value": "202231203" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6242.46, "providers": [{ "billed_charge": 12460.00, "npi": [1447454012] } ] }, { "allowed_amount": 3226.44, "providers": [{ "billed_charge": 6440.00, "npi": [1235337254] } ] }, { "allowed_amount": 701.40, "providers": [{ "billed_charge": 1400.00, "npi": [1447454012] } ] }, { "allowed_amount": 4208.40, "providers": [{ "billed_charge": 8400.00, "npi": [1235337254] } ] } ] }, { "tin": { "type": "ein", "value": "760530248" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.28, "providers": [{ "billed_charge": 400.00, "npi": [1982929253] } ] } ] }, { "tin": { "type": "ein", "value": "814005993" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2984.63, "providers": [{ "billed_charge": 6493.00, "npi": [1740212042] } ] }, { "allowed_amount": 7704.51, "providers": [{ "billed_charge": 16761.00, "npi": [1154393817] } ] }, { "allowed_amount": 14645.51, "providers": [{ "billed_charge": 31861.00, "npi": [1215076229] } ] }, { "allowed_amount": 1665.84, "providers": [{ "billed_charge": 3624.00, "npi": [1710333620] } ] } ] }, { "tin": { "type": "ein", "value": "760443692" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 771.54, "providers": [{ "billed_charge": 7230.00, "npi": [1265442420] } ] }, { "allowed_amount": 6593.16, "providers": [{ "billed_charge": 38070.00, "npi": [1285898403] } ] }, { "allowed_amount": 561.12, "providers": [{ "billed_charge": 4660.00, "npi": [1245427020] } ] } ] }, { "tin": { "type": "ein", "value": "843372323" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 13607.16, "providers": [{ "billed_charge": 43650.00, "npi": [1588911390] } ] } ] }, { "tin": { "type": "ein", "value": "200445029" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 106.92, "npi": [1992843163] } ] } ] }, { "tin": { "type": "ein", "value": "371897694" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 5115.46, "providers": [{ "billed_charge": 11534.00, "npi": [1164682431] } ] } ] }, { "tin": { "type": "ein", "value": "464143234" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 701.40, "providers": [{ "billed_charge": 2169.30, "npi": [1033346366] } ] } ] }, { "tin": { "type": "ein", "value": "990869376" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7773.92, "providers": [{ "billed_charge": 10080.00, "npi": [1255852422] } ] } ] }, { "tin": { "type": "ein", "value": "760151399" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 4672.73, "providers": [{ "billed_charge": 9125.00, "npi": [1982671590] } ] } ] }, { "tin": { "type": "ein", "value": "10726196" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.82, "providers": [{ "billed_charge": 422.00, "npi": [1659474203] } ] } ] }, { "tin": { "type": "ein", "value": "831838315" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1735.25, "providers": [{ "billed_charge": 3475.00, "npi": [1265666036] } ] }, { "allowed_amount": 763.51, "providers": [{ "billed_charge": 1529.00, "npi": [1265666036] } ] } ] }, { "tin": { "type": "ein", "value": "300369495" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.31, "providers": [{ "billed_charge": 121.00, "npi": [1952665234] } ] } ] }, { "tin": { "type": "ein", "value": "611715115" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.14, "providers": [{ "billed_charge": 288.00, "npi": [1639187263] } ] }, { "allowed_amount": 406.78, "providers": [{ "billed_charge": 1590.00, "npi": [1639187263] } ] } ] }, { "tin": { "type": "ein", "value": "861071456" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2112.33, "providers": [{ "billed_charge": 4950.00, "npi": [1932294584] } ] } ] }, { "tin": { "type": "ein", "value": "752613493" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 69.41, "providers": [{ "billed_charge": 238.00, "npi": [1285150755] } ] } ] }, { "tin": { "type": "ein", "value": "208770785" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9906.47, "providers": [{ "billed_charge": 20550.00, "npi": [1154488195] } ] } ] }, { "tin": { "type": "ein", "value": "824683113" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.56, "providers": [{ "billed_charge": 676.00, "npi": [1063695336] } ] } ] }, { "tin": { "type": "ein", "value": "813260624" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1527.02, "providers": [{ "billed_charge": 4400.00, "npi": [1871855585] } ] } ] }, { "tin": { "type": "ein", "value": "651216461" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.70, "providers": [{ "billed_charge": 750.00, "npi": [1457413775] } ] } ] }, { "tin": { "type": "ein", "value": "752536818" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.90, "providers": [{ "billed_charge": 558.57, "npi": [1306017983] } ] }, { "allowed_amount": 84.30, "providers": [{ "billed_charge": 186.19, "npi": [1306017983] } ] } ] }, { "tin": { "type": "ein", "value": "842548672" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 457.84, "providers": [{ "billed_charge": 1320.00, "npi": [1902489305] } ] } ] }, { "tin": { "type": "ein", "value": "760617615" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 673.20, "providers": [{ "billed_charge": 2780.00, "npi": [1962089714] } ] }, { "allowed_amount": 336.60, "providers": [{ "billed_charge": 1420.00, "npi": [1811510076] }, { "billed_charge": 1390.00, "npi": [1124348347] } ] }, { "allowed_amount": 134.64, "providers": [{ "billed_charge": 568.00, "npi": [1811510076] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7696.19, "providers": [{ "billed_charge": 23132.00, "npi": [1356637227] } ] }, { "allowed_amount": 208.23, "providers": [{ "billed_charge": 624.00, "npi": [1356637227] } ] }, { "allowed_amount": 3956.37, "providers": [{ "billed_charge": 11874.00, "npi": [1790123495] } ] } ] }, { "tin": { "type": "ein", "value": "300979881" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.41, "providers": [{ "billed_charge": 681.00, "npi": [1760063861] } ] } ] }, { "tin": { "type": "ein", "value": "833767505" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 701.40, "providers": [{ "billed_charge": 1100.00, "npi": [1295178507] } ] } ] }, { "tin": { "type": "ein", "value": "30562624" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7014.00, "providers": [{ "billed_charge": 10000.00, "npi": [1952621294] } ] }, { "allowed_amount": 3086.16, "providers": [{ "billed_charge": 4400.00, "npi": [1528168051] } ] } ] }, { "tin": { "type": "ein", "value": "760693452" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3857.70, "providers": [{ "billed_charge": 8690.00, "npi": [1144226515] } ] }, { "allowed_amount": 3787.56, "providers": [{ "billed_charge": 8634.00, "npi": [1265607725] } ] } ] }, { "tin": { "type": "ein", "value": "471603609" }, "service_code": ["22", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.06, "providers": [{ "billed_charge": 780.00, "npi": [1083900955] } ] }, { "allowed_amount": 3904.61, "providers": [{ "billed_charge": 7930.00, "npi": [1083900955] } ] } ] }, { "tin": { "type": "ein", "value": "463847386" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5761.03, "providers": [{ "billed_charge": 12450.00, "npi": [1164442778] } ] }, { "allowed_amount": 624.69, "providers": [{ "billed_charge": 1350.00, "npi": [1164442778] } ] } ] }, { "tin": { "type": "ein", "value": "264232139" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 782.32, "providers": [{ "billed_charge": 1650.00, "npi": [1477622710] } ] } ] }, { "tin": { "type": "ein", "value": "352335295" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.23, "providers": [{ "billed_charge": 675.00, "npi": [1194787200] } ] } ] }, { "tin": { "type": "ein", "value": "341983840" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1963.93, "providers": [{ "billed_charge": 3640.00, "npi": [1932327749] } ] } ] }, { "tin": { "type": "ein", "value": "832991106" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 914.65, "providers": [{ "billed_charge": 1725.00, "npi": [1669003760] } ] } ] }, { "tin": { "type": "ein", "value": "884316260" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 1010.70, "providers": [{ "billed_charge": 1875.00, "npi": [1285012641] } ] } ] }, { "tin": { "type": "ein", "value": "651255384" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 69.41, "providers": [{ "billed_charge": 153.00, "npi": [1508830985] } ] }, { "allowed_amount": 5899.85, "providers": [{ "billed_charge": 13005.00, "npi": [1508830985] } ] } ] }, { "tin": { "type": "ein", "value": "842103878" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.14, "providers": [{ "billed_charge": 245.00, "npi": [1043849433] } ] } ] }, { "tin": { "type": "ein", "value": "832621574" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 348.57, "providers": [{ "billed_charge": 359.35, "npi": [1366627523] } ] } ] }, { "tin": { "type": "ein", "value": "752896138" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1624.14, "providers": [{ "billed_charge": 3240.00, "npi": [1750673125] } ] }, { "allowed_amount": 812.07, "providers": [{ "billed_charge": 1620.00, "npi": [1255445953] } ] }, { "allowed_amount": 613.98, "providers": [{ "billed_charge": 1620.00, "npi": [1770774580] } ] } ] }, { "tin": { "type": "ein", "value": "463359105" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 371.00, "npi": [1508067885] } ] } ] }, { "tin": { "type": "ein", "value": "811443260" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3103.38, "providers": [{ "billed_charge": 9240.00, "npi": [1629365671] } ] } ] }, { "tin": { "type": "ein", "value": "832574302" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 526.28, "providers": [{ "billed_charge": 1377.00, "npi": [1245626373] } ] } ] }, { "tin": { "type": "ein", "value": "272177929" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 624.69, "providers": [{ "billed_charge": 2250.00, "npi": [1659412591] } ] } ] }, { "tin": { "type": "ein", "value": "852260461" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2338.21, "providers": [{ "billed_charge": 6554.86, "npi": [1891944708] } ] } ] }, { "tin": { "type": "ein", "value": "760420935" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3086.16, "providers": [{ "billed_charge": 6320.00, "npi": [1629043500] } ] } ] }, { "tin": { "type": "ein", "value": "833198217" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3817.55, "providers": [{ "billed_charge": 15950.00, "npi": [1285924142] } ] } ] }, { "tin": { "type": "ein", "value": "741941710" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1402.80, "providers": [{ "billed_charge": 4730.40, "npi": [1275578544] } ] } ] }, { "tin": { "type": "ein", "value": "461846537" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 782.58, "providers": [{ "billed_charge": 3640.00, "npi": [1295067106] } ] }, { "allowed_amount": 2368.37, "providers": [{ "billed_charge": 9620.00, "npi": [1811169501] } ] }, { "allowed_amount": 3277.11, "providers": [{ "billed_charge": 14300.00, "npi": [1538880349] } ] } ] }, { "tin": { "type": "ein", "value": "455038058" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1179.97, "providers": [{ "billed_charge": 3060.00, "npi": [1407056443] } ] } ] }, { "tin": { "type": "ein", "value": "451766766" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1627.20, "providers": [{ "billed_charge": 2040.00, "npi": [1427165588] } ] } ] }, { "tin": { "type": "ein", "value": "991682710" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 416.46, "providers": [{ "billed_charge": 759.24, "npi": [1417935826] } ] }, { "allowed_amount": 4164.60, "providers": [{ "billed_charge": 7604.67, "npi": [1417935826] } ] } ] }, { "tin": { "type": "ein", "value": "934013640" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 69.41, "providers": [{ "billed_charge": 200.00, "npi": [1639599632] } ] } ] }, { "tin": { "type": "ein", "value": "760187419" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3997.98, "providers": [{ "billed_charge": 9850.00, "npi": [1366440265] } ] } ] }, { "tin": { "type": "ein", "value": "352526373" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 393.40, "providers": [{ "billed_charge": 702.50, "npi": [1275798019] } ] } ] }, { "tin": { "type": "ein", "value": "751772118" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1227.96, "providers": [{ "billed_charge": 4284.00, "npi": [1871733188] } ] } ] }, { "tin": { "type": "ein", "value": "201790156" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.64, "providers": [{ "billed_charge": 640.00, "npi": [1386636025] } ] } ] }, { "tin": { "type": "ein", "value": "752673928" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1435.20, "providers": [{ "billed_charge": 4784.00, "npi": [1174606065] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3635.28, "providers": [{ "billed_charge": 8467.00, "npi": [1326173386] } ] }, { "allowed_amount": 70.14, "providers": [{ "billed_charge": 145.00, "npi": [1265052625] } ] }, { "allowed_amount": 1052.10, "providers": [{ "billed_charge": 2370.00, "npi": [1477588192] } ] }, { "allowed_amount": 538.56, "providers": [{ "billed_charge": 1238.00, "npi": [1548494016] } ] }, { "allowed_amount": 1015.44, "providers": [{ "billed_charge": 2318.00, "npi": [1992759070] } ] }, { "allowed_amount": 350.70, "providers": [{ "billed_charge": 790.00, "npi": [1225483423] } ] }, { "allowed_amount": 201.96, "providers": [{ "billed_charge": 461.00, "npi": [1124443288] } ] }, { "allowed_amount": 1683.00, "providers": [{ "billed_charge": 3937.00, "npi": [1124443288] } ] }, { "allowed_amount": 140.28, "providers": [{ "billed_charge": 316.00, "npi": [1851528475, 1700026457] } ] }, { "allowed_amount": 280.56, "providers": [{ "billed_charge": 632.00, "npi": [1477588192] }, { "billed_charge": 619.00, "npi": [1265052625] } ] }, { "allowed_amount": 1262.52, "providers": [{ "billed_charge": 2714.00, "npi": [1528267812] } ] }, { "allowed_amount": 611.52, "providers": [{ "billed_charge": 1344.00, "npi": [1578795209] } ] }, { "allowed_amount": 134.64, "providers": [{ "billed_charge": 316.00, "npi": [1326173386] }, { "billed_charge": 290.00, "npi": [1508367939] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 158.00, "npi": [1578795209] } ] } ] }, { "tin": { "type": "ein", "value": "760624055" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2454.90, "providers": [{ "billed_charge": 4200.00, "npi": [1194786137] } ] } ] }, { "tin": { "type": "ein", "value": "923102279" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1388.20, "providers": [{ "billed_charge": 4000.00, "npi": [1720391279] } ] } ] }, { "tin": { "type": "ein", "value": "522306954" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 121.00, "npi": [1316044530] } ] } ] }, { "tin": { "type": "ein", "value": "464534404" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 763.51, "providers": [{ "billed_charge": 1760.00, "npi": [1417967423] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["22", "61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2086.92, "providers": [{ "billed_charge": 6851.00, "npi": [1952663916] } ] }, { "allowed_amount": 7876.44, "providers": [{ "billed_charge": 25857.00, "npi": [1992952261] } ] }, { "allowed_amount": 403.92, "providers": [{ "billed_charge": 1326.00, "npi": [1174987820, 1154568558] } ] }, { "allowed_amount": 2154.24, "providers": [{ "billed_charge": 7072.00, "npi": [1992952261] } ] }, { "allowed_amount": 3096.72, "providers": [{ "billed_charge": 10166.00, "npi": [1235101221] } ] }, { "allowed_amount": 1144.44, "providers": [{ "billed_charge": 3757.00, "npi": [1235101221] } ] }, { "allowed_amount": 6193.44, "providers": [{ "billed_charge": 20332.00, "npi": [1902292808] } ] }, { "allowed_amount": 875.16, "providers": [{ "billed_charge": 2873.00, "npi": [1952663916] } ] }, { "allowed_amount": 201.96, "providers": [{ "billed_charge": 663.00, "npi": [1235101221, 1992952261] } ] }, { "allowed_amount": 1279.08, "providers": [{ "billed_charge": 4199.00, "npi": [1841547759] } ] }, { "allowed_amount": 1683.00, "providers": [{ "billed_charge": 5525.00, "npi": [1154568558] } ] }, { "allowed_amount": 2288.88, "providers": [{ "billed_charge": 7514.00, "npi": [1386140002] } ] }, { "allowed_amount": 471.24, "providers": [{ "billed_charge": 1547.00, "npi": [1386140002, 1841547759] } ] }, { "allowed_amount": 3904.56, "providers": [{ "billed_charge": 12818.00, "npi": [1669889291] } ] }, { "allowed_amount": 134.64, "providers": [{ "billed_charge": 442.00, "npi": [1669889291, 1386140002] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 221.00, "npi": [1902292808, 1841547759, 1952663916] } ] } ] }, { "tin": { "type": "ein", "value": "752732552" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 469.18, "providers": [{ "billed_charge": 1200.00, "npi": [1497945836] } ] } ] }, { "tin": { "type": "ein", "value": "463853362" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.02, "providers": [{ "billed_charge": 300.00, "npi": [1437378999] } ] } ] }, { "tin": { "type": "ein", "value": "813904483" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4700.15, "providers": [{ "billed_charge": 12969.45, "npi": [1386903037] } ] } ] }, { "tin": { "type": "ein", "value": "461522270" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 507.00, "npi": [1700227501] } ] } ] }, { "tin": { "type": "ein", "value": "832716119" }, "service_code": ["02", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3480.41, "providers": [{ "billed_charge": 54183.24, "npi": [1881182160] } ] }, { "allowed_amount": 884.85, "providers": [{ "billed_charge": 13775.40, "npi": [1881182160] } ] } ] }, { "tin": { "type": "ein", "value": "752836096" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 1710.71, "providers": [{ "billed_charge": 3277.00, "npi": [1740571660] } ] } ] }, { "tin": { "type": "ein", "value": "994830411" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 540.36, "providers": [{ "billed_charge": 1344.00, "npi": [1477087856] } ] }, { "allowed_amount": 1705.50, "providers": [{ "billed_charge": 4200.00, "npi": [1477087856] } ] } ] }, { "tin": { "type": "ein", "value": "462009634" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 416.46, "providers": [{ "billed_charge": 1312.00, "npi": [1518039965] } ] } ] }, { "tin": { "type": "ein", "value": "261162574" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 490.98, "providers": [{ "billed_charge": 1050.00, "npi": [1851597793] } ] } ] }, { "tin": { "type": "ein", "value": "371868760" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 605.88, "providers": [{ "billed_charge": 3537.00, "npi": [1073190898] } ] }, { "allowed_amount": 228.92, "providers": [{ "billed_charge": 1572.00, "npi": [1366793952] } ] }, { "allowed_amount": 2692.80, "providers": [{ "billed_charge": 15720.00, "npi": [1386619765] } ] }, { "allowed_amount": 201.96, "providers": [{ "billed_charge": 1179.00, "npi": [1386619765] } ] }, { "allowed_amount": 740.52, "providers": [{ "billed_charge": 4323.00, "npi": [1164835195] } ] }, { "allowed_amount": 3567.96, "providers": [{ "billed_charge": 20829.00, "npi": [1043705528] } ] }, { "allowed_amount": 134.64, "providers": [{ "billed_charge": 786.00, "npi": [1881009215, 1952798001, 1043705528, 1174883177] } ] }, { "allowed_amount": 67.32, "providers": [{ "billed_charge": 393.00, "npi": [1952798001, 1164835195] } ] } ] }, { "tin": { "type": "ein", "value": "263214045" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 832.92, "providers": [{ "billed_charge": 1692.00, "npi": [1871890616] } ] } ] }, { "tin": { "type": "ein", "value": "760567853" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 911.82, "providers": [{ "billed_charge": 1820.00, "npi": [1770596736] } ] } ] }, { "tin": { "type": "ein", "value": "760580939" }, "service_code": ["22", "61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 624.69, "providers": [{ "billed_charge": 1125.00, "npi": [1487760229] } ] }, { "allowed_amount": 277.64, "providers": [{ "billed_charge": 500.00, "npi": [1487760229] } ] }, { "allowed_amount": 69.41, "providers": [{ "billed_charge": 125.00, "npi": [1487760229] } ] } ] }, { "tin": { "type": "ein", "value": "475554737" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 572.30, "providers": [{ "billed_charge": 2410.00, "npi": [1649713595] } ] } ] }, { "tin": { "type": "ein", "value": "850741151" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 69.41, "providers": [{ "billed_charge": 160.00, "npi": [1619223104] } ] } ] }, { "tin": { "type": "ein", "value": "465019838" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1683.36, "providers": [{ "billed_charge": 3600.00, "npi": [1194040451] } ] } ] }, { "tin": { "type": "ein", "value": "470964891" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 13677.30, "providers": [{ "billed_charge": 29250.00, "npi": [1710025515] } ] } ] }, { "tin": { "type": "ein", "value": "205036495" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.75, "providers": [{ "billed_charge": 1119.00, "npi": [1356747257] } ] }, { "allowed_amount": 1615.75, "providers": [{ "billed_charge": 8579.00, "npi": [1891808333] } ] }, { "allowed_amount": 1107.07, "providers": [{ "billed_charge": 5222.00, "npi": [1528389954] } ] }, { "allowed_amount": 2388.50, "providers": [{ "billed_charge": 12682.00, "npi": [1821652421] } ] }, { "allowed_amount": 491.75, "providers": [{ "billed_charge": 2611.00, "npi": [1003565797, 1194785923] } ] }, { "allowed_amount": 931.54, "providers": [{ "billed_charge": 4476.00, "npi": [1194785923] } ] } ] }, { "tin": { "type": "ein", "value": "208757995" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 853.44, "providers": [{ "billed_charge": 2603.16, "npi": [1790730430] } ] } ] }, { "tin": { "type": "ein", "value": "753129210" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6373.45, "providers": [{ "billed_charge": 18200.00, "npi": [1184041436] } ] }, { "allowed_amount": 2377.34, "providers": [{ "billed_charge": 6800.00, "npi": [1316279326] } ] }, { "allowed_amount": 4049.36, "providers": [{ "billed_charge": 11200.00, "npi": [1215925185] } ] }, { "allowed_amount": 17230.49, "providers": [{ "billed_charge": 50200.00, "npi": [1235363862] } ] } ] }, { "tin": { "type": "ein", "value": "421651562" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.70, "providers": [{ "billed_charge": 500.00, "npi": [1477604668] } ] } ] }, { "tin": { "type": "ein", "value": "462747441" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 294.28, "providers": [{ "billed_charge": 500.00, "npi": [1396991162] } ] } ] }, { "tin": { "type": "ein", "value": "10744731" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.14, "providers": [{ "billed_charge": 157.00, "npi": [1255433611] } ] } ] }, { "tin": { "type": "ein", "value": "205146786" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3192.86, "providers": [{ "billed_charge": 9978.78, "npi": [1750450342] } ] }, { "allowed_amount": 624.69, "providers": [{ "billed_charge": 1952.37, "npi": [1063413235, 1215110556, 1790936144] } ] }, { "allowed_amount": 1110.56, "providers": [{ "billed_charge": 3470.88, "npi": [1215971049] } ] }, { "allowed_amount": 841.68, "providers": [{ "billed_charge": 2603.16, "npi": [1114163979] } ] }, { "allowed_amount": 3296.58, "providers": [{ "billed_charge": 10195.71, "npi": [1386723989] } ] }, { "allowed_amount": 1179.97, "providers": [{ "billed_charge": 3687.81, "npi": [1710025556] } ] }, { "allowed_amount": 1041.15, "providers": [{ "billed_charge": 3253.95, "npi": [1053406546] } ] } ] }, { "tin": { "type": "ein", "value": "473553486" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.24, "providers": [{ "billed_charge": 614.00, "npi": [1992144414] } ] } ] }, { "tin": { "type": "ein", "value": "450675246" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 213.36, "providers": [{ "billed_charge": 900.00, "npi": [1629099635] } ] } ] }, { "tin": { "type": "ein", "value": "834429224" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1356.00, "providers": [{ "billed_charge": 3600.00, "npi": [1063626455] } ] } ] }, { "tin": { "type": "ein", "value": "471770620" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3702.14, "providers": [{ "billed_charge": 11939.40, "npi": [1740442144] } ] } ] }, { "tin": { "type": "ein", "value": "261996124" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 946.22, "providers": [{ "billed_charge": 1464.82, "npi": [1245791425] } ] } ] }, { "tin": { "type": "ein", "value": "352527258" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 483.05, "providers": [{ "billed_charge": 1643.18, "npi": [1245811074] } ] } ] }, { "tin": { "type": "ein", "value": "760699297" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 971.74, "providers": [{ "billed_charge": 1484.00, "npi": [1699782417] } ] } ] }, { "tin": { "type": "ein", "value": "931760767" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 1548.36, "providers": [{ "billed_charge": 3335.00, "npi": [1760629240] } ] } ] }, { "tin": { "type": "ein", "value": "831325073" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2024.68, "providers": [{ "billed_charge": 4203.36, "npi": [1003257999] } ] }, { "allowed_amount": 1012.34, "providers": [{ "billed_charge": 2101.68, "npi": [1568818508] } ] } ] }, { "tin": { "type": "ein", "value": "462991144" }, "service_code": ["02", "51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 650.79, "providers": [{ "billed_charge": 2340.00, "npi": [1487833042] } ] }, { "allowed_amount": 72.31, "providers": [{ "billed_charge": 260.00, "npi": [1487833042] } ] } ] }, { "tin": { "type": "ein", "value": "993690074" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.86, "providers": [{ "billed_charge": 152.96, "npi": [1386814226] } ] } ] }, { "tin": { "type": "ein", "value": "742542858" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 210.00, "npi": [1902878044] } ] } ] }, { "tin": { "type": "ein", "value": "752668018" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 471.24, "providers": [{ "billed_charge": 1260.00, "npi": [1598705055] } ] } ] }, { "tin": { "type": "ein", "value": "814695407" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 336.60, "providers": [{ "billed_charge": 750.00, "npi": [1871836635] } ] } ] }, { "tin": { "type": "ein", "value": "455388396" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4677.69, "providers": [{ "billed_charge": 12169.08, "npi": [1366615866] } ] }, { "allowed_amount": 3834.35, "providers": [{ "billed_charge": 10272.60, "npi": [1275540700] } ] } ] }, { "tin": { "type": "ein", "value": "752668019" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.32, "providers": [{ "billed_charge": 126.00, "npi": [1427679612] } ] } ] }, { "tin": { "type": "ein", "value": "760317231" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1280.20, "providers": [{ "billed_charge": 3000.00, "npi": [1225058852] } ] } ] }, { "tin": { "type": "ein", "value": "873018884" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 749.54, "providers": [{ "billed_charge": 1727.00, "npi": [1366437865] } ] } ] }, { "tin": { "type": "ein", "value": "271368002" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 14095.78, "providers": [{ "billed_charge": 67925.00, "npi": [1306048277] } ] } ] }, { "tin": { "type": "ein", "value": "611648898" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 10661.28, "providers": [{ "billed_charge": 19000.00, "npi": [1275532046] } ] } ] }, { "tin": { "type": "ein", "value": "510484748" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.44, "providers": [{ "billed_charge": 490.00, "npi": [1982632857] } ] }, { "allowed_amount": 68.22, "providers": [{ "billed_charge": 245.00, "npi": [1982632857] } ] } ] }, { "tin": { "type": "ein", "value": "463932990" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.28, "providers": [{ "billed_charge": 300.00, "npi": [1326206822] } ] } ] }, { "tin": { "type": "ein", "value": "760434450" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4418.82, "providers": [{ "billed_charge": 9261.00, "npi": [1366436263] } ] } ] }, { "tin": { "type": "ein", "value": "263269355" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1052.10, "providers": [{ "billed_charge": 1800.00, "npi": [1982617940] } ] } ] }, { "tin": { "type": "ein", "value": "161728507" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2525.04, "providers": [{ "billed_charge": 6480.00, "npi": [1851360499] } ] } ] }, { "tin": { "type": "ein", "value": "752646477" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.23, "providers": [{ "billed_charge": 226.00, "npi": [1205316288] } ] } ] }, { "tin": { "type": "ein", "value": "760189664" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4266.29, "providers": [{ "billed_charge": 12862.59, "npi": [1881770576] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["55", "51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6823.04, "providers": [{ "billed_charge": 14972.00, "npi": [1255388203] } ] }, { "allowed_amount": 1190.40, "providers": [{ "billed_charge": 2822.00, "npi": [1255388203] } ] }, { "allowed_amount": 3136.86, "providers": [{ "billed_charge": 7158.00, "npi": [1255388203] } ] } ] }, { "tin": { "type": "ein", "value": "371714382" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 134.64, "providers": [{ "billed_charge": 350.90, "npi": [1639120827] } ] }, { "allowed_amount": 558.30, "providers": [{ "billed_charge": 1403.60, "npi": [1245200393] } ] } ] }, { "tin": { "type": "ein", "value": "463417207" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.42, "providers": [{ "billed_charge": 660.00, "npi": [1043472756] } ] }, { "allowed_amount": 885.82, "providers": [{ "billed_charge": 2860.00, "npi": [1841219912] } ] } ] }, { "tin": { "type": "ein", "value": "832926945" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2665.32, "providers": [{ "billed_charge": 10260.00, "npi": [1841337128] } ] } ] }, { "tin": { "type": "ein", "value": "134236446" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4215.29, "providers": [{ "billed_charge": 15250.00, "npi": [1043396211] } ] } ] }, { "tin": { "type": "ein", "value": "455399300" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 971.74, "providers": [{ "billed_charge": 1965.04, "npi": [1194938035] } ] } ] }, { "tin": { "type": "ein", "value": "752547668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1076.73, "providers": [{ "billed_charge": 4800.00, "npi": [1336240399] } ] } ] }, { "tin": { "type": "ein", "value": "751604753" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1158.38, "providers": [{ "billed_charge": 2652.00, "npi": [1023491255] } ] }, { "allowed_amount": 1430.94, "providers": [{ "billed_charge": 3276.00, "npi": [1700871019] } ] }, { "allowed_amount": 115.84, "providers": [{ "billed_charge": 312.00, "npi": [1275819674] } ] } ] }, { "tin": { "type": "ein", "value": "271463889" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1449.75, "providers": [{ "billed_charge": 6125.00, "npi": [1912096694] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 498.96, "providers": [{ "billed_charge": 1200.00, "npi": [1528771607] } ] }, { "allowed_amount": 249.48, "providers": [{ "billed_charge": 600.00, "npi": [1578921243, 1861889891] } ] }, { "allowed_amount": 556.08, "providers": [{ "billed_charge": 1400.00, "npi": [1396204228] } ] }, { "allowed_amount": 1829.52, "providers": [{ "billed_charge": 4400.00, "npi": [1609220656] } ] }, { "allowed_amount": 1995.84, "providers": [{ "billed_charge": 4800.00, "npi": [1457914517] } ] }, { "allowed_amount": 1496.88, "providers": [{ "billed_charge": 3600.00, "npi": [1144676156] } ] }, { "allowed_amount": 494.76, "providers": [{ "billed_charge": 1400.00, "npi": [1912656521] } ] }, { "allowed_amount": 1580.04, "providers": [{ "billed_charge": 3800.00, "npi": [1407342785] } ] }, { "allowed_amount": 3076.92, "providers": [{ "billed_charge": 7400.00, "npi": [1114718459] } ] } ] }, { "tin": { "type": "ein", "value": "853027612" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1804.66, "providers": [{ "billed_charge": 4550.00, "npi": [1619921988] } ] } ] }, { "tin": { "type": "ein", "value": "202264193" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.33, "providers": [{ "billed_charge": 1950.00, "npi": [1144277294] } ] } ] }, { "tin": { "type": "ein", "value": "273390698" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1402.80, "providers": [{ "billed_charge": 3600.00, "npi": [1740431113] } ] } ] }, { "tin": { "type": "ein", "value": "752254247" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 416.46, "providers": [{ "billed_charge": 1419.12, "npi": [1336107507] } ] } ] }, { "tin": { "type": "ein", "value": "842897951" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.33, "providers": [{ "billed_charge": 2353.00, "npi": [1003197088] } ] }, { "allowed_amount": 69.41, "providers": [{ "billed_charge": 181.00, "npi": [1003197088] } ] } ] }, { "tin": { "type": "ein", "value": "461224002" }, "service_code": ["02", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.23, "providers": [{ "billed_charge": 450.00, "npi": [1336339340] } ] }, { "allowed_amount": 5713.99, "providers": [{ "billed_charge": 12600.00, "npi": [1649470931] } ] }, { "allowed_amount": 1665.84, "providers": [{ "billed_charge": 3600.00, "npi": [1336339340] } ] } ] }, { "tin": { "type": "ein", "value": "873249972" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2174.34, "providers": [{ "billed_charge": 3224.00, "npi": [1982915013] } ] } ] }, { "tin": { "type": "ein", "value": "832962661" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 605.88, "providers": [{ "billed_charge": 2250.00, "npi": [1346436276] } ] } ] }, { "tin": { "type": "ein", "value": "600811631" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2368.37, "providers": [{ "billed_charge": 5735.00, "npi": [1730190638] } ] } ] }, { "tin": { "type": "ein", "value": "320119960" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 231.68, "providers": [{ "billed_charge": 572.00, "npi": [1316447642] } ] }, { "allowed_amount": 1022.10, "providers": [{ "billed_charge": 2145.00, "npi": [1992702062] } ] } ] }, { "tin": { "type": "ein", "value": "760341906" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 859.02, "providers": [{ "billed_charge": 1800.00, "npi": [1689940579] } ] } ] }, { "tin": { "type": "ein", "value": "862536544" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 13949.71, "providers": [{ "billed_charge": 43010.00, "npi": [1700170867] } ] } ] }, { "tin": { "type": "ein", "value": "752712328" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 911.65, "providers": [{ "billed_charge": 3250.00, "npi": [1801274477] } ] }, { "allowed_amount": 2458.83, "providers": [{ "billed_charge": 8750.00, "npi": [1013982511] } ] } ] }, { "tin": { "type": "ein", "value": "845003224" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 294.95, "providers": [{ "billed_charge": 775.00, "npi": [1235880717] } ] }, { "allowed_amount": 8193.92, "providers": [{ "billed_charge": 21545.00, "npi": [1235880717] } ] } ] }, { "tin": { "type": "ein", "value": "472004181" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2280.67, "providers": [{ "billed_charge": 5580.00, "npi": [1922028125] } ] } ] }, { "tin": { "type": "ein", "value": "269983488" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3001.68, "providers": [{ "billed_charge": 6219.84, "npi": [1770556995] } ] } ] }, { "tin": { "type": "ein", "value": "452783909" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 361.55, "providers": [{ "billed_charge": 756.50, "npi": [1497174320] } ] } ] }, { "tin": { "type": "ein", "value": "852062843" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 1548.36, "providers": [{ "billed_charge": 3680.00, "npi": [1881081297] } ] } ] }, { "tin": { "type": "ein", "value": "452654166" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.82, "providers": [{ "billed_charge": 384.00, "npi": [1679737605, 1972253920] } ] } ] }, { "tin": { "type": "ein", "value": "760007874" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9539.04, "providers": [{ "billed_charge": 20400.00, "npi": [1790861102] } ] } ] }, { "tin": { "type": "ein", "value": "861923754" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.70, "providers": [{ "billed_charge": 2600.00, "npi": [1235486440] } ] } ] }, { "tin": { "type": "ein", "value": "461375202" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1726.76, "providers": [{ "billed_charge": 2760.00, "npi": [1104055094] } ] } ] }, { "tin": { "type": "ein", "value": "463551659" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7575.12, "providers": [{ "billed_charge": 37983.60, "npi": [1396944658] } ] } ] }, { "tin": { "type": "ein", "value": "465465130" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.82, "providers": [{ "billed_charge": 364.00, "npi": [1417447798] }, { "billed_charge": 363.36, "npi": [1053999656] } ] }, { "allowed_amount": 971.74, "providers": [{ "billed_charge": 2543.52, "npi": [1053999656] } ] }, { "allowed_amount": 969.82, "providers": [{ "billed_charge": 2548.00, "npi": [1417447798] } ] }, { "allowed_amount": 58.99, "providers": [{ "billed_charge": 182.00, "npi": [1649919861] } ] }, { "allowed_amount": 4219.16, "providers": [{ "billed_charge": 12922.00, "npi": [1689339608] } ] }, { "allowed_amount": 235.96, "providers": [{ "billed_charge": 728.00, "npi": [1649919861] } ] } ] }, { "tin": { "type": "ein", "value": "832802070" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1158.38, "providers": [{ "billed_charge": 2403.12, "npi": [1740512649] } ] } ] }, { "tin": { "type": "ein", "value": "870837459" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3054.04, "providers": [{ "billed_charge": 4840.00, "npi": [1043444789] } ] } ] }, { "tin": { "type": "ein", "value": "815340807" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1635.48, "providers": [{ "billed_charge": 3360.00, "npi": [1972850170] } ] } ] }, { "tin": { "type": "ein", "value": "452555165" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2174.34, "providers": [{ "billed_charge": 5425.00, "npi": [1194751214] } ] } ] }, { "tin": { "type": "ein", "value": "752005254" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1078.80, "providers": [{ "billed_charge": 2190.00, "npi": [1083202501] } ] }, { "allowed_amount": 2284.47, "providers": [{ "billed_charge": 3942.00, "npi": [1407849946] } ] }, { "allowed_amount": 1692.20, "providers": [{ "billed_charge": 2920.00, "npi": [1205847944] } ] }, { "allowed_amount": 318.58, "providers": [{ "billed_charge": 584.00, "npi": [1942687066] } ] }, { "allowed_amount": 169.22, "providers": [{ "billed_charge": 292.00, "npi": [1073581773] } ] }, { "allowed_amount": 253.83, "providers": [{ "billed_charge": 438.00, "npi": [1528051042] } ] }, { "allowed_amount": 1099.93, "providers": [{ "billed_charge": 1898.00, "npi": [1265636831] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "CPT", "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": "861543241" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1578.60, "providers": [{ "billed_charge": 4301.25, "npi": [1689957482] } ] } ] }, { "tin": { "type": "ein", "value": "472401409" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 25843.05, "providers": [{ "billed_charge": 57834.00, "npi": [1407879489] } ] } ] }, { "tin": { "type": "ein", "value": "273852113" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3069.92, "providers": [{ "billed_charge": 7000.00, "npi": [1053366351] } ] } ] }, { "tin": { "type": "ein", "value": "751772118" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 413.88, "providers": [{ "billed_charge": 1432.00, "npi": [1871733188] } ] } ] }, { "tin": { "type": "ein", "value": "752616977" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.09, "providers": [{ "billed_charge": 263.00, "npi": [1679990527] } ] } ] }, { "tin": { "type": "ein", "value": "830594617" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 850.80, "providers": [{ "billed_charge": 2569.20, "npi": [1497918155] } ] } ] }, { "tin": { "type": "ein", "value": "743207127" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2654.34, "providers": [{ "billed_charge": 8476.00, "npi": [1033216643] } ] } ] }, { "tin": { "type": "ein", "value": "272319883" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.05, "providers": [{ "billed_charge": 825.00, "npi": [1871673137] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4083.60, "providers": [{ "billed_charge": 9265.00, "npi": [1154709665] } ] }, { "allowed_amount": 2020.65, "providers": [{ "billed_charge": 4360.00, "npi": [1891271904] } ] }, { "allowed_amount": 1914.30, "providers": [{ "billed_charge": 4125.00, "npi": [1366822330] } ] }, { "allowed_amount": 425.40, "providers": [{ "billed_charge": 940.00, "npi": [1023564176, 1316399769] }, { "billed_charge": 925.00, "npi": [1518908763, 1477138238, 1730615873] } ] }, { "allowed_amount": 212.70, "providers": [{ "billed_charge": 440.00, "npi": [1346636586] }, { "billed_charge": 455.00, "npi": [1275065559] }, { "billed_charge": 470.00, "npi": [1164699518, 1699936708, 1891271904] } ] }, { "allowed_amount": 638.10, "providers": [{ "billed_charge": 1395.00, "npi": [1558788950] } ] }, { "allowed_amount": 927.33, "providers": [{ "billed_charge": 2070.00, "npi": [1912355983] } ] }, { "allowed_amount": 531.75, "providers": [{ "billed_charge": 1175.00, "npi": [1477755510, 1538664842] }, { "billed_charge": 1160.00, "npi": [1821654872] } ] }, { "allowed_amount": 719.81, "providers": [{ "billed_charge": 1645.00, "npi": [1528640406] } ] }, { "allowed_amount": 204.18, "providers": [{ "billed_charge": 455.00, "npi": [1831473081] }, { "billed_charge": 470.00, "npi": [1801450127, 1326487638] } ] }, { "allowed_amount": 816.72, "providers": [{ "billed_charge": 1865.00, "npi": [1700406501] }, { "billed_charge": 1850.00, "npi": [1881049500] } ] }, { "allowed_amount": 2862.78, "providers": [{ "billed_charge": 6415.00, "npi": [1275198053] } ] }, { "allowed_amount": 306.27, "providers": [{ "billed_charge": 690.00, "npi": [1518547108, 1093132383] } ] }, { "allowed_amount": 957.15, "providers": [{ "billed_charge": 2085.00, "npi": [1336300516] } ] }, { "allowed_amount": 1429.26, "providers": [{ "billed_charge": 3275.00, "npi": [1578916490, 1528621687] } ] }, { "allowed_amount": 106.35, "providers": [{ "billed_charge": 220.00, "npi": [1477755510] }, { "billed_charge": 235.00, "npi": [1467834879, 1518908763, 1730615873, 1821654872, 1902434616] } ] }, { "allowed_amount": 2348.07, "providers": [{ "billed_charge": 5405.00, "npi": [1518547108] } ] }, { "allowed_amount": 1969.53, "providers": [{ "billed_charge": 4345.00, "npi": [1699020883] } ] }, { "allowed_amount": 1122.99, "providers": [{ "billed_charge": 2570.00, "npi": [1639494743] } ] }, { "allowed_amount": 1169.85, "providers": [{ "billed_charge": 2555.00, "npi": [1316399769] }, { "billed_charge": 2540.00, "npi": [1477940856] }, { "billed_charge": 2480.00, "npi": [1699936708, 1417488164] } ] }, { "allowed_amount": 319.05, "providers": [{ "billed_charge": 675.00, "npi": [1568824100] }, { "billed_charge": 690.00, "npi": [1083058515, 1346636586] } ] }, { "allowed_amount": 408.36, "providers": [{ "billed_charge": 910.00, "npi": [1740586411] }, { "billed_charge": 925.00, "npi": [1578916490] } ] }, { "allowed_amount": 1225.08, "providers": [{ "billed_charge": 2820.00, "npi": [1881821775] } ] }, { "allowed_amount": 3373.23, "providers": [{ "billed_charge": 7665.00, "npi": [1346778644] } ] }, { "allowed_amount": 820.98, "providers": [{ "billed_charge": 1865.00, "npi": [1437310083] } ] }, { "allowed_amount": 3071.22, "providers": [{ "billed_charge": 6885.00, "npi": [1093132383] } ] }, { "allowed_amount": 1063.50, "providers": [{ "billed_charge": 2305.00, "npi": [1801066733] } ] }, { "allowed_amount": 612.54, "providers": [{ "billed_charge": 1410.00, "npi": [1437405164] }, { "billed_charge": 1380.00, "npi": [1386027472] } ] }, { "allowed_amount": 1488.90, "providers": [{ "billed_charge": 3200.00, "npi": [1700469335] } ] }, { "allowed_amount": 2552.25, "providers": [{ "billed_charge": 5785.00, "npi": [1326487638] } ] }, { "allowed_amount": 102.09, "providers": [{ "billed_charge": 220.00, "npi": [1538426135] }, { "billed_charge": 235.00, "npi": [1801450127, 1346778644, 1154709665, 1437508074, 1740586411, 1538426135, 1437310083] } ] } ] }, { "tin": { "type": "ein", "value": "260685264" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.09, "providers": [{ "billed_charge": 170.00, "npi": [1073521019] } ] } ] }, { "tin": { "type": "ein", "value": "200201407" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1589.92, "providers": [{ "billed_charge": 2550.00, "npi": [1700957230] } ] } ] }, { "tin": { "type": "ein", "value": "752387191" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3346.80, "providers": [{ "billed_charge": 10260.00, "npi": [1760529515] } ] }, { "allowed_amount": 2454.32, "providers": [{ "billed_charge": 7524.00, "npi": [1588168157] } ] } ] }, { "tin": { "type": "ein", "value": "862932341" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1644.60, "providers": [{ "billed_charge": 7392.00, "npi": [1720308463] } ] } ] }, { "tin": { "type": "ein", "value": "202798379" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1807.95, "providers": [{ "billed_charge": 5591.64, "npi": [1831304724] } ] } ] }, { "tin": { "type": "ein", "value": "522306954" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 408.36, "providers": [{ "billed_charge": 680.00, "npi": [1316044530] } ] } ] }, { "tin": { "type": "ein", "value": "460664930" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4815.15, "providers": [{ "billed_charge": 15459.24, "npi": [1922204270] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["22", "61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.18, "providers": [{ "billed_charge": 638.00, "npi": [1841547759] } ] }, { "allowed_amount": 2960.61, "providers": [{ "billed_charge": 9251.00, "npi": [1992952261] } ] }, { "allowed_amount": 8779.74, "providers": [{ "billed_charge": 27434.00, "npi": [1174987820] } ] }, { "allowed_amount": 4696.14, "providers": [{ "billed_charge": 14674.00, "npi": [1841547759] } ] }, { "allowed_amount": 7146.30, "providers": [{ "billed_charge": 22330.00, "npi": [1669889291] } ] }, { "allowed_amount": 7350.48, "providers": [{ "billed_charge": 22968.00, "npi": [1386140002] } ] }, { "allowed_amount": 5308.68, "providers": [{ "billed_charge": 16588.00, "npi": [1154568558] } ] }, { "allowed_amount": 3675.24, "providers": [{ "billed_charge": 11484.00, "npi": [1902292808] } ] }, { "allowed_amount": 102.09, "providers": [{ "billed_charge": 319.00, "npi": [1669889291, 1154568558] } ] }, { "allowed_amount": 306.27, "providers": [{ "billed_charge": 957.00, "npi": [1174987820] } ] }, { "allowed_amount": 3471.06, "providers": [{ "billed_charge": 10846.00, "npi": [1952663916] } ] } ] }, { "tin": { "type": "ein", "value": "742958277" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.09, "providers": [{ "billed_charge": 201.00, "npi": [1932161254] } ] } ] }, { "tin": { "type": "ein", "value": "882064487" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 841.92, "providers": [{ "billed_charge": 2160.00, "npi": [1437531126] } ] } ] }, { "tin": { "type": "ein", "value": "463853362" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 368.84, "providers": [{ "billed_charge": 700.00, "npi": [1437378999] } ] } ] }, { "tin": { "type": "ein", "value": "202971454" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2756.43, "providers": [{ "billed_charge": 4401.00, "npi": [1497719306] } ] } ] }, { "tin": { "type": "ein", "value": "461522270" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.57, "providers": [{ "billed_charge": 2187.00, "npi": [1114244860] } ] } ] }, { "tin": { "type": "ein", "value": "760613299" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 850.80, "providers": [{ "billed_charge": 3400.00, "npi": [1255713160] } ] }, { "allowed_amount": 106.35, "providers": [{ "billed_charge": 425.00, "npi": [1255713160] } ] } ] }, { "tin": { "type": "ein", "value": "752836096" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 447.30, "providers": [{ "billed_charge": 1000.00, "npi": [1740571660] } ] } ] }, { "tin": { "type": "ein", "value": "752907253" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1671.05, "providers": [{ "billed_charge": 6962.55, "npi": [1730733239] } ] } ] }, { "tin": { "type": "ein", "value": "850811864" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11127.60, "providers": [{ "billed_charge": 16350.00, "npi": [1700970282] } ] } ] }, { "tin": { "type": "ein", "value": "823224794" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4933.80, "providers": [{ "billed_charge": 19342.00, "npi": [1043251044] } ] } ] }, { "tin": { "type": "ein", "value": "994830411" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3104.10, "providers": [{ "billed_charge": 7560.00, "npi": [1477087856] } ] }, { "allowed_amount": 620.82, "providers": [{ "billed_charge": 1512.00, "npi": [1477087856] } ] } ] }, { "tin": { "type": "ein", "value": "460894804" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.56, "providers": [{ "billed_charge": 1740.00, "npi": [1871977843] } ] }, { "allowed_amount": 109.64, "providers": [{ "billed_charge": 435.00, "npi": [1366461311] } ] } ] }, { "tin": { "type": "ein", "value": "752511572" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2379.81, "providers": [{ "billed_charge": 5175.00, "npi": [1467475244] } ] } ] }, { "tin": { "type": "ein", "value": "10593260" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 638.10, "providers": [{ "billed_charge": 924.00, "npi": [1720585474] } ] } ] }, { "tin": { "type": "ein", "value": "752905110" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3621.45, "providers": [{ "billed_charge": 4200.00, "npi": [1598933558] } ] } ] }, { "tin": { "type": "ein", "value": "270794018" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 14207.40, "providers": [{ "billed_charge": 20250.00, "npi": [1932300779] } ] } ] }, { "tin": { "type": "ein", "value": "371868760" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6840.03, "providers": [{ "billed_charge": 37788.00, "npi": [1386619765] } ] }, { "allowed_amount": 1429.26, "providers": [{ "billed_charge": 7896.00, "npi": [1043705528] } ] }, { "allowed_amount": 9392.28, "providers": [{ "billed_charge": 51888.00, "npi": [1952798001] } ] }, { "allowed_amount": 3877.32, "providers": [{ "billed_charge": 21432.00, "npi": [1679768089] } ] }, { "allowed_amount": 1214.78, "providers": [{ "billed_charge": 7896.00, "npi": [1366793952] } ] }, { "allowed_amount": 1224.38, "providers": [{ "billed_charge": 6768.00, "npi": [1336777028] } ] }, { "allowed_amount": 204.18, "providers": [{ "billed_charge": 1128.00, "npi": [1073190898, 1043705528] } ] }, { "allowed_amount": 8779.74, "providers": [{ "billed_charge": 48504.00, "npi": [1497068233] } ] }, { "allowed_amount": 1633.44, "providers": [{ "billed_charge": 9024.00, "npi": [1073190898] } ] }, { "allowed_amount": 1837.62, "providers": [{ "billed_charge": 10152.00, "npi": [1992454797] } ] }, { "allowed_amount": 816.72, "providers": [{ "billed_charge": 4512.00, "npi": [1881154201] } ] }, { "allowed_amount": 7758.14, "providers": [{ "billed_charge": 42864.00, "npi": [1164835195] } ] }, { "allowed_amount": 6737.24, "providers": [{ "billed_charge": 37224.00, "npi": [1174883177] } ] }, { "allowed_amount": 612.54, "providers": [{ "billed_charge": 3384.00, "npi": [1649401589] } ] }, { "allowed_amount": 102.09, "providers": [{ "billed_charge": 564.00, "npi": [1952798001, 1336777028, 1174883177, 1992454797] } ] }, { "allowed_amount": 306.27, "providers": [{ "billed_charge": 1692.00, "npi": [1164835195] } ] }, { "allowed_amount": 1327.17, "providers": [{ "billed_charge": 7332.00, "npi": [1881009215] } ] } ] }, { "tin": { "type": "ein", "value": "20571980" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 960.03, "providers": [{ "billed_charge": 1665.00, "npi": [1033226006] } ] } ] }, { "tin": { "type": "ein", "value": "455423722" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1450.28, "providers": [{ "billed_charge": 2704.00, "npi": [1770863615] } ] } ] }, { "tin": { "type": "ein", "value": "264113201" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1096.40, "providers": [{ "billed_charge": 2680.00, "npi": [1447464458] } ] }, { "allowed_amount": 109.64, "providers": [{ "billed_charge": 268.00, "npi": [1447464458] } ] } ] }, { "tin": { "type": "ein", "value": "455270128" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.42, "providers": [{ "billed_charge": 400.00, "npi": [1730392549] } ] } ] }, { "tin": { "type": "ein", "value": "752903739" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 612.54, "providers": [{ "billed_charge": 1620.00, "npi": [1710900527] } ] } ] }, { "tin": { "type": "ein", "value": "883703657" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1998.12, "providers": [{ "billed_charge": 5110.00, "npi": [1194179010] } ] } ] }, { "tin": { "type": "ein", "value": "833838272" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1276.20, "providers": [{ "billed_charge": 3216.00, "npi": [1194354019] } ] }, { "allowed_amount": 1701.60, "providers": [{ "billed_charge": 4288.00, "npi": [1366881393] } ] }, { "allowed_amount": 744.45, "providers": [{ "billed_charge": 1876.00, "npi": [1790133049, 1174749816] } ] } ] }, { "tin": { "type": "ein", "value": "205036495" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.72, "providers": [{ "billed_charge": 1608.00, "npi": [1669630265] } ] }, { "allowed_amount": 103.34, "providers": [{ "billed_charge": 536.00, "npi": [1194806158] } ] }, { "allowed_amount": 106.67, "providers": [{ "billed_charge": 536.00, "npi": [1245330745] } ] }, { "allowed_amount": 1811.18, "providers": [{ "billed_charge": 9112.00, "npi": [1356865406] } ] }, { "allowed_amount": 745.78, "providers": [{ "billed_charge": 3752.00, "npi": [1457796732] } ] }, { "allowed_amount": 852.32, "providers": [{ "billed_charge": 4288.00, "npi": [1023638277] } ] }, { "allowed_amount": 1536.52, "providers": [{ "billed_charge": 6432.00, "npi": [1134384118] } ] }, { "allowed_amount": 840.96, "providers": [{ "billed_charge": 3216.00, "npi": [1659508380] } ] }, { "allowed_amount": 958.86, "providers": [{ "billed_charge": 4824.00, "npi": [1760989024] } ] }, { "allowed_amount": 1917.72, "providers": [{ "billed_charge": 9648.00, "npi": [1609134550] } ] }, { "allowed_amount": 2450.42, "providers": [{ "billed_charge": 12328.00, "npi": [1891808333] } ] }, { "allowed_amount": 532.70, "providers": [{ "billed_charge": 2680.00, "npi": [1871633636] } ] }, { "allowed_amount": 2983.12, "providers": [{ "billed_charge": 15008.00, "npi": [1073527339] } ] }, { "allowed_amount": 10501.25, "providers": [{ "billed_charge": 39664.00, "npi": [1194785923] } ] }, { "allowed_amount": 663.02, "providers": [{ "billed_charge": 2680.00, "npi": [1760713424] } ] }, { "allowed_amount": 479.92, "providers": [{ "billed_charge": 2144.00, "npi": [1144802893] } ] }, { "allowed_amount": 1053.65, "providers": [{ "billed_charge": 4288.00, "npi": [1194785923] } ] }, { "allowed_amount": 106.54, "providers": [{ "billed_charge": 536.00, "npi": [1114204971] } ] }, { "allowed_amount": 947.16, "providers": [{ "billed_charge": 4824.00, "npi": [1477900496] } ] }, { "allowed_amount": 1225.08, "providers": [{ "billed_charge": 6432.00, "npi": [1053688457] } ] }, { "allowed_amount": 1240.08, "providers": [{ "billed_charge": 6432.00, "npi": [1649920174] } ] }, { "allowed_amount": 768.26, "providers": [{ "billed_charge": 3216.00, "npi": [1649675315] } ] }, { "allowed_amount": 4687.76, "providers": [{ "billed_charge": 23584.00, "npi": [1821652421] } ] }, { "allowed_amount": 873.50, "providers": [{ "billed_charge": 3752.00, "npi": [1235496779] } ] }, { "allowed_amount": 1280.04, "providers": [{ "billed_charge": 6432.00, "npi": [1265745459] } ] }, { "allowed_amount": 206.68, "providers": [{ "billed_charge": 1072.00, "npi": [1316143498] } ] }, { "allowed_amount": 1385.02, "providers": [{ "billed_charge": 6968.00, "npi": [1003807462] } ] }, { "allowed_amount": 319.62, "providers": [{ "billed_charge": 1608.00, "npi": [1275820698] } ] }, { "allowed_amount": 173.65, "providers": [{ "billed_charge": 536.00, "npi": [1720485279] } ] }, { "allowed_amount": 2273.48, "providers": [{ "billed_charge": 11792.00, "npi": [1770640567] } ] }, { "allowed_amount": 526.20, "providers": [{ "billed_charge": 2680.00, "npi": [1689052409] } ] }, { "allowed_amount": 1065.40, "providers": [{ "billed_charge": 5360.00, "npi": [1316250707] } ] } ] }, { "tin": { "type": "ein", "value": "473891182" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 863.92, "providers": [{ "billed_charge": 2379.36, "npi": [1346776770] } ] }, { "allowed_amount": 3661.76, "providers": [{ "billed_charge": 10147.38, "npi": [1265643563] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 957.15, "providers": [{ "billed_charge": 2718.00, "npi": [1295954147] } ] } ] }, { "tin": { "type": "ein", "value": "205146786" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5051.52, "providers": [{ "billed_charge": 15788.16, "npi": [1821064304] } ] }, { "allowed_amount": 315.72, "providers": [{ "billed_charge": 986.76, "npi": [1063413235] } ] }, { "allowed_amount": 2210.04, "providers": [{ "billed_charge": 6930.27, "npi": [1255575049] } ] }, { "allowed_amount": 631.44, "providers": [{ "billed_charge": 1973.52, "npi": [1053406546] } ] }, { "allowed_amount": 847.47, "providers": [{ "billed_charge": 2654.31, "npi": [1396754537] } ] }, { "allowed_amount": 3472.92, "providers": [{ "billed_charge": 10854.36, "npi": [1598719338] } ] }, { "allowed_amount": 1999.56, "providers": [{ "billed_charge": 6249.48, "npi": [1245493360] } ] }, { "allowed_amount": 5472.48, "providers": [{ "billed_charge": 17103.84, "npi": [1790936144] } ] }, { "allowed_amount": 530.64, "providers": [{ "billed_charge": 1644.60, "npi": [1265616858] } ] } ] }, { "tin": { "type": "ein", "value": "332241086" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 425.40, "providers": [{ "billed_charge": 904.00, "npi": [1699702837] } ] }, { "allowed_amount": 212.70, "providers": [{ "billed_charge": 452.00, "npi": [1265993976] } ] } ] }, { "tin": { "type": "ein", "value": "990512892" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.72, "providers": [{ "billed_charge": 726.00, "npi": [1336555390] } ] } ] }, { "tin": { "type": "ein", "value": "845048280" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1169.85, "providers": [{ "billed_charge": 4125.00, "npi": [1902255102] } ] } ] }, { "tin": { "type": "ein", "value": "843654061" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2801.29, "providers": [{ "billed_charge": 6300.00, "npi": [1063546406] } ] } ] }, { "tin": { "type": "ein", "value": "880857678" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.72, "providers": [{ "billed_charge": 810.00, "npi": [1588005276] } ] } ] }, { "tin": { "type": "ein", "value": "822401359" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7641.58, "providers": [{ "billed_charge": 27040.29, "npi": [1376543553] } ] } ] }, { "tin": { "type": "ein", "value": "463990821" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1052.40, "providers": [{ "billed_charge": 3420.00, "npi": [1750809968] } ] } ] }, { "tin": { "type": "ein", "value": "651287824" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11950.76, "providers": [{ "billed_charge": 28667.00, "npi": [1417069246] } ] } ] }, { "tin": { "type": "ein", "value": "760096979" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.34, "providers": [{ "billed_charge": 420.00, "npi": [1316327679] } ] } ] }, { "tin": { "type": "ein", "value": "814594733" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 10106.91, "providers": [{ "billed_charge": 20394.00, "npi": [1891044434] } ] } ] }, { "tin": { "type": "ein", "value": "271724682" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2631.00, "providers": [{ "billed_charge": 5140.00, "npi": [1063837912] } ] } ] }, { "tin": { "type": "ein", "value": "842068606" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.24, "providers": [{ "billed_charge": 319.00, "npi": [1427478965, 1780264317] } ] }, { "allowed_amount": 12313.08, "providers": [{ "billed_charge": 37323.00, "npi": [1083136360] } ] }, { "allowed_amount": 841.92, "providers": [{ "billed_charge": 2552.00, "npi": [1942863170] } ] }, { "allowed_amount": 4735.80, "providers": [{ "billed_charge": 14355.00, "npi": [1922685866, 1861769663] } ] }, { "allowed_amount": 736.68, "providers": [{ "billed_charge": 2233.00, "npi": [1922685866, 1497216121] } ] }, { "allowed_amount": 6840.60, "providers": [{ "billed_charge": 20735.00, "npi": [1497216121] } ] }, { "allowed_amount": 1157.64, "providers": [{ "billed_charge": 3509.00, "npi": [1518198407] } ] }, { "allowed_amount": 420.96, "providers": [{ "billed_charge": 1276.00, "npi": [1083136360, 1861769663] } ] }, { "allowed_amount": 7787.76, "providers": [{ "billed_charge": 23606.00, "npi": [1942863170] } ] }, { "allowed_amount": 6209.16, "providers": [{ "billed_charge": 18821.00, "npi": [1780264317] } ] } ] }, { "tin": { "type": "ein", "value": "810990293" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 2352.39, "providers": [{ "billed_charge": 8050.00, "npi": [1780840587] } ] } ] }, { "tin": { "type": "ein", "value": "831325073" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.56, "providers": [{ "billed_charge": 1600.00, "npi": [1003257999] } ] } ] }, { "tin": { "type": "ein", "value": "384109786" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 378.27, "providers": [{ "billed_charge": 849.00, "npi": [1275944902] } ] } ] }, { "tin": { "type": "ein", "value": "471197805" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.72, "providers": [{ "billed_charge": 450.00, "npi": [1770726309] } ] } ] }, { "tin": { "type": "ein", "value": "760259707" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 860.67, "providers": [{ "billed_charge": 1200.00, "npi": [1245239177] } ] } ] }, { "tin": { "type": "ein", "value": "472815347" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1807.95, "providers": [{ "billed_charge": 3145.00, "npi": [1699784819] } ] } ] }, { "tin": { "type": "ein", "value": "742542858" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1225.08, "providers": [{ "billed_charge": 3600.00, "npi": [1275505570] } ] } ] }, { "tin": { "type": "ein", "value": "751739707" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.24, "providers": [{ "billed_charge": 263.00, "npi": [1851952543] } ] }, { "allowed_amount": 1033.40, "providers": [{ "billed_charge": 2679.59, "npi": [1407262694] } ] } ] }, { "tin": { "type": "ein", "value": "741697101" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1534.96, "providers": [{ "billed_charge": 3500.00, "npi": [1558556001] } ] } ] }, { "tin": { "type": "ein", "value": "880417904" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 349.89, "providers": [{ "billed_charge": 634.62, "npi": [1235110511] } ] } ] }, { "tin": { "type": "ein", "value": "843216980" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 103.34, "providers": [{ "billed_charge": 171.17, "npi": [1598960528] } ] } ] }, { "tin": { "type": "ein", "value": "812881707" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3925.03, "providers": [{ "billed_charge": 9435.00, "npi": [1982700837] } ] } ] }, { "tin": { "type": "ein", "value": "475541222" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1894.32, "providers": [{ "billed_charge": 5100.00, "npi": [1184910382] } ] } ] }, { "tin": { "type": "ein", "value": "271371893" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3368.97, "providers": [{ "billed_charge": 23694.00, "npi": [1134484264] } ] }, { "allowed_amount": 319.15, "providers": [{ "billed_charge": 2154.00, "npi": [1700217411] } ] }, { "allowed_amount": 1091.60, "providers": [{ "billed_charge": 7180.00, "npi": [1376999748] } ] }, { "allowed_amount": 5206.59, "providers": [{ "billed_charge": 36618.00, "npi": [1326305624] } ] }, { "allowed_amount": 1446.76, "providers": [{ "billed_charge": 10052.00, "npi": [1881988020, 1801226576] } ] }, { "allowed_amount": 947.16, "providers": [{ "billed_charge": 6462.00, "npi": [1144674144] } ] }, { "allowed_amount": 102.09, "providers": [{ "billed_charge": 718.00, "npi": [1154056737, 1932193687] } ] }, { "allowed_amount": 1473.36, "providers": [{ "billed_charge": 10052.00, "npi": [1053949362] } ] }, { "allowed_amount": 1225.08, "providers": [{ "billed_charge": 8616.00, "npi": [1457705428, 1982354916] } ] } ] }, { "tin": { "type": "ein", "value": "463932990" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1382.55, "providers": [{ "billed_charge": 2600.00, "npi": [1326206822] } ] } ] }, { "tin": { "type": "ein", "value": "464983994" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 3102.67, "providers": [{ "billed_charge": 6000.00, "npi": [1518989474] } ] } ] }, { "tin": { "type": "ein", "value": "853804440" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 268.38, "providers": [{ "billed_charge": 375.00, "npi": [1023096237] } ] } ] }, { "tin": { "type": "ein", "value": "760434450" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12549.30, "providers": [{ "billed_charge": 25606.00, "npi": [1366436263] } ] } ] }, { "tin": { "type": "ein", "value": "760189664" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11731.48, "providers": [{ "billed_charge": 34561.00, "npi": [1881770576] } ] } ] }, { "tin": { "type": "ein", "value": "821251954" }, "service_code": ["55", "02", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 6003.32, "providers": [{ "billed_charge": 13139.00, "npi": [1255388203] } ] }, { "allowed_amount": 6572.79, "providers": [{ "billed_charge": 14905.00, "npi": [1598023079] } ] }, { "allowed_amount": 210.48, "providers": [{ "billed_charge": 430.00, "npi": [1255388203] } ] }, { "allowed_amount": 268.38, "providers": [{ "billed_charge": 645.00, "npi": [1194386094] } ] }, { "allowed_amount": 1564.95, "providers": [{ "billed_charge": 3463.00, "npi": [1598023079] } ] }, { "allowed_amount": 312.99, "providers": [{ "billed_charge": 645.00, "npi": [1598023079] } ] }, { "allowed_amount": 626.22, "providers": [{ "billed_charge": 1505.00, "npi": [1194386094] } ] } ] }, { "tin": { "type": "ein", "value": "811214303" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 413.88, "providers": [{ "billed_charge": 852.00, "npi": [1811197338] } ] } ] }, { "tin": { "type": "ein", "value": "352238379" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 271.20, "providers": [{ "billed_charge": 1200.00, "npi": [1780565085] } ] } ] }, { "tin": { "type": "ein", "value": "832926945" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 425.40, "providers": [{ "billed_charge": 1160.00, "npi": [1841337128] } ] } ] }, { "tin": { "type": "ein", "value": "821493649" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1049.99, "providers": [{ "billed_charge": 2500.00, "npi": [1184929333] } ] } ] }, { "tin": { "type": "ein", "value": "861975468" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 631.44, "providers": [{ "billed_charge": 1554.00, "npi": [1558895771] } ] } ] }, { "tin": { "type": "ein", "value": "814005993" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8313.96, "providers": [{ "billed_charge": 17775.00, "npi": [1215076229] } ] } ] }, { "tin": { "type": "ein", "value": "862330456" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2210.04, "providers": [{ "billed_charge": 6300.00, "npi": [1821388075] } ] } ] }, { "tin": { "type": "ein", "value": "271463889" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8091.40, "providers": [{ "billed_charge": 32292.00, "npi": [1912096694] } ] } ] }, { "tin": { "type": "ein", "value": "464143234" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3934.95, "providers": [{ "billed_charge": 12170.04, "npi": [1033346366] } ] } ] }, { "tin": { "type": "ein", "value": "932594175" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 520.62, "providers": [{ "billed_charge": 3384.00, "npi": [1295022804] } ] }, { "allowed_amount": 2245.98, "providers": [{ "billed_charge": 12408.00, "npi": [1851336341] } ] }, { "allowed_amount": 714.63, "providers": [{ "billed_charge": 3948.00, "npi": [1598960528] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 504.36, "providers": [{ "billed_charge": 1132.00, "npi": [1154940732] } ] }, { "allowed_amount": 126.09, "providers": [{ "billed_charge": 283.00, "npi": [1225614191] } ] }, { "allowed_amount": 1386.99, "providers": [{ "billed_charge": 3113.00, "npi": [1033641873] } ] }, { "allowed_amount": 756.54, "providers": [{ "billed_charge": 1698.00, "npi": [1093378119] } ] }, { "allowed_amount": 3404.43, "providers": [{ "billed_charge": 7641.00, "npi": [1225614191] } ] } ] }, { "tin": { "type": "ein", "value": "460792526" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1262.88, "providers": [{ "billed_charge": 2040.00, "npi": [1225103872] } ] } ] }, { "tin": { "type": "ein", "value": "861071456" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7930.06, "providers": [{ "billed_charge": 15050.00, "npi": [1932294584] } ] } ] }, { "tin": { "type": "ein", "value": "742810500" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.08, "providers": [{ "billed_charge": 199.00, "npi": [1568447233] } ] } ] }, { "tin": { "type": "ein", "value": "752613493" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1567.20, "providers": [{ "billed_charge": 5130.00, "npi": [1609015312] } ] }, { "allowed_amount": 526.20, "providers": [{ "billed_charge": 1710.00, "npi": [1043243488] } ] } ] }, { "tin": { "type": "ein", "value": "455613680" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 730.73, "providers": [{ "billed_charge": 1155.00, "npi": [1902022056] } ] } ] }, { "tin": { "type": "ein", "value": "922608976" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 744.45, "providers": [{ "billed_charge": 2625.00, "npi": [1629328026] } ] } ] }, { "tin": { "type": "ein", "value": "260480661" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.09, "providers": [{ "billed_charge": 344.94, "npi": [1386714871] } ] } ] }, { "tin": { "type": "ein", "value": "460542878" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3062.70, "providers": [{ "billed_charge": 6300.00, "npi": [1699722280] } ] } ] }, { "tin": { "type": "ein", "value": "421708103" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 17016.00, "providers": [{ "billed_charge": 28000.00, "npi": [1861486482] } ] } ] }, { "tin": { "type": "ein", "value": "833767505" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.35, "providers": [{ "billed_charge": 150.00, "npi": [1295178507] } ] }, { "allowed_amount": 212.70, "providers": [{ "billed_charge": 300.00, "npi": [1295178507] } ] } ] }, { "tin": { "type": "ein", "value": "461224002" }, "service_code": ["02", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 736.68, "providers": [{ "billed_charge": 1295.00, "npi": [1336339340] } ] }, { "allowed_amount": 2985.17, "providers": [{ "billed_charge": 5365.00, "npi": [1649470931] } ] }, { "allowed_amount": 210.48, "providers": [{ "billed_charge": 370.00, "npi": [1336339340] } ] } ] }, { "tin": { "type": "ein", "value": "352335295" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1578.60, "providers": [{ "billed_charge": 3750.00, "npi": [1194787200] } ] } ] }, { "tin": { "type": "ein", "value": "264232139" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1438.20, "providers": [{ "billed_charge": 2450.00, "npi": [1477622710] } ] } ] }, { "tin": { "type": "ein", "value": "873249972" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 22120.80, "providers": [{ "billed_charge": 41600.00, "npi": [1982915013] } ] } ] }, { "tin": { "type": "ein", "value": "832962661" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 306.27, "providers": [{ "billed_charge": 1050.00, "npi": [1346436276] } ] } ] }, { "tin": { "type": "ein", "value": "873385999" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 452.00, "providers": [{ "billed_charge": 1250.00, "npi": [1902680556] } ] }, { "allowed_amount": 4771.76, "providers": [{ "billed_charge": 13700.00, "npi": [1902680556] } ] }, { "allowed_amount": 6681.29, "providers": [{ "billed_charge": 19250.00, "npi": [1811534902] } ] }, { "allowed_amount": 1648.63, "providers": [{ "billed_charge": 4750.00, "npi": [1053702316] } ] } ] }, { "tin": { "type": "ein", "value": "862536544" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 6541.92, "providers": [{ "billed_charge": 13888.00, "npi": [1700170867] } ] } ] }, { "tin": { "type": "ein", "value": "320119960" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.68, "providers": [{ "billed_charge": 412.00, "npi": [1093735292] } ] }, { "allowed_amount": 351.36, "providers": [{ "billed_charge": 824.00, "npi": [1316447642] } ] } ] }, { "tin": { "type": "ein", "value": "881752632" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1052.40, "providers": [{ "billed_charge": 3262.00, "npi": [1508025412] } ] } ] }, { "tin": { "type": "ein", "value": "752896138" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1241.64, "providers": [{ "billed_charge": 3108.00, "npi": [1770774580] } ] } ] }, { "tin": { "type": "ein", "value": "472004181" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.80, "providers": [{ "billed_charge": 1300.00, "npi": [1922028125] } ] } ] }, { "tin": { "type": "ein", "value": "934915781" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3051.96, "providers": [{ "billed_charge": 6380.00, "npi": [1932339371] } ] } ] }, { "tin": { "type": "ein", "value": "811443260" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 550.62, "providers": [{ "billed_charge": 1550.00, "npi": [1629365671] } ] } ] }, { "tin": { "type": "ein", "value": "820669611" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.67, "providers": [{ "billed_charge": 328.35, "npi": [1780951970] } ] } ] }, { "tin": { "type": "ein", "value": "823278539" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8629.87, "providers": [{ "billed_charge": 13833.99, "npi": [1770575177] } ] } ] }, { "tin": { "type": "ein", "value": "392672150" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1368.12, "providers": [{ "billed_charge": 3811.86, "npi": [1598025496] } ] } ] }, { "tin": { "type": "ein", "value": "760007874" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12336.60, "providers": [{ "billed_charge": 24592.00, "npi": [1790861102] } ] } ] }, { "tin": { "type": "ein", "value": "455599557" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 850.80, "providers": [{ "billed_charge": 1200.00, "npi": [1093881278] } ] } ] }, { "tin": { "type": "ein", "value": "300791563" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1184.13, "providers": [{ "billed_charge": 2718.00, "npi": [1235713116] } ] } ] }, { "tin": { "type": "ein", "value": "873935687" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 420.96, "providers": [{ "billed_charge": 800.00, "npi": [1619286994] } ] } ] }, { "tin": { "type": "ein", "value": "465465130" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 315.72, "providers": [{ "billed_charge": 826.44, "npi": [1053999656] } ] }, { "allowed_amount": 736.68, "providers": [{ "billed_charge": 1928.36, "npi": [1053999656] } ] }, { "allowed_amount": 210.48, "providers": [{ "billed_charge": 550.00, "npi": [1417447798] } ] } ] }, { "tin": { "type": "ein", "value": "832802070" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7440.48, "providers": [{ "billed_charge": 15436.80, "npi": [1740512649] } ] } ] }, { "tin": { "type": "ein", "value": "461846537" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 2076.21, "providers": [{ "billed_charge": 7130.00, "npi": [1538880349] } ] } ] }, { "tin": { "type": "ein", "value": "274716160" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7051.08, "providers": [{ "billed_charge": 14405.00, "npi": [1922027838] } ] } ] }, { "tin": { "type": "ein", "value": "272420316" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 420.96, "providers": [{ "billed_charge": 1600.00, "npi": [1669905865] } ] } ] } ] }, { "name": "HOSPITAL DISCHARGE DAY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99238", "description": "HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "421708103" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 371.40, "providers": [{ "billed_charge": 850.00, "npi": [1861486482] } ] } ] }, { "tin": { "type": "ein", "value": "611648898" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 594.24, "providers": [{ "billed_charge": 1400.00, "npi": [1275532046] } ] } ] }, { "tin": { "type": "ein", "value": "753129210" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2298.15, "providers": [{ "billed_charge": 3040.00, "npi": [1235363862] } ] } ] }, { "tin": { "type": "ein", "value": "260822356" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1395.26, "providers": [{ "billed_charge": 3450.00, "npi": [1053929729] } ] } ] }, { "tin": { "type": "ein", "value": "861395398" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 2714.69, "providers": [{ "billed_charge": 15725.00, "npi": [1063546844] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["51", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3228.28, "providers": [{ "billed_charge": 10252.00, "npi": [1356637227] } ] }, { "allowed_amount": 1100.55, "providers": [{ "billed_charge": 3535.00, "npi": [1790123495] } ] }, { "allowed_amount": 73.37, "providers": [{ "billed_charge": 243.00, "npi": [1356637227] } ] } ] } ] }, { "name": "HOSPITAL DISCHARGE DAY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99239", "description": "HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271368002" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1419.60, "providers": [{ "billed_charge": 7000.00, "npi": [1306048277] } ] } ] }, { "tin": { "type": "ein", "value": "204923281" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.32, "providers": [{ "billed_charge": 456.00, "npi": [1538664842] }, { "billed_charge": 446.00, "npi": [1538664842] } ] }, { "allowed_amount": 101.40, "providers": [{ "billed_charge": 228.00, "npi": [1801450127, 1154709665, 1578916490] }, { "billed_charge": 218.00, "npi": [1275198053, 1578916490] } ] }, { "allowed_amount": 405.60, "providers": [{ "billed_charge": 912.00, "npi": [1881821775] }, { "billed_charge": 902.00, "npi": [1346778644, 1881821775, 1124443288] } ] }, { "allowed_amount": 202.80, "providers": [{ "billed_charge": 456.00, "npi": [1154709665, 1124443288] } ] } ] }, { "tin": { "type": "ein", "value": "472401409" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1901.88, "providers": [{ "billed_charge": 4122.00, "npi": [1407879489] } ] } ] }, { "tin": { "type": "ein", "value": "470964891" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 633.96, "providers": [{ "billed_charge": 900.00, "npi": [1710025515] } ] } ] }, { "tin": { "type": "ein", "value": "371868760" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 101.40, "providers": [{ "billed_charge": 579.00, "npi": [1073190898] } ] }, { "allowed_amount": 405.60, "providers": [{ "billed_charge": 2316.00, "npi": [1679768089] } ] }, { "allowed_amount": 1622.40, "providers": [{ "billed_charge": 9264.00, "npi": [1164835195, 1043705528] } ] }, { "allowed_amount": 709.80, "providers": [{ "billed_charge": 4053.00, "npi": [1386619765, 1164835195] } ] }, { "allowed_amount": 507.00, "providers": [{ "billed_charge": 2895.00, "npi": [1497068233, 1952798001, 1043705528] } ] }, { "allowed_amount": 1926.60, "providers": [{ "billed_charge": 11001.00, "npi": [1497068233] } ] }, { "allowed_amount": 1317.57, "providers": [{ "billed_charge": 7527.00, "npi": [1174883177] } ] }, { "allowed_amount": 304.20, "providers": [{ "billed_charge": 1737.00, "npi": [1073190898, 1679768089, 1174883177] } ] }, { "allowed_amount": 1925.97, "providers": [{ "billed_charge": 11001.00, "npi": [1952798001] } ] } ] }, { "tin": { "type": "ein", "value": "814005993" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 836.24, "providers": [{ "billed_charge": 1744.00, "npi": [1154393817] } ] }, { "allowed_amount": 2822.31, "providers": [{ "billed_charge": 5886.00, "npi": [1215076229] } ] }, { "allowed_amount": 104.53, "providers": [{ "billed_charge": 218.00, "npi": [1710333620] } ] } ] }, { "tin": { "type": "ein", "value": "752387191" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 554.00, "providers": [{ "billed_charge": 1660.00, "npi": [1760529515] } ] } ] }, { "tin": { "type": "ein", "value": "842068606" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3658.55, "providers": [{ "billed_charge": 11445.00, "npi": [1942863170] } ] }, { "allowed_amount": 1463.42, "providers": [{ "billed_charge": 4578.00, "npi": [1922685866] } ] }, { "allowed_amount": 836.24, "providers": [{ "billed_charge": 2616.00, "npi": [1780264317] } ] }, { "allowed_amount": 627.18, "providers": [{ "billed_charge": 1962.00, "npi": [1861769663] } ] }, { "allowed_amount": 1777.01, "providers": [{ "billed_charge": 5559.00, "npi": [1780264317] } ] }, { "allowed_amount": 1358.89, "providers": [{ "billed_charge": 4251.00, "npi": [1942863170] } ] }, { "allowed_amount": 1672.48, "providers": [{ "billed_charge": 5232.00, "npi": [1861769663] } ] }, { "allowed_amount": 209.06, "providers": [{ "billed_charge": 654.00, "npi": [1083136360] } ] }, { "allowed_amount": 2611.58, "providers": [{ "billed_charge": 8175.00, "npi": [1518198407] } ] }, { "allowed_amount": 2090.60, "providers": [{ "billed_charge": 6540.00, "npi": [1083136360] } ] }, { "allowed_amount": 418.12, "providers": [{ "billed_charge": 1308.00, "npi": [1922685866] } ] } ] }, { "tin": { "type": "ein", "value": "271463889" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2103.84, "providers": [{ "billed_charge": 8064.00, "npi": [1912096694] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["22", "61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1419.60, "providers": [{ "billed_charge": 4578.00, "npi": [1174987820] } ] }, { "allowed_amount": 3346.20, "providers": [{ "billed_charge": 10791.00, "npi": [1992952261] } ] }, { "allowed_amount": 202.80, "providers": [{ "billed_charge": 654.00, "npi": [1174987820, 1952663916] } ] }, { "allowed_amount": 608.40, "providers": [{ "billed_charge": 1962.00, "npi": [1992952261] } ] }, { "allowed_amount": 1115.40, "providers": [{ "billed_charge": 3597.00, "npi": [1841547759] } ] }, { "allowed_amount": 1723.80, "providers": [{ "billed_charge": 5559.00, "npi": [1669889291] } ] }, { "allowed_amount": 2230.80, "providers": [{ "billed_charge": 7194.00, "npi": [1902292808] } ] }, { "allowed_amount": 4765.80, "providers": [{ "billed_charge": 15369.00, "npi": [1154568558] } ] }, { "allowed_amount": 2129.40, "providers": [{ "billed_charge": 6867.00, "npi": [1952663916] } ] }, { "allowed_amount": 811.20, "providers": [{ "billed_charge": 2616.00, "npi": [1154568558] } ] }, { "allowed_amount": 101.40, "providers": [{ "billed_charge": 327.00, "npi": [1669889291, 1386140002] } ] }, { "allowed_amount": 405.60, "providers": [{ "billed_charge": 1308.00, "npi": [1386140002] } ] }, { "allowed_amount": 2535.00, "providers": [{ "billed_charge": 8175.00, "npi": [1386140002] } ] }, { "allowed_amount": 304.20, "providers": [{ "billed_charge": 981.00, "npi": [1235101221, 1992952261] } ] } ] }, { "tin": { "type": "ein", "value": "651255384" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.06, "providers": [{ "billed_charge": 446.00, "npi": [1508830985] } ] } ] }, { "tin": { "type": "ein", "value": "270794018" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2404.19, "providers": [{ "billed_charge": 3450.00, "npi": [1932300779] } ] } ] } ] }, { "name": "OFFICE CONSULTATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99244", "description": "OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "204701276" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2753.31, "providers": [{ "billed_charge": 7098.00, "npi": [1386297356] } ] } ] } ] }, { "name": "OFFICE CONSULTATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99245", "description": "OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "204701276" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1931.93, "providers": [{ "billed_charge": 4686.00, "npi": [1386297356] } ] } ] } ] }, { "name": "INPATIENT CONSULTATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99254", "description": "INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A CO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842068606" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 803.04, "providers": [{ "billed_charge": 2954.00, "npi": [1790890929] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "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": "320326595" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1572.05, "providers": [{ "billed_charge": 6028.17, "npi": [1164409355] } ] } ] }, { "tin": { "type": "ein", "value": "931525992" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.97, "providers": [{ "billed_charge": 2201.12, "npi": [1033197769] } ] } ] }, { "tin": { "type": "ein", "value": "873769568" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1039.61, "providers": [{ "billed_charge": 50512.80, "npi": [1629143029] } ] } ] }, { "tin": { "type": "ein", "value": "474649080" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1199.55, "providers": [{ "billed_charge": 24260.16, "npi": [1992952089] } ] }, { "allowed_amount": 1119.58, "providers": [{ "billed_charge": 21796.38, "npi": [1588825301] } ] }, { "allowed_amount": 1679.37, "providers": [{ "billed_charge": 33652.62, "npi": [1114069895] }, { "billed_charge": 30861.18, "npi": [1235118951] } ] }, { "allowed_amount": 2479.07, "providers": [{ "billed_charge": 51325.44, "npi": [1417167982] } ] }, { "allowed_amount": 1919.28, "providers": [{ "billed_charge": 34481.04, "npi": [1326400714] }, { "billed_charge": 38445.18, "npi": [1326280058] } ] }, { "allowed_amount": 159.94, "providers": [{ "billed_charge": 2967.48, "npi": [1255658027] } ] }, { "allowed_amount": 959.64, "providers": [{ "billed_charge": 19467.60, "npi": [1578852877] } ] }, { "allowed_amount": 319.88, "providers": [{ "billed_charge": 5444.94, "npi": [1720067432] }, { "billed_charge": 5934.96, "npi": [1669460192] } ] }, { "allowed_amount": 79.97, "providers": [{ "billed_charge": 1483.74, "npi": [1588849475, 1013996883] } ] }, { "allowed_amount": 2079.22, "providers": [{ "billed_charge": 39942.60, "npi": [1639631492] } ] }, { "allowed_amount": 479.82, "providers": [{ "billed_charge": 8902.44, "npi": [1790866242] } ] } ] }, { "tin": { "type": "ein", "value": "332012020" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.97, "providers": [{ "billed_charge": 946.08, "npi": [1902416597] } ] }, { "allowed_amount": 399.85, "providers": [{ "billed_charge": 4340.48, "npi": [1124047410] } ] }, { "allowed_amount": 227.94, "providers": [{ "billed_charge": 2740.00, "npi": [1861204885] } ] } ] }, { "tin": { "type": "ein", "value": "872457837" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3073.14, "providers": [{ "billed_charge": 30343.00, "npi": [1306596697] } ] } ] }, { "tin": { "type": "ein", "value": "853082840" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.28, "providers": [{ "billed_charge": 4255.00, "npi": [1710910443] } ] }, { "allowed_amount": 634.24, "providers": [{ "billed_charge": 22484.00, "npi": [1881815017] } ] }, { "allowed_amount": 396.40, "providers": [{ "billed_charge": 12250.00, "npi": [1013103209] } ] } ] }, { "tin": { "type": "ein", "value": "463902289" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 239.91, "providers": [{ "billed_charge": 1458.00, "npi": [1861492886] } ] }, { "allowed_amount": 399.85, "providers": [{ "billed_charge": 4170.00, "npi": [1831400035] } ] } ] }, { "tin": { "type": "ein", "value": "743019172" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3950.39, "providers": [{ "billed_charge": 105783.00, "npi": [1043455348] } ] }, { "allowed_amount": 3079.30, "providers": [{ "billed_charge": 85921.00, "npi": [1083822100] } ] }, { "allowed_amount": 5750.26, "providers": [{ "billed_charge": 160065.00, "npi": [1922200807] } ] }, { "allowed_amount": 751.85, "providers": [{ "billed_charge": 18659.00, "npi": [1770565673] } ] }, { "allowed_amount": 2802.35, "providers": [{ "billed_charge": 70954.00, "npi": [1447232194] } ] }, { "allowed_amount": 1093.60, "providers": [{ "billed_charge": 30052.00, "npi": [1588646145] } ] }, { "allowed_amount": 1435.35, "providers": [{ "billed_charge": 36446.00, "npi": [1578129847] } ] } ] }, { "tin": { "type": "ein", "value": "932457529" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 319.44, "providers": [{ "billed_charge": 8832.00, "npi": [1942227574] } ] } ] }, { "tin": { "type": "ein", "value": "852464463" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1450.62, "providers": [{ "billed_charge": 25494.00, "npi": [1144473570] } ] }, { "allowed_amount": 444.54, "providers": [{ "billed_charge": 7500.00, "npi": [1922595727] } ] }, { "allowed_amount": 858.07, "providers": [{ "billed_charge": 15000.00, "npi": [1992764419] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1777.10, "providers": [{ "billed_charge": 10861.00, "npi": [1295756955] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "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": "831661941" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.77, "providers": [{ "billed_charge": 1004.00, "npi": [1912480591, 1477169027] } ] }, { "allowed_amount": 2572.62, "providers": [{ "billed_charge": 6024.00, "npi": [1083097786] } ] } ] }, { "tin": { "type": "ein", "value": "831533748" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 408.36, "providers": [{ "billed_charge": 7350.00, "npi": [1316020456] } ] } ] }, { "tin": { "type": "ein", "value": "752737522" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3858.93, "providers": [{ "billed_charge": 10368.00, "npi": [1396165502] } ] }, { "allowed_amount": 2612.82, "providers": [{ "billed_charge": 6912.00, "npi": [1306301668] } ] }, { "allowed_amount": 2143.85, "providers": [{ "billed_charge": 5760.00, "npi": [1538189980] } ] }, { "allowed_amount": 1306.41, "providers": [{ "billed_charge": 3456.00, "npi": [1932142445] } ] }, { "allowed_amount": 435.47, "providers": [{ "billed_charge": 1152.00, "npi": [1922462928] } ] }, { "allowed_amount": 3048.29, "providers": [{ "billed_charge": 8064.00, "npi": [1407803125] } ] }, { "allowed_amount": 1286.31, "providers": [{ "billed_charge": 3456.00, "npi": [1255702692] } ] } ] }, { "tin": { "type": "ein", "value": "931525992" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3403.00, "providers": [{ "billed_charge": 111156.50, "npi": [1033197769] } ] }, { "allowed_amount": 680.60, "providers": [{ "billed_charge": 22231.30, "npi": [1548519168] } ] }, { "allowed_amount": 2314.04, "providers": [{ "billed_charge": 75586.42, "npi": [1942527015] } ] }, { "allowed_amount": 2177.92, "providers": [{ "billed_charge": 71140.16, "npi": [1770560385] } ] } ] }, { "tin": { "type": "ein", "value": "742501542" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5312.46, "providers": [{ "billed_charge": 38982.84, "npi": [1306221122] } ] } ] }, { "tin": { "type": "ein", "value": "332012020" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.12, "providers": [{ "billed_charge": 946.08, "npi": [1124047410] } ] } ] }, { "tin": { "type": "ein", "value": "872457837" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3559.97, "providers": [{ "billed_charge": 16031.00, "npi": [1306596697] } ] } ] }, { "tin": { "type": "ein", "value": "841832545" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 612.90, "providers": [{ "billed_charge": 10605.00, "npi": [1649663295] } ] } ] }, { "tin": { "type": "ein", "value": "844504483" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1009.47, "providers": [{ "billed_charge": 5474.00, "npi": [1245593573] } ] }, { "allowed_amount": 424.54, "providers": [{ "billed_charge": 2346.00, "npi": [1942645932] } ] }, { "allowed_amount": 424.44, "providers": [{ "billed_charge": 2346.00, "npi": [1932545183] } ] }, { "allowed_amount": 144.21, "providers": [{ "billed_charge": 782.00, "npi": [1821330044] } ] }, { "allowed_amount": 721.05, "providers": [{ "billed_charge": 3910.00, "npi": [1992125728] } ] } ] }, { "tin": { "type": "ein", "value": "853082840" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 404.85, "providers": [{ "billed_charge": 8802.00, "npi": [1013103209] } ] }, { "allowed_amount": 134.95, "providers": [{ "billed_charge": 2934.00, "npi": [1881815017] } ] } ] }, { "tin": { "type": "ein", "value": "463902289" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 576.84, "providers": [{ "billed_charge": 3684.00, "npi": [1265499909, 1952798126] } ] }, { "allowed_amount": 712.96, "providers": [{ "billed_charge": 4605.00, "npi": [1629381538] } ] }, { "allowed_amount": 816.72, "providers": [{ "billed_charge": 5526.00, "npi": [1790783694, 1144326570] } ] }, { "allowed_amount": 593.52, "providers": [{ "billed_charge": 3684.00, "npi": [1548222193] } ] }, { "allowed_amount": 280.33, "providers": [{ "billed_charge": 1842.00, "npi": [1477561199] } ] }, { "allowed_amount": 865.26, "providers": [{ "billed_charge": 5526.00, "npi": [1972705333, 1639494412] } ] }, { "allowed_amount": 144.21, "providers": [{ "billed_charge": 921.00, "npi": [1699705129, 1891716601, 1326465246] } ] } ] }, { "tin": { "type": "ein", "value": "452317041" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 234.68, "providers": [{ "billed_charge": 1844.00, "npi": [1487073680] } ] }, { "allowed_amount": 352.02, "providers": [{ "billed_charge": 2766.00, "npi": [1568082501] } ] } ] }, { "tin": { "type": "ein", "value": "743019172" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4647.83, "providers": [{ "billed_charge": 66035.00, "npi": [1922200807] } ] }, { "allowed_amount": 6922.30, "providers": [{ "billed_charge": 98350.00, "npi": [1043455348] } ] }, { "allowed_amount": 5438.95, "providers": [{ "billed_charge": 77275.00, "npi": [1083822100] } ] }, { "allowed_amount": 1163.40, "providers": [{ "billed_charge": 14050.00, "npi": [1447232194] } ] } ] }, { "tin": { "type": "ein", "value": "204362558" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 680.60, "providers": [{ "billed_charge": 8465.00, "npi": [1265844401] } ] } ] }, { "tin": { "type": "ein", "value": "752684562" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.24, "providers": [{ "billed_charge": 2052.00, "npi": [1326525502] } ] }, { "allowed_amount": 680.60, "providers": [{ "billed_charge": 5130.00, "npi": [1669885679] } ] }, { "allowed_amount": 544.48, "providers": [{ "billed_charge": 4104.00, "npi": [1144809112] } ] } ] }, { "tin": { "type": "ein", "value": "823656564" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.24, "providers": [{ "billed_charge": 4784.00, "npi": [1952557928] } ] } ] }, { "tin": { "type": "ein", "value": "474649080" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2450.16, "providers": [{ "billed_charge": 26707.32, "npi": [1326280058] } ] }, { "allowed_amount": 680.60, "providers": [{ "billed_charge": 7418.70, "npi": [1588825301] } ] }, { "allowed_amount": 4083.60, "providers": [{ "billed_charge": 44512.20, "npi": [1114069895] } ] }, { "allowed_amount": 1088.96, "providers": [{ "billed_charge": 11869.92, "npi": [1578852877] } ] }, { "allowed_amount": 2314.04, "providers": [{ "billed_charge": 25223.58, "npi": [1992952089] } ] }, { "allowed_amount": 1769.56, "providers": [{ "billed_charge": 19288.62, "npi": [1790866242] } ] }, { "allowed_amount": 3675.24, "providers": [{ "billed_charge": 40060.98, "npi": [1326400714, 1235118951] } ] }, { "allowed_amount": 136.12, "providers": [{ "billed_charge": 1483.74, "npi": [1417167982] } ] }, { "allowed_amount": 408.36, "providers": [{ "billed_charge": 4451.22, "npi": [1275066854, 1639631492] } ] } ] }, { "tin": { "type": "ein", "value": "883330119" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2305.24, "providers": [{ "billed_charge": 51128.35, "npi": [1184980922] } ] }, { "allowed_amount": 369.78, "providers": [{ "billed_charge": 9022.65, "npi": [1043573207] } ] } ] }, { "tin": { "type": "ein", "value": "472071789" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.12, "providers": [{ "billed_charge": 1693.00, "npi": [1619429404] } ] } ] }, { "tin": { "type": "ein", "value": "752562784" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3858.93, "providers": [{ "billed_charge": 9036.00, "npi": [1497736375, 1881644938] }, { "billed_charge": 9468.00, "npi": [1235196502] } ] }, { "allowed_amount": 2143.85, "providers": [{ "billed_charge": 5020.00, "npi": [1467018887] } ] }, { "allowed_amount": 13291.87, "providers": [{ "billed_charge": 31124.00, "npi": [1568178903] } ] }, { "allowed_amount": 5574.01, "providers": [{ "billed_charge": 13052.00, "npi": [1093522278] } ] }, { "allowed_amount": 2572.62, "providers": [{ "billed_charge": 6024.00, "npi": [1760055784] }, { "billed_charge": 6312.00, "npi": [1679033476] } ] }, { "allowed_amount": 1715.08, "providers": [{ "billed_charge": 3772.00, "npi": [1013456649] }, { "billed_charge": 4016.00, "npi": [1932197662] } ] }, { "allowed_amount": 1286.31, "providers": [{ "billed_charge": 3012.00, "npi": [1821016189] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "CPT", "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": "831661941" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3119.90, "providers": [{ "billed_charge": 7285.00, "npi": [1659338887] } ] }, { "allowed_amount": 3743.88, "providers": [{ "billed_charge": 8742.00, "npi": [1306519293] } ] }, { "allowed_amount": 623.98, "providers": [{ "billed_charge": 1457.00, "npi": [1548886708] } ] } ] }, { "tin": { "type": "ein", "value": "752737522" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 14567.05, "providers": [{ "billed_charge": 38479.00, "npi": [1417149592] } ] }, { "allowed_amount": 8233.55, "providers": [{ "billed_charge": 21749.00, "npi": [1922462928] } ] }, { "allowed_amount": 3166.75, "providers": [{ "billed_charge": 8365.00, "npi": [1578042735, 1104270016, 1902067622] } ] }, { "allowed_amount": 623.98, "providers": [{ "billed_charge": 1673.00, "npi": [1154301588, 1053617571] } ] }, { "allowed_amount": 7600.20, "providers": [{ "billed_charge": 20076.00, "npi": [1407803125] } ] }, { "allowed_amount": 5066.80, "providers": [{ "billed_charge": 13384.00, "npi": [1700079985, 1477916443] } ] }, { "allowed_amount": 5700.15, "providers": [{ "billed_charge": 15057.00, "npi": [1538692520] } ] }, { "allowed_amount": 633.35, "providers": [{ "billed_charge": 1673.00, "npi": [1861513830] } ] }, { "allowed_amount": 1871.94, "providers": [{ "billed_charge": 5019.00, "npi": [1538189980] } ] }, { "allowed_amount": 5615.82, "providers": [{ "billed_charge": 15057.00, "npi": [1740713122] } ] }, { "allowed_amount": 3800.10, "providers": [{ "billed_charge": 10038.00, "npi": [1871099978] } ] }, { "allowed_amount": 9500.25, "providers": [{ "billed_charge": 25095.00, "npi": [1528594942] } ] }, { "allowed_amount": 1900.05, "providers": [{ "billed_charge": 5019.00, "npi": [1720344161] } ] }, { "allowed_amount": 1266.70, "providers": [{ "billed_charge": 3346.00, "npi": [1649451725] } ] }, { "allowed_amount": 12033.65, "providers": [{ "billed_charge": 31787.00, "npi": [1487910154] } ] } ] }, { "tin": { "type": "ein", "value": "742501542" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4144.56, "providers": [{ "billed_charge": 30980.46, "npi": [1306221122] } ] } ] }, { "tin": { "type": "ein", "value": "332012020" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1381.52, "providers": [{ "billed_charge": 9550.00, "npi": [1902427073] } ] } ] }, { "tin": { "type": "ein", "value": "841832545" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 354.62, "providers": [{ "billed_charge": 6146.00, "npi": [1962776377] } ] }, { "allowed_amount": 531.93, "providers": [{ "billed_charge": 9219.00, "npi": [1649663295] } ] }, { "allowed_amount": 592.08, "providers": [{ "billed_charge": 9219.00, "npi": [1174545461] } ] }, { "allowed_amount": 1006.50, "providers": [{ "billed_charge": 18438.00, "npi": [1013121565] } ] }, { "allowed_amount": 522.37, "providers": [{ "billed_charge": 9219.00, "npi": [1740670538] } ] }, { "allowed_amount": 838.75, "providers": [{ "billed_charge": 15365.00, "npi": [1528563848] } ] }, { "allowed_amount": 394.72, "providers": [{ "billed_charge": 6146.00, "npi": [1679715379] } ] }, { "allowed_amount": 998.04, "providers": [{ "billed_charge": 15365.00, "npi": [1356877526] } ] }, { "allowed_amount": 789.44, "providers": [{ "billed_charge": 12292.00, "npi": [1871121574] } ] }, { "allowed_amount": 1668.80, "providers": [{ "billed_charge": 24584.00, "npi": [1710627898] } ] }, { "allowed_amount": 2076.52, "providers": [{ "billed_charge": 30730.00, "npi": [1043881915] } ] }, { "allowed_amount": 1405.76, "providers": [{ "billed_charge": 21511.00, "npi": [1467023515] } ] } ] }, { "tin": { "type": "ein", "value": "872457837" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 20343.21, "providers": [{ "billed_charge": 90834.00, "npi": [1306596697] } ] } ] }, { "tin": { "type": "ein", "value": "844504483" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1877.40, "providers": [{ "billed_charge": 10224.00, "npi": [1154578052] } ] }, { "allowed_amount": 592.08, "providers": [{ "billed_charge": 3408.00, "npi": [1518100064, 1619224383] } ] }, { "allowed_amount": 5920.80, "providers": [{ "billed_charge": 34080.00, "npi": [1346982444] } ] }, { "allowed_amount": 2960.40, "providers": [{ "billed_charge": 17040.00, "npi": [1437310562] } ] }, { "allowed_amount": 1043.00, "providers": [{ "billed_charge": 5680.00, "npi": [1467682617, 1669797619, 1881155679] } ] }, { "allowed_amount": 3749.84, "providers": [{ "billed_charge": 21584.00, "npi": [1568849412] } ] }, { "allowed_amount": 2294.60, "providers": [{ "billed_charge": 12496.00, "npi": [1902052038] } ] }, { "allowed_amount": 625.80, "providers": [{ "billed_charge": 3408.00, "npi": [1316352628, 1497074991, 1457448151, 1518193408] } ] }, { "allowed_amount": 2565.68, "providers": [{ "billed_charge": 14768.00, "npi": [1588197131] } ] }, { "allowed_amount": 1381.52, "providers": [{ "billed_charge": 7952.00, "npi": [1275973927] } ] }, { "allowed_amount": 603.33, "providers": [{ "billed_charge": 3408.00, "npi": [1548495286] } ] }, { "allowed_amount": 208.60, "providers": [{ "billed_charge": 1136.00, "npi": [1063856235, 1770872921, 1205062262, 1114211620] } ] }, { "allowed_amount": 2503.20, "providers": [{ "billed_charge": 13632.00, "npi": [1710328232] } ] }, { "allowed_amount": 1668.80, "providers": [{ "billed_charge": 9088.00, "npi": [1659717734, 1255837381] } ] }, { "allowed_amount": 2711.80, "providers": [{ "billed_charge": 14768.00, "npi": [1245812486, 1245593573] } ] }, { "allowed_amount": 3337.60, "providers": [{ "billed_charge": 18176.00, "npi": [1821330044] } ] }, { "allowed_amount": 2897.94, "providers": [{ "billed_charge": 15904.00, "npi": [1316443229] } ] }, { "allowed_amount": 3355.12, "providers": [{ "billed_charge": 19312.00, "npi": [1932393428] } ] }, { "allowed_amount": 2788.32, "providers": [{ "billed_charge": 17040.00, "npi": [1154680973] } ] }, { "allowed_amount": 3754.80, "providers": [{ "billed_charge": 20448.00, "npi": [1083000111] } ] }, { "allowed_amount": 1578.88, "providers": [{ "billed_charge": 9088.00, "npi": [1942280102, 1447278288, 1912268582] } ] }, { "allowed_amount": 3963.40, "providers": [{ "billed_charge": 21584.00, "npi": [1992125728] } ] }, { "allowed_amount": 2086.00, "providers": [{ "billed_charge": 11360.00, "npi": [1295479152, 1396189536] } ] }, { "allowed_amount": 1184.16, "providers": [{ "billed_charge": 6816.00, "npi": [1770813610, 1972952927] } ] }, { "allowed_amount": 417.20, "providers": [{ "billed_charge": 2272.00, "npi": [1336568203, 1922637842] } ] }, { "allowed_amount": 834.40, "providers": [{ "billed_charge": 4544.00, "npi": [1972520419, 1467822213, 1407016405, 1326487323, 1912004797] } ] }, { "allowed_amount": 3129.00, "providers": [{ "billed_charge": 17040.00, "npi": [1760879829] } ] }, { "allowed_amount": 1460.20, "providers": [{ "billed_charge": 7952.00, "npi": [1538486451, 1730574625, 1881919793] } ] }, { "allowed_amount": 1251.60, "providers": [{ "billed_charge": 6816.00, "npi": [1881883080, 1164876298] } ] }, { "allowed_amount": 1009.28, "providers": [{ "billed_charge": 5680.00, "npi": [1578208633] } ] }, { "allowed_amount": 394.72, "providers": [{ "billed_charge": 2272.00, "npi": [1285954677, 1831418292] } ] }, { "allowed_amount": 197.37, "providers": [{ "billed_charge": 1136.00, "npi": [1619363413] } ] }, { "allowed_amount": 986.80, "providers": [{ "billed_charge": 5680.00, "npi": [1982998308] } ] }, { "allowed_amount": 789.44, "providers": [{ "billed_charge": 4544.00, "npi": [1720279748] } ] }, { "allowed_amount": 713.16, "providers": [{ "billed_charge": 4544.00, "npi": [1033345855] } ] } ] }, { "tin": { "type": "ein", "value": "452317041" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2722.88, "providers": [{ "billed_charge": 21824.00, "npi": [1487073680] } ] }, { "allowed_amount": 2042.16, "providers": [{ "billed_charge": 16368.00, "npi": [1447510805] } ] }, { "allowed_amount": 1701.80, "providers": [{ "billed_charge": 13640.00, "npi": [1932780426, 1528697026] } ] }, { "allowed_amount": 2382.52, "providers": [{ "billed_charge": 19096.00, "npi": [1568082501] } ] }, { "allowed_amount": 879.83, "providers": [{ "billed_charge": 6820.00, "npi": [1548840051] } ] }, { "allowed_amount": 1531.62, "providers": [{ "billed_charge": 12276.00, "npi": [1801472253] } ] } ] }, { "tin": { "type": "ein", "value": "743019172" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2530.20, "providers": [{ "billed_charge": 30540.00, "npi": [1770565673] } ] }, { "allowed_amount": 7759.28, "providers": [{ "billed_charge": 93656.00, "npi": [1447232194] } ] }, { "allowed_amount": 4731.54, "providers": [{ "billed_charge": 67188.00, "npi": [1043455348] } ] }, { "allowed_amount": 3584.50, "providers": [{ "billed_charge": 50900.00, "npi": [1083822100] } ] }, { "allowed_amount": 10626.84, "providers": [{ "billed_charge": 128268.00, "npi": [1578129847] } ] }, { "allowed_amount": 6241.16, "providers": [{ "billed_charge": 75332.00, "npi": [1588646145] } ] }, { "allowed_amount": 3010.98, "providers": [{ "billed_charge": 42756.00, "npi": [1922200807] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 410.06, "providers": [{ "billed_charge": 3914.00, "npi": [1366070864] } ] } ] }, { "tin": { "type": "ein", "value": "752684562" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1381.52, "providers": [{ "billed_charge": 10612.00, "npi": [1144809112] } ] }, { "allowed_amount": 2088.72, "providers": [{ "billed_charge": 12128.00, "npi": [1649857590] } ] }, { "allowed_amount": 789.44, "providers": [{ "billed_charge": 6064.00, "npi": [1669885679] } ] } ] }, { "tin": { "type": "ein", "value": "823656564" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1973.60, "providers": [{ "billed_charge": 35220.00, "npi": [1396749727] } ] }, { "allowed_amount": 1184.16, "providers": [{ "billed_charge": 21132.00, "npi": [1902539471] } ] } ] }, { "tin": { "type": "ein", "value": "842988873" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 394.72, "providers": [{ "billed_charge": 5806.00, "npi": [1932789732] } ] } ] }, { "tin": { "type": "ein", "value": "461415202" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1280.34, "providers": [{ "billed_charge": 3346.00, "npi": [1346604352] } ] }, { "allowed_amount": 4433.45, "providers": [{ "billed_charge": 11711.00, "npi": [1912952227] } ] } ] }, { "tin": { "type": "ein", "value": "474649080" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 592.08, "providers": [{ "billed_charge": 6945.30, "npi": [1790866242] } ] } ] }, { "tin": { "type": "ein", "value": "810872075" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1531.62, "providers": [{ "billed_charge": 8916.00, "npi": [1992333157] } ] } ] }, { "tin": { "type": "ein", "value": "752562784" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6863.78, "providers": [{ "billed_charge": 15026.00, "npi": [1164066387] } ] }, { "allowed_amount": 3119.90, "providers": [{ "billed_charge": 7285.00, "npi": [1700095700, 1184827834] }, { "billed_charge": 6830.00, "npi": [1689847287] }, { "billed_charge": 7635.00, "npi": [1235196502] } ] }, { "allowed_amount": 3743.88, "providers": [{ "billed_charge": 8742.00, "npi": [1497736375, 1346316411] } ] }, { "allowed_amount": 2495.92, "providers": [{ "billed_charge": 5828.00, "npi": [1407813108] } ] }, { "allowed_amount": 14351.54, "providers": [{ "billed_charge": 33511.00, "npi": [1932197662] } ] }, { "allowed_amount": 623.98, "providers": [{ "billed_charge": 1766.00, "npi": [1013357920] }, { "billed_charge": 1457.00, "npi": [1023165982] } ] }, { "allowed_amount": 13103.58, "providers": [{ "billed_charge": 30597.00, "npi": [1205452828, 1477081297] } ] }, { "allowed_amount": 7487.76, "providers": [{ "billed_charge": 17484.00, "npi": [1881644938] } ] }, { "allowed_amount": 8735.72, "providers": [{ "billed_charge": 20398.00, "npi": [1750517926] } ] }, { "allowed_amount": 1871.94, "providers": [{ "billed_charge": 4371.00, "npi": [1821016189, 1497100804] }, { "billed_charge": 5298.00, "npi": [1356913586] } ] }, { "allowed_amount": 5615.82, "providers": [{ "billed_charge": 13113.00, "npi": [1750635835, 1528683554] }, { "billed_charge": 13743.00, "npi": [1598328858] } ] }, { "allowed_amount": 1247.96, "providers": [{ "billed_charge": 2914.00, "npi": [1467018887] } ] }, { "allowed_amount": 11231.64, "providers": [{ "billed_charge": 27486.00, "npi": [1952404261] } ] } ] }, { "tin": { "type": "ein", "value": "204701276" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 11976.28, "providers": [{ "billed_charge": 36168.00, "npi": [1295756955] } ] } ] } ] }, { "name": "CRITICAL CARE, FIRST HOUR", "billing_code_type": "CPT", "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": "752384505" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2291.76, "providers": [{ "billed_charge": 3195.00, "npi": [1144633124] } ] } ] }, { "tin": { "type": "ein", "value": "203542589" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1397.48, "providers": [{ "billed_charge": 10738.00, "npi": [1164684908] } ] } ] }, { "tin": { "type": "ein", "value": "833838272" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2595.32, "providers": [{ "billed_charge": 7475.00, "npi": [1366881393] } ] } ] }, { "tin": { "type": "ein", "value": "760567380" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.52, "providers": [{ "billed_charge": 1130.00, "npi": [1679898829] } ] } ] }, { "tin": { "type": "ein", "value": "271072321" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 768.64, "providers": [{ "billed_charge": 3612.00, "npi": [1326577909] } ] } ] }, { "tin": { "type": "ein", "value": "741613878" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1397.48, "providers": [{ "billed_charge": 3969.00, "npi": [1063673051] } ] } ] }, { "tin": { "type": "ein", "value": "760077790" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 598.92, "providers": [{ "billed_charge": 1050.00, "npi": [1942838958] } ] } ] }, { "tin": { "type": "ein", "value": "923083345" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2986.42, "providers": [{ "billed_charge": 13387.00, "npi": [1790031292] } ] } ] }, { "tin": { "type": "ein", "value": "452317041" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1187.82, "providers": [{ "billed_charge": 10530.00, "npi": [1447510805] } ] } ] }, { "tin": { "type": "ein", "value": "332241086" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.00, "providers": [{ "billed_charge": 603.00, "npi": [1023200623] } ] } ] }, { "tin": { "type": "ein", "value": "261498683" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 11361.04, "providers": [{ "billed_charge": 29928.00, "npi": [1588079529] } ] } ] }, { "tin": { "type": "ein", "value": "992442600" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1762.92, "providers": [{ "billed_charge": 3240.00, "npi": [1730209719] } ] } ] }, { "tin": { "type": "ein", "value": "800725733" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2090.00, "providers": [{ "billed_charge": 7480.00, "npi": [1386140002] } ] } ] }, { "tin": { "type": "ein", "value": "205768117" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6188.84, "providers": [{ "billed_charge": 35867.00, "npi": [1457333775] } ] } ] }, { "tin": { "type": "ein", "value": "810917577" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2280.00, "providers": [{ "billed_charge": 4800.00, "npi": [1942438098] } ] } ] }, { "tin": { "type": "ein", "value": "471728945" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 10773.40, "providers": [{ "billed_charge": 36990.00, "npi": [1326425182] } ] }, { "allowed_amount": 11948.68, "providers": [{ "billed_charge": 41316.00, "npi": [1508271404] } ] }, { "allowed_amount": 13123.96, "providers": [{ "billed_charge": 45837.00, "npi": [1104003607] } ] }, { "allowed_amount": 9989.88, "providers": [{ "billed_charge": 35211.00, "npi": [1497890198] }, { "billed_charge": 35406.00, "npi": [1568625432] } ] } ] }, { "tin": { "type": "ein", "value": "751604753" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.06, "providers": [{ "billed_charge": 840.00, "npi": [1548375827] } ] } ] }, { "tin": { "type": "ein", "value": "453796432" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 990.55, "providers": [{ "billed_charge": 3075.00, "npi": [1912966045] } ] } ] }, { "tin": { "type": "ein", "value": "844504483" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 481.62, "providers": [{ "billed_charge": 2910.00, "npi": [1992125728] } ] }, { "allowed_amount": 240.81, "providers": [{ "billed_charge": 1455.00, "npi": [1760879829] } ] } ] }, { "tin": { "type": "ein", "value": "932594175" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1520.00, "providers": [{ "billed_charge": 9640.00, "npi": [1710068135] } ] }, { "allowed_amount": 190.00, "providers": [{ "billed_charge": 1205.00, "npi": [1942461439] } ] } ] }, { "tin": { "type": "ein", "value": "384109786" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4970.49, "providers": [{ "billed_charge": 46452.00, "npi": [1598196743] } ] }, { "allowed_amount": 3550.35, "providers": [{ "billed_charge": 33180.00, "npi": [1790219087] } ] }, { "allowed_amount": 236.69, "providers": [{ "billed_charge": 2212.00, "npi": [1649513425, 1912131053] } ] }, { "allowed_amount": 946.76, "providers": [{ "billed_charge": 8848.00, "npi": [1841443108] } ] }, { "allowed_amount": 473.38, "providers": [{ "billed_charge": 4424.00, "npi": [1528409968, 1285096404] } ] } ] }, { "tin": { "type": "ein", "value": "743019172" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 195.88, "providers": [{ "billed_charge": 2481.00, "npi": [1770565673] } ] } ] }, { "tin": { "type": "ein", "value": "455423722" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3737.34, "providers": [{ "billed_charge": 9882.00, "npi": [1770863615] } ] } ] }, { "tin": { "type": "ein", "value": "852906340" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 998.20, "providers": [{ "billed_charge": 1500.00, "npi": [1639154883] } ] } ] }, { "tin": { "type": "ein", "value": "932683132" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3168.30, "providers": [{ "billed_charge": 7810.00, "npi": [1790195378] } ] } ] }, { "tin": { "type": "ein", "value": "752536818" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3091.06, "providers": [{ "billed_charge": 13299.58, "npi": [1720220387] } ] } ] }, { "tin": { "type": "ein", "value": "454323821" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4100.94, "providers": [{ "billed_charge": 7250.04, "npi": [1093095127] } ] }, { "allowed_amount": 2506.13, "providers": [{ "billed_charge": 4430.58, "npi": [1972913002] } ] }, { "allowed_amount": 509.28, "providers": [{ "billed_charge": 805.56, "npi": [1104945773] } ] }, { "allowed_amount": 1782.48, "providers": [{ "billed_charge": 2819.46, "npi": [1568995405] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99307", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203988983" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1376.78, "providers": [{ "billed_charge": 5106.00, "npi": [1346750064] } ] } ] }, { "tin": { "type": "ein", "value": "880595187" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.34, "providers": [{ "billed_charge": 150.00, "npi": [1154708022] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "CPT", "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": "383870044" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 566.90, "providers": [{ "billed_charge": 1450.00, "npi": [1174084024] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "CPT", "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": "825244490" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 843.03, "providers": [{ "billed_charge": 1923.48, "npi": [1083034771] } ] } ] }, { "tin": { "type": "ein", "value": "464983519" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1665.75, "providers": [{ "billed_charge": 3064.08, "npi": [1316980295] } ] } ] }, { "tin": { "type": "ein", "value": "333819930" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.02, "providers": [{ "billed_charge": 450.00, "npi": [1518191444] } ] } ] }, { "tin": { "type": "ein", "value": "993351630" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 452.85, "providers": [{ "billed_charge": 700.00, "npi": [1689710444] } ] } ] }, { "tin": { "type": "ein", "value": "833973422" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 414.70, "providers": [{ "billed_charge": 840.00, "npi": [1255092938] } ] } ] }, { "tin": { "type": "ein", "value": "863473693" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1544.96, "providers": [{ "billed_charge": 2400.00, "npi": [1699129973] } ] } ] }, { "tin": { "type": "ein", "value": "472590836" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 97.58, "providers": [{ "billed_charge": 338.00, "npi": [1669674453] } ] } ] }, { "tin": { "type": "ein", "value": "824684335" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 820.80, "providers": [{ "billed_charge": 2790.00, "npi": [1528772894] } ] } ] }, { "tin": { "type": "ein", "value": "272022354" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.07, "providers": [{ "billed_charge": 233.00, "npi": [1528526795] } ] }, { "allowed_amount": 1161.16, "providers": [{ "billed_charge": 3262.00, "npi": [1750930855] } ] }, { "allowed_amount": 580.58, "providers": [{ "billed_charge": 1631.00, "npi": [1528526795] } ] }, { "allowed_amount": 576.42, "providers": [{ "billed_charge": 1398.00, "npi": [1144767096] } ] }, { "allowed_amount": 1742.43, "providers": [{ "billed_charge": 4893.00, "npi": [1144767096] } ] }, { "allowed_amount": 113.02, "providers": [{ "billed_charge": 233.00, "npi": [1043599178] } ] }, { "allowed_amount": 405.30, "providers": [{ "billed_charge": 1165.00, "npi": [1043479462] } ] }, { "allowed_amount": 833.35, "providers": [{ "billed_charge": 2097.00, "npi": [1932649761] } ] }, { "allowed_amount": 663.52, "providers": [{ "billed_charge": 1864.00, "npi": [1871017582] } ] }, { "allowed_amount": 666.50, "providers": [{ "billed_charge": 1631.00, "npi": [1043599178] } ] }, { "allowed_amount": 192.14, "providers": [{ "billed_charge": 466.00, "npi": [1871017582] } ] }, { "allowed_amount": 636.96, "providers": [{ "billed_charge": 1864.00, "npi": [1932649761] } ] } ] }, { "tin": { "type": "ein", "value": "845000210" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 1597.66, "providers": [{ "billed_charge": 8921.09, "npi": [1366766875] } ] }, { "allowed_amount": 113.02, "providers": [{ "billed_charge": 524.77, "npi": [1316712227] } ] } ] }, { "tin": { "type": "ein", "value": "471039380" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 487.90, "providers": [{ "billed_charge": 850.00, "npi": [1578520953] } ] } ] } ] }, { "name": "HOME VISIT EST PATIENT", "billing_code_type": "CPT", "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": "464725163" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6931.26, "providers": [{ "billed_charge": 9450.63, "npi": [1942535828] } ] } ] } ] }, { "name": "HOME VISIT EST PATIENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99350", "description": "HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464725163" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1766.93, "providers": [{ "billed_charge": 2145.11, "npi": [1942535828] } ] } ] } ] }, { "name": "PREV VISIT EST AGE 1-4", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99392", "description": "PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1367.56, "providers": [{ "billed_charge": 2080.00, "npi": [1265546287] } ] } ] } ] }, { "name": "PREV VISIT EST AGE 5-11", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99393", "description": "PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.45, "providers": [{ "billed_charge": 180.00, "npi": [1265546287] } ] } ] } ] }, { "name": "PREV VISIT EST AGE 18-39", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99395", "description": "PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 590.95, "providers": [{ "billed_charge": 1640.00, "npi": [1508068438] } ] } ] } ] }, { "name": "PREV VISIT EST AGE 40-64", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99396", "description": "PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "820962731" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4263.60, "providers": [{ "billed_charge": 6140.00, "npi": [1639511397] } ] } ] }, { "tin": { "type": "ein", "value": "741721807" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2257.20, "providers": [{ "billed_charge": 3978.00, "npi": [1891855656] } ] } ] }, { "tin": { "type": "ein", "value": "200537948" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3628.86, "providers": [{ "billed_charge": 6409.00, "npi": [1831383355] } ] } ] }, { "tin": { "type": "ein", "value": "741794256" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 846.14, "providers": [{ "billed_charge": 880.00, "npi": [1518249150] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5015.31, "providers": [{ "billed_charge": 13120.00, "npi": [1508068438] } ] } ] } ] }, { "name": "PREVENTIVE COUNSELING INDIV", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99401", "description": "PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO AN INDIVIDUA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208271258" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1603.60, "providers": [{ "billed_charge": 2000.00, "npi": [1417944943] } ] } ] }, { "tin": { "type": "ein", "value": "742515841" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.34, "providers": [{ "billed_charge": 180.00, "npi": [1932205838] } ] } ] } ] }, { "name": "BEHAV CHNG SMOKING 3-10 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99406", "description": "SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208271258" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.15, "providers": [{ "billed_charge": 250.00, "npi": [1417944943] } ] } ] }, { "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 89.04, "providers": [{ "billed_charge": 196.00, "npi": [1831544808] } ] } ] } ] }, { "name": "BEHAV CHNG SMOKING > 10 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99407", "description": "SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTENSIVE, GREATER THAN 10 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832802070" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.31, "providers": [{ "billed_charge": 44.20, "npi": [1740512649] } ] } ] } ] }, { "name": "PROLNG OFF/OP E/M EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99417", "description": "PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463951057" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5119.43, "providers": [{ "billed_charge": 17441.00, "npi": [1144330762] } ] } ] }, { "tin": { "type": "ein", "value": "832419554" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 391.89, "providers": [{ "billed_charge": 1296.00, "npi": [1134516032] } ] } ] }, { "tin": { "type": "ein", "value": "995025033" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 942.30, "providers": [{ "billed_charge": 1500.00, "npi": [1891289310] } ] } ] } ] }, { "name": "PRIN CARE MGMT STAFF 1ST 30", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99426", "description": "PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823763668" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8265.84, "providers": [{ "billed_charge": 14880.00, "npi": [1689633711] } ] } ] } ] }, { "name": "Under Digitally Stored Data Services/Remote Physiologic Monitoring", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99445", "description": "Under Digitally Stored Data Services/Remote Physiologic Monitoring", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460796181" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1193.01, "providers": [{ "billed_charge": 3523.35, "npi": [1811557333] } ] } ] } ] }, { "name": "NTRPROF PH1/NTRNET/EHR 5/>", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99451", "description": "NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208164988" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 393.67, "providers": [{ "billed_charge": 600.00, "npi": [1851779326] } ] }, { "allowed_amount": 289.76, "providers": [{ "billed_charge": 400.00, "npi": [1417140641] } ] }, { "allowed_amount": 72.44, "providers": [{ "billed_charge": 100.00, "npi": [1689164949] } ] } ] } ] }, { "name": "REM PHYSIOL MNTR 20 MIN MO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99457", "description": "REMOTE PHYSIOLOGIC MONITORING 20 MIN+ PER MONTH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460796181" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2141.43, "providers": [{ "billed_charge": 6247.32, "npi": [1811557333] } ] } ] } ] }, { "name": "REM PHYSIOL MNTR EA ADDL 20", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99458", "description": "REMOTE PHYSIOLOGIC MONITORING EA ADDL 20 MIN MO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460796181" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1384.11, "providers": [{ "billed_charge": 4027.74, "npi": [1811557333] } ] } ] } ] }, { "name": "INIT NB EM PER DAY HOSP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99460", "description": "INITIAL HOSPITAL OR BIRTHING CENTER CARE, PER DAY, FOR EVALUATION AND MANAGEMENT OF NORMAL NEWBORN I", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260822356" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1118.43, "providers": [{ "billed_charge": 2584.00, "npi": [1053929729] } ] } ] } ] }, { "name": "ATTENDANCE AT DELIVERY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99464", "description": "ATTENDANCE AT DELIVERY (WHEN REQUESTED BY THE DELIVERING PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260822356" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 308.40, "providers": [{ "billed_charge": 1638.00, "npi": [1053929729] } ] } ] } ] }, { "name": "NEONATE CRIT CARE SUBSQ", "billing_code_type": "CPT", "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": "332672530" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2256.87, "providers": [{ "billed_charge": 15463.00, "npi": [1346212990] } ] } ] } ] }, { "name": "IC LBW INF 1500-2500 G SUBSQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99479", "description": "SUBSEQUENT INTENSIVE CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF THE RECOVERING LOW BIRTH WE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "650578395" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2553.40, "providers": [{ "billed_charge": 6545.00, "npi": [1760562029] } ] } ] } ] }, { "name": "IC INF PBW 2501-5000 G SUBSQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99480", "description": "SUBSEQUENT INTENSIVE CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF THE RECOVERING INFANT (PRES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "650578395" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3427.41, "providers": [{ "billed_charge": 8792.00, "npi": [1770548190] } ] }, { "allowed_amount": 6854.82, "providers": [{ "billed_charge": 17584.00, "npi": [1306812151] } ] } ] } ] }, { "name": "CHRON CARE MGMT SRVC 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99490", "description": "CHRONIC CARE MANAGEMENT SERVICES, AT LEAST 20 MINUTES OF CLINICAL STAFF TIME DIRECTED BY A PHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "990758914" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2896.20, "providers": [{ "billed_charge": 8650.80, "npi": [1619129624] } ] } ] }, { "tin": { "type": "ein", "value": "874664294" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1609.00, "providers": [{ "billed_charge": 4701.75, "npi": [1619129624] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5599.32, "providers": [{ "billed_charge": 10875.00, "npi": [1508068438] } ] } ] } ] }, { "name": "CHRNC CARE MGMT SVC 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99491", "description": "CHRONIC CARE MGMT SVC AT LEAST 30 MIN PER MONTH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812122050" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2010.89, "providers": [{ "billed_charge": 5120.00, "npi": [1649682857] } ] } ] } ] }, { "name": "HOME INFUSION/VISIT, 2 HRS", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["12", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.00, "providers": [{ "billed_charge": 720.00, "npi": [1234567893] } ] }, { "allowed_amount": 12820.00, "providers": [{ "billed_charge": 50380.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HOME INFUSION EACH ADDTL HR", "billing_code_type": "CPT", "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1812.50, "providers": [{ "billed_charge": 12260.00, "npi": [1234567893] } ] } ] } ] }, { "name": "BLS ROUTINE DISPOSABLE SUPPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0382", "description": "BLS ROUTINE DISPOSABLE SUPPLIES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752234266" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16404.80, "providers": [{ "billed_charge": 16416.00, "npi": [1710981774] } ] } ] }, { "tin": { "type": "ein", "value": "746000978" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 114.32, "providers": [{ "billed_charge": 114.32, "npi": [1114995586] } ] } ] }, { "tin": { "type": "ein", "value": "746000246" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3800.00, "providers": [{ "billed_charge": 3800.00, "npi": [1043311434] } ] } ] }, { "tin": { "type": "ein", "value": "756000588" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6300.00, "providers": [{ "billed_charge": 6300.00, "npi": [1073516548] } ] } ] } ] }, { "name": "ALS ROUTNE DISPSABLE SUPPLS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0398", "description": "ALS ROUTINE DISPOSABLE SUPPLIES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752234266" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23580.00, "providers": [{ "billed_charge": 23580.00, "npi": [1710981774] } ] } ] }, { "tin": { "type": "ein", "value": "800685304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9492.02, "providers": [{ "billed_charge": 9492.02, "npi": [1457716037] } ] } ] }, { "tin": { "type": "ein", "value": "742277841" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14800.00, "providers": [{ "billed_charge": 14936.00, "npi": [1558812602] } ] } ] }, { "tin": { "type": "ein", "value": "746027491" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 832.00, "providers": [{ "billed_charge": 960.12, "npi": [1447674825] } ] } ] }, { "tin": { "type": "ein", "value": "746000978" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2143.42, "providers": [{ "billed_charge": 2143.42, "npi": [1114995586] } ] } ] }, { "tin": { "type": "ein", "value": "746000246" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2000.00, "providers": [{ "billed_charge": 2000.00, "npi": [1043311434] } ] } ] }, { "tin": { "type": "ein", "value": "756000543" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4800.00, "providers": [{ "billed_charge": 4800.00, "npi": [1194728402] } ] } ] }, { "tin": { "type": "ein", "value": "756000588" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11250.00, "providers": [{ "billed_charge": 11250.00, "npi": [1073516548] } ] } ] } ] }, { "name": "AMB OXYGEN&O2 SPL LIFE SUSTA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0422", "description": "AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES, LIFE SUSTAINING SITUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "752474011" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1352.75, "providers": [{ "billed_charge": 1428.50, "npi": [1639103864] } ] } ] } ] }, { "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": "825198494" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 82534.50, "providers": [{ "billed_charge": 82534.50, "npi": [1518451749] } ] } ] }, { "tin": { "type": "ein", "value": "746001923" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 10179.52, "providers": [{ "billed_charge": 10189.31, "npi": [1245338433] } ] } ] }, { "tin": { "type": "ein", "value": "202950769" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 25561.96, "providers": [{ "billed_charge": 28328.16, "npi": [1700801693] } ] } ] }, { "tin": { "type": "ein", "value": "454331997" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9078.40, "providers": [{ "billed_charge": 9078.40, "npi": [1871854075] } ] } ] }, { "tin": { "type": "ein", "value": "205608001" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7443.00, "providers": [{ "billed_charge": 7443.00, "npi": [1801077987] } ] } ] }, { "tin": { "type": "ein", "value": "731038915" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 57.00, "providers": [{ "billed_charge": 57.00, "npi": [1457378150] } ] } ] }, { "tin": { "type": "ein", "value": "752234266" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 56470.89, "providers": [{ "billed_charge": 56797.79, "npi": [1710981774] } ] } ] }, { "tin": { "type": "ein", "value": "742857452" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 394.16, "providers": [{ "billed_charge": 455.00, "npi": [1972534980] } ] } ] }, { "tin": { "type": "ein", "value": "756004644" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.00, "providers": [{ "billed_charge": 48.00, "npi": [1891716452] } ] } ] }, { "tin": { "type": "ein", "value": "746001490" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7009.20, "providers": [{ "billed_charge": 8177.40, "npi": [1730186636] } ] } ] }, { "tin": { "type": "ein", "value": "934900709" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8601.00, "providers": [{ "billed_charge": 8601.00, "npi": [1063276582] } ] } ] }, { "tin": { "type": "ein", "value": "746000441" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2660.00, "providers": [{ "billed_charge": 2660.00, "npi": [1831155647] } ] } ] }, { "tin": { "type": "ein", "value": "756000608" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3771.00, "providers": [{ "billed_charge": 3771.00, "npi": [1356324446] } ] } ] }, { "tin": { "type": "ein", "value": "454891186" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2909.18, "providers": [{ "billed_charge": 2909.18, "npi": [1043586647] } ] } ] }, { "tin": { "type": "ein", "value": "272612460" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 20645.10, "providers": [{ "billed_charge": 20645.10, "npi": [1164854733] } ] } ] }, { "tin": { "type": "ein", "value": "923266410" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4430.40, "providers": [{ "billed_charge": 4430.40, "npi": [1326734229] } ] } ] }, { "tin": { "type": "ein", "value": "760613179" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3698.60, "providers": [{ "billed_charge": 3698.60, "npi": [1053461392] } ] } ] }, { "tin": { "type": "ein", "value": "473442335" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3274.40, "providers": [{ "billed_charge": 3274.40, "npi": [1316301054] } ] } ] }, { "tin": { "type": "ein", "value": "751570670" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 525.00, "npi": [1699811034] } ] } ] }, { "tin": { "type": "ein", "value": "756000602" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1265.00, "providers": [{ "billed_charge": 1265.00, "npi": [1134263908] } ] } ] }, { "tin": { "type": "ein", "value": "261296735" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11488.03, "providers": [{ "billed_charge": 16395.15, "npi": [1235307752] } ] } ] }, { "tin": { "type": "ein", "value": "853395488" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 927.20, "providers": [{ "billed_charge": 927.20, "npi": [1598353708] } ] } ] }, { "tin": { "type": "ein", "value": "760133493" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 21961.62, "providers": [{ "billed_charge": 21961.62, "npi": [1760033526] } ] } ] }, { "tin": { "type": "ein", "value": "455508689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5786.40, "providers": [{ "billed_charge": 5786.40, "npi": [1992144885] } ] } ] }, { "tin": { "type": "ein", "value": "760517401" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1836.00, "providers": [{ "billed_charge": 1836.00, "npi": [1205899374] } ] } ] }, { "tin": { "type": "ein", "value": "274539737" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14136.00, "providers": [{ "billed_charge": 14136.00, "npi": [1295014140] } ] } ] }, { "tin": { "type": "ein", "value": "208424689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 453201.62, "providers": [{ "billed_charge": 1261970.60, "npi": [1952588329] } ] } ] }, { "tin": { "type": "ein", "value": "742391176" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2127.50, "providers": [{ "billed_charge": 2127.50, "npi": [1760850648] } ] } ] }, { "tin": { "type": "ein", "value": "746027491" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1035.50, "providers": [{ "billed_charge": 1145.12, "npi": [1447674825] } ] } ] }, { "tin": { "type": "ein", "value": "300754305" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.90, "providers": [{ "billed_charge": 279.00, "npi": [1417456583] } ] } ] }, { "tin": { "type": "ein", "value": "746000278" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8652.00, "providers": [{ "billed_charge": 8652.00, "npi": [1982695268] } ] } ] }, { "tin": { "type": "ein", "value": "811488160" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 28381.60, "providers": [{ "billed_charge": 28381.60, "npi": [1457057291] } ] } ] }, { "tin": { "type": "ein", "value": "752747708" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 82100.00, "providers": [{ "billed_charge": 82100.00, "npi": [1457444150] } ] } ] }, { "tin": { "type": "ein", "value": "331132313" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 392.50, "providers": [{ "billed_charge": 392.50, "npi": [1922234368] } ] } ] }, { "tin": { "type": "ein", "value": "746000978" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4809.54, "providers": [{ "billed_charge": 4809.54, "npi": [1114995586] } ] } ] }, { "tin": { "type": "ein", "value": "208346277" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5423.00, "providers": [{ "billed_charge": 5423.00, "npi": [1003098047] } ] } ] }, { "tin": { "type": "ein", "value": "743023503" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 38025.00, "providers": [{ "billed_charge": 38025.00, "npi": [1831207919] } ] } ] }, { "tin": { "type": "ein", "value": "260316725" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3150.20, "providers": [{ "billed_charge": 4952.00, "npi": [1114199320] } ] } ] }, { "tin": { "type": "ein", "value": "845023030" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 58190.00, "providers": [{ "billed_charge": 58190.00, "npi": [1487257010] } ] } ] }, { "tin": { "type": "ein", "value": "900486115" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3262.40, "providers": [{ "billed_charge": 3262.40, "npi": [1043537475] } ] } ] }, { "tin": { "type": "ein", "value": "756000588" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5736.00, "providers": [{ "billed_charge": 5736.00, "npi": [1073516548] } ] } ] }, { "tin": { "type": "ein", "value": "720701964" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 19188.80, "providers": [{ "billed_charge": 27346.45, "npi": [1316943566] } ] } ] }, { "tin": { "type": "ein", "value": "453268127" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2600.00, "providers": [{ "billed_charge": 2600.00, "npi": [1003245093] } ] } ] }, { "tin": { "type": "ein", "value": "756000583" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 975.00, "providers": [{ "billed_charge": 975.00, "npi": [1871623470] } ] } ] }, { "tin": { "type": "ein", "value": "746001432" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2709.00, "providers": [{ "billed_charge": 2942.50, "npi": [1710977061] } ] } ] }, { "tin": { "type": "ein", "value": "205829641" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 45761.00, "providers": [{ "billed_charge": 45761.00, "npi": [1447436613] } ] } ] }, { "tin": { "type": "ein", "value": "741402838" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.00, "providers": [{ "billed_charge": 162.00, "npi": [1407941479] } ] } ] }, { "tin": { "type": "ein", "value": "756000508" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16935.00, "providers": [{ "billed_charge": 16935.00, "npi": [1861530990] } ] } ] }, { "tin": { "type": "ein", "value": "756000626" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2444.00, "providers": [{ "billed_charge": 2447.90, "npi": [1801890637] } ] } ] }, { "tin": { "type": "ein", "value": "751360556" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1752.00, "providers": [{ "billed_charge": 1752.00, "npi": [1235285289] } ] } ] }, { "tin": { "type": "ein", "value": "451837687" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2850.08, "providers": [{ "billed_charge": 2850.08, "npi": [1316229677] } ] } ] }, { "tin": { "type": "ein", "value": "300662178" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 42048.00, "providers": [{ "billed_charge": 42048.00, "npi": [1932471075] } ] } ] }, { "tin": { "type": "ein", "value": "200253831" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5584.48, "providers": [{ "billed_charge": 5749.00, "npi": [1669462982] } ] } ] }, { "tin": { "type": "ein", "value": "746002070" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2937.60, "providers": [{ "billed_charge": 2937.60, "npi": [1053377713] } ] } ] }, { "tin": { "type": "ein", "value": "921690554" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 44303.20, "providers": [{ "billed_charge": 44303.20, "npi": [1538872239] } ] } ] }, { "tin": { "type": "ein", "value": "453584448" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2288.80, "providers": [{ "billed_charge": 2288.80, "npi": [1679832125] } ] } ] }, { "tin": { "type": "ein", "value": "270955008" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 27332.80, "providers": [{ "billed_charge": 27332.80, "npi": [1164707444] } ] } ] }, { "tin": { "type": "ein", "value": "756000478" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2655.00, "providers": [{ "billed_charge": 2655.00, "npi": [1033240718] } ] } ] }, { "tin": { "type": "ein", "value": "203948307" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 74533.09, "providers": [{ "billed_charge": 74533.09, "npi": [1376644609] } ] } ] }, { "tin": { "type": "ein", "value": "746000574" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2657.76, "providers": [{ "billed_charge": 2657.76, "npi": [1972609337] } ] } ] }, { "tin": { "type": "ein", "value": "746001420" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 802.53, "providers": [{ "billed_charge": 802.53, "npi": [1710064100] } ] } ] }, { "tin": { "type": "ein", "value": "751657155" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 118920.27, "providers": [{ "billed_charge": 156372.00, "npi": [1275509259] } ] } ] }, { "tin": { "type": "ein", "value": "746001969" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 36608.91, "providers": [{ "billed_charge": 37486.61, "npi": [1457322885] } ] } ] }, { "tin": { "type": "ein", "value": "756000514" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1939.50, "providers": [{ "billed_charge": 1939.50, "npi": [1275548182] } ] } ] }, { "tin": { "type": "ein", "value": "260368797" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2236.00, "providers": [{ "billed_charge": 2236.00, "npi": [1326217738] } ] } ] }, { "tin": { "type": "ein", "value": "993485961" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1131.00, "providers": [{ "billed_charge": 1131.00, "npi": [1598632515] } ] } ] }, { "tin": { "type": "ein", "value": "746003078" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 51960.62, "providers": [{ "billed_charge": 52680.00, "npi": [1023124328] } ] } ] }, { "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 374136.10, "providers": [{ "billed_charge": 374136.10, "npi": [1104286087] } ] } ] }, { "tin": { "type": "ein", "value": "746000085" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12561.00, "providers": [{ "billed_charge": 13929.00, "npi": [1295704732] } ] } ] }, { "tin": { "type": "ein", "value": "752474011" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 38930.27, "providers": [{ "billed_charge": 45374.12, "npi": [1194750802] } ] }, { "allowed_amount": 19534.62, "providers": [{ "billed_charge": 21341.20, "npi": [1639103864] } ] }, { "allowed_amount": 46166.38, "providers": [{ "billed_charge": 46245.20, "npi": [1881628014] } ] } ] }, { "tin": { "type": "ein", "value": "452538975" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 19072.00, "providers": [{ "billed_charge": 19072.00, "npi": [1083912554] } ] } ] }, { "tin": { "type": "ein", "value": "746000246" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3850.00, "providers": [{ "billed_charge": 3850.00, "npi": [1043311434] } ] } ] }, { "tin": { "type": "ein", "value": "201919780" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 59858.32, "providers": [{ "billed_charge": 64326.40, "npi": [1952995888] } ] } ] }, { "tin": { "type": "ein", "value": "746002544" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8020.80, "providers": [{ "billed_charge": 8020.80, "npi": [1073588612] } ] } ] }, { "tin": { "type": "ein", "value": "741282696" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 51770.70, "providers": [{ "billed_charge": 51851.20, "npi": [1083744940] } ] } ] }, { "tin": { "type": "ein", "value": "743015865" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12696.00, "providers": [{ "billed_charge": 12696.00, "npi": [1780398644] } ] } ] }, { "tin": { "type": "ein", "value": "756000640" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3487.50, "providers": [{ "billed_charge": 3487.50, "npi": [1982742698] } ] } ] }, { "tin": { "type": "ein", "value": "746001573" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23063.25, "providers": [{ "billed_charge": 23063.25, "npi": [1255396156] } ] } ] }, { "tin": { "type": "ein", "value": "320356516" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 168.00, "providers": [{ "billed_charge": 168.00, "npi": [1386908499] } ] } ] }, { "tin": { "type": "ein", "value": "756000528" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 63696.54, "providers": [{ "billed_charge": 63760.50, "npi": [1629871512] } ] } ] }, { "tin": { "type": "ein", "value": "760521530" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3017.70, "providers": [{ "billed_charge": 3017.70, "npi": [1801864368] } ] } ] }, { "tin": { "type": "ein", "value": "453970120" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 340.00, "providers": [{ "billed_charge": 340.00, "npi": [1316295645] } ] } ] }, { "tin": { "type": "ein", "value": "273061469" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12926.80, "providers": [{ "billed_charge": 12926.80, "npi": [1669756904] } ] } ] }, { "tin": { "type": "ein", "value": "453837763" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 24900.00, "providers": [{ "billed_charge": 24900.00, "npi": [1528335478] } ] } ] }, { "tin": { "type": "ein", "value": "746001164" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 156200.32, "providers": [{ "billed_charge": 156295.74, "npi": [1447375282] } ] } ] }, { "tin": { "type": "ein", "value": "800685304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 13839.12, "providers": [{ "billed_charge": 13839.12, "npi": [1457716037] } ] }, { "allowed_amount": 183.69, "providers": [{ "billed_charge": 189.42, "npi": [1013301647] } ] } ] }, { "tin": { "type": "ein", "value": "743253181" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 31907.50, "providers": [{ "billed_charge": 31907.50, "npi": [1588809255] } ] } ] }, { "tin": { "type": "ein", "value": "933583304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 27973.99, "providers": [{ "billed_charge": 27973.99, "npi": [1386416212] } ] } ] }, { "tin": { "type": "ein", "value": "756000534" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1440.00, "providers": [{ "billed_charge": 1440.00, "npi": [1750323556] } ] } ] }, { "tin": { "type": "ein", "value": "742028156" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 10003.51, "providers": [{ "billed_charge": 10003.51, "npi": [1588734594] } ] } ] }, { "tin": { "type": "ein", "value": "932146476" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8820.00, "providers": [{ "billed_charge": 8820.00, "npi": [1679328520] } ] } ] }, { "tin": { "type": "ein", "value": "746000874" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1221.00, "providers": [{ "billed_charge": 1221.00, "npi": [1093706269] } ] } ] }, { "tin": { "type": "ein", "value": "756000531" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 810.00, "providers": [{ "billed_charge": 810.00, "npi": [1538207642] } ] } ] }, { "tin": { "type": "ein", "value": "275484272" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23550.00, "providers": [{ "billed_charge": 23550.00, "npi": [1760736938] } ] } ] }, { "tin": { "type": "ein", "value": "742277841" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14712.00, "providers": [{ "billed_charge": 14867.52, "npi": [1558812602] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 970.32, "providers": [{ "billed_charge": 5920.00, "npi": [1215064506] } ] } ] }, { "tin": { "type": "ein", "value": "746001504" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11112.79, "providers": [{ "billed_charge": 11389.00, "npi": [1568429090] } ] } ] }, { "tin": { "type": "ein", "value": "208993021" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 596.14, "providers": [{ "billed_charge": 1640.00, "npi": [1760662274] } ] } ] }, { "tin": { "type": "ein", "value": "756000659" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5852.00, "providers": [{ "billed_charge": 5852.00, "npi": [1265498935] } ] } ] }, { "tin": { "type": "ein", "value": "462829506" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 34839.20, "providers": [{ "billed_charge": 34839.20, "npi": [1619393436] } ] } ] }, { "tin": { "type": "ein", "value": "741685167" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14435.30, "providers": [{ "billed_charge": 14619.00, "npi": [1447316377] } ] } ] }, { "tin": { "type": "ein", "value": "932952716" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5821.91, "providers": [{ "billed_charge": 6713.00, "npi": [1356120109] } ] } ] }, { "tin": { "type": "ein", "value": "261789627" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23712.22, "providers": [{ "billed_charge": 35199.00, "npi": [1093988784] } ] } ] }, { "tin": { "type": "ein", "value": "760487923" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6090.00, "providers": [{ "billed_charge": 6090.00, "npi": [1437254471] } ] }, { "allowed_amount": 9004.04, "providers": [{ "billed_charge": 11506.44, "npi": [1235248089] } ] } ] }, { "tin": { "type": "ein", "value": "272953899" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 28305.20, "providers": [{ "billed_charge": 28305.20, "npi": [1356649826] } ] } ] }, { "tin": { "type": "ein", "value": "264304912" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 325346.13, "providers": [{ "billed_charge": 372715.00, "npi": [1871724864] } ] } ] }, { "tin": { "type": "ein", "value": "746000422" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2675.00, "providers": [{ "billed_charge": 2675.00, "npi": [1982661666] } ] } ] }, { "tin": { "type": "ein", "value": "756000543" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5424.00, "providers": [{ "billed_charge": 5424.00, "npi": [1194728402] } ] } ] }, { "tin": { "type": "ein", "value": "746001875" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 35406.91, "providers": [{ "billed_charge": 36288.00, "npi": [1013595800] } ] } ] }, { "tin": { "type": "ein", "value": "746000544" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5671.20, "providers": [{ "billed_charge": 5671.20, "npi": [1295759942] } ] } ] }, { "tin": { "type": "ein", "value": "746002441" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3260.00, "providers": [{ "billed_charge": 3294.80, "npi": [1336169192] } ] } ] }, { "tin": { "type": "ein", "value": "746001738" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23620.00, "providers": [{ "billed_charge": 28334.40, "npi": [1821727041] } ] } ] }, { "tin": { "type": "ein", "value": "832708510" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1920.00, "providers": [{ "billed_charge": 1920.00, "npi": [1104398999] } ] } ] }, { "tin": { "type": "ein", "value": "752707125" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 183684.21, "providers": [{ "billed_charge": 184722.00, "npi": [1942201272] } ] } ] }, { "tin": { "type": "ein", "value": "741772120" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 67911.88, "providers": [{ "billed_charge": 67959.69, "npi": [1437218062] } ] } ] }, { "tin": { "type": "ein", "value": "742777597" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 247910.32, "providers": [{ "billed_charge": 247915.00, "npi": [1063588143] } ] } ] }, { "tin": { "type": "ein", "value": "10548955" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 113431.50, "providers": [{ "billed_charge": 114548.00, "npi": [1164526745] } ] } ] }, { "tin": { "type": "ein", "value": "741862375" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 207.00, "providers": [{ "billed_charge": 207.00, "npi": [1043239296] } ] } ] }, { "tin": { "type": "ein", "value": "201891818" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.62, "providers": [{ "billed_charge": 190.00, "npi": [1285650846] } ] } ] }, { "tin": { "type": "ein", "value": "300688582" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 198151.37, "providers": [{ "billed_charge": 296000.93, "npi": [1750676870] } ] } ] }, { "tin": { "type": "ein", "value": "760426477" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4263.00, "providers": [{ "billed_charge": 4263.00, "npi": [1821036831] } ] } ] } ] }, { "name": "AMB SVC ALS NON ER TRSPRT L1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0426", "description": "AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742777597" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 72250.00, "providers": [{ "billed_charge": 72250.00, "npi": [1063588143] } ] } ] }, { "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 114187.10, "providers": [{ "billed_charge": 132440.00, "npi": [1104286087] } ] } ] }, { "tin": { "type": "ein", "value": "752747708" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 20857.61, "providers": [{ "billed_charge": 23123.00, "npi": [1457444150] } ] } ] }, { "tin": { "type": "ein", "value": "264304912" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7729.35, "providers": [{ "billed_charge": 8750.00, "npi": [1871724864] } ] } ] }, { "tin": { "type": "ein", "value": "300688582" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 82097.16, "providers": [{ "billed_charge": 190304.00, "npi": [1750676870] } ] } ] }, { "tin": { "type": "ein", "value": "752707125" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 18556.86, "providers": [{ "billed_charge": 18700.00, "npi": [1942201272] } ] } ] }, { "tin": { "type": "ein", "value": "202950769" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2249.71, "providers": [{ "billed_charge": 5343.60, "npi": [1700801693] } ] } ] } ] }, { "name": "AMB SVC ALS ER TRNSPRT LVL1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751657155" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 87154.73, "providers": [{ "billed_charge": 105000.00, "npi": [1275509259] } ] } ] }, { "tin": { "type": "ein", "value": "746001969" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 151800.00, "providers": [{ "billed_charge": 155169.00, "npi": [1457322885] } ] } ] }, { "tin": { "type": "ein", "value": "756000514" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6426.39, "providers": [{ "billed_charge": 6426.39, "npi": [1275548182] } ] } ] }, { "tin": { "type": "ein", "value": "202950769" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 26274.75, "providers": [{ "billed_charge": 47287.20, "npi": [1700801693] } ] } ] }, { "tin": { "type": "ein", "value": "752234266" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 244971.55, "providers": [{ "billed_charge": 245084.91, "npi": [1710981774] } ] } ] }, { "tin": { "type": "ein", "value": "746003078" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 96372.00, "providers": [{ "billed_charge": 99000.00, "npi": [1023124328] } ] } ] }, { "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 547044.95, "providers": [{ "billed_charge": 675675.00, "npi": [1104286087] } ] } ] }, { "tin": { "type": "ein", "value": "746000085" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 114271.50, "providers": [{ "billed_charge": 139576.50, "npi": [1295704732] } ] } ] }, { "tin": { "type": "ein", "value": "752474011" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 306462.65, "providers": [{ "billed_charge": 308005.80, "npi": [1881628014] } ] }, { "allowed_amount": 157589.13, "providers": [{ "billed_charge": 166396.72, "npi": [1639103864] } ] }, { "allowed_amount": 168939.30, "providers": [{ "billed_charge": 171490.03, "npi": [1194750802] } ] } ] }, { "tin": { "type": "ein", "value": "746001490" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3278.94, "providers": [{ "billed_charge": 3937.05, "npi": [1730186636] } ] } ] }, { "tin": { "type": "ein", "value": "746000246" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9800.00, "providers": [{ "billed_charge": 9800.00, "npi": [1043311434] } ] } ] }, { "tin": { "type": "ein", "value": "201919780" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 534152.54, "providers": [{ "billed_charge": 568189.26, "npi": [1952995888] } ] } ] }, { "tin": { "type": "ein", "value": "741282696" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 33670.00, "providers": [{ "billed_charge": 44427.00, "npi": [1083744940] } ] } ] }, { "tin": { "type": "ein", "value": "746002544" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 43350.00, "providers": [{ "billed_charge": 43350.00, "npi": [1073588612] } ] } ] }, { "tin": { "type": "ein", "value": "743015865" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8000.00, "providers": [{ "billed_charge": 8000.00, "npi": [1780398644] } ] } ] }, { "tin": { "type": "ein", "value": "746001573" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 277496.00, "providers": [{ "billed_charge": 277496.00, "npi": [1255396156] } ] } ] }, { "tin": { "type": "ein", "value": "756000640" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 30712.50, "providers": [{ "billed_charge": 30712.50, "npi": [1982742698] } ] } ] }, { "tin": { "type": "ein", "value": "746000441" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 32850.00, "providers": [{ "billed_charge": 32850.00, "npi": [1831155647] } ] } ] }, { "tin": { "type": "ein", "value": "756000608" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 35720.00, "providers": [{ "billed_charge": 35720.00, "npi": [1356324446] } ] } ] }, { "tin": { "type": "ein", "value": "756000528" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 296287.09, "providers": [{ "billed_charge": 298095.00, "npi": [1629871512] } ] } ] }, { "tin": { "type": "ein", "value": "760521530" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3470.32, "providers": [{ "billed_charge": 3484.00, "npi": [1801864368] } ] } ] }, { "tin": { "type": "ein", "value": "760133493" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 211653.62, "providers": [{ "billed_charge": 212774.85, "npi": [1760033526] } ] } ] }, { "tin": { "type": "ein", "value": "746001164" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1116613.29, "providers": [{ "billed_charge": 1120085.04, "npi": [1447375282] } ] } ] }, { "tin": { "type": "ein", "value": "742391176" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12429.32, "providers": [{ "billed_charge": 13468.00, "npi": [1760850648] } ] } ] }, { "tin": { "type": "ein", "value": "800685304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 25764.75, "providers": [{ "billed_charge": 29568.90, "npi": [1457716037] } ] } ] }, { "tin": { "type": "ein", "value": "208424689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 585754.63, "providers": [{ "billed_charge": 1016513.00, "npi": [1952588329] } ] } ] }, { "tin": { "type": "ein", "value": "746027491" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3914.00, "providers": [{ "billed_charge": 4096.64, "npi": [1447674825] } ] } ] }, { "tin": { "type": "ein", "value": "756000534" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5350.00, "providers": [{ "billed_charge": 5350.00, "npi": [1750323556] } ] } ] }, { "tin": { "type": "ein", "value": "746000278" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 34176.00, "providers": [{ "billed_charge": 34176.00, "npi": [1982695268] } ] } ] }, { "tin": { "type": "ein", "value": "742028156" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4970.00, "providers": [{ "billed_charge": 4970.00, "npi": [1588734594] } ] } ] }, { "tin": { "type": "ein", "value": "756000531" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1929.00, "providers": [{ "billed_charge": 1929.00, "npi": [1538207642] } ] } ] }, { "tin": { "type": "ein", "value": "742577746" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1728.32, "providers": [{ "billed_charge": 9831.00, "npi": [1215064506] } ] } ] }, { "tin": { "type": "ein", "value": "752747708" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 114683.00, "providers": [{ "billed_charge": 114683.00, "npi": [1457444150] } ] } ] }, { "tin": { "type": "ein", "value": "742277841" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 55125.00, "providers": [{ "billed_charge": 59007.00, "npi": [1558812602] } ] } ] }, { "tin": { "type": "ein", "value": "746001504" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 70754.04, "providers": [{ "billed_charge": 73008.00, "npi": [1568429090] } ] } ] }, { "tin": { "type": "ein", "value": "756000659" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 45388.00, "providers": [{ "billed_charge": 45588.00, "npi": [1265498935] } ] } ] }, { "tin": { "type": "ein", "value": "741685167" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 53173.92, "providers": [{ "billed_charge": 74400.00, "npi": [1447316377] } ] } ] }, { "tin": { "type": "ein", "value": "746000978" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16261.21, "providers": [{ "billed_charge": 16261.21, "npi": [1114995586] } ] } ] }, { "tin": { "type": "ein", "value": "272953899" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 155661.00, "providers": [{ "billed_charge": 156560.00, "npi": [1356649826] } ] } ] }, { "tin": { "type": "ein", "value": "264304912" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 443081.06, "providers": [{ "billed_charge": 531300.00, "npi": [1871724864] } ] } ] }, { "tin": { "type": "ein", "value": "756000543" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 19200.00, "providers": [{ "billed_charge": 19200.00, "npi": [1194728402] } ] } ] }, { "tin": { "type": "ein", "value": "720701964" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 21947.35, "providers": [{ "billed_charge": 32175.00, "npi": [1316943566] } ] } ] }, { "tin": { "type": "ein", "value": "756000588" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 20861.00, "providers": [{ "billed_charge": 20861.00, "npi": [1073516548] } ] } ] }, { "tin": { "type": "ein", "value": "746001875" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 275931.79, "providers": [{ "billed_charge": 277200.00, "npi": [1013595800] } ] } ] }, { "tin": { "type": "ein", "value": "746001432" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1500.00, "providers": [{ "billed_charge": 1500.00, "npi": [1710977061] } ] } ] }, { "tin": { "type": "ein", "value": "746002441" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 37500.00, "providers": [{ "billed_charge": 48290.40, "npi": [1336169192] } ] } ] }, { "tin": { "type": "ein", "value": "746001738" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 209300.00, "providers": [{ "billed_charge": 257600.00, "npi": [1821727041] } ] } ] }, { "tin": { "type": "ein", "value": "756000508" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 284050.11, "providers": [{ "billed_charge": 289504.58, "npi": [1861530990] } ] } ] }, { "tin": { "type": "ein", "value": "752707125" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 782928.96, "providers": [{ "billed_charge": 906000.00, "npi": [1942201272] } ] } ] }, { "tin": { "type": "ein", "value": "741772120" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 304183.88, "providers": [{ "billed_charge": 304183.88, "npi": [1437218062] } ] } ] }, { "tin": { "type": "ein", "value": "742777597" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 691200.00, "providers": [{ "billed_charge": 691200.00, "npi": [1063588143] } ] } ] }, { "tin": { "type": "ein", "value": "10548955" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 272415.00, "providers": [{ "billed_charge": 272415.00, "npi": [1164526745] } ] } ] }, { "tin": { "type": "ein", "value": "746002070" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 27000.00, "providers": [{ "billed_charge": 27000.00, "npi": [1053377713] } ] } ] }, { "tin": { "type": "ein", "value": "300688582" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 326824.03, "providers": [{ "billed_charge": 470042.00, "npi": [1750676870] } ] } ] }, { "tin": { "type": "ein", "value": "760426477" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 18302.18, "providers": [{ "billed_charge": 18302.18, "npi": [1821036831] } ] } ] }, { "tin": { "type": "ein", "value": "756000478" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6800.00, "providers": [{ "billed_charge": 10300.00, "npi": [1033240718] } ] } ] }, { "tin": { "type": "ein", "value": "203948307" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 422311.79, "providers": [{ "billed_charge": 569541.89, "npi": [1376644609] } ] } ] }, { "tin": { "type": "ein", "value": "746000574" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 17972.46, "providers": [{ "billed_charge": 17972.46, "npi": [1972609337] } ] } ] }, { "tin": { "type": "ein", "value": "746001420" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9771.77, "providers": [{ "billed_charge": 9771.77, "npi": [1710064100] } ] } ] } ] }, { "name": "AMB SERVICE BLS NONEMERG TRA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0428", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751657155" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 75015.36, "providers": [{ "billed_charge": 88000.00, "npi": [1275509259] } ] } ] }, { "tin": { "type": "ein", "value": "811488160" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 78656.72, "providers": [{ "billed_charge": 129000.00, "npi": [1457057291] } ] } ] }, { "tin": { "type": "ein", "value": "825198494" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 183600.00, "providers": [{ "billed_charge": 183600.00, "npi": [1518451749] } ] } ] }, { "tin": { "type": "ein", "value": "462829506" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 389560.50, "providers": [{ "billed_charge": 622500.00, "npi": [1619393436] } ] } ] }, { "tin": { "type": "ein", "value": "261789627" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 17283.16, "providers": [{ "billed_charge": 32300.00, "npi": [1093988784] } ] } ] }, { "tin": { "type": "ein", "value": "454331997" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 193689.14, "providers": [{ "billed_charge": 313500.00, "npi": [1871854075] } ] } ] }, { "tin": { "type": "ein", "value": "260368797" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 25469.92, "providers": [{ "billed_charge": 42000.00, "npi": [1326217738] } ] } ] }, { "tin": { "type": "ein", "value": "205608001" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 69674.80, "providers": [{ "billed_charge": 132000.00, "npi": [1801077987] } ] } ] }, { "tin": { "type": "ein", "value": "742857452" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11825.32, "providers": [{ "billed_charge": 24050.00, "npi": [1972534980] } ] } ] }, { "tin": { "type": "ein", "value": "760487923" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14220.28, "providers": [{ "billed_charge": 18750.00, "npi": [1437254471] } ] } ] }, { "tin": { "type": "ein", "value": "993485961" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3754.80, "providers": [{ "billed_charge": 6000.00, "npi": [1598632515] } ] } ] }, { "tin": { "type": "ein", "value": "743023503" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 106427.88, "providers": [{ "billed_charge": 111150.00, "npi": [1831207919] } ] } ] }, { "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 39161.80, "providers": [{ "billed_charge": 42850.00, "npi": [1104286087] } ] } ] }, { "tin": { "type": "ein", "value": "260316725" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6124.58, "providers": [{ "billed_charge": 61500.00, "npi": [1114199320] } ] } ] }, { "tin": { "type": "ein", "value": "845023030" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 10915.68, "providers": [{ "billed_charge": 21000.00, "npi": [1487257010] } ] } ] }, { "tin": { "type": "ein", "value": "264304912" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 57253.24, "providers": [{ "billed_charge": 75600.00, "npi": [1871724864] } ] } ] }, { "tin": { "type": "ein", "value": "752474011" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11349.95, "providers": [{ "billed_charge": 11349.95, "npi": [1881628014] } ] } ] }, { "tin": { "type": "ein", "value": "900486115" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 15463.88, "providers": [{ "billed_charge": 25500.00, "npi": [1043537475] } ] } ] }, { "tin": { "type": "ein", "value": "452538975" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 79632.89, "providers": [{ "billed_charge": 151200.00, "npi": [1083912554] } ] } ] }, { "tin": { "type": "ein", "value": "453268127" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 24406.20, "providers": [{ "billed_charge": 52000.00, "npi": [1003245093] } ] } ] }, { "tin": { "type": "ein", "value": "454891186" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 43662.72, "providers": [{ "billed_charge": 85200.00, "npi": [1043586647] } ] } ] }, { "tin": { "type": "ein", "value": "205829641" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 482109.20, "providers": [{ "billed_charge": 795000.00, "npi": [1447436613] } ] } ] }, { "tin": { "type": "ein", "value": "272612460" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 245125.00, "providers": [{ "billed_charge": 245125.00, "npi": [1164854733] } ] } ] }, { "tin": { "type": "ein", "value": "923266410" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 93692.92, "providers": [{ "billed_charge": 154500.00, "npi": [1326734229] } ] } ] }, { "tin": { "type": "ein", "value": "760613179" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 57260.70, "providers": [{ "billed_charge": 91500.00, "npi": [1053461392] } ] } ] }, { "tin": { "type": "ein", "value": "473442335" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 53505.90, "providers": [{ "billed_charge": 85500.00, "npi": [1316301054] } ] } ] }, { "tin": { "type": "ein", "value": "832708510" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 17835.30, "providers": [{ "billed_charge": 28500.00, "npi": [1104398999] } ] } ] }, { "tin": { "type": "ein", "value": "752707125" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 143100.00, "providers": [{ "billed_charge": 143100.00, "npi": [1942201272] } ] } ] }, { "tin": { "type": "ein", "value": "300662178" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 244750.00, "providers": [{ "billed_charge": 244750.00, "npi": [1932471075] } ] } ] }, { "tin": { "type": "ein", "value": "261296735" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 24879.94, "providers": [{ "billed_charge": 41850.00, "npi": [1235307752] } ] } ] }, { "tin": { "type": "ein", "value": "453970120" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8900.00, "providers": [{ "billed_charge": 8900.00, "npi": [1316295645] } ] } ] }, { "tin": { "type": "ein", "value": "853395488" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9096.40, "providers": [{ "billed_charge": 15000.00, "npi": [1598353708] } ] } ] }, { "tin": { "type": "ein", "value": "200253831" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16896.60, "providers": [{ "billed_charge": 36000.00, "npi": [1669462982] } ] } ] }, { "tin": { "type": "ein", "value": "273061469" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 38350.31, "providers": [{ "billed_charge": 74100.00, "npi": [1669756904] } ] } ] }, { "tin": { "type": "ein", "value": "760517401" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6300.00, "providers": [{ "billed_charge": 6300.00, "npi": [1205899374] } ] } ] }, { "tin": { "type": "ein", "value": "455508689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1819.28, "providers": [{ "billed_charge": 3000.00, "npi": [1992144885] } ] } ] }, { "tin": { "type": "ein", "value": "453837763" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 40200.00, "providers": [{ "billed_charge": 40200.00, "npi": [1528335478] } ] } ] }, { "tin": { "type": "ein", "value": "742777597" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 240550.00, "providers": [{ "billed_charge": 240550.00, "npi": [1063588143] } ] } ] }, { "tin": { "type": "ein", "value": "743253181" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7286.03, "providers": [{ "billed_charge": 14080.00, "npi": [1588809255] } ] } ] }, { "tin": { "type": "ein", "value": "10548955" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 270000.00, "providers": [{ "billed_charge": 270000.00, "npi": [1164526745] } ] } ] }, { "tin": { "type": "ein", "value": "274539737" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 275977.80, "providers": [{ "billed_charge": 441000.00, "npi": [1295014140] } ] } ] }, { "tin": { "type": "ein", "value": "933583304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 30018.12, "providers": [{ "billed_charge": 66000.00, "npi": [1386416212] } ] } ] }, { "tin": { "type": "ein", "value": "921690554" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 137060.79, "providers": [{ "billed_charge": 225000.00, "npi": [1538872239] } ] } ] }, { "tin": { "type": "ein", "value": "453584448" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 26283.60, "providers": [{ "billed_charge": 42000.00, "npi": [1679832125] } ] } ] }, { "tin": { "type": "ein", "value": "270955008" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 316554.72, "providers": [{ "billed_charge": 522000.00, "npi": [1164707444] } ] } ] }, { "tin": { "type": "ein", "value": "932146476" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 107470.35, "providers": [{ "billed_charge": 128700.00, "npi": [1679328520] } ] } ] }, { "tin": { "type": "ein", "value": "275484272" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 117343.56, "providers": [{ "billed_charge": 258000.00, "npi": [1760736938] } ] } ] } ] }, { "name": "AMB SERVICE BLS EMERGENCY TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751657155" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 8796.44, "providers": [{ "billed_charge": 9600.00, "npi": [1275509259] } ] } ] }, { "tin": { "type": "ein", "value": "746001969" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 50400.00, "providers": [{ "billed_charge": 51555.00, "npi": [1457322885] } ] } ] }, { "tin": { "type": "ein", "value": "746001504" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 18880.07, "providers": [{ "billed_charge": 19503.00, "npi": [1568429090] } ] } ] }, { "tin": { "type": "ein", "value": "756000659" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 39585.00, "providers": [{ "billed_charge": 39585.00, "npi": [1265498935] } ] } ] }, { "tin": { "type": "ein", "value": "741685167" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9011.52, "providers": [{ "billed_charge": 11050.00, "npi": [1447316377] } ] } ] }, { "tin": { "type": "ein", "value": "746000978" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 1085.99, "providers": [{ "billed_charge": 1085.99, "npi": [1114995586] } ] } ] }, { "tin": { "type": "ein", "value": "756000514" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 12272.00, "providers": [{ "billed_charge": 12272.00, "npi": [1275548182] } ] } ] }, { "tin": { "type": "ein", "value": "752234266" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 281395.00, "providers": [{ "billed_charge": 281395.00, "npi": [1710981774] } ] } ] }, { "tin": { "type": "ein", "value": "760487923" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3219.63, "providers": [{ "billed_charge": 3596.10, "npi": [1235248089] } ] } ] }, { "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 59871.86, "providers": [{ "billed_charge": 87550.00, "npi": [1104286087] } ] } ] }, { "tin": { "type": "ein", "value": "272953899" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 33040.32, "providers": [{ "billed_charge": 34620.00, "npi": [1356649826] } ] } ] }, { "tin": { "type": "ein", "value": "746000085" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 71017.00, "providers": [{ "billed_charge": 87370.00, "npi": [1295704732] } ] } ] }, { "tin": { "type": "ein", "value": "845023030" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 30563.82, "providers": [{ "billed_charge": 36750.00, "npi": [1487257010] } ] } ] }, { "tin": { "type": "ein", "value": "752474011" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 18358.80, "providers": [{ "billed_charge": 18358.80, "npi": [1881628014] } ] }, { "allowed_amount": 21798.80, "providers": [{ "billed_charge": 21984.39, "npi": [1194750802] } ] } ] }, { "tin": { "type": "ein", "value": "264304912" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 102936.49, "providers": [{ "billed_charge": 105000.00, "npi": [1871724864] } ] } ] }, { "tin": { "type": "ein", "value": "746000246" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 23000.00, "providers": [{ "billed_charge": 23000.00, "npi": [1043311434] } ] } ] }, { "tin": { "type": "ein", "value": "201919780" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 162025.94, "providers": [{ "billed_charge": 172585.40, "npi": [1952995888] } ] } ] }, { "tin": { "type": "ein", "value": "746002544" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 20150.00, "providers": [{ "billed_charge": 20150.00, "npi": [1073588612] } ] } ] }, { "tin": { "type": "ein", "value": "756000588" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14310.00, "providers": [{ "billed_charge": 14310.00, "npi": [1073516548] } ] } ] }, { "tin": { "type": "ein", "value": "746001875" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 44800.00, "providers": [{ "billed_charge": 44800.00, "npi": [1013595800] } ] } ] }, { "tin": { "type": "ein", "value": "746001573" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 25492.50, "providers": [{ "billed_charge": 25492.50, "npi": [1255396156] } ] } ] }, { "tin": { "type": "ein", "value": "756000583" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3135.00, "providers": [{ "billed_charge": 3135.00, "npi": [1871623470] } ] } ] }, { "tin": { "type": "ein", "value": "756000608" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2080.00, "providers": [{ "billed_charge": 2080.00, "npi": [1356324446] } ] } ] }, { "tin": { "type": "ein", "value": "746001738" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9900.00, "providers": [{ "billed_charge": 12600.00, "npi": [1821727041] } ] } ] }, { "tin": { "type": "ein", "value": "756000508" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 314454.21, "providers": [{ "billed_charge": 336333.50, "npi": [1861530990] } ] } ] }, { "tin": { "type": "ein", "value": "756000626" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9900.00, "providers": [{ "billed_charge": 9900.00, "npi": [1801890637] } ] } ] }, { "tin": { "type": "ein", "value": "756000528" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 273299.88, "providers": [{ "billed_charge": 308355.00, "npi": [1629871512] } ] } ] }, { "tin": { "type": "ein", "value": "752707125" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 112067.34, "providers": [{ "billed_charge": 115500.00, "npi": [1942201272] } ] } ] }, { "tin": { "type": "ein", "value": "741772120" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 42095.08, "providers": [{ "billed_charge": 42095.08, "npi": [1437218062] } ] } ] }, { "tin": { "type": "ein", "value": "760133493" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 10726.19, "providers": [{ "billed_charge": 10726.19, "npi": [1760033526] } ] } ] }, { "tin": { "type": "ein", "value": "455508689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 11821.68, "providers": [{ "billed_charge": 12000.00, "npi": [1992144885] } ] } ] }, { "tin": { "type": "ein", "value": "742777597" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 79900.00, "providers": [{ "billed_charge": 79900.00, "npi": [1063588143] } ] } ] }, { "tin": { "type": "ein", "value": "746001164" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2305789.43, "providers": [{ "billed_charge": 2307492.85, "npi": [1447375282] } ] } ] }, { "tin": { "type": "ein", "value": "208424689" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 408699.11, "providers": [{ "billed_charge": 755535.00, "npi": [1952588329] } ] } ] }, { "tin": { "type": "ein", "value": "933583304" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 16009.62, "providers": [{ "billed_charge": 26000.00, "npi": [1386416212] } ] } ] }, { "tin": { "type": "ein", "value": "300688582" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 57464.59, "providers": [{ "billed_charge": 81971.00, "npi": [1750676870] } ] } ] }, { "tin": { "type": "ein", "value": "746000278" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 79931.00, "providers": [{ "billed_charge": 79931.00, "npi": [1982695268] } ] } ] }, { "tin": { "type": "ein", "value": "746000574" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 14554.20, "providers": [{ "billed_charge": 14919.04, "npi": [1972609337] } ] } ] } ] }, { "name": "ADVNCED LIFE SUPPORT LEVEL 2", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0433", "description": "ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811424190" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 30008.94, "providers": [{ "billed_charge": 30150.00, "npi": [1104286087] } ] } ] } ] }, { "name": "SPECIALTY CARE TRANSPORT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A0434", "description": "SPECIALTY CARE TRANSPORT (SCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300688582" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 32704.16, "providers": [{ "billed_charge": 52980.00, "npi": [1750676870] } ] } ] } ] }, { "name": "INFUS SET EXT INSULIN PUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4230", "description": "INFUSION SET FOR EXTERNAL INSULIN PUMP, NONNEEDLE CANNULA TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2515.05, "providers": [{ "billed_charge": 16953.30, "npi": [1234567893] } ] } ] } ] }, { "name": "SYRINGE NDLE EXT INSULIN PUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4232", "description": "SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3 CC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.00, "providers": [{ "billed_charge": 4311.20, "npi": [1234567893] } ] } ] } ] }, { "name": "SPLY ALW NONIMPL CGM 1 MO SP=1 UOS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4239", "description": "SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "223865781" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 91002.24, "providers": [{ "billed_charge": 363525.00, "npi": [1245259282] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13527.40, "providers": [{ "billed_charge": 47547.52, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9515.00, "providers": [{ "billed_charge": 22884.00, "npi": [1234567893] } ] } ] } ] }, { "name": "SKN BARRIER; SOLID 4X4/EQUVA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4362", "description": "SKIN BARRIER; SOLID, 4 X 4 OR EQUIVALENT; EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 327.60, "providers": [{ "billed_charge": 1260.00, "npi": [1234567893] } ] } ] } ] }, { "name": "OST SKN BARRIER 4X4 EXT W/O", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4385", "description": "OSTOMY SKIN BARRIER, SOLID 4 X 4 OR EQUIVALENT, EXTENDED WEAR, WITHOUT BUILT-IN CONVEXITY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 208.80, "providers": [{ "billed_charge": 780.00, "npi": [1234567893] } ] } ] } ] }, { "name": "OSTOMY DEODORANT W/WO LUB PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4394", "description": "OSTOMY DEODORANT, WITH OR WITHOUT LUBRICANT, FOR USE IN OSTOMY POUCH, PER FL OZ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.20, "providers": [{ "billed_charge": 280.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ADHESIVE REMOVER, WIPES, ANY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4456", "description": "ADHESIVE REMOVER, WIPES, ANY TYPE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.70, "providers": [{ "billed_charge": 55.00, "npi": [1234567893] } ] } ] } ] }, { "name": "INCONTNCE GARMENT ANY TYPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4520", "description": "INCONTINENCE GARMENT, ANY TYPE, (E.G., BRIEF, DIAPER), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202087851" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1098.98, "providers": [{ "billed_charge": 2747.42, "npi": [1972583078] } ] } ] } ] }, { "name": "DISPOSABLE UNDERPADS ALL SIZ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4554", "description": "DISPOSABLE UNDERPADS, ALL SIZES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202087851" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.73, "providers": [{ "billed_charge": 93.00, "npi": [1972583078] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 880.34, "providers": [{ "billed_charge": 3163.12, "npi": [1234567893] } ] } ] } ] }, { "name": "OST POUCH DRAIN EXT BARRIER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A5056", "description": "OSTOMY POUCH, DRAINABLE, WITH EXTENDED WEAR BARRIER ATTACHED, WITH FILTER, (1 PIECE), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 852.00, "providers": [{ "billed_charge": 2880.00, "npi": [1234567893] } ] } ] } ] }, { "name": "COLLEGEN WOUND FILLR DRY FOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A6010", "description": "COLLAGEN BASED WOUND FILLER, DRY FORM, STERILE, PER G OF COLLAGEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "834323569" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 309.00, "providers": [{ "billed_charge": 442.50, "npi": [1932543246] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 924.35, "providers": [{ "billed_charge": 3391.78, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 752.28, "providers": [{ "billed_charge": 2172.52, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.24, "providers": [{ "billed_charge": 220.00, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.15, "providers": [{ "billed_charge": 1073.61, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 369.12, "providers": [{ "billed_charge": 1763.64, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.25, "providers": [{ "billed_charge": 609.32, "npi": [1234567893] } ] } ] } ] }, { "name": "SENSOR; INVSV INTRSTL GLU MO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9276", "description": "SENSOR; INVASIVE (E.G., SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 16342.50, "providers": [{ "billed_charge": 26954.71, "npi": [1234567893] } ] } ] } ] }, { "name": "HYG I/DVC DISPBL/NON-DISPBL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9286", "description": "HYGIENIC ITEM OR DEVICE, DISPOSABLE OR NON-DISPOSABLE, ANY TYPE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202087851" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.51, "providers": [{ "billed_charge": 241.32, "npi": [1972583078] } ] } ] } ] }, { "name": "PARENTRL NUTRITION SOL-10 GM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "B4185", "description": "PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2163.11, "providers": [{ "billed_charge": 3825.89, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1197.81, "providers": [{ "billed_charge": 3836.25, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9500.00, "providers": [{ "billed_charge": 24900.00, "npi": [1234567893] } ] } ] } ] }, { "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": "134204348" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 620.06, "providers": [{ "billed_charge": 1080.00, "npi": [1134127517] } ] } ] } ] }, { "name": "PROSTATE CANCER SCREENING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0103", "description": "PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "473968494" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 255.99, "providers": [{ "billed_charge": 1131.00, "npi": [1134585946] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12767.22, "providers": [{ "billed_charge": 131129.38, "npi": [1234567893] } ] } ] } ] }, { "name": "SCR CERV/VAG THIN LAY W/PHYS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0123", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2546.67, "providers": [{ "billed_charge": 15005.75, "npi": [1234567893] } ] } ] } ] }, { "name": "SCR CERV/VAG THIN LAY PHYS I", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0124", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8030.88, "providers": [{ "billed_charge": 30153.27, "npi": [1234567893] } ] } ] } ] }, { "name": "Code for Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0136", "description": "Code for Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760540476" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 135.12, "providers": [{ "billed_charge": 315.00, "npi": [1609288208] } ] } ] } ] }, { "name": "SCR CERV/VAG AUTO&MNL RSCR P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0145", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.80, "providers": [{ "billed_charge": 733.11, "npi": [1881679751] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 47720.05, "providers": [{ "billed_charge": 299153.35, "npi": [1234567893] } ] } ] } ] }, { "name": "MED NUT TX; REASSESS W/PT EA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0270", "description": "MEDICAL NUTRITION THERAPY; REASSESSMENT AND SUBSEQUENT INTERVENTION(S) FOLLOWING SECOND REFERRAL IN ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 600.00, "providers": [{ "billed_charge": 600.00, "npi": [1265546287] } ] } ] } ] }, { "name": "HPO UND PRSS FULL B CHMBR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0277", "description": "HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208033976" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10405.16, "providers": [{ "billed_charge": 37971.36, "npi": [1619408325] } ] }, { "allowed_amount": 5057.74, "providers": [{ "billed_charge": 18985.68, "npi": [1497893754] } ] } ] } ] }, { "name": "DX DIGTL BRST TOMOSYN UNI/BI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0279", "description": "DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 658.30, "providers": [{ "billed_charge": 2610.00, "npi": [1871989780] } ] } ] }, { "tin": { "type": "ein", "value": "824337061" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1587.00, "providers": [{ "billed_charge": 6180.00, "npi": [1295799088] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 720.00, "providers": [{ "billed_charge": 4096.00, "npi": [1861663924] } ] }, { "allowed_amount": 883.91, "providers": [{ "billed_charge": 4864.00, "npi": [1770936908] } ] } ] } ] }, { "name": "Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0316", "description": "Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822401359" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.41, "providers": [{ "billed_charge": 256.23, "npi": [1659358968] } ] } ] }, { "tin": { "type": "ein", "value": "272319883" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 331.44, "providers": [{ "billed_charge": 732.00, "npi": [1871673137] } ] } ] } ] }, { "name": "COLOREC CA SCR; FOB TST IMMU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0328", "description": "COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9486.48, "providers": [{ "billed_charge": 83910.33, "npi": [1234567893] } ] } ] } ] }, { "name": "ANL ALCHL MISUSE SCREN 15MIM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0442", "description": "ANNUAL ALCOHOL MISUSE SCREENING, 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 138.06, "providers": [{ "billed_charge": 324.00, "npi": [1831544808] } ] } ] } ] }, { "name": "ANL DEPRSSION SCREENG 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0444", "description": "ANNUAL DEPRESSION SCREENING, 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "933075034" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 996.83, "providers": [{ "billed_charge": 2340.00, "npi": [1831544808] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1244.57, "providers": [{ "billed_charge": 3450.00, "npi": [1508068438] } ] } ] } ] }, { "name": "FCE-FCE BEHAVRL CNSL OBESITY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0447", "description": "FACE-TO-FACE BEHAVIORAL COUNSELING FOR OBESITY, 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261794516" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 525.00, "npi": [1265546287] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.29, "providers": [{ "billed_charge": 53.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "851207309" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 665.80, "providers": [{ "billed_charge": 1000.00, "npi": [1508068438] } ] } ] } ] }, { "name": "FQHC VISIT ESTABLISHED PATIE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0467", "description": "FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760289927" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 1750.00, "npi": [1912904897] } ] } ] } ] }, { "name": "FQHC VISIT MENTAL HEALTH EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0470", "description": "FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, MENTAL HEALTH, ESTABLISHED PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "270653014" }, "service_code": ["02", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1537.63, "providers": [{ "billed_charge": 6029.75, "npi": [1508497108] } ] }, { "allowed_amount": 139.80, "providers": [{ "billed_charge": 548.23, "npi": [1508497108] } ] } ] } ] }, { "name": "HEP C ABO SC IND HI RSK&OTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0472", "description": "HEPATITIS C ANTIBODY SCREENING FOR INDIVIDUAL AT HIGH RISK AND OTHER COVERED INDICATION(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7474.26, "providers": [{ "billed_charge": 36270.69, "npi": [1234567893] } ] } ] } ] }, { "name": "HIV ANTIGEN/ANTIBODY, COMBIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0475", "description": "HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8008.88, "providers": [{ "billed_charge": 82092.10, "npi": [1234567893] } ] } ] } ] }, { "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": "812244474" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 457.76, "providers": [{ "billed_charge": 1830.88, "npi": [1558717827] } ] } ] }, { "tin": { "type": "ein", "value": "830973361" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 228.88, "providers": [{ "billed_charge": 1830.88, "npi": [1447814272] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3646.53, "providers": [{ "billed_charge": 14964.65, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "461242694" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 400.54, "providers": [{ "billed_charge": 1155.00, "npi": [1134559685] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 8-1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0481", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880241758" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5246.10, "providers": [{ "billed_charge": 39329.00, "npi": [1699782722] } ] } ] }, { "tin": { "type": "ein", "value": "994142539" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 626.40, "providers": [{ "billed_charge": 1879.12, "npi": [1164257499] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1332.88, "providers": [{ "billed_charge": 7380.08, "npi": [1234567893] } ] } ] } ] }, { "name": "Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0545", "description": "Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273852113" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6344.91, "providers": [{ "billed_charge": 13770.00, "npi": [1053366351] } ] } ] }, { "tin": { "type": "ein", "value": "202971454" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 539.98, "providers": [{ "billed_charge": 1190.00, "npi": [1497719306] } ] } ] }, { "tin": { "type": "ein", "value": "760681269" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1312.08, "providers": [{ "billed_charge": 2211.00, "npi": [1154680320] } ] }, { "allowed_amount": 1550.64, "providers": [{ "billed_charge": 2613.00, "npi": [1649591835] } ] }, { "allowed_amount": 159.04, "providers": [{ "billed_charge": 268.00, "npi": [1861871204] } ] } ] }, { "tin": { "type": "ein", "value": "205146786" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.92, "providers": [{ "billed_charge": 531.00, "npi": [1619405149] } ] }, { "allowed_amount": 1669.92, "providers": [{ "billed_charge": 5225.22, "npi": [1821064304] } ] }, { "allowed_amount": 198.80, "providers": [{ "billed_charge": 622.05, "npi": [1215971049] } ] }, { "allowed_amount": 1113.28, "providers": [{ "billed_charge": 3483.48, "npi": [1710025556] } ] }, { "allowed_amount": 401.36, "providers": [{ "billed_charge": 1244.10, "npi": [1265616858] } ] }, { "allowed_amount": 1630.16, "providers": [{ "billed_charge": 5100.81, "npi": [1245493360] } ] }, { "allowed_amount": 596.40, "providers": [{ "billed_charge": 1866.15, "npi": [1750450342] } ] }, { "allowed_amount": 39.76, "providers": [{ "billed_charge": 124.41, "npi": [1790936144] } ] }, { "allowed_amount": 318.08, "providers": [{ "billed_charge": 995.28, "npi": [1528471141] } ] } ] }, { "tin": { "type": "ein", "value": "882064487" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 477.12, "providers": [{ "billed_charge": 600.00, "npi": [1437531126] } ] } ] }, { "tin": { "type": "ein", "value": "752905110" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1603.51, "providers": [{ "billed_charge": 1845.00, "npi": [1598933558] } ] }, { "allowed_amount": 703.44, "providers": [{ "billed_charge": 810.00, "npi": [1144457649] } ] }, { "allowed_amount": 156.44, "providers": [{ "billed_charge": 180.00, "npi": [1093135089] } ] } ] }, { "tin": { "type": "ein", "value": "760459500" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.24, "providers": [{ "billed_charge": 1326.00, "npi": [1598499824] } ] } ] } ] }, { "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": "200719874" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1547.41, "providers": [{ "billed_charge": 2275.00, "npi": [1932785854] } ] } ] }, { "tin": { "type": "ein", "value": "760151142" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.68, "providers": [{ "billed_charge": 21.00, "npi": [1326676362] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC; GRP CNSL CL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0005", "description": "ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760549240" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.50, "providers": [{ "billed_charge": 560.00, "npi": [1962056614] } ] } ] } ] }, { "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": "274250532" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 236.70, "providers": [{ "billed_charge": 553.08, "npi": [1770781106] } ] } ] }, { "tin": { "type": "ein", "value": "942880847" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 600.00, "providers": [{ "billed_charge": 600.00, "npi": [1629519335] } ] } ] } ] }, { "name": "ALCOHOL &/OR DRUG SCREENING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0049", "description": "ALCOHOL AND/OR DRUG SCREENING", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760537608" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.00, "providers": [{ "billed_charge": 125.00, "npi": [1770583411] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 903.60, "providers": [{ "billed_charge": 4933.46, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ CEFEPIME HYDRCHLRID500MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0692", "description": "INJECTION, CEFEPIME HCL, 500 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.44, "providers": [{ "billed_charge": 1873.59, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ CEFTRIAXONE SODM PER 250", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0696", "description": "INJECTION, CEFTRIAXONE SODIUM, PER 250 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.82, "providers": [{ "billed_charge": 140.00, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.10, "providers": [{ "billed_charge": 300.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 48.19, "providers": [{ "billed_charge": 156.96, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "461513436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.02, "providers": [{ "billed_charge": 500.00, "npi": [1629099221] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 152.64, "providers": [{ "billed_charge": 27520.00, "npi": [1093920399] } ] } ] } ] }, { "name": "INJ DEXMETH SODM PHOSHA 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1100", "description": "INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271271893" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.75, "providers": [{ "billed_charge": 400.00, "npi": [1942832191] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.36, "providers": [{ "billed_charge": 1104.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.28, "providers": [{ "billed_charge": 48.00, "npi": [1497716401] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.55, "providers": [{ "billed_charge": 5880.00, "npi": [1093920399] } ] } ] } ] }, { "name": "INJ DIPHNHYDRMN HCL TO 50 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1200", "description": "INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.62, "providers": [{ "billed_charge": 16.00, "npi": [1497716401] } ] } ] } ] }, { "name": "INJ KETOROLAC TROMETHAMINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "842477526" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.34, "providers": [{ "billed_charge": 40.00, "npi": [1134828494] } ] } ] }, { "tin": { "type": "ein", "value": "832666588" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.04, "providers": [{ "billed_charge": 700.00, "npi": [1063072734] } ] } ] }, { "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.36, "providers": [{ "billed_charge": 60.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.33, "providers": [{ "billed_charge": 127.92, "npi": [1972519544] } ] } ] }, { "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.45, "providers": [{ "billed_charge": 3540.00, "npi": [1093920399] } ] } ] } ] }, { "name": "INJECTION MEROPENEM 100 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2185", "description": "INJECTION, MEROPENEM, 100 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2264.63, "providers": [{ "billed_charge": 74939.59, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ ONDANSETRON HCL PER 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2405", "description": "INJECTION, ONDANSETRON HCL, PER 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.66, "providers": [{ "billed_charge": 20.72, "npi": [1972519544] } ] } ] } ] }, { "name": "Injection, methylprednisolone sodium succinate, 5 mg", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2919", "description": "Injection, methylprednisolone sodium succinate, 5 mg", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921457580" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.00, "providers": [{ "billed_charge": 240.00, "npi": [1114210416] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 60.52, "providers": [{ "billed_charge": 191.10, "npi": [1972519544] } ] } ] } ] }, { "name": "INJ PYRIDOXINE HCL 100 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3415", "description": "INJECTION, PYRIDOXINE HCL, 100 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "815097602" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 392.02, "providers": [{ "billed_charge": 2210.00, "npi": [1649235490] } ] } ] } ] }, { "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": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.98, "providers": [{ "billed_charge": 8.52, "npi": [1972519544] } ] } ] } ] }, { "name": "INFUS NORMAL SALINE SOL 1000", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J7030", "description": "INFUSION, NORMAL SALINE SOLUTION, 1,000 CC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "815097602" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.33, "providers": [{ "billed_charge": 650.00, "npi": [1649235490] } ] } ] }, { "tin": { "type": "ein", "value": "274967011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.20, "providers": [{ "billed_charge": 273.60, "npi": [1972519544] } ] } ] } ] }, { "name": "TRAVL 1 WAY NEC LAB SPEC; AC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "P9603", "description": "TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "823021953" }, "service_code": ["13", "31"], "billing_class": "professional", "payments": [{ "allowed_amount": 546.42, "providers": [{ "billed_charge": 671.25, "npi": [1447760814] } ] }, { "allowed_amount": 26.59, "providers": [{ "billed_charge": 30.00, "npi": [1447760814] } ] } ] }, { "tin": { "type": "ein", "value": "208015163" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.36, "providers": [{ "billed_charge": 23.31, "npi": [1649459744] } ] } ] }, { "tin": { "type": "ein", "value": "812244474" }, "service_code": ["12", "13", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.26, "providers": [{ "billed_charge": 139.20, "npi": [1558717827] } ] }, { "allowed_amount": 285.18, "providers": [{ "billed_charge": 705.60, "npi": [1558717827] } ] }, { "allowed_amount": 41.71, "providers": [{ "billed_charge": 103.20, "npi": [1558717827] } ] } ] } ] }, { "name": "TRAVL 1 WAY NEC LAB SPEC; TR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "P9604", "description": "TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844939989" }, "service_code": ["81", "31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.92, "providers": [{ "billed_charge": 1.92, "npi": [1639791007] } ] }, { "allowed_amount": 139.07, "providers": [{ "billed_charge": 171.04, "npi": [1639791007] } ] } ] } ] }, { "name": "SET-UP PORTABLE X-RAY EQUIPM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "Q0092", "description": "SET-UP PORTABLE X-RAY EQUIPMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742523929" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.14, "providers": [{ "billed_charge": 97.80, "npi": [1245322627] } ] } ] } ] }, { "name": "TELEHEALTH ORIG SITE FACILIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "Q3014", "description": "TELEHEALTH ORIGINATING SITE FACILITY FEE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "741659064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.08, "providers": [{ "billed_charge": 216.00, "npi": [1861915266] } ] } ] } ] }, { "name": "NON-PVC IV ADMN SET RX NOT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S1016", "description": "NON-PVC (POLYVINYL CHLORIDE) INTRAVENOUS ADMINISTRATION SET, FOR USE WITH DRUGS THAT ARE NOT STABLE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742966092" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 900.00, "providers": [{ "billed_charge": 3000.00, "npi": [1497716401] } ] } ] } ] }, { "name": "HIT IMPLANTED PUMP PAIN MGMT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9328", "description": "HOME INFUSION THERAPY, IMPLANTED PUMP PAIN MANAGEMENT INFUSION; ADMINISTRATIVE SERVICES, PROFESSIONA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13896.00, "providers": [{ "billed_charge": 46320.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HT; ENTERAL NUTRIT VIA PUMP;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9342", "description": "HOME THERAPY; ENTERAL NUTRITION VIA PUMP; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10530.00, "providers": [{ "billed_charge": 58400.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HT; ENTERAL NUTRIT VIA BOLUS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9343", "description": "HOME THERAPY; ENTERAL NUTRITION VIA BOLUS; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2770.00, "providers": [{ "billed_charge": 27700.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT SYMPATHOMIMETIC/INOTROPI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9348", "description": "HOME INFUSION THERAPY, SYMPATHOMIMETIC/INOTROPIC AGENT INFUSION THERAPY (E.G., DOBUTAMINE); ADMINIST", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3509.00, "providers": [{ "billed_charge": 14833.32, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT TPN; >1 L BUT NOT > 2 L-", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9366", "description": "HOME INFUSION THERAPY, TOTAL PARENTERAL NUTRITION (TPN); MORE THAN 1 LITER BUT NO MORE THAN 2 LITERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14550.00, "providers": [{ "billed_charge": 65450.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HOME INFUS TX INFUSION TX NO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9379", "description": "HOME INFUSION THERAPY, INFUSION THERAPY, NOT OTHERWISE CLASSIFIED; ADMINISTRATIVE SERVICES, PROFESSI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1827.00, "providers": [{ "billed_charge": 8070.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9500", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 24 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8475.00, "providers": [{ "billed_charge": 60860.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9501", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 12 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8755.00, "providers": [{ "billed_charge": 42920.00, "npi": [1234567893] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 41980.00, "providers": [{ "billed_charge": 194936.00, "npi": [1234567893] } ] } ] } ] }, { "name": "NON-CDC 2019 NOVEL COV RT RT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "U0002", "description": "NON-CDC 2019 NOVEL CORONAVIRUS RT RT-PCR DX", "allowed_amounts": [{ "tin": { "type": "ein", "value": "843627265" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1231.68, "providers": [{ "billed_charge": 9600.00, "npi": [1093920399] } ] } ] } ] } ] }