{ "reporting_entity_name": "Alliant Health Plans, Inc.", "reporting_entity_type": "health insurance issuer", "plan_name": "Alliant Health Plans, Inc.", "plan_id_type": "hios", "plan_id": "83761", "plan_market_type": "group", "out_of_network": [ { "name": "1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB", "billing_code_type": "CPT", "billing_code": "99460", "billing_code_type_version": "2020", "description": "1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 102.53, "providers": [ { "billed_charge": 760.0, "npi": [ 1285743278, 1639769979, 1710940903, 1720078504 ] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.4, "providers": [ { "billed_charge": 238.0, "npi": [ 1437174570 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 102.53, "providers": [ { "billed_charge": 281.0, "npi": [ 1578026837 ] } ] }, { "allowed_amount": 140.4, "providers": [ { "billed_charge": 215.0, "npi": [ 1760740716, 1932459112 ] } ] } ] }, { "tin": { "type": "ein", "value": "582255198" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 102.53, "providers": [ { "billed_charge": 191.0, "npi": [ 1588727614 ] } ] } ] }, { "tin": { "type": "ein", "value": "273597705" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 102.53, "providers": [ { "billed_charge": 203.0, "npi": [ 1619984101 ] } ] } ] }, { "tin": { "type": "ein", "value": "332672530" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 102.53, "providers": [ { "billed_charge": 529.0, "npi": [ 1639682768 ] } ] } ] }, { "tin": { "type": "ein", "value": "581435386" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.4, "providers": [ { "billed_charge": 160.0, "npi": [ 1679530638 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.4, "providers": [ { "billed_charge": 667.0, "npi": [ 1790779122 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.4, "providers": [ { "billed_charge": 263.0, "npi": [ 1922329481 ] } ] } ] } ] }, { "name": "1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES", "billing_code_type": "CPT", "billing_code": "99223", "billing_code_type_version": "2020", "description": "1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "451846825" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 515.0, "npi": [ 1003357864, 1528322112 ] } ] } ] }, { "tin": { "type": "ein", "value": "591784470" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 500.0, "npi": [ 1003360645 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 853.0, "npi": [ 1003854449, 1063939007, 1093978660, 1104321082, 1134172588, 1144726860, 1154321248, 1528417177, 1669164182, 1699268839, 1790488104, 1871912048, 1881108520, 1922310457, 1972132660 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 853.0, "npi": [ 1033869821, 1043300858, 1114554029, 1306073028, 1326538083, 1366432544, 1386602407, 1447921812, 1467764381, 1518318989, 1538414495, 1548767486, 1629728027, 1649771569, 1699353573, 1801676762, 1811798655, 1821186826, 1821220039, 1821404070, 1841684198, 1871242461, 1881256824, 1891065546, 1912655713, 1922640531, 1972116242 ] }, { "billed_charge": 729.0, "npi": [ 1164097622, 1245736172, 1265826341, 1699403758, 1720644107, 1801424122, 1851032023, 1881257277 ] }, { "billed_charge": 765.0, "npi": [ 1245817329 ] } ] } ] }, { "tin": { "type": "ein", "value": "621658774" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 515.0, "npi": [ 1013275627 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 945.62, "npi": [ 1013276385, 1356375315 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 945.62, "npi": [ 1114287190, 1386149334, 1720079486, 1952806762, 1972039881 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 674.0, "npi": [ 1013285097, 1083118004, 1346357019, 1366682577, 1376962753, 1467807719, 1689197964 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 674.0, "npi": [ 1346351533, 1508445453, 1578022620, 1841640166 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 1389.0, "npi": [ 1023066206, 1124605928, 1922685544 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1389.0, "npi": [ 1053859140, 1104635150, 1255760757, 1598405334, 1790849495, 1831196682, 1871024802 ] } ] } ] }, { "tin": { "type": "ein", "value": "454006393" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 749.0, "npi": [ 1023330222 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1516.0, "npi": [ 1023423332, 1083009682, 1114968518, 1124522339, 1174895007, 1528332939, 1558689521, 1629566385, 1649502873, 1669858981, 1689641508, 1720026610, 1720032733, 1730200908, 1801453618, 1821374380, 1891845590, 1932580107, 1932594850 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 1516.0, "npi": [ 1932580107 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1318.0, "npi": [ 1053969782 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 522.0, "npi": [ 1063851236, 1639617665, 1669644589 ] } ] }, { "allowed_amount": 271.02, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 522.0, "npi": [ 1134869506, 1710447206, 1750888046, 1891373031 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 522.0, "npi": [ 1417377821, 1598296717, 1699119982 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 1107.0, "npi": [ 1083347793, 1215793146, 1649724832, 1801788021 ] } ] } ] }, { "tin": { "type": "ein", "value": "832356574" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 448.0, "npi": [ 1083951834 ] } ] } ] }, { "tin": { "type": "ein", "value": "452743899" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 427.0, "npi": [ 1083966709, 1316982911, 1396477808 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 522.0, "npi": [ 1093372690, 1437319993, 1578609780 ] } ] } ] }, { "tin": { "type": "ein", "value": "991566468" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1318.0, "npi": [ 1104264134, 1427037910 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 1107.0, "npi": [ 1104990795, 1124280268, 1518540012, 1912976275, 1922238518 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1107.0, "npi": [ 1124280268 ] } ] } ] }, { "tin": { "type": "ein", "value": "010613970" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 414.7, "npi": [ 1124010616 ] } ] } ] }, { "tin": { "type": "ein", "value": "581992673" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 321.7, "npi": [ 1134382088 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 427.0, "npi": [ 1144258831, 1700851284 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 427.0, "npi": [ 1316546013, 1538639851, 1629752274, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 409.0, "npi": [ 1144601048 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 409.0, "npi": [ 1508279332 ] } ] } ] }, { "tin": { "type": "ein", "value": "823551399" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 691.0, "npi": [ 1154624427 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 427.0, "npi": [ 1154629640, 1346675246, 1447466446, 1457980948, 1619218740, 1669621215, 1689940165, 1841501285, 1922758234 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 618.0, "npi": [ 1154769008, 1811574718, 1871113787, 1952988917 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 618.0, "npi": [ 1841814126 ] } ] } ] }, { "tin": { "type": "ein", "value": "721597863" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 625.0, "npi": [ 1154958882 ] } ] } ] }, { "tin": { "type": "ein", "value": "473885964" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 499.0, "npi": [ 1174139026 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 499.0, "npi": [ 1174139026 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 1199.0, "npi": [ 1184064867 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1199.0, "npi": [ 1801235817 ] } ] } ] }, { "tin": { "type": "ein", "value": "844995668" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 467.0, "npi": [ 1194729582, 1578768016 ] } ] } ] }, { "tin": { "type": "ein", "value": "203279920" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 723.0, "npi": [ 1215914635, 1295261790, 1508392325, 1619413861, 1841795804 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 723.0, "npi": [ 1215914635, 1700053097 ] } ] } ] }, { "tin": { "type": "ein", "value": "821505834" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 250.0, "providers": [ { "billed_charge": 250.0, "npi": [ 1225144140 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 464.0, "npi": [ 1225281330, 1750351326 ] } ] } ] }, { "tin": { "type": "ein", "value": "581020324" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 427.0, "npi": [ 1275994261 ] } ] } ] }, { "tin": { "type": "ein", "value": "581330744" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 475.0, "npi": [ 1285757666, 1457303638 ] } ] } ] }, { "tin": { "type": "ein", "value": "581651447" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 340.0, "npi": [ 1306399043 ] } ] } ] }, { "tin": { "type": "ein", "value": "203447115" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 573.0, "npi": [ 1326660002 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 558.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "263412753" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 250.0, "providers": [ { "billed_charge": 250.0, "npi": [ 1336324144 ] } ] } ] }, { "tin": { "type": "ein", "value": "475162204" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 617.0, "npi": [ 1346314069 ] } ] } ] }, { "tin": { "type": "ein", "value": "843754429" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 412.0, "npi": [ 1356664007 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 674.0, "npi": [ 1376034215, 1720024292, 1972985273 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 674.0, "npi": [ 1740418177 ] } ] } ] }, { "tin": { "type": "ein", "value": "873113031" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 385.0, "npi": [ 1376048967, 1629014030, 1750734323 ] } ] } ] }, { "tin": { "type": "ein", "value": "920380998" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 1415.0, "npi": [ 1376075101, 1881089936, 1881973147 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1415.0, "npi": [ 1538262076, 1649701343, 1679835649 ] } ] } ] }, { "tin": { "type": "ein", "value": "582146852" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 600.0, "npi": [ 1376786871 ] } ] } ] }, { "tin": { "type": "ein", "value": "931371454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 552.0, "npi": [ 1386302552 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 552.0, "npi": [ 1417504325 ] } ] } ] }, { "tin": { "type": "ein", "value": "394697862" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 346.0, "npi": [ 1386609055 ] } ] } ] }, { "tin": { "type": "ein", "value": "233044978" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 250.0, "providers": [ { "billed_charge": 250.0, "npi": [ 1386902856 ] } ] } ] }, { "tin": { "type": "ein", "value": "822423015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 356.0, "npi": [ 1386927382, 1396716312 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 356.0, "npi": [ 1396716312 ] } ] } ] }, { "tin": { "type": "ein", "value": "582600830" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 175.0, "providers": [ { "billed_charge": 175.0, "npi": [ 1417031428 ] } ] } ] }, { "tin": { "type": "ein", "value": "333772642" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 434.0, "npi": [ 1417277112 ] } ] } ] }, { "tin": { "type": "ein", "value": "822444447" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 443.0, "npi": [ 1427386689 ] } ] } ] }, { "tin": { "type": "ein", "value": "582537874" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 595.0, "npi": [ 1437633229 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 337.52, "npi": [ 1457558132 ] }, { "billed_charge": 1024.55, "npi": [ 1457558132 ] } ] } ] }, { "tin": { "type": "ein", "value": "260146811" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 350.0, "npi": [ 1487821989, 1992751093 ] } ] } ] }, { "tin": { "type": "ein", "value": "834257679" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 520.0, "npi": [ 1497162309 ] } ] } ] }, { "tin": { "type": "ein", "value": "570605223" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 325.0, "npi": [ 1528583614 ] } ] } ] }, { "tin": { "type": "ein", "value": "462774672" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1000.0, "npi": [ 1538274592 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 443.0, "npi": [ 1548357213 ] } ] } ] }, { "tin": { "type": "ein", "value": "593555797" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 380.0, "npi": [ 1598295651 ] } ] } ] }, { "tin": { "type": "ein", "value": "461380712" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 320.0, "npi": [ 1619158730 ] } ] } ] }, { "tin": { "type": "ein", "value": "333168508" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 1389.0, "npi": [ 1619285590 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 618.0, "npi": [ 1629389127 ] } ] }, { "allowed_amount": 271.02, "providers": [ { "billed_charge": 618.0, "npi": [ 1679994693 ] } ] } ] }, { "tin": { "type": "ein", "value": "204623957" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 235.0, "providers": [ { "billed_charge": 235.0, "npi": [ 1629418603 ] } ] } ] }, { "tin": { "type": "ein", "value": "264444385" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 370.0, "npi": [ 1639105620 ] } ] } ] }, { "tin": { "type": "ein", "value": "570992104" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 372.0, "npi": [ 1639183544 ] } ] } ] }, { "tin": { "type": "ein", "value": "581268632" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 700.0, "npi": [ 1649261926 ] } ] } ] }, { "tin": { "type": "ein", "value": "582336054" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 950.0, "npi": [ 1649775594 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 522.0, "npi": [ 1659310761 ] } ] } ] }, { "tin": { "type": "ein", "value": "202110456" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 330.0, "npi": [ 1659311645 ] } ] } ] }, { "tin": { "type": "ein", "value": "455523028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 357.0, "npi": [ 1659788941 ] } ] } ] }, { "tin": { "type": "ein", "value": "582629795" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 526.0, "npi": [ 1689729055 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 358.0, "npi": [ 1689838526, 1861938383 ] } ] } ] }, { "tin": { "type": "ein", "value": "460881518" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 325.0, "npi": [ 1700896156 ] } ] } ] }, { "tin": { "type": "ein", "value": "364795028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 710.0, "npi": [ 1710962113 ] } ] } ] }, { "tin": { "type": "ein", "value": "825415284" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 494.0, "npi": [ 1730162926 ] } ] } ] }, { "tin": { "type": "ein", "value": "030417049" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 448.0, "npi": [ 1740220920 ] } ] } ] }, { "tin": { "type": "ein", "value": "760841500" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 443.0, "npi": [ 1760616601 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 443.0, "npi": [ 1760616601 ] } ] } ] }, { "tin": { "type": "ein", "value": "862411778" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1198.0, "npi": [ 1770840761 ] } ] } ] }, { "tin": { "type": "ein", "value": "582651479" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 300.0, "providers": [ { "billed_charge": 300.0, "npi": [ 1770858953 ] } ] } ] }, { "tin": { "type": "ein", "value": "814208547" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 169.26, "providers": [ { "billed_charge": 169.26, "npi": [ 1790125813, 1811474828 ] } ] } ] }, { "tin": { "type": "ein", "value": "363966745" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 480.0, "npi": [ 1811251762, 1871531442 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 867.65, "npi": [ 1831128958 ] } ] } ] }, { "tin": { "type": "ein", "value": "874461181" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 600.0, "npi": [ 1831548536 ] } ] } ] }, { "tin": { "type": "ein", "value": "593369532" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 422.0, "npi": [ 1861921298 ] } ] } ] }, { "tin": { "type": "ein", "value": "273274203" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 357.0, "npi": [ 1881794162 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 535.0, "npi": [ 1902046899 ] } ] } ] }, { "tin": { "type": "ein", "value": "320325973" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1107.0, "npi": [ 1912141094 ] } ] } ] }, { "tin": { "type": "ein", "value": "830729449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 400.0, "npi": [ 1922217926 ] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "providers": [ { "billed_charge": 1400.0, "npi": [ 1922313592 ] } ] } ] }, { "tin": { "type": "ein", "value": "453667307" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 150.0, "providers": [ { "billed_charge": 150.0, "npi": [ 1932319613 ] } ] }, { "allowed_amount": 250.0, "providers": [ { "billed_charge": 250.0, "npi": [ 1932319613 ] } ] }, { "allowed_amount": 300.0, "providers": [ { "billed_charge": 300.0, "npi": [ 1932319613 ] } ] }, { "allowed_amount": 316.47, "providers": [ { "billed_charge": 320.0, "npi": [ 1932319613 ] } ] } ] }, { "tin": { "type": "ein", "value": "384008024" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 271.02, "billing_code_modifier": [ "AI" ], "providers": [ { "billed_charge": 1389.0, "npi": [ 1962881896 ] } ] } ] }, { "tin": { "type": "ein", "value": "874714839" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.47, "providers": [ { "billed_charge": 715.0, "npi": [ 1982224622 ] } ] } ] } ] }, { "name": "1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES", "billing_code_type": "CPT", "billing_code": "99222", "billing_code_type_version": "2020", "description": "1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 312.0, "npi": [ 1003797473, 1225520679, 1235134669, 1629752274 ] } ] } ] }, { "tin": { "type": "ein", "value": "452743899" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 312.0, "npi": [ 1023097326, 1265297873 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 1208.0, "npi": [ 1023423332, 1083009682, 1124522339, 1174895007, 1528332939, 1629566385, 1649502873, 1669858981, 1720032733, 1801453618, 1821374380, 1932580107 ] } ] } ] }, { "tin": { "type": "ein", "value": "460667707" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 400.0, "npi": [ 1043267628 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 348.0, "npi": [ 1063897379 ] } ] } ] }, { "tin": { "type": "ein", "value": "030417049" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 334.0, "npi": [ 1083024558, 1093432528 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 312.0, "npi": [ 1083222160, 1396085981, 1689940165 ] } ] }, { "allowed_amount": 216.76, "providers": [ { "billed_charge": 312.0, "npi": [ 1689940165 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 709.86, "npi": [ 1114287190, 1871868182 ] } ] }, { "allowed_amount": 216.76, "providers": [ { "billed_charge": 709.86, "npi": [ 1982630059 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 817.0, "npi": [ 1114945979, 1609432566 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 948.0, "npi": [ 1134093099, 1295219939, 1760045462, 1982467841 ] } ] }, { "allowed_amount": 216.76, "providers": [ { "billed_charge": 948.0, "npi": [ 1689837775 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 260.0, "npi": [ 1144110271, 1548410590, 1639796196 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 276.0, "npi": [ 1144458662, 1386930170, 1902231327 ] } ] } ] }, { "tin": { "type": "ein", "value": "582491034" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 225.0, "npi": [ 1164484911 ] } ] } ] }, { "tin": { "type": "ein", "value": "581586758" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 294.0, "npi": [ 1164530051 ] } ] } ] }, { "tin": { "type": "ein", "value": "863772298" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 238.14, "npi": [ 1164812202 ] } ] } ] }, { "tin": { "type": "ein", "value": "844995668" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 319.0, "npi": [ 1194729582 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 506.0, "npi": [ 1235316639 ] } ] } ] }, { "tin": { "type": "ein", "value": "912160693" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 247.94, "npi": [ 1245219534 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 506.0, "npi": [ 1245596998, 1992334403 ] } ] }, { "allowed_amount": 202.93, "providers": [ { "billed_charge": 506.0, "npi": [ 1538150198, 1639182033, 1649891078 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 498.0, "npi": [ 1245736172, 1720644107, 1801424122 ] }, { "billed_charge": 579.0, "npi": [ 1427507243 ] }, { "billed_charge": 523.0, "npi": [ 1730604620 ] } ] } ] }, { "tin": { "type": "ein", "value": "201722595" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 324.0, "npi": [ 1275737066 ] } ] } ] }, { "tin": { "type": "ein", "value": "203447115" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 390.0, "npi": [ 1316467467 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 419.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259435" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 392.0, "npi": [ 1336582329 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 392.0, "npi": [ 1336644459, 1578609780, 1588690382, 1609003912, 1609033315 ] } ] } ] }, { "tin": { "type": "ein", "value": "582569828" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 521.88, "npi": [ 1356699920 ] } ] }, { "allowed_amount": 216.76, "providers": [ { "billed_charge": 521.88, "npi": [ 1588844286 ] } ] } ] }, { "tin": { "type": "ein", "value": "626014528" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 382.0, "npi": [ 1366499261 ] } ] } ] }, { "tin": { "type": "ein", "value": "352297438" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 303.0, "npi": [ 1407188626 ] } ] } ] }, { "tin": { "type": "ein", "value": "451846825" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 348.0, "npi": [ 1427243252 ] } ] } ] }, { "tin": { "type": "ein", "value": "834390271" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 392.0, "npi": [ 1437390150 ] } ] } ] }, { "tin": { "type": "ein", "value": "263566828" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 347.0, "npi": [ 1437599883 ] } ] } ] }, { "tin": { "type": "ein", "value": "582352829" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 348.0, "npi": [ 1477557130 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 421.0, "npi": [ 1487811550, 1528378577 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 657.1, "npi": [ 1518449768 ] } ] }, { "allowed_amount": 216.76, "providers": [ { "billed_charge": 657.1, "npi": [ 1619381316 ] } ] } ] }, { "tin": { "type": "ein", "value": "261758203" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 336.0, "npi": [ 1528365723 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 303.0, "npi": [ 1568434637 ] } ] } ] }, { "tin": { "type": "ein", "value": "582197074" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 220.0, "npi": [ 1588626030 ] } ] } ] }, { "tin": { "type": "ein", "value": "462537433" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 402.0, "npi": [ 1619380003 ] } ] } ] }, { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 400.0, "npi": [ 1629640040, 1689327520, 1831899848 ] } ] } ] }, { "tin": { "type": "ein", "value": "581926426" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 500.0, "npi": [ 1659373611 ] } ] } ] }, { "tin": { "type": "ein", "value": "912073120" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 492.0, "npi": [ 1659765634 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 506.0, "npi": [ 1679077234, 1720024292, 1972985273, 1992718100 ] } ] } ] }, { "tin": { "type": "ein", "value": "200137107" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 425.0, "npi": [ 1699701995 ] } ] } ] }, { "tin": { "type": "ein", "value": "825415284" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 335.0, "npi": [ 1730162926 ] } ] } ] }, { "tin": { "type": "ein", "value": "611665353" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 709.86, "npi": [ 1740674035 ] } ] }, { "allowed_amount": 202.93, "providers": [ { "billed_charge": 709.86, "npi": [ 1831621390 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 296.0, "npi": [ 1760740716 ] } ] } ] }, { "tin": { "type": "ein", "value": "472111282" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 195.0, "providers": [ { "billed_charge": 195.0, "npi": [ 1780629519 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 1302.0, "npi": [ 1780959932 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 757.0, "npi": [ 1790125813 ] } ] } ] }, { "tin": { "type": "ein", "value": "263066845" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 230.0, "npi": [ 1790755759 ] } ] } ] }, { "tin": { "type": "ein", "value": "582272300" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 505.0, "npi": [ 1801114335 ] } ] } ] }, { "tin": { "type": "ein", "value": "881352492" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 400.0, "npi": [ 1811126741 ] } ] } ] }, { "tin": { "type": "ein", "value": "582321454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 342.0, "npi": [ 1841388782 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 392.0, "npi": [ 1841653508 ] } ] } ] }, { "tin": { "type": "ein", "value": "272244677" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 363.72, "npi": [ 1861858623 ] } ] } ] }, { "tin": { "type": "ein", "value": "843707279" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 485.0, "npi": [ 1932138906 ] } ] } ] }, { "tin": { "type": "ein", "value": "260522515" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 387.0, "npi": [ 1942243704 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 309.0, "npi": [ 1952861916 ] } ] } ] }, { "tin": { "type": "ein", "value": "823352623" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 468.0, "npi": [ 1962024323 ] } ] } ] }, { "tin": { "type": "ein", "value": "271872248" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 216.76, "providers": [ { "billed_charge": 400.0, "npi": [ 1962856674 ] } ] } ] }, { "tin": { "type": "ein", "value": "640964506" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 202.93, "providers": [ { "billed_charge": 250.0, "npi": [ 1982680104 ] } ] } ] } ] }, { "name": "AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS", "billing_code_type": "CPT", "billing_code": "92650", "billing_code_type_version": "2020", "description": "AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "844622204" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 35.23, "providers": [ { "billed_charge": 326.0, "npi": [ 1821480518 ] } ] } ] } ] }, { "name": "AI DS SLE ALYS 8 IGG AUTOANT&2 CLL BOUND PRDCTS", "billing_code_type": "CPT", "billing_code": "0312U", "billing_code_type_version": "2020", "description": "AI DS SLE ALYS 8 IGG AUTOANT&2 CLL BOUND PRDCTS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 588.46, "providers": [ { "billed_charge": 1787.22, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "Albumin; serum, plasma or whole blood", "billing_code_type": "CPT", "billing_code": "82040", "billing_code_type_version": "2020", "description": "Albumin; serum, plasma or whole blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.47, "providers": [ { "billed_charge": 14.85, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.47, "providers": [ { "billed_charge": 92.24, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.47, "providers": [ { "billed_charge": 10.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.47, "providers": [ { "billed_charge": 12.38, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.47, "providers": [ { "billed_charge": 60.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Albumin; urine (eg, microalbumin), quantitative", "billing_code_type": "CPT", "billing_code": "82043", "billing_code_type_version": "2020", "description": "Albumin; urine (eg, microalbumin), quantitative", "allowed_amounts": [ { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 5.78, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 17.34, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 17.34, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 88.2, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 71.38, "npi": [ 1376323998 ] }, { "billed_charge": 71.43, "npi": [ 1487969341 ] }, { "billed_charge": 37.55, "npi": [ 1821565045 ] }, { "billed_charge": 37.58, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 48.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 71.38, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 14.45, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.05, "providers": [ { "billed_charge": 11.56, "npi": [ 1831851039 ] } ] } ] } ] }, { "name": "Alcohol and/or drug assessment", "billing_code_type": "HCPCS", "billing_code": "H0001", "billing_code_type_version": "2020", "description": "Alcohol and/or drug assessment", "allowed_amounts": [ { "tin": { "type": "ein", "value": "933060676" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 80.0, "providers": [ { "billed_charge": 1750.0, "npi": [ 1548648678 ] } ] } ] } ] }, { "name": "Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)", "billing_code_type": "HCPCS", "billing_code": "H0020", "billing_code_type_version": "2020", "description": "Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "273234645" }, "service_code": [ "58" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 243.0, "providers": [ { "billed_charge": 245.0, "npi": [ 1477041143 ] } ] } ] } ] }, { "name": "Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 - emergency)", "billing_code_type": "HCPCS", "billing_code": "A0427", "billing_code_type_version": "2020", "description": "Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 - emergency)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "566001524" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1025.3, "npi": [ 1013949403 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011882" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1023063567 ] } ] } ] }, { "tin": { "type": "ein", "value": "263293246" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2250.0, "npi": [ 1023269321 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000898" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1043390677 ] } ] } ] }, { "tin": { "type": "ein", "value": "581249934" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1073659595 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000604" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1150.0, "npi": [ 1083624902 ] } ] } ] }, { "tin": { "type": "ein", "value": "621368669" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1093871618 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011374" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 575.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 575.0, "npi": [ 1134291842 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000816" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 500.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1154401768 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363827" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3000.0, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 3000.0, "npi": [ 1164445391 ] } ] } ] }, { "tin": { "type": "ein", "value": "814571957" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1164966164 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000829" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1095.0, "npi": [ 1184614208 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000854" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1194762450 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000636" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1477.0, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1477.0, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1477.0, "npi": [ 1194797761 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000883" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 535.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 535.0, "npi": [ 1205932381 ] } ] } ] }, { "tin": { "type": "ein", "value": "461615070" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1215368634 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000783" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 819.5, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 819.5, "npi": [ 1225193048 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000809" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1225436033 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1225436033 ] } ] } ] }, { "tin": { "type": "ein", "value": "646001544" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1650.0, "npi": [ 1245218742 ] } ] } ] }, { "tin": { "type": "ein", "value": "822125340" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1250.0, "npi": [ 1255859179 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000902" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1265439137 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001495" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1285135715 ] } ] } ] }, { "tin": { "type": "ein", "value": "261706720" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1295113868 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000835" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 975.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 975.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 975.0, "npi": [ 1316052566 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000859" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 540.61, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 540.61, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 540.61, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 540.61, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 925.0, "npi": [ 1316154222 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000873" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1142.45, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1142.45, "npi": [ 1326001108 ] } ] } ] }, { "tin": { "type": "ein", "value": "582469468" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1544.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1544.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1544.0, "npi": [ 1326036161 ] } ] } ] }, { "tin": { "type": "ein", "value": "591155275" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1073.0, "npi": [ 1326044793 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149128" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1662.15, "npi": [ 1326630153 ] }, { "billed_charge": 1703.7, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1662.15, "npi": [ 1326630153 ] }, { "billed_charge": 1703.7, "npi": [ 1326630153 ] }, { "billed_charge": 1749.41, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1703.7, "npi": [ 1326630153 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000894" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1356447536 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1356447536 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000815" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 650.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1386824589 ] } ] }, { "allowed_amount": 650.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1386824589 ] } ] } ] }, { "tin": { "type": "ein", "value": "581282570" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 3336.78, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3336.78, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 3336.78, "npi": [ 1396950770 ] } ] } ] }, { "tin": { "type": "ein", "value": "263941348" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1100.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1100.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1100.0, "npi": [ 1407294028 ] } ] } ] }, { "tin": { "type": "ein", "value": "753106281" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1407872153 ] } ] } ] }, { "tin": { "type": "ein", "value": "581048752" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1427037522 ] } ] } ] }, { "tin": { "type": "ein", "value": "586003349" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 500.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1427135540 ] } ] } ] }, { "tin": { "type": "ein", "value": "630818351" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1437152212 ] } ] } ] }, { "tin": { "type": "ein", "value": "741772120" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1063.58, "npi": [ 1437218062 ] } ] } ] }, { "tin": { "type": "ein", "value": "453639743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1477830164 ] }, { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1477830164 ] }, { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] } ] }, { "tin": { "type": "ein", "value": "272030893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1497075279 ] } ] } ] }, { "tin": { "type": "ein", "value": "581157005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1518718832 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 758.0, "npi": [ 1538103049 ] } ] } ] }, { "tin": { "type": "ein", "value": "581608892" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2527.0, "npi": [ 1538211081 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000818" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1207.7, "npi": [ 1548329899 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1207.7, "npi": [ 1548329899 ] } ] } ] }, { "tin": { "type": "ein", "value": "586004467" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 887.0, "npi": [ 1558141671 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1568569556 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149691" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1568772689 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1790234102 ] } ] } ] }, { "tin": { "type": "ein", "value": "464991734" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1250.0, "npi": [ 1588084578 ] } ] } ] }, { "tin": { "type": "ein", "value": "842568754" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1600.0, "npi": [ 1588215628 ] } ] } ] }, { "tin": { "type": "ein", "value": "452393528" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3375.0, "npi": [ 1639462476 ] } ] } ] }, { "tin": { "type": "ein", "value": "472931229" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2000.0, "npi": [ 1639560832 ] } ] } ] }, { "tin": { "type": "ein", "value": "452735005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1005.0, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1005.0, "npi": [ 1649558768 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000910" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 563.56, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 563.56, "npi": [ 1659435303 ] } ] } ] }, { "tin": { "type": "ein", "value": "581425000" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1033.71, "npi": [ 1669867487 ] } ] } ] }, { "tin": { "type": "ein", "value": "596000627" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1679568943 ] } ] } ] }, { "tin": { "type": "ein", "value": "956000751" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2041.0, "npi": [ 1679579296 ] } ] } ] }, { "tin": { "type": "ein", "value": "582605844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1975.0, "npi": [ 1699769158 ] }, { "billed_charge": 2432.87, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1975.0, "npi": [ 1699769158 ] }, { "billed_charge": 2432.87, "npi": [ 1699769158 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000790" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 600.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1699855049 ] } ] } ] }, { "tin": { "type": "ein", "value": "581097948" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1730133471 ] } ] } ] }, { "tin": { "type": "ein", "value": "581923254" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2269.99, "npi": [ 1730156266 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2269.99, "npi": [ 1730156266 ] } ] } ] }, { "tin": { "type": "ein", "value": "824030857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2256.0, "npi": [ 1730697335 ] }, { "billed_charge": 2452.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 2256.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2256.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2256.0, "npi": [ 1730697335 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000878" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1750471272 ] } ] } ] }, { "tin": { "type": "ein", "value": "621642499" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1549.05, "npi": [ 1750688172 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000778" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1780644617 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1780668608 ] } ] } ] }, { "tin": { "type": "ein", "value": "586002987" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1780969964 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000906" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 550.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1790846665 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000826" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 825.0, "npi": [ 1790880474 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000825" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 650.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 650.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1801912597 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000799" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1801972625 ] } ] } ] }, { "tin": { "type": "ein", "value": "311836178" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1668.31, "npi": [ 1821028945 ] }, { "billed_charge": 3980.0, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1668.31, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4134.0, "npi": [ 1821028945 ] } ] } ] }, { "tin": { "type": "ein", "value": "582164513" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2103.4, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2103.4, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2103.4, "npi": [ 1821141821 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001500" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1831154558 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000501" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1298.0, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1298.0, "npi": [ 1841276300 ] } ] } ] }, { "tin": { "type": "ein", "value": "596000605" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1851400881 ] } ] } ] }, { "tin": { "type": "ein", "value": "630737822" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 675.0, "npi": [ 1851471932 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000913" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1871665174 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000791" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1020.22, "npi": [ 1881859114 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000785" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1544.34, "npi": [ 1912086612 ] } ] } ] }, { "tin": { "type": "ein", "value": "586003047" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1932260007 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010502" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1942310800 ] } ] } ] }, { "tin": { "type": "ein", "value": "586012659" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1942386289 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000842" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1100.0, "npi": [ 1952363301 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000908" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 580.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 580.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 580.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 580.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1962444141 ] } ] } ] }, { "tin": { "type": "ein", "value": "581036407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2269.99, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2269.99, "npi": [ 1962452870 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 865.0, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 865.0, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 865.0, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 865.0, "npi": [ 1962478511 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000865" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1962487942 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1962487942 ] } ] } ] }, { "tin": { "type": "ein", "value": "586009406" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1962593541 ] } ] } ] }, { "tin": { "type": "ein", "value": "882026637" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2278.0, "npi": [ 1972248599 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000817" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 650.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 650.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 650.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1972608644 ] } ] } ] }, { "tin": { "type": "ein", "value": "582612884" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1888.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1888.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2300.0, "npi": [ 1982674636 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000845" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1050.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1050.0, "npi": [ 1982755138 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000836" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 657.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 775.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 775.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 657.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 775.0, "npi": [ 1992734867 ] } ] } ] } ] }, { "name": "Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)", "billing_code_type": "HCPCS", "billing_code": "A0426", "billing_code_type_version": "2020", "description": "Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "263293246" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1023269321 ] } ] } ] }, { "tin": { "type": "ein", "value": "331752989" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1164389649 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363827" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1164445391 ] } ] } ] }, { "tin": { "type": "ein", "value": "822125340" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1255859179 ] } ] } ] }, { "tin": { "type": "ein", "value": "450600978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1018.91, "npi": [ 1275823122 ] } ] } ] }, { "tin": { "type": "ein", "value": "261706720" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1295113868 ] } ] } ] }, { "tin": { "type": "ein", "value": "582469468" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1137.0, "npi": [ 1326036161 ] } ] } ] }, { "tin": { "type": "ein", "value": "581282570" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3608.75, "npi": [ 1396950770 ] } ] } ] }, { "tin": { "type": "ein", "value": "753106281" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 969.1, "npi": [ 1407872153 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000446" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1447217484 ] } ] } ] }, { "tin": { "type": "ein", "value": "272030893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1497075279 ] } ] } ] }, { "tin": { "type": "ein", "value": "934415873" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1060.0, "npi": [ 1518732643 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 452.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 452.0, "npi": [ 1538103049 ] } ] } ] }, { "tin": { "type": "ein", "value": "842568754" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1588215628 ] } ] } ] }, { "tin": { "type": "ein", "value": "452393528" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3375.0, "npi": [ 1639462476 ] } ] } ] }, { "tin": { "type": "ein", "value": "472931229" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1639560832 ] } ] } ] }, { "tin": { "type": "ein", "value": "452735005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1649558768 ] } ] } ] }, { "tin": { "type": "ein", "value": "581425000" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 969.1, "npi": [ 1669867487 ] } ] } ] }, { "tin": { "type": "ein", "value": "582605844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3527.68, "npi": [ 1720300379 ] } ] } ] }, { "tin": { "type": "ein", "value": "621642499" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1208.25, "npi": [ 1750688172 ] } ] } ] }, { "tin": { "type": "ein", "value": "311836178" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3980.0, "npi": [ 1821028945 ] } ] } ] }, { "tin": { "type": "ein", "value": "582164513" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2103.4, "npi": [ 1821141821 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000501" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1072.5, "npi": [ 1841276300 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 598.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 865.0, "npi": [ 1962478511 ] } ] } ] } ] }, { "name": "Ambulance service, basic life support, emergency transport (BLS, emergency)", "billing_code_type": "HCPCS", "billing_code": "A0429", "billing_code_type_version": "2020", "description": "Ambulance service, basic life support, emergency transport (BLS, emergency)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "990611768" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2885.75, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2885.75, "npi": [ 1003788852 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011882" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 675.0, "npi": [ 1023063567 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1995.0, "npi": [ 1023269321 ] }, { "billed_charge": 1534.0, "npi": [ 1134156045 ] } ] } ] }, { "tin": { "type": "ein", "value": "263293246" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1995.0, "npi": [ 1023269321 ] } ] } ] }, { "tin": { "type": "ein", "value": "561371972" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 439.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 439.5, "npi": [ 1053438697 ] } ] } ] }, { "tin": { "type": "ein", "value": "581249934" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1073659595 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000802" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1100.0, "npi": [ 1073683603 ] } ] } ] }, { "tin": { "type": "ein", "value": "621368669" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 850.0, "npi": [ 1093871618 ] } ] } ] }, { "tin": { "type": "ein", "value": "620694743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1134131915 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011374" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 450.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 450.0, "npi": [ 1134291842 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363827" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3000.0, "npi": [ 1164445391 ] } ] } ] }, { "tin": { "type": "ein", "value": "994108358" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 995.0, "npi": [ 1174333470 ] } ] } ] }, { "tin": { "type": "ein", "value": "464600407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 895.0, "npi": [ 1184037616 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000829" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 895.0, "npi": [ 1184614208 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000854" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 525.0, "npi": [ 1194762450 ] } ] } ] }, { "tin": { "type": "ein", "value": "461615070" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1600.0, "npi": [ 1215368634 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000783" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 819.5, "npi": [ 1225193048 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000902" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1265439137 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001495" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1285135715 ] } ] } ] }, { "tin": { "type": "ein", "value": "261706720" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1295113868 ] } ] } ] }, { "tin": { "type": "ein", "value": "590737717" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1306896790 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000859" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 455.25, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 455.25, "npi": [ 1316154222 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000873" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 897.64, "npi": [ 1326001108 ] } ] } ] }, { "tin": { "type": "ein", "value": "582469468" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1300.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1300.0, "npi": [ 1326036161 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149128" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1357.65, "npi": [ 1326630153 ] }, { "billed_charge": 1391.59, "npi": [ 1326630153 ] }, { "billed_charge": 1428.93, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1357.65, "npi": [ 1326630153 ] }, { "billed_charge": 1391.59, "npi": [ 1326630153 ] }, { "billed_charge": 1428.93, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1357.65, "npi": [ 1326630153 ] }, { "billed_charge": 1391.59, "npi": [ 1326630153 ] }, { "billed_charge": 1428.93, "npi": [ 1326630153 ] } ] } ] }, { "tin": { "type": "ein", "value": "824692084" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1800.0, "npi": [ 1346744943 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000894" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1356447536 ] } ] } ] }, { "tin": { "type": "ein", "value": "630725492" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1483.2, "npi": [ 1386710515 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000815" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1386824589 ] } ] } ] }, { "tin": { "type": "ein", "value": "581282570" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3336.78, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 3336.78, "npi": [ 1396950770 ] } ] } ] }, { "tin": { "type": "ein", "value": "263941348" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1407294028 ] } ] } ] }, { "tin": { "type": "ein", "value": "753106281" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 904.5, "npi": [ 1407872153 ] } ] } ] }, { "tin": { "type": "ein", "value": "581048752" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1427037522 ] } ] } ] }, { "tin": { "type": "ein", "value": "576000398" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 631.86, "npi": [ 1437142742 ] } ] } ] }, { "tin": { "type": "ein", "value": "831214083" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1437778883 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000822" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1477542983 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1477542983 ] } ] } ] }, { "tin": { "type": "ein", "value": "453639743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1921.5, "npi": [ 1477830164 ] } ] } ] }, { "tin": { "type": "ein", "value": "581608892" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2210.0, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 2210.0, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2210.0, "npi": [ 1538211081 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000818" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 997.1, "npi": [ 1548329899 ] } ] } ] }, { "tin": { "type": "ein", "value": "586004467" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 744.0, "npi": [ 1558141671 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 744.0, "npi": [ 1558141671 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1568569556 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149691" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1568772689 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1609325018, 1821308941 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1790234102, 1821308941 ] } ] } ] }, { "tin": { "type": "ein", "value": "452393528" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2925.0, "npi": [ 1639462476 ] } ] } ] }, { "tin": { "type": "ein", "value": "452735005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1649558768 ] } ] } ] }, { "tin": { "type": "ein", "value": "581425000" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 904.5, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 904.5, "npi": [ 1669867487 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000904" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 725.0, "npi": [ 1699778530 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000840" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 450.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 450.0, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 450.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 450.0, "npi": [ 1700877016 ] } ] } ] }, { "tin": { "type": "ein", "value": "824030857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1900.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1900.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1900.0, "npi": [ 1730697335 ] } ] } ] }, { "tin": { "type": "ein", "value": "822238883" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 961.0, "npi": [ 1740709393 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 525.0, "npi": [ 1780668608 ] } ] } ] }, { "tin": { "type": "ein", "value": "586002987" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 725.0, "npi": [ 1780969964 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000799" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1801972625 ] } ] } ] }, { "tin": { "type": "ein", "value": "311836178" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3980.0, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3980.0, "npi": [ 1821028945 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001500" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1831154558 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1831231216 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000837" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1831260306 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000501" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1039.5, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1039.5, "npi": [ 1841276300 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000913" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 750.0, "npi": [ 1871665174 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000833" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1881861300 ] } ] } ] }, { "tin": { "type": "ein", "value": "271466450" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1288.63, "npi": [ 1881915155 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000756" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1902800527 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000853" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1902890205 ] } ] } ] }, { "tin": { "type": "ein", "value": "586003047" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1932260007 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000842" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1952363301 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000908" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 437.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 437.0, "npi": [ 1962444141 ] } ] } ] }, { "tin": { "type": "ein", "value": "581036407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1911.9, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1911.9, "npi": [ 1962452870 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1962478511 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000817" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 525.0, "npi": [ 1972608644 ] } ] } ] }, { "tin": { "type": "ein", "value": "582612884" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1888.0, "npi": [ 1982674636 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000845" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1982755138 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000834" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 800.0, "npi": [ 1992715908 ] } ] } ] }, { "tin": { "type": "ein", "value": "536001131" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 475.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 2000.0, "npi": [ 1992805022 ] } ] } ] } ] }, { "name": "Ambulance service, basic life support, nonemergency transport, (BLS)", "billing_code_type": "HCPCS", "billing_code": "A0428", "billing_code_type_version": "2020", "description": "Ambulance service, basic life support, nonemergency transport, (BLS)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "991130803" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 375.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 375.0, "npi": [ 1003706938 ] } ] } ] }, { "tin": { "type": "ein", "value": "990611768" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1803.62, "npi": [ 1003788852 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363827" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1164445391 ] } ] } ] }, { "tin": { "type": "ein", "value": "994108358" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 895.0, "npi": [ 1174333470 ] } ] } ] }, { "tin": { "type": "ein", "value": "464600407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 795.0, "npi": [ 1184037616 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 795.0, "npi": [ 1184037616 ] } ] } ] }, { "tin": { "type": "ein", "value": "237239334" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2400.0, "npi": [ 1194798082 ] } ] } ] }, { "tin": { "type": "ein", "value": "453801631" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1205112752 ] } ] } ] }, { "tin": { "type": "ein", "value": "453827742" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1700.0, "npi": [ 1225305964 ] } ] } ] }, { "tin": { "type": "ein", "value": "822125340" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1255859179 ] } ] } ] }, { "tin": { "type": "ein", "value": "261706720" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1295113868 ] } ] } ] }, { "tin": { "type": "ein", "value": "582469468" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1075.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1075.0, "npi": [ 1326036161 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149128" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1357.65, "npi": [ 1326630153 ] } ] } ] }, { "tin": { "type": "ein", "value": "824692084" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1346744943 ] } ] } ] }, { "tin": { "type": "ein", "value": "581282570" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3608.75, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 3608.75, "npi": [ 1396950770 ] } ] } ] }, { "tin": { "type": "ein", "value": "753106281" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 710.68, "npi": [ 1407872153 ] } ] } ] }, { "tin": { "type": "ein", "value": "630818351" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1437152212 ] } ] } ] }, { "tin": { "type": "ein", "value": "831214083" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1437778883 ] } ] } ] }, { "tin": { "type": "ein", "value": "453639743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1286.25, "npi": [ 1477830164 ] } ] } ] }, { "tin": { "type": "ein", "value": "272030893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 400.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 400.0, "npi": [ 1497075279 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 380.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 380.0, "npi": [ 1538103049 ] } ] } ] }, { "tin": { "type": "ein", "value": "581608892" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1788.0, "npi": [ 1538211081 ] } ] } ] }, { "tin": { "type": "ein", "value": "842568754" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1150.0, "npi": [ 1588215628 ] } ] } ] }, { "tin": { "type": "ein", "value": "452393528" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2700.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 425.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 2700.0, "npi": [ 1639462476 ] } ] } ] }, { "tin": { "type": "ein", "value": "452735005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 845.0, "npi": [ 1649558768 ] } ] } ] }, { "tin": { "type": "ein", "value": "581425000" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 710.68, "npi": [ 1669867487 ] } ] } ] }, { "tin": { "type": "ein", "value": "582605844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3527.68, "npi": [ 1720300379 ] } ] } ] }, { "tin": { "type": "ein", "value": "621642499" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1179.7, "npi": [ 1750688172 ] } ] } ] }, { "tin": { "type": "ein", "value": "311836178" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3980.0, "npi": [ 1821028945 ] } ] } ] }, { "tin": { "type": "ein", "value": "582164513" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1964.25, "npi": [ 1821141821 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000913" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1871665174 ] } ] } ] }, { "tin": { "type": "ein", "value": "331880865" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 475.0, "npi": [ 1962273532 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1962478511 ] } ] } ] }, { "tin": { "type": "ein", "value": "582612884" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 425.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1982674636 ] } ] } ] } ] }, { "name": "ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP LMBR/SAC", "billing_code_type": "CPT", "billing_code": "01938", "billing_code_type_version": "2020", "description": "ANES PERQ IMG NJX DRG/ASPIR PX SPI/SP LMBR/SAC", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271533256" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 371.06, "billing_code_modifier": [ "QZ", "QS", "P3" ], "providers": [ { "billed_charge": 2880.0, "npi": [ 1043755853, 1265674402, 1538137096, 1932352291, 1982848974 ] } ] }, { "allowed_amount": 432.9, "billing_code_modifier": [ "QZ", "QS", "P3" ], "providers": [ { "billed_charge": 3360.0, "npi": [ 1407025976 ] } ] }, { "allowed_amount": 488.68, "billing_code_modifier": [ "QZ", "QS", "P3" ], "providers": [ { "billed_charge": 2880.0, "npi": [ 1598104408 ] } ] } ] }, { "tin": { "type": "ein", "value": "820834166" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 371.06, "billing_code_modifier": [ "QZ", "QS", "P3" ], "providers": [ { "billed_charge": 1500.0, "npi": [ 1154852820, 1265736755, 1902882558 ] }, { "billed_charge": 1250.0, "npi": [ 1598028169, 1952593865 ] }, { "billed_charge": 1425.0, "npi": [ 1952593865 ] } ] }, { "allowed_amount": 432.9, "billing_code_modifier": [ "QZ", "QS", "P3" ], "providers": [ { "billed_charge": 1525.0, "npi": [ 1598028169 ] }, { "billed_charge": 1550.0, "npi": [ 1598028169 ] } ] } ] } ] }, { "name": "Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum", "billing_code_type": "CPT", "billing_code": "00813", "billing_code_type_version": "2020", "description": "Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum", "allowed_amounts": [ { "tin": { "type": "ein", "value": "844923323" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 610.68, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033537022, 1699795864, 1811279243, 1932157484 ] } ] }, { "allowed_amount": 697.92, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1811279243, 1891717930 ] } ] }, { "allowed_amount": 785.16, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 3150.0, "npi": [ 1891717930 ] } ] } ] }, { "tin": { "type": "ein", "value": "922715940" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 697.92, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 3200.0, "npi": [ 1093128092 ] } ] } ] }, { "tin": { "type": "ein", "value": "272308793" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 610.68, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1346208329 ] } ] } ] }, { "tin": { "type": "ein", "value": "810686617" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 610.68, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1396017679, 1649491424, 1962925974 ] } ] }, { "allowed_amount": 697.92, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1649491424, 1780739987, 1962925974, 1982848974 ] } ] } ] }, { "tin": { "type": "ein", "value": "333436735" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 697.92, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1487618161 ] } ] } ] }, { "tin": { "type": "ein", "value": "464689612" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 785.16, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 3150.0, "npi": [ 1699816876 ] } ] } ] } ] }, { "name": "Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified", "billing_code_type": "CPT", "billing_code": "00811", "billing_code_type_version": "2020", "description": "Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified", "allowed_amounts": [ { "tin": { "type": "ein", "value": "844923323" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1033537022, 1275553786, 1477741379, 1699795864, 1811279243, 1891717930, 1932157484 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033537022, 1699795864, 1811279243 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1275553786, 1477741379, 1811279243, 1891717930, 1932157484 ] } ] } ] }, { "tin": { "type": "ein", "value": "464689612" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033831508, 1245362367, 1417920539, 1699816876 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1699816876, 1700105103 ] } ] } ] }, { "tin": { "type": "ein", "value": "810686617" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1164643946, 1780739987, 1962925974 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1962925974 ] } ] } ] }, { "tin": { "type": "ein", "value": "874196925" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1866.0, "npi": [ 1497087134 ] } ] } ] }, { "tin": { "type": "ein", "value": "272308793" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1720865678, 1861447344 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1861447344 ] } ] } ] }, { "tin": { "type": "ein", "value": "203858572" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1831529486 ] } ] } ] } ] }, { "name": "Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy", "billing_code_type": "CPT", "billing_code": "00812", "billing_code_type_version": "2020", "description": "Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582160708" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 101.05, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 900.0, "npi": [ 1033191358 ] } ] } ] }, { "tin": { "type": "ein", "value": "844923323" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1033537022, 1275553786, 1477741379, 1689988578, 1699795864, 1811279243, 1891717930, 1932157484 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1033537022 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033537022, 1275553786, 1699795864, 1811279243, 1891717930 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033537022, 1275553786, 1699795864, 1811279243, 1891717930 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1033537022, 1699795864 ] } ] }, { "allowed_amount": 370.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1275553786, 1689988578, 1699795864, 1811279243 ] } ] } ] }, { "tin": { "type": "ein", "value": "464689612" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033831508, 1245362367, 1417920539, 1700105103 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1033831508, 1699816876 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1245362367, 1417920539, 1700105103 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1245362367 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1700105103 ] } ] } ] }, { "tin": { "type": "ein", "value": "810686617" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1073903175, 1164643946, 1649491424, 1659362283, 1962925974 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1073903175, 1659362283, 1962925974 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1164643946 ] } ] }, { "allowed_amount": 370.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1396017679, 1962925974 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1396017679, 1962925974 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1659362283 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1780739987 ] } ] } ] }, { "tin": { "type": "ein", "value": "922715940" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2400.0, "npi": [ 1093128092 ] } ] } ] }, { "tin": { "type": "ein", "value": "333436735" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1144892787, 1841268018 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1407828452, 1467409268, 1700105103, 1841268018 ] } ] } ] }, { "tin": { "type": "ein", "value": "874196925" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1866.0, "npi": [ 1235684044, 1497087134 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1235684044, 1427883883 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1497087134 ] } ] } ] }, { "tin": { "type": "ein", "value": "863500478" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 510.0, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 510.0, "npi": [ 1265987473 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 510.0, "npi": [ 1598724544 ] } ] } ] }, { "tin": { "type": "ein", "value": "272308793" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1346208329, 1437657723, 1720865678, 1861447344 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1346208329 ] } ] }, { "allowed_amount": 370.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1437657723 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1861447344 ] } ] } ] }, { "tin": { "type": "ein", "value": "203858572" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1427158252, 1922608116, 1982692612 ] } ] }, { "allowed_amount": 370.0, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1555.0, "npi": [ 1457621047 ] } ] }, { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1866.0, "npi": [ 1457621047, 1770961765, 1922608116 ] } ] }, { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1831529486 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2799.0, "npi": [ 1902910565 ] } ] } ] }, { "tin": { "type": "ein", "value": "843262186" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 370.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 1750.0, "npi": [ 1508532631 ] } ] } ] }, { "tin": { "type": "ein", "value": "452857531" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 400.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 400.0, "npi": [ 1609825959 ] } ] } ] }, { "tin": { "type": "ein", "value": "823430528" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 462.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2400.0, "npi": [ 1689988578 ] } ] } ] } ] }, { "name": "Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified", "billing_code_type": "CPT", "billing_code": "00731", "billing_code_type_version": "2020", "description": "Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified", "allowed_amounts": [ { "tin": { "type": "ein", "value": "844923323" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1033537022, 1275553786, 1477741379, 1689988578, 1699795864, 1811279243, 1891717930 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033537022, 1275553786, 1689988578, 1699795864, 1811279243, 1891717930, 1932157484 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1275553786, 1699795864, 1811279243 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1275553786, 1477741379, 1699795864, 1811279243 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1477741379, 1811279243 ] } ] } ] }, { "tin": { "type": "ein", "value": "464689612" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1033831508, 1124442074, 1245362367, 1700105103 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1033831508 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1417920539 ] } ] } ] }, { "tin": { "type": "ein", "value": "810686617" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1053854364, 1649491424, 1962925974 ] } ] }, { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 2800.0, "npi": [ 1073903175, 1164643946, 1659362283, 1962925974 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1164643946, 1659362283 ] } ] } ] }, { "tin": { "type": "ein", "value": "272308793" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 555.0, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2100.0, "npi": [ 1346208329, 1437657723, 1861447344 ] } ] }, { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P2" ], "providers": [ { "billed_charge": 2450.0, "npi": [ 1437657723, 1861447344 ] } ] } ] }, { "tin": { "type": "ein", "value": "832071149" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 647.5, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 875.0, "npi": [ 1528108982 ] } ] } ] }, { "tin": { "type": "ein", "value": "452857531" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 480.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 480.0, "npi": [ 1609825959 ] } ] } ] }, { "tin": { "type": "ein", "value": "922715940" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 740.0, "billing_code_modifier": [ "QZ", "P3" ], "providers": [ { "billed_charge": 3200.0, "npi": [ 1760581284 ] } ] } ] } ] }, { "name": "ANESTHESIA PX ON EYE LENS SURGERY", "billing_code_type": "CPT", "billing_code": "00142", "billing_code_type_version": "2020", "description": "ANESTHESIA PX ON EYE LENS SURGERY", "allowed_amounts": [ { "tin": { "type": "ein", "value": "203858572" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 488.9, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1555.0, "npi": [ 1013695485, 1437502085, 1457825127 ] } ] }, { "allowed_amount": 684.46, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 2177.0, "npi": [ 1013695485 ] } ] }, { "allowed_amount": 586.68, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1866.0, "npi": [ 1285914416, 1457825127 ] } ] } ] }, { "tin": { "type": "ein", "value": "474640168" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 488.9, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 611.0, "npi": [ 1104412733 ] }, { "billed_charge": 637.0, "npi": [ 1104412733, 1346215829, 1912109844 ] } ] }, { "allowed_amount": 586.68, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 767.0, "npi": [ 1912109844 ] } ] } ] }, { "tin": { "type": "ein", "value": "621709852" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 684.46, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1265660252, 1588743991 ] } ] }, { "allowed_amount": 586.68, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1821586835 ] } ] } ] }, { "tin": { "type": "ein", "value": "581501437" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 488.9, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1316186224 ] } ] } ] }, { "tin": { "type": "ein", "value": "270039586" }, "service_code": [ "24" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 488.9, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 500.0, "npi": [ 1518036193 ] } ] }, { "allowed_amount": 510.0, "billing_code_modifier": [ "QZ", "QS", "P2" ], "providers": [ { "billed_charge": 510.0, "npi": [ 1518036193 ] } ] } ] } ] }, { "name": "ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)", "billing_code_type": "CPT", "billing_code": "81200", "billing_code_type_version": "2020", "description": "ASPA (aspartoacylase) (eg, Canavan disease) gene analysis, common variants (eg, E285A, Y231X)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 125.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 125.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 75.32, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 75.32, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 93.52, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 93.52, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "ASSAY OF TOTAL ESTRADIOL", "billing_code_type": "CPT", "billing_code": "82670", "billing_code_type_version": "2020", "description": "ASSAY OF TOTAL ESTRADIOL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 125.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 27.94, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 223.5, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 41.91, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 83.82, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 200.25, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 182.7, "npi": [ 1306896253, 1801883780 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 132.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 91.4, "npi": [ 1639264575 ] }, { "billed_charge": 95.7, "npi": [ 1639264575 ] }, { "billed_charge": 182.7, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 80.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 19.56, "providers": [ { "billed_charge": 69.85, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "Beta 2 Glycoprotein I antibody, each", "billing_code_type": "CPT", "billing_code": "86146", "billing_code_type_version": "2020", "description": "Beta 2 Glycoprotein I antibody, each", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 35.63, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 272.32, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)", "billing_code_type": "CPT", "billing_code": "85027", "billing_code_type_version": "2020", "description": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 9.71, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 19.41, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 38.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 36.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 32.23, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 23.65, "npi": [ 1821565045 ] } ] } ] } ] }, { "name": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count", "billing_code_type": "CPT", "billing_code": "85025", "billing_code_type_version": "2020", "description": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 95.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 7.77, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 16.0, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 11.66, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 23.31, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 32.55, "npi": [ 1194712083, 1306896253, 1376323998, 1487969341, 1821565045, 1851388748 ] }, { "billed_charge": 29.5, "npi": [ 1487969341 ] }, { "billed_charge": 23.75, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 32.19, "npi": [ 1194769497 ] }, { "billed_charge": 41.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 174.75, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.89, "providers": [ { "billed_charge": 105.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 49.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 36.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 25.5, "npi": [ 1639264575 ] }, { "billed_charge": 32.55, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 9.32, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 25.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 62.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 24.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 101.0, "npi": [ 1841351566 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 27.2, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 9.71, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.44, "providers": [ { "billed_charge": 94.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Blood count; hematocrit (Hct)", "billing_code_type": "CPT", "billing_code": "85014", "billing_code_type_version": "2020", "description": "Blood count; hematocrit (Hct)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.66, "providers": [ { "billed_charge": 9.71, "npi": [ 1174092548 ] }, { "billed_charge": 11.66, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.66, "providers": [ { "billed_charge": 29.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Blood count; hemoglobin (Hgb)", "billing_code_type": "CPT", "billing_code": "85018", "billing_code_type_version": "2020", "description": "Blood count; hemoglobin (Hgb)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.66, "providers": [ { "billed_charge": 9.7, "npi": [ 1174092548 ] }, { "billed_charge": 11.65, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.66, "providers": [ { "billed_charge": 53.18, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.66, "providers": [ { "billed_charge": 29.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "C-reactive protein;", "billing_code_type": "CPT", "billing_code": "86140", "billing_code_type_version": "2020", "description": "C-reactive protein;", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 105.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 5.18, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 7.77, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "521022572" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 30.0, "npi": [ 1164420568 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 56.25, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 71.4, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 71.4, "npi": [ 1801883780, 1851388748 ] } ] } ] } ] }, { "name": "C-reactive protein; high sensitivity (hsCRP)", "billing_code_type": "CPT", "billing_code": "86141", "billing_code_type_version": "2020", "description": "C-reactive protein; high sensitivity (hsCRP)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.07, "providers": [ { "billed_charge": 12.95, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.07, "providers": [ { "billed_charge": 103.6, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.07, "providers": [ { "billed_charge": 38.85, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "208833340" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.07, "providers": [ { "billed_charge": 21.0, "npi": [ 1922259753 ] } ] } ] } ] }, { "name": "Calcium; total", "billing_code_type": "CPT", "billing_code": "82310", "billing_code_type_version": "2020", "description": "Calcium; total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.61, "providers": [ { "billed_charge": 45.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.61, "providers": [ { "billed_charge": 115.93, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.61, "providers": [ { "billed_charge": 62.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Calprotectin, fecal", "billing_code_type": "CPT", "billing_code": "83993", "billing_code_type_version": "2020", "description": "Calprotectin, fecal", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561565047" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.74, "providers": [ { "billed_charge": 70.88, "npi": [ 1073591822 ] } ] } ] }, { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.74, "providers": [ { "billed_charge": 37.3, "npi": [ 1497423198 ] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.74, "providers": [ { "billed_charge": 33.0, "npi": [ 1659574127 ] } ] } ] } ] }, { "name": "CAR SCR SEV INH COND GENOMIC SEQ ALYS PNL 5 GEN", "billing_code_type": "CPT", "billing_code": "0449U", "billing_code_type_version": "2020", "description": "CAR SCR SEV INH COND GENOMIC SEQ ALYS PNL 5 GEN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "811082020" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1277.42, "providers": [ { "billed_charge": 7299.52, "npi": [ 1598314437 ] }, { "billed_charge": 11852.56, "npi": [ 1598314437 ] } ] } ] } ] }, { "name": "Cardiolipin (phospholipid) antibody, each Ig class", "billing_code_type": "CPT", "billing_code": "86147", "billing_code_type_version": "2020", "description": "Cardiolipin (phospholipid) antibody, each Ig class", "allowed_amounts": [ { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 53.45, "providers": [ { "billed_charge": 533.07, "npi": [ 1215914585 ] }, { "billed_charge": 505.5, "npi": [ 1962489237 ] }, { "billed_charge": 505.53, "npi": [ 1962489237 ] } ] } ] }, { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.82, "providers": [ { "billed_charge": 136.16, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 35.63, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 272.32, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines)", "billing_code_type": "CPT", "billing_code": "81220", "billing_code_type_version": "2020", "description": "CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "743238060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 999.0, "providers": [ { "billed_charge": 999.0, "npi": [ 1346479169 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1026.56, "providers": [ { "billed_charge": 2233.44, "npi": [ 1518713072 ] }, { "billed_charge": 2311.5, "npi": [ 1518713072 ] }, { "billed_charge": 1101.54, "npi": [ 1730481078 ] }, { "billed_charge": 1416.79, "npi": [ 1730481078 ] } ] } ] }, { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1026.56, "providers": [ { "billed_charge": 2975.0, "npi": [ 1558672279 ] }, { "billed_charge": 3500.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "Chemiluminescent assay", "billing_code_type": "CPT", "billing_code": "82397", "billing_code_type_version": "2020", "description": "Chemiluminescent assay", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.88, "providers": [ { "billed_charge": 107.0, "npi": [ 1245494517 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.88, "providers": [ { "billed_charge": 135.09, "npi": [ 1962489237 ] }, { "billed_charge": 142.97, "npi": [ 1962489237 ] }, { "billed_charge": 235.34, "npi": [ 1962489237 ] } ] } ] } ] }, { "name": "CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS", "billing_code_type": "CPT", "billing_code": "98941", "billing_code_type_version": "2020", "description": "CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "460786913" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 36.85, "providers": [ { "billed_charge": 53.0, "npi": [ 1922429091 ] } ] } ] } ] }, { "name": "COLLECTION CAPILLARY BLOOD SPECIMEN", "billing_code_type": "CPT", "billing_code": "36416", "billing_code_type_version": "2020", "description": "COLLECTION CAPILLARY BLOOD SPECIMEN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "863781787" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 10.0, "npi": [ 1013774033, 1871136770 ] } ] } ] }, { "tin": { "type": "ein", "value": "464354068" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 15.0, "npi": [ 1023423845, 1194952739 ] } ] } ] }, { "tin": { "type": "ein", "value": "455103789" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 20.0, "npi": [ 1043848583 ] } ] } ] }, { "tin": { "type": "ein", "value": "581394645" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 11.0, "npi": [ 1063995561 ] } ] } ] }, { "tin": { "type": "ein", "value": "582019024" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 14.0, "npi": [ 1083409676, 1326583360, 1518270719 ] } ] } ] }, { "tin": { "type": "ein", "value": "821679625" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 25.0, "npi": [ 1104891472, 1932556453 ] } ] } ] }, { "tin": { "type": "ein", "value": "581896468" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 36.0, "npi": [ 1124552070, 1710373816, 1841555893 ] } ] } ] }, { "tin": { "type": "ein", "value": "833053631" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 20.0, "npi": [ 1134160468 ] } ] } ] }, { "tin": { "type": "ein", "value": "844255408" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 15.75, "npi": [ 1194953638 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 11.0, "npi": [ 1215909361 ] } ] } ] }, { "tin": { "type": "ein", "value": "331196353" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 10.0, "npi": [ 1326480112 ] } ] } ] }, { "tin": { "type": "ein", "value": "200539417" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 10.0, "npi": [ 1336118108 ] } ] } ] }, { "tin": { "type": "ein", "value": "262578966" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 13.0, "npi": [ 1437670858 ] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 12.0, "npi": [ 1538157631 ] } ] } ] }, { "tin": { "type": "ein", "value": "800002707" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.25, "providers": [ { "billed_charge": 29.0, "npi": [ 1538940911 ] } ] } ] }, { "tin": { "type": "ein", "value": "421736565" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 15.0, "npi": [ 1548461643 ] } ] } ] }, { "tin": { "type": "ein", "value": "463531751" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 16.0, "npi": [ 1639354434 ] } ] } ] }, { "tin": { "type": "ein", "value": "260299290" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 20.0, "npi": [ 1649237207 ] } ] } ] }, { "tin": { "type": "ein", "value": "932711866" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.0, "providers": [ { "billed_charge": 3.0, "npi": [ 1649875311 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 11.0, "npi": [ 1821520453 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.0, "providers": [ { "billed_charge": 15.0, "npi": [ 1871556167 ] } ] } ] } ] }, { "name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code": "36415", "billing_code_type_version": "2020", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 25.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 9.09, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 21.0, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 13.25, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 28.02, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 25.71, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 15.3, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 26.25, "npi": [ 1376323998, 1487969341, 1821565045 ] }, { "billed_charge": 15.8, "npi": [ 1487969341 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.55, "providers": [ { "billed_charge": 33.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 15.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 18.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 10.91, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "205657908" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 25.0, "npi": [ 1710064811 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 10.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 42.0, "npi": [ 1841351566 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 32.69, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "394147500" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 19.0, "npi": [ 1871781476 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.54, "providers": [ { "billed_charge": 11.67, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Pot", "billing_code_type": "CPT", "billing_code": "80053", "billing_code_type_version": "2020", "description": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Pot", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 85.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 10.56, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 21.5, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 15.84, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 31.68, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 31.68, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 48.3, "npi": [ 1194712083, 1801883780, 1821565045, 1851388748 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 78.25, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.28, "providers": [ { "billed_charge": 264.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 88.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 48.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 31.68, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 40.4, "npi": [ 1639264575 ] }, { "billed_charge": 48.3, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 125.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 32.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 36.96, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 21.12, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 13.2, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.39, "providers": [ { "billed_charge": 127.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Continuous positive airway pressure (CPAP) device", "billing_code_type": "HCPCS", "billing_code": "E0601", "billing_code_type_version": "2020", "description": "Continuous positive airway pressure (CPAP) device", "allowed_amounts": [ { "tin": { "type": "ein", "value": "510447627" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1033195110 ] }, { "billed_charge": 260.0, "npi": [ 1033195110 ] } ] } ] }, { "tin": { "type": "ein", "value": "270110308" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1124251913 ] } ] } ] }, { "tin": { "type": "ein", "value": "593758015" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1184640393 ] } ] } ] }, { "tin": { "type": "ein", "value": "010676164" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 95.0, "npi": [ 1205831765 ] } ] } ] }, { "tin": { "type": "ein", "value": "203589086" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 106.87, "npi": [ 1285739268 ] } ] } ] }, { "tin": { "type": "ein", "value": "760653019" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1538471412 ] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 105.25, "npi": [ 1740527654 ] } ] } ] }, { "tin": { "type": "ein", "value": "571111621" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 56.93, "npi": [ 1801428776 ] } ] } ] }, { "tin": { "type": "ein", "value": "273319284" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1811206741 ] } ] } ] }, { "tin": { "type": "ein", "value": "582507620" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.47, "billing_code_modifier": [ "RR" ], "providers": [ { "billed_charge": 97.02, "npi": [ 1861487373 ] } ] } ] } ] }, { "name": "Cortisol; total", "billing_code_type": "CPT", "billing_code": "82533", "billing_code_type_version": "2020", "description": "Cortisol; total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 24.45, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 48.9, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 118.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 102.9, "npi": [ 1306896253, 1801883780 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 102.9, "npi": [ 1639264575, 1962489237 ] }, { "billed_charge": 80.85, "npi": [ 1962489237 ] } ] }, { "allowed_amount": 22.82, "providers": [ { "billed_charge": 161.7, "npi": [ 1962489237 ] } ] }, { "allowed_amount": 45.64, "providers": [ { "billed_charge": 323.4, "npi": [ 1962489237 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.41, "providers": [ { "billed_charge": 40.75, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "Creatinine; blood", "billing_code_type": "CPT", "billing_code": "82565", "billing_code_type_version": "2020", "description": "Creatinine; blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.58, "providers": [ { "billed_charge": 46.1, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.58, "providers": [ { "billed_charge": 115.14, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.58, "providers": [ { "billed_charge": 25.0, "npi": [ 1265854855 ] } ] } ] } ] }, { "name": "Creatinine; other source", "billing_code_type": "CPT", "billing_code": "82570", "billing_code_type_version": "2020", "description": "Creatinine; other source", "allowed_amounts": [ { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 5.18, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "561565047" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 14.79, "npi": [ 1073591822 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 29.86, "npi": [ 1083698534 ] }, { "billed_charge": 30.11, "npi": [ 1083698534 ] }, { "billed_charge": 30.14, "npi": [ 1083698534 ] }, { "billed_charge": 54.69, "npi": [ 1639264575 ] }, { "billed_charge": 64.07, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "273012584" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 6.0, "npi": [ 1104255215 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 15.54, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 15.54, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 79.05, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 116.25, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 54.69, "npi": [ 1376323998 ] }, { "billed_charge": 64.07, "npi": [ 1376323998 ] }, { "billed_charge": 26.34, "npi": [ 1487969341 ] }, { "billed_charge": 33.67, "npi": [ 1821565045 ] }, { "billed_charge": 33.7, "npi": [ 1821565045 ] } ] }, { "allowed_amount": 7.25, "providers": [ { "billed_charge": 118.76, "npi": [ 1376323998 ] }, { "billed_charge": 90.36, "npi": [ 1487969341 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 37.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 12.95, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 16.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 63.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN", "billing_code_type": "CPT", "billing_code": "99292", "billing_code_type_version": "2020", "description": "CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "330978554" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 349.3, "providers": [ { "billed_charge": 465.52, "npi": [ 1033426341 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 507.0, "npi": [ 1043700081, 1184253312, 1326497447 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 174.65, "providers": [ { "billed_charge": 523.0, "npi": [ 1053635581 ] } ] }, { "allowed_amount": 698.6, "providers": [ { "billed_charge": 2092.0, "npi": [ 1124292511 ] } ] }, { "allowed_amount": 218.47, "providers": [ { "billed_charge": 523.0, "npi": [ 1124550272, 1740444504 ] } ] }, { "allowed_amount": 436.94, "providers": [ { "billed_charge": 1046.0, "npi": [ 1124550272, 1730116146, 1740444504 ] } ] }, { "allowed_amount": 655.41, "providers": [ { "billed_charge": 1569.0, "npi": [ 1639147077 ] } ] }, { "allowed_amount": 1747.76, "providers": [ { "billed_charge": 4184.0, "npi": [ 1730116146 ] } ] }, { "allowed_amount": 349.3, "providers": [ { "billed_charge": 1046.0, "npi": [ 1801044342 ] } ] }, { "allowed_amount": 523.95, "providers": [ { "billed_charge": 1569.0, "npi": [ 1801044342 ] } ] }, { "allowed_amount": 873.88, "providers": [ { "billed_charge": 2092.0, "npi": [ 1871810465 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 954.0, "npi": [ 1063478139 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 1504.0, "npi": [ 1063708006 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 436.94, "providers": [ { "billed_charge": 856.0, "npi": [ 1124420856 ] } ] } ] }, { "tin": { "type": "ein", "value": "204553410" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 323.0, "npi": [ 1144780214 ] } ] } ] }, { "tin": { "type": "ein", "value": "431600770" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 174.65, "providers": [ { "billed_charge": 444.0, "npi": [ 1295779379 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 349.3, "providers": [ { "billed_charge": 704.0, "npi": [ 1336759513 ] } ] }, { "allowed_amount": 218.47, "providers": [ { "billed_charge": 352.0, "npi": [ 1699361105 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259435" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 323.0, "npi": [ 1376512897 ] } ] } ] }, { "tin": { "type": "ein", "value": "330734849" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 174.65, "providers": [ { "billed_charge": 193.0, "npi": [ 1396107520 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 799.0, "npi": [ 1396756680, 1427404409 ] } ] }, { "allowed_amount": 655.41, "providers": [ { "billed_charge": 2397.0, "npi": [ 1427404409 ] } ] }, { "allowed_amount": 436.94, "providers": [ { "billed_charge": 2060.0, "npi": [ 1912163825 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 193.46, "providers": [ { "billed_charge": 799.0, "npi": [ 1427404409 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 628.0, "npi": [ 1457881260 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 428.0, "npi": [ 1568412146 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 1140.0, "npi": [ 1578732335, 1750479408 ] } ] } ] }, { "tin": { "type": "ein", "value": "471988466" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 903.0, "npi": [ 1578925533 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 523.0, "npi": [ 1699194597 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 873.0, "npi": [ 1831417278 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 1092.35, "providers": [ { "billed_charge": 1950.0, "npi": [ 1841170669 ] } ] } ] }, { "tin": { "type": "ein", "value": "464319695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.47, "providers": [ { "billed_charge": 1140.0, "npi": [ 1881641439 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 436.94, "providers": [ { "billed_charge": 2110.0, "npi": [ 1902878804 ] } ] } ] } ] }, { "name": "CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN", "billing_code_type": "CPT", "billing_code": "99291", "billing_code_type_version": "2020", "description": "CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1678.0, "npi": [ 1003357864, 1154731388, 1306370853, 1447781638, 1528322112, 1588197339, 1841425824 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2101.0, "npi": [ 1003565318, 1033776372, 1164059473, 1205994985, 1235794488, 1598343998, 1639185903, 1902878804 ] }, { "billed_charge": 1847.0, "npi": [ 1629728613 ] }, { "billed_charge": 2174.0, "npi": [ 1912134180 ] } ] } ] }, { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1813.0, "npi": [ 1003854738, 1164772372, 1235768342, 1376574863, 1881630515 ] } ] } ] }, { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1300.0, "npi": [ 1003877523, 1013545391, 1730560137 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 2420.0, "npi": [ 1013530807 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2420.0, "npi": [ 1932499803 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1863.0, "npi": [ 1013957844, 1043575178, 1447614391, 1972038487 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2115.0, "npi": [ 1023117272 ] }, { "billed_charge": 2041.0, "npi": [ 1023472065, 1255794053, 1356508972, 1396756680, 1427404409, 1588057038, 1699138719 ] }, { "billed_charge": 1988.0, "npi": [ 1073831871 ] }, { "billed_charge": 2050.0, "npi": [ 1912163825 ] } ] } ] }, { "tin": { "type": "ein", "value": "330978554" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 463.36, "npi": [ 1033426341, 1679598817 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 463.36, "npi": [ 1952510851 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1908.0, "npi": [ 1033571799, 1063478139 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1104.0, "npi": [ 1043505977 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1104.0, "npi": [ 1043700081, 1184253312, 1326497447, 1407331143, 1780325571 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2249.0, "npi": [ 1053393637, 1073995965, 1154304384, 1154439321, 1205842309, 1346422243, 1386627529, 1447389242, 1457091274, 1609066786, 1740579457, 1750363438, 1871119990, 1942332325 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 1198.0, "npi": [ 1053635581, 1093167066, 1124292511, 1801044342 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1198.0, "npi": [ 1124550272, 1407104862, 1447747258, 1609366996, 1639147077, 1730116146, 1740444504, 1871810465 ] } ] } ] }, { "tin": { "type": "ein", "value": "473053199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 858.0, "npi": [ 1053791434 ] } ] } ] }, { "tin": { "type": "ein", "value": "824486211" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 4522.0, "npi": [ 1063031995, 1396164141 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 4522.0, "npi": [ 1588393987 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 3001.0, "npi": [ 1063708006 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2157.0, "npi": [ 1063972461 ] }, { "billed_charge": 2170.0, "npi": [ 1285640326 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 704.0, "npi": [ 1073091831, 1104486711, 1205414109, 1467951707, 1669182614, 1699361105, 1710221841 ] } ] }, { "allowed_amount": 347.22, "providers": [ { "billed_charge": 704.0, "npi": [ 1124663331, 1174337042, 1336759513 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 778.0, "npi": [ 1083971451, 1104207125, 1336602325, 1396589420, 1417488925, 1841170669 ] } ] } ] }, { "tin": { "type": "ein", "value": "582540964" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 762.0, "npi": [ 1093334229, 1871657221 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2280.0, "npi": [ 1104804491, 1174151591, 1205125960, 1508253022, 1578684437, 1578732335, 1750479408 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1326.0, "npi": [ 1114945979 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1217.0, "npi": [ 1124074356 ] } ] } ] }, { "tin": { "type": "ein", "value": "582636306" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2280.0, "npi": [ 1124206792, 1225529233, 1689135675, 1710649652 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 858.0, "npi": [ 1124420856, 1265491294, 1649278334 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1960.0, "npi": [ 1124654157, 1326545823, 1720440555 ] } ] } ] }, { "tin": { "type": "ein", "value": "591835473" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1902.43, "npi": [ 1134324056 ] } ] } ] }, { "tin": { "type": "ein", "value": "204553410" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 642.0, "npi": [ 1134370711, 1346808797 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 642.0, "npi": [ 1144780214, 1174861892 ] } ] } ] }, { "tin": { "type": "ein", "value": "412279037" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 487.0, "npi": [ 1144225293 ] } ] }, { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 487.0, "npi": [ 1144225293 ] } ] } ] }, { "tin": { "type": "ein", "value": "883688910" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 740.0, "npi": [ 1144531641 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1164954483 ] } ] }, { "allowed_amount": 347.22, "providers": [ { "billed_charge": 580.0, "npi": [ 1841464443 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1862.0, "npi": [ 1174569016 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2135.0, "npi": [ 1184374464, 1366896409 ] } ] } ] }, { "tin": { "type": "ein", "value": "954534163" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1158.0, "npi": [ 1194212357 ] } ] } ] }, { "tin": { "type": "ein", "value": "202252101" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1217.0, "npi": [ 1205289063 ] } ] }, { "allowed_amount": 347.22, "providers": [ { "billed_charge": 1217.0, "npi": [ 1336485150, 1770927501, 1821650474 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1217.0, "npi": [ 1689065591 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 3001.0, "npi": [ 1215190772 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 3001.0, "npi": [ 1558473223, 1972923258 ] } ] } ] }, { "tin": { "type": "ein", "value": "823125568" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2280.0, "npi": [ 1215565551 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 858.0, "npi": [ 1225520679, 1336602325 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 531.72, "npi": [ 1225535933 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2157.0, "npi": [ 1235606138, 1275221483, 1528332939, 1538856448, 1609429570, 1629608492, 1659683175, 1942594429, 1962804104 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 704.0, "npi": [ 1255722377, 1760941694 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 704.0, "npi": [ 1649540535, 1790946762 ] } ] } ] }, { "tin": { "type": "ein", "value": "991100562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1813.0, "npi": [ 1265057590, 1275257388, 1336319342, 1568611390, 1578055323, 1598858086, 1720471873, 1760917587, 1841752029, 1871682443 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010601" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1098.0, "npi": [ 1265491294 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 704.0, "npi": [ 1275769135, 1497780860 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1251.0, "npi": [ 1316143118, 1457881260 ] } ] }, { "allowed_amount": 347.22, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1251.0, "npi": [ 1457881260 ] } ] } ] }, { "tin": { "type": "ein", "value": "582307485" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 1020.0, "npi": [ 1336363373 ] } ] } ] }, { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2113.0, "npi": [ 1346735180, 1710294491 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 3001.0, "npi": [ 1346875564, 1568048973 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 3001.0, "npi": [ 1992095418 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1702.0, "npi": [ 1356780894, 1922628882 ] } ] } ] }, { "tin": { "type": "ein", "value": "822423015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 645.0, "npi": [ 1356970354, 1366447187, 1396716312, 1548764053 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 645.0, "npi": [ 1396716312, 1760416077 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 564.0, "npi": [ 1366025561 ] } ] }, { "allowed_amount": 347.22, "providers": [ { "billed_charge": 564.0, "npi": [ 1902638901 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259435" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 642.0, "npi": [ 1376512897 ] } ] }, { "allowed_amount": 347.22, "providers": [ { "billed_charge": 642.0, "npi": [ 1811186828 ] } ] } ] }, { "tin": { "type": "ein", "value": "330734849" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 439.0, "npi": [ 1396107520 ] } ] } ] }, { "tin": { "type": "ein", "value": "465034266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2324.0, "npi": [ 1396716312 ] } ] } ] }, { "tin": { "type": "ein", "value": "582293514" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 425.0, "npi": [ 1396797833 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 858.0, "npi": [ 1417247073, 1427146125, 1437193927, 1548958648, 1558883868, 1689752636, 1841880655 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 424.87, "providers": [ { "billed_charge": 2041.0, "npi": [ 1427404409 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 858.0, "npi": [ 1447466446, 1457980948 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 858.0, "npi": [ 1689940165 ] } ] } ] }, { "tin": { "type": "ein", "value": "475329008" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 778.0, "npi": [ 1457518813 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 858.0, "npi": [ 1568412146 ] } ] } ] }, { "tin": { "type": "ein", "value": "932501591" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 588.0, "npi": [ 1578212197 ] } ] } ] }, { "tin": { "type": "ein", "value": "471988466" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1805.0, "npi": [ 1578925533 ] } ] } ] }, { "tin": { "type": "ein", "value": "201395801" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 444.0, "npi": [ 1609326537 ] } ] } ] }, { "tin": { "type": "ein", "value": "593541589" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 839.0, "npi": [ 1619980893 ] } ] } ] }, { "tin": { "type": "ein", "value": "934387494" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1802.0, "npi": [ 1629031455 ] } ] } ] }, { "tin": { "type": "ein", "value": "264444385" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 420.0, "npi": [ 1639105620 ] } ] } ] }, { "tin": { "type": "ein", "value": "260312405" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 866.0, "npi": [ 1649569591 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 642.0, "npi": [ 1669698510, 1801089842 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 941.0, "npi": [ 1689324527 ] }, { "billed_charge": 805.0, "npi": [ 1851032023 ] } ] }, { "allowed_amount": 458.48, "providers": [ { "billed_charge": 941.0, "npi": [ 1730344094 ] } ] } ] }, { "tin": { "type": "ein", "value": "582569828" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 855.32, "npi": [ 1699182238 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1198.0, "npi": [ 1699194597 ] } ] } ] }, { "tin": { "type": "ein", "value": "824225028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 500.0, "npi": [ 1720243751 ] } ] } ] }, { "tin": { "type": "ein", "value": "880262438" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2126.0, "npi": [ 1730169111 ] } ] } ] }, { "tin": { "type": "ein", "value": "911939739" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 617.0, "npi": [ 1750499513 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 675.0, "npi": [ 1790923969, 1811558125 ] } ] } ] }, { "tin": { "type": "ein", "value": "593082909" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2200.0, "npi": [ 1821580986 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1678.0, "npi": [ 1831417278 ] } ] } ] }, { "tin": { "type": "ein", "value": "582518112" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 265.0, "providers": [ { "billed_charge": 265.0, "npi": [ 1841368933 ] } ] } ] }, { "tin": { "type": "ein", "value": "413178803" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1217.0, "npi": [ 1841553328 ] } ] } ] }, { "tin": { "type": "ein", "value": "464319695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 2280.0, "npi": [ 1881641439 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 347.22, "providers": [ { "billed_charge": 680.0, "npi": [ 1922329481 ] } ] } ] }, { "tin": { "type": "ein", "value": "911753075" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1923.0, "npi": [ 1932468774 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 1840.0, "npi": [ 1962634766 ] } ] } ] }, { "tin": { "type": "ein", "value": "820989586" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 458.48, "providers": [ { "billed_charge": 858.0, "npi": [ 1992391346 ] } ] } ] } ] }, { "name": "CT ABDOMEN & PELVIS W/CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "74177", "billing_code_type_version": "2020", "description": "CT ABDOMEN & PELVIS W/CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1946.0, "npi": [ 1003018342, 1003806381, 1033379151, 1063494425, 1063498400, 1083875991, 1104058213, 1114903408, 1114956695, 1114994738, 1124002217, 1134101116, 1144410283, 1184646499, 1184937021, 1225021413, 1235423187, 1255316873, 1255368353, 1295144137, 1306865639, 1336332295, 1396751426, 1396761748, 1417113002, 1447613005, 1457617045, 1497720148, 1508182742, 1508865510, 1518935022, 1538167804, 1548231541, 1558336834, 1568678225, 1578772364, 1588710487, 1598342461, 1649229063, 1659536514, 1669521803, 1679553671, 1710208988, 1730186719, 1740351543, 1760514574, 1760598924, 1770534869, 1790737328, 1790760064, 1790879062, 1811108061, 1861455271, 1881080042, 1881973550, 1891839718, 1902192438, 1922115492, 1932123155, 1932170131, 1932428455, 1952359697, 1962499418, 1962923706, 1972550416, 1972620730, 1972639615, 1992768352 ] } ] } ] }, { "tin": { "type": "ein", "value": "471497384" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 326.0, "npi": [ 1003203324, 1609966225 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 490.0, "npi": [ 1003841875, 1164049011, 1245491505, 1275616849, 1306466412, 1326274291, 1417272667, 1578865721, 1700166733, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 470.0, "npi": [ 1013446798, 1063497006, 1134104334, 1316922354, 1396233565, 1477711919, 1558345777, 1629258066, 1669450284, 1770926156, 1841482478, 1871561803, 1972583805 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 252.0, "npi": [ 1013958883, 1174513253, 1225021413, 1255368353, 1376800342, 1508865510, 1588710487, 1770763484, 1932170131 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 530.0, "npi": [ 1043265937, 1093178956, 1144789280, 1427262104, 1447756960, 1841463627, 1902168149, 1922084748, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1323.0, "npi": [ 1063533149 ] } ] } ] }, { "tin": { "type": "ein", "value": "760686474" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 275.0, "npi": [ 1073541835 ] } ] } ] }, { "tin": { "type": "ein", "value": "351344539" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 302.0, "npi": [ 1073856118 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 440.0, "npi": [ 1083143309, 1285121921, 1306307525, 1427462811, 1649474743, 1831651819 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 407.0, "npi": [ 1083684765, 1194922120, 1346262458, 1548497639 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 265.0, "npi": [ 1083979710, 1245712835, 1346536414, 1649411422, 1750547493, 1992124515 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 240.66, "npi": [ 1114131588, 1821444142, 1831543487, 1851654263 ] } ] } ] }, { "tin": { "type": "ein", "value": "932501469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 397.0, "npi": [ 1124161872 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 232.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 232.0, "npi": [ 1184831471, 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "620909696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 701.0, "npi": [ 1194352484 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23", "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 414.0, "npi": [ 1245573997, 1275512956, 1285711671, 1295199115, 1316925654, 1346655982, 1457795296, 1669675658, 1811293525, 1851633572, 1891088670 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 414.0, "npi": [ 1285711671, 1316925654, 1457795296, 1700864055, 1790168540 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 402.0, "npi": [ 1306895818, 1780669978 ] } ] } ] }, { "tin": { "type": "ein", "value": "591289802" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 429.0, "npi": [ 1336114206 ] }, { "billed_charge": 287.0, "npi": [ 1558789115 ] } ] } ] }, { "tin": { "type": "ein", "value": "620859738" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 399.0, "npi": [ 1336142520 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 529.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "582091280" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 602.7, "npi": [ 1366490617 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 590.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "991380793" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 419.0, "npi": [ 1487890117 ] } ] } ] }, { "tin": { "type": "ein", "value": "135562308" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 650.0, "npi": [ 1497048722 ] } ] } ] }, { "tin": { "type": "ein", "value": "264058719" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1497751937 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1946.0, "npi": [ 1538285366 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 452.0, "npi": [ 1639497282 ] } ] } ] }, { "tin": { "type": "ein", "value": "203972695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 275.0, "npi": [ 1659321248 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 429.0, "npi": [ 1659351666 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 832.97, "npi": [ 1659564078 ] } ] } ] }, { "tin": { "type": "ein", "value": "412007905" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 336.0, "npi": [ 1679667422 ] } ] } ] }, { "tin": { "type": "ein", "value": "332353320" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 284.0, "npi": [ 1730407230 ] } ] } ] }, { "tin": { "type": "ein", "value": "631041806" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 287.0, "npi": [ 1750475331 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1069.0, "npi": [ 1750812400 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 442.0, "npi": [ 1871625178 ] } ] } ] }, { "tin": { "type": "ein", "value": "611336534" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 230.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 230.0, "npi": [ 1881089456 ] } ] } ] }, { "tin": { "type": "ein", "value": "333984600" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 237.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 248.85, "npi": [ 1881190015 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 163.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 163.0, "npi": [ 1912430182, 1952838567 ] } ] } ] } ] }, { "name": "CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "74176", "billing_code_type_version": "2020", "description": "CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1860.0, "npi": [ 1003018342, 1023240561, 1114956695, 1134101116, 1144410283, 1184646499, 1184937021, 1205830726, 1215904677, 1316267404, 1336137165, 1346286317, 1396009007, 1396021648, 1396751426, 1447230289, 1508865510, 1518935022, 1538167804, 1558694984, 1588710487, 1649229063, 1659393965, 1669521803, 1699928150, 1710208988, 1720024680, 1720174238, 1730382821, 1770534869, 1790737328, 1790879062, 1841216306, 1861455271, 1891839718, 1922115492, 1932123155, 1952359697, 1962499418, 1972620730, 1972639615 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 459.0, "npi": [ 1003841875, 1245491505, 1275616849, 1417272667, 1700166733, 1740488527, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 241.0, "npi": [ 1023094737, 1386608172, 1396734430, 1770763484, 1780624254, 1932170131 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 421.0, "npi": [ 1023278421, 1033572425, 1407845464 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 250.0, "npi": [ 1063498632, 1346536414, 1649411422 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 323.0, "npi": [ 1093178956, 1134109762, 1184828972, 1386645828, 1649626326, 1902168149, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 154.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 154.0, "npi": [ 1164410916 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 396.0, "npi": [ 1265791784, 1285711671, 1487114658, 1528046877 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 396.0, "npi": [ 1285711671, 1316925654, 1386050250, 1457795296, 1528046877, 1669675658, 1891088670 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 374.0, "npi": [ 1306895818, 1780669978 ] } ] } ] }, { "tin": { "type": "ein", "value": "591289802" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 259.0, "npi": [ 1326082975 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 478.0, "npi": [ 1346623667 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 341.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 448.0, "npi": [ 1477711919, 1659356947, 1841482478 ] } ] } ] }, { "tin": { "type": "ein", "value": "991380793" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 398.0, "npi": [ 1487890117 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 267.0, "npi": [ 1538472543 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1860.0, "npi": [ 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "920177956" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 701.0, "npi": [ 1619159647 ] } ] } ] }, { "tin": { "type": "ein", "value": "820945402" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 326.39, "npi": [ 1619396934 ] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1860.0, "npi": [ 1629364138 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 409.0, "npi": [ 1659351666 ] } ] } ] }, { "tin": { "type": "ein", "value": "462439952" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 346.0, "npi": [ 1760694285 ] } ] } ] }, { "tin": { "type": "ein", "value": "208112143" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 309.0, "npi": [ 1770740854 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 229.83, "npi": [ 1831543487 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 229.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 350.1, "npi": [ 1851581540 ] } ] } ] } ] }, { "name": "CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST", "billing_code_type": "CPT", "billing_code": "71275", "billing_code_type_version": "2020", "description": "CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 438.0, "npi": [ 1003253238, 1134252182, 1174020127, 1487281341, 1871152447 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 388.0, "npi": [ 1003841875, 1275616849, 1326274291, 1578865721, 1700166733, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 468.0, "npi": [ 1013446798, 1124227368, 1134104334, 1396233565, 1477711919, 1669450284, 1770926156, 1871561803, 1902881287 ] } ] }, { "allowed_amount": 221.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 221.0, "npi": [ 1134104334, 1871561803 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 436.0, "npi": [ 1043265937, 1174631410, 1386645828, 1922084748, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 393.0, "npi": [ 1063533149 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1915.0, "npi": [ 1083696561, 1083875991, 1093700957, 1134101116, 1144410283, 1184937021, 1215931027, 1255316873, 1295144137, 1336137165, 1346286317, 1386976207, 1396761748, 1508865510, 1518935022, 1548231541, 1598266017, 1710431044, 1740351543, 1760598924, 1770534869, 1811156086, 1861455271, 1891057527, 1891839718, 1922115492, 1952359697, 1992768352 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 405.0, "npi": [ 1114958741, 1174573901 ] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 704.0, "npi": [ 1124214945 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 265.0, "npi": [ 1144410283, 1386608172, 1396761748, 1770763484 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 357.0, "npi": [ 1154304434 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 181.0, "npi": [ 1184831471, 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 326.0, "npi": [ 1275512956, 1285711671, 1457795296 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 414.0, "npi": [ 1285711671, 1316925654, 1346655982, 1376809095, 1386050250, 1669675658, 1811293525, 1891088670 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 318.0, "npi": [ 1306895818, 1487898706 ] } ] } ] }, { "tin": { "type": "ein", "value": "610945743" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 360.0, "npi": [ 1457889560 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 284.0, "npi": [ 1548231541 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1915.0, "npi": [ 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "591289802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 286.0, "npi": [ 1558789115 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 279.0, "npi": [ 1609226851, 1760798565, 1841370723, 1881987972 ] } ] } ] }, { "tin": { "type": "ein", "value": "208112143" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 283.0, "npi": [ 1619986478 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 428.0, "npi": [ 1659351666 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1064.0, "npi": [ 1750812400 ] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.31, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 319.0, "npi": [ 1770927287 ] } ] } ] } ] }, { "name": "CT CERVICAL SPINE W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "72125", "billing_code_type_version": "2020", "description": "CT CERVICAL SPINE W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 830.0, "npi": [ 1063498400, 1134101116, 1144410283, 1225053036, 1295144137, 1306865639, 1396761748, 1396969945, 1417117268, 1588710487, 1639175888, 1669521803, 1689601502, 1699928150, 1740454412, 1770534869, 1851778542, 1891839718, 1891955803, 1962499418 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 246.4, "npi": [ 1114239001 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 230.0, "npi": [ 1134489438 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 88.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 88.0, "npi": [ 1164410916 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 233.0, "npi": [ 1245491505, 1679684872, 1740488527, 1801201090, 1841463452 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 179.0, "npi": [ 1265791784, 1295199115 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 227.0, "npi": [ 1265791784, 1376809095, 1538497300, 1760461313, 1831177179, 1962456012 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 177.0, "npi": [ 1275996316, 1356787840, 1437208246, 1609226851, 1760798565 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 235.0, "npi": [ 1316920069 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 275.0, "npi": [ 1326536103, 1477711919, 1821557141, 1841482478, 1871561803, 1942650122 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 142.0, "npi": [ 1356589980 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 255.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "621203441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 179.0, "npi": [ 1447756572 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 154.0, "npi": [ 1467430082 ] } ] } ] }, { "tin": { "type": "ein", "value": "991380793" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 227.0, "npi": [ 1487890117 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 148.0, "npi": [ 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 830.0, "npi": [ 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 170.0, "npi": [ 1700171329 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 160.0, "npi": [ 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 239.0, "npi": [ 1760650055 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 133.32, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 133.32, "npi": [ 1851654263 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 224.0, "npi": [ 1871625178 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 264.0, "npi": [ 1962651828 ] } ] } ] } ] }, { "name": "CT HEAD/BRAIN W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "70450", "billing_code_type_version": "2020", "description": "CT HEAD/BRAIN W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21", "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 172.0, "npi": [ 1003841875, 1164049011, 1245491505, 1275616849, 1306466412, 1326274291, 1417272667, 1578865721, 1679684872, 1700166733, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 219.0, "npi": [ 1013446798, 1134104334, 1396233565, 1447235643, 1477711919, 1578725701, 1629258066, 1669450284, 1720265861, 1821557141, 1871561803, 1912439159, 1942650122, 1972583805 ] } ] }, { "allowed_amount": 103.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 103.0, "npi": [ 1912439159 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 733.0, "npi": [ 1033379151, 1043536139, 1063498400, 1104058213, 1114956695, 1114994738, 1134101116, 1134353378, 1144410283, 1184937021, 1215931027, 1235156894, 1245421692, 1255316873, 1295144137, 1306865639, 1336332295, 1386976207, 1396751426, 1396761748, 1396969945, 1447613005, 1487636445, 1508865510, 1518935022, 1538167804, 1558694984, 1588710487, 1669521803, 1679553671, 1679736284, 1689601502, 1730186719, 1740454412, 1760514574, 1770534869, 1790737328, 1790760064, 1801186689, 1851778542, 1881973550, 1891839718, 1891955803, 1902192438, 1932170131, 1952359697, 1962499418, 1972639615, 1982641916, 1992768352 ] } ] }, { "allowed_amount": 67.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 733.0, "npi": [ 1124002217 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 124.0, "npi": [ 1043298417, 1083979710, 1851424899 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 183.0, "npi": [ 1063533149, 1134489438 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.64, "npi": [ 1114239001, 1215926274, 1710060595 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 189.0, "npi": [ 1114958741, 1194969204 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 142.0, "npi": [ 1144218017, 1164819017, 1275996316, 1356787840, 1437208246, 1457748527, 1467974766, 1609226851, 1760798565, 1881198273 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 205.0, "npi": [ 1144218017, 1295146108, 1730441593 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 76.0, "npi": [ 1164410916 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 117.0, "npi": [ 1174513253, 1497866214, 1538285366, 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 196.0, "npi": [ 1174631410, 1447756960, 1669401196, 1841463627, 1902168149, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 140.0, "npi": [ 1184831471, 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "611121623" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 171.0, "npi": [ 1225032758 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 152.0, "npi": [ 1265791784, 1295199115, 1760461313, 1790168540, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 193.0, "npi": [ 1265791784, 1316925654, 1376809095, 1386050250, 1457795296, 1538497300, 1669675658, 1760461313, 1790168540, 1811293525, 1831177179, 1851633572, 1922050756, 1962456012 ] } ] } ] }, { "tin": { "type": "ein", "value": "470587199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1265845192 ] } ] } ] }, { "tin": { "type": "ein", "value": "591226176" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 733.0, "npi": [ 1275500225 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 191.0, "npi": [ 1316920069 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 122.0, "npi": [ 1356589980 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 271.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 190.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "621203441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 152.0, "npi": [ 1447756572 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1467430082, 1740454412 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 99.0, "npi": [ 1639150741 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 387.16, "npi": [ 1528295599, 1740374925, 1750349676, 1972577336 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 733.0, "npi": [ 1548323173 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 561.0, "npi": [ 1609221662 ] } ] } ] }, { "tin": { "type": "ein", "value": "721367427" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 185.0, "npi": [ 1629364369 ] } ] } ] }, { "tin": { "type": "ein", "value": "820945402" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 197.2, "npi": [ 1649411422 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1730365156 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 498.0, "npi": [ 1750812400 ] } ] } ] }, { "tin": { "type": "ein", "value": "470376487" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 233.87, "npi": [ 1821210220 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 113.19, "npi": [ 1831543487, 1851654263 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 189.0, "npi": [ 1871625178 ] } ] } ] }, { "tin": { "type": "ein", "value": "820549580" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 113.0, "npi": [ 1952571549 ] } ] } ] } ] }, { "name": "CT LUMBAR SPINE W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "72131", "billing_code_type_version": "2020", "description": "CT LUMBAR SPINE W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 264.0, "npi": [ 1043265937, 1386645828, 1891765061, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 715.0, "npi": [ 1053384644, 1144410283, 1538167804, 1699928150, 1700838620, 1770534869, 1861455271 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 179.0, "npi": [ 1295199115 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 258.0, "npi": [ 1295911808, 1821557141 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 170.0, "npi": [ 1295946564 ] } ] } ] }, { "tin": { "type": "ein", "value": "431598353" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 139.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 139.0, "npi": [ 1326032301 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 391.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 227.0, "npi": [ 1376809095, 1962456012 ] } ] } ] }, { "tin": { "type": "ein", "value": "310745303" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 715.0, "npi": [ 1396746236 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 142.0, "npi": [ 1427361773 ] } ] } ] }, { "tin": { "type": "ein", "value": "991380793" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 227.0, "npi": [ 1487890117 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 140.75, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1871625178 ] } ] } ] } ] }, { "name": "Culture, bacterial; quantitative colony count, urine", "billing_code_type": "CPT", "billing_code": "87086", "billing_code_type_version": "2020", "description": "Culture, bacterial; quantitative colony count, urine", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 125.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 12.11, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 20.0, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 8.07, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 24.21, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 79.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621687140" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 17.05, "npi": [ 1487657573 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 25.17, "npi": [ 1639264575 ] }, { "billed_charge": 26.37, "npi": [ 1639264575 ] }, { "billed_charge": 37.75, "npi": [ 1639264575 ] }, { "billed_charge": 39.6, "npi": [ 1639264575 ] }, { "billed_charge": 52.8, "npi": [ 1639264575 ] }, { "billed_charge": 75.6, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "621729316" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.65, "providers": [ { "billed_charge": 19.77, "npi": [ 1831135896 ] } ] } ] } ] }, { "name": "Cyanocobalamin (Vitamin B-12);", "billing_code_type": "CPT", "billing_code": "82607", "billing_code_type_version": "2020", "description": "Cyanocobalamin (Vitamin B-12);", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 125.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 120.64, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 50.0, "npi": [ 1114161601 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 22.62, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 45.24, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 45.24, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 82.72, "npi": [ 1174882948 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 140.25, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 90.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 45.24, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 50.53, "npi": [ 1639264575 ] }, { "billed_charge": 103.14, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 37.7, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.56, "providers": [ { "billed_charge": 111.3, "npi": [ 1801883780, 1851388748 ] }, { "billed_charge": 42.85, "npi": [ 1821565045 ] } ] } ] } ] }, { "name": "Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision", "billing_code_type": "CPT", "billing_code": "88175", "billing_code_type_version": "2020", "description": "Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010709650" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.63, "providers": [ { "billed_charge": 109.2, "npi": [ 1023216975 ] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.63, "providers": [ { "billed_charge": 94.0, "npi": [ 1104973080, 1366964397 ] } ] }, { "allowed_amount": 46.57, "providers": [ { "billed_charge": 94.0, "npi": [ 1821206962 ] } ] } ] } ] }, { "name": "CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN", "billing_code_type": "CPT", "billing_code": "88141", "billing_code_type_version": "2020", "description": "CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.29, "providers": [ { "billed_charge": 71.99, "npi": [ 1821206962 ] } ] }, { "allowed_amount": 78.58, "providers": [ { "billed_charge": 143.98, "npi": [ 1821206962 ] } ] } ] } ] }, { "name": "DETOX/SEMI-PVT", "billing_code_type": "RC", "billing_code": "0126", "billing_code_type_version": "2020", "description": "Room & Board-Semiprivate (Two-Beds)-Detoxification", "allowed_amounts": [ { "tin": { "type": "ein", "value": "993440627" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 664.0, "providers": [ { "billed_charge": 9800.0, "npi": [ 1033930839 ] } ] } ] }, { "tin": { "type": "ein", "value": "992321824" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 664.0, "providers": [ { "billed_charge": 9700.0, "npi": [ 1245031616 ] } ] } ] }, { "tin": { "type": "ein", "value": "621400167" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 4648.0, "providers": [ { "billed_charge": 18550.0, "npi": [ 1558479758 ] } ] } ] }, { "tin": { "type": "ein", "value": "850667698" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 664.0, "providers": [ { "billed_charge": 3995.0, "npi": [ 1649914813 ] } ] } ] }, { "tin": { "type": "ein", "value": "621736983" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 4648.0, "providers": [ { "billed_charge": 31871.0, "npi": [ 1760436810 ] } ] } ] }, { "tin": { "type": "ein", "value": "811711136" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 3320.0, "providers": [ { "billed_charge": 20000.0, "npi": [ 1811442312 ] } ] }, { "allowed_amount": 3984.0, "providers": [ { "billed_charge": 24000.0, "npi": [ 1811442312 ] } ] }, { "allowed_amount": 4648.0, "providers": [ { "billed_charge": 28000.0, "npi": [ 1811442312 ] } ] } ] }, { "tin": { "type": "ein", "value": "991147960" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 664.0, "providers": [ { "billed_charge": 9500.0, "npi": [ 1962269662 ] } ] } ] }, { "tin": { "type": "ein", "value": "992590575" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 664.0, "providers": [ { "billed_charge": 9500.0, "npi": [ 1962297333 ] } ] } ] } ] }, { "name": "DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST", "billing_code_type": "CPT", "billing_code": "71260", "billing_code_type_version": "2020", "description": "DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 249.0, "npi": [ 1003841875, 1245491505, 1740488527 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 897.0, "npi": [ 1053384644, 1063498400, 1114903408, 1134101116, 1336332295, 1396761748, 1417113002, 1417117268, 1538167804, 1548231541, 1710208988, 1760434955, 1760598924, 1902192438, 1932428455, 1962499418 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 154.35, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 154.35, "npi": [ 1114131588, 1851654263 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 276.0, "npi": [ 1144789280, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 897.0, "npi": [ 1215904677 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 266.0, "npi": [ 1245573997, 1457795296 ] } ] } ] }, { "tin": { "type": "ein", "value": "620859738" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 315.0, "npi": [ 1336142520 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 463.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "582091280" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 386.39, "npi": [ 1366490617 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 268.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "610945743" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 246.0, "npi": [ 1457889560 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 320.0, "npi": [ 1477711919, 1841482478 ] } ] } ] }, { "tin": { "type": "ein", "value": "991380793" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 266.0, "npi": [ 1487890117 ] } ] } ] }, { "tin": { "type": "ein", "value": "591226176" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 897.0, "npi": [ 1518941251 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 258.0, "npi": [ 1548497639 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 230.0, "npi": [ 1639497282 ] } ] } ] }, { "tin": { "type": "ein", "value": "453597157" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 272.0, "npi": [ 1801970744 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.93, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 218.0, "npi": [ 1871625178 ] } ] } ] } ] }, { "name": "DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST", "billing_code_type": "CPT", "billing_code": "71250", "billing_code_type_version": "2020", "description": "DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.89, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 233.0, "npi": [ 1003841875, 1275616849, 1326274291, 1578865721, 1740488527, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.89, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 768.0, "npi": [ 1134101116, 1184718272, 1184937021, 1396021648, 1518935022, 1538167804, 1881973550, 1952359697 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.89, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 247.0, "npi": [ 1275512956, 1346655982, 1457795296 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.89, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 189.0, "npi": [ 1366427569 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 141.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 141.0, "npi": [ 1578677647 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.89, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 275.0, "npi": [ 1598010910 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 142.14, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 142.14, "npi": [ 1831543487 ] } ] } ] } ] }, { "name": "DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI", "billing_code_type": "CPT", "billing_code": "77066", "billing_code_type_version": "2020", "description": "DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 429.0, "npi": [ 1083696561, 1316267404 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 179.0, "npi": [ 1114970829, 1124205356, 1346668191, 1447436894 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 197.0, "npi": [ 1700166733, 1811955255 ] } ] } ] }, { "tin": { "type": "ein", "value": "462023006" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 193.0, "npi": [ 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 232.0, "npi": [ 1922084748 ] } ] } ] } ] }, { "name": "Digital breast tomosynthesis; bilateral", "billing_code_type": "CPT", "billing_code": "77062", "billing_code_type_version": "2020", "description": "Digital breast tomosynthesis; bilateral", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.47, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 304.0, "npi": [ 1083696561, 1316267404 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.47, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 189.0, "npi": [ 1114970829, 1124205356, 1346668191, 1447436894 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.47, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 89.0, "npi": [ 1700166733, 1811955255 ] } ] } ] }, { "tin": { "type": "ein", "value": "462023006" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.47, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.47, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1922084748 ] } ] } ] } ] }, { "name": "DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed", "billing_code_type": "CPT", "billing_code": "81161", "billing_code_type_version": "2020", "description": "DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis, and duplication analysis, if performed", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 195.3, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 250.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "DRUG TEST DEFINITV DR ID METH P DAY 1-7 DRUG CL", "billing_code_type": "HCPCS", "billing_code": "G0480", "billing_code_type_version": "2020", "description": "DRUG TEST DEFINITV DR ID METH P DAY 1-7 DRUG CL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "462993772" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 230.0, "npi": [ 1023439627 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 2988.1, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "273012584" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 115.0, "npi": [ 1104255215 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 171.65, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 228.86, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "474583693" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 229.0, "npi": [ 1225413099 ] } ] } ] }, { "tin": { "type": "ein", "value": "453782366" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 401.0, "npi": [ 1255608469 ] } ] } ] }, { "tin": { "type": "ein", "value": "920470457" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 2199.0, "npi": [ 1497472401 ] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 1797.31, "npi": [ 1508499393 ] } ] } ] }, { "tin": { "type": "ein", "value": "330289164" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 1797.31, "npi": [ 1518039486 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 137.32, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "871038632" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 172.5, "npi": [ 1689340267 ] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 176.0, "npi": [ 1730466590 ] } ] } ] }, { "tin": { "type": "ein", "value": "912180910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 114.43, "npi": [ 1821092297 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 779.86, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.89, "providers": [ { "billed_charge": 143.04, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "DRUG TEST DEFINITV DR ID METH P DAY 15-21 DR CL", "billing_code_type": "HCPCS", "billing_code": "G0482", "billing_code_type_version": "2020", "description": "DRUG TEST DEFINITV DR ID METH P DAY 15-21 DR CL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "273012584" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 200.0, "npi": [ 1104255215 ] } ] } ] }, { "tin": { "type": "ein", "value": "474583693" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 397.0, "npi": [ 1225413099 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 500.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "261565558" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 405.0, "npi": [ 1497933162 ] } ] } ] }, { "tin": { "type": "ein", "value": "474756381" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 397.48, "npi": [ 1518324300 ] } ] } ] }, { "tin": { "type": "ein", "value": "813168134" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 298.11, "npi": [ 1639621659 ] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 304.0, "npi": [ 1730466590 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 597.0, "npi": [ 1962266890 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 183.91, "providers": [ { "billed_charge": 248.43, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "DRUG TEST DEFINITV DR ID METH P DAY 8-14 DRUG CL", "billing_code_type": "HCPCS", "billing_code": "G0481", "billing_code_type_version": "2020", "description": "DRUG TEST DEFINITV DR ID METH P DAY 8-14 DRUG CL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "843172409" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 2761.18, "npi": [ 1003437500 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 313.18, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "474583693" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 313.0, "npi": [ 1225413099 ] } ] } ] }, { "tin": { "type": "ein", "value": "813115799" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 1780.9, "npi": [ 1306381694 ] } ] } ] }, { "tin": { "type": "ein", "value": "261565558" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 320.0, "npi": [ 1497933162 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 187.91, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "871038632" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 235.5, "npi": [ 1689340267 ] } ] } ] }, { "tin": { "type": "ein", "value": "833301652" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 500.0, "npi": [ 1801449327 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 195.74, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "611721663" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 144.89, "providers": [ { "billed_charge": 200.02, "npi": [ 1982023305 ] } ] } ] } ] }, { "name": "Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry eit", "billing_code_type": "CPT", "billing_code": "80307", "billing_code_type_version": "2020", "description": "Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry eit", "allowed_amounts": [ { "tin": { "type": "ein", "value": "843172409" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 4198.4, "npi": [ 1003437500 ] } ] } ] }, { "tin": { "type": "ein", "value": "462993772" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 125.0, "npi": [ 1023439627 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 3295.93, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "273012584" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 65.0, "providers": [ { "billed_charge": 65.0, "npi": [ 1104255215 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 93.21, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "932922559" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 124.28, "npi": [ 1124890934 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 124.28, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "474583693" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 124.0, "npi": [ 1225413099 ] } ] } ] }, { "tin": { "type": "ein", "value": "453782366" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 226.0, "npi": [ 1255608469 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 200.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "813115799" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 2485.2, "npi": [ 1306381694 ] } ] } ] }, { "tin": { "type": "ein", "value": "465081856" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 310.7, "npi": [ 1336556745 ] } ] } ] }, { "tin": { "type": "ein", "value": "273440467" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 107.75, "npi": [ 1447592308 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 106.62, "npi": [ 1487639381 ] }, { "billed_charge": 107.81, "npi": [ 1487639381 ] }, { "billed_charge": 115.45, "npi": [ 1487639381 ] }, { "billed_charge": 117.16, "npi": [ 1487639381 ] }, { "billed_charge": 122.09, "npi": [ 1487639381 ] }, { "billed_charge": 126.61, "npi": [ 1487639381 ] }, { "billed_charge": 128.83, "npi": [ 1487639381 ] }, { "billed_charge": 132.54, "npi": [ 1487639381 ] }, { "billed_charge": 133.6, "npi": [ 1487639381 ] }, { "billed_charge": 165.9, "npi": [ 1487639381 ] }, { "billed_charge": 176.32, "npi": [ 1487639381 ] }, { "billed_charge": 178.6, "npi": [ 1487639381 ] }, { "billed_charge": 181.93, "npi": [ 1487639381 ] }, { "billed_charge": 184.16, "npi": [ 1487639381 ] }, { "billed_charge": 205.85, "npi": [ 1487639381 ] }, { "billed_charge": 214.38, "npi": [ 1487639381 ] }, { "billed_charge": 215.94, "npi": [ 1487639381 ] }, { "billed_charge": 224.88, "npi": [ 1487639381 ] }, { "billed_charge": 232.49, "npi": [ 1487639381 ] }, { "billed_charge": 241.82, "npi": [ 1487639381 ] }, { "billed_charge": 242.84, "npi": [ 1487639381 ] }, { "billed_charge": 252.58, "npi": [ 1487639381 ] }, { "billed_charge": 256.86, "npi": [ 1487639381 ] }, { "billed_charge": 289.8, "npi": [ 1487639381 ] }, { "billed_charge": 359.1, "npi": [ 1487639381 ] }, { "billed_charge": 446.25, "npi": [ 1487639381 ] } ] } ] }, { "tin": { "type": "ein", "value": "920470457" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 999.0, "npi": [ 1497472401 ] } ] } ] }, { "tin": { "type": "ein", "value": "261565558" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 124.0, "npi": [ 1497933162 ] } ] } ] }, { "tin": { "type": "ein", "value": "843045583" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 4275.28, "npi": [ 1508499393 ] } ] } ] }, { "tin": { "type": "ein", "value": "330289164" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 4275.28, "npi": [ 1518039486 ] } ] } ] }, { "tin": { "type": "ein", "value": "474756381" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 186.23, "npi": [ 1518324300 ] } ] } ] }, { "tin": { "type": "ein", "value": "460629729" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 108.75, "providers": [ { "billed_charge": 500.0, "npi": [ 1528055027 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 74.57, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 97.71, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "453717894" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 99.0, "npi": [ 1730466590 ] } ] } ] }, { "tin": { "type": "ein", "value": "833301652" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 300.0, "npi": [ 1801449327 ] } ] } ] }, { "tin": { "type": "ein", "value": "912180910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 62.14, "providers": [ { "billed_charge": 62.14, "npi": [ 1821092297 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 125.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 2277.2, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 119.22, "npi": [ 1932166386 ] }, { "billed_charge": 120.12, "npi": [ 1932166386 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 77.68, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "DRUG TST DEFINITV DR ID METH P DAY 22/MORE DR CL", "billing_code_type": "HCPCS", "billing_code": "G0483", "billing_code_type_version": "2020", "description": "DRUG TST DEFINITV DR ID METH P DAY 22/MORE DR CL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "993413349" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 1500.0, "npi": [ 1083427272 ] } ] } ] }, { "tin": { "type": "ein", "value": "932922559" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 493.84, "npi": [ 1124890934 ] } ] } ] }, { "tin": { "type": "ein", "value": "474583693" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 494.0, "npi": [ 1225413099 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 600.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "465081856" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 1234.6, "npi": [ 1336556745 ] } ] } ] }, { "tin": { "type": "ein", "value": "273440467" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 370.38, "npi": [ 1447592308 ] } ] } ] }, { "tin": { "type": "ein", "value": "261565558" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 499.0, "npi": [ 1497933162 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 296.3, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 370.38, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 495.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "611721663" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 68.81, "providers": [ { "billed_charge": 300.03, "npi": [ 1982023305 ] } ] } ] } ] }, { "name": "DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY", "billing_code_type": "CPT", "billing_code": "93971", "billing_code_type_version": "2020", "description": "DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 417.0, "npi": [ 1023541430, 1538167804, 1710431044, 1770534869 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 111.0, "npi": [ 1043298417 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 92.0, "npi": [ 1326274291, 1417272667, 1679684872, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 116.0, "npi": [ 1477711919, 1598949570 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 98.0, "npi": [ 1568470961 ] } ] } ] } ] }, { "name": "DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL", "billing_code_type": "CPT", "billing_code": "77080", "billing_code_type_version": "2020", "description": "DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 61.0, "npi": [ 1003841875, 1053304428, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 16.03, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1215900048, 1740911163, 1982018057 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 49.0, "npi": [ 1245215433 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1285711671 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 194.0, "npi": [ 1396108502, 1417117268, 1750599742, 1891839718 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1477816551 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1598793028, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "581839412" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1679709299 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 26.94, "npi": [ 1831543487 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 44.0, "npi": [ 1942229299 ] } ] } ] } ] }, { "name": "ECG ROUTINE ECG W/LEAST 12 LDS W/I&R", "billing_code_type": "CPT", "billing_code": "93000", "billing_code_type_version": "2020", "description": "ECG ROUTINE ECG W/LEAST 12 LDS W/I&R", "allowed_amounts": [ { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.41, "providers": [ { "billed_charge": 124.0, "npi": [ 1174596324 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.41, "providers": [ { "billed_charge": 90.0, "npi": [ 1700831047 ] } ] } ] }, { "tin": { "type": "ein", "value": "473501366" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.41, "providers": [ { "billed_charge": 75.0, "npi": [ 1861998528 ] } ] } ] } ] }, { "name": "ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D", "billing_code_type": "CPT", "billing_code": "93306", "billing_code_type_version": "2020", "description": "ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 373.0, "npi": [ 1013924760, 1053331215, 1144316795, 1205256609, 1710270079, 1730392838 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 262.0, "npi": [ 1043659840, 1851618565 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 205.0, "npi": [ 1093009425, 1104237908, 1588167365, 1669698510, 1932561909 ] } ] } ] }, { "tin": { "type": "ein", "value": "630925859" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 205.0, "npi": [ 1124017728 ] } ] } ] }, { "tin": { "type": "ein", "value": "412279037" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1144225293, 1518304534 ] } ] }, { "allowed_amount": 170.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1144225293 ] } ] } ] }, { "tin": { "type": "ein", "value": "582563008" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 300.0, "npi": [ 1154777167 ] } ] } ] }, { "tin": { "type": "ein", "value": "582234927" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 264.0, "npi": [ 1205126851 ] } ] } ] }, { "tin": { "type": "ein", "value": "581311015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 300.0, "npi": [ 1215990098 ] } ] } ] }, { "tin": { "type": "ein", "value": "582307485" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 325.0, "npi": [ 1245469519, 1972547651 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1346415353 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 203.0, "npi": [ 1366629644, 1740523778, 1902231327 ] }, { "billed_charge": 373.0, "npi": [ 1568994341 ] } ] } ] }, { "tin": { "type": "ein", "value": "330734849" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 106.0, "npi": [ 1396107520 ] } ] } ] }, { "tin": { "type": "ein", "value": "631205990" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 360.0, "npi": [ 1649651217 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 225.0, "npi": [ 1679991632, 1952301830, 1972881639 ] } ] } ] }, { "tin": { "type": "ein", "value": "812971996" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 390.0, "npi": [ 1699746552 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 361.36, "npi": [ 1700194966 ] } ] } ] }, { "tin": { "type": "ein", "value": "820927461" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 405.0, "npi": [ 1700838273 ] } ] } ] }, { "tin": { "type": "ein", "value": "271872248" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1710914247 ] }, { "billed_charge": 210.0, "npi": [ 1710914247 ] } ] }, { "allowed_amount": 170.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1962856674 ] }, { "billed_charge": 210.0, "npi": [ 1962856674 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 178.0, "npi": [ 1720308851 ] } ] } ] }, { "tin": { "type": "ein", "value": "760841500" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1760616601 ] } ] }, { "allowed_amount": 170.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1760616601 ] } ] } ] }, { "tin": { "type": "ein", "value": "264045534" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 170.68, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 221.0, "npi": [ 1760772990 ] } ] } ] }, { "tin": { "type": "ein", "value": "581990255" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 445.0, "npi": [ 1851338727 ] } ] } ] }, { "tin": { "type": "ein", "value": "582629795" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 271.0, "npi": [ 1851719116 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 209.0, "npi": [ 1861938383 ] } ] } ] }, { "tin": { "type": "ein", "value": "473501366" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 504.0, "npi": [ 1861998528 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 188.0, "npi": [ 1871579888 ] } ] } ] }, { "tin": { "type": "ein", "value": "271198208" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 182.0, "npi": [ 1902800972 ] } ] } ] }, { "tin": { "type": "ein", "value": "453597157" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 339.0, "npi": [ 1912254624 ] } ] } ] }, { "tin": { "type": "ein", "value": "272239880" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1912282948 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.17, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 225.0, "npi": [ 1972650794 ] } ] } ] } ] }, { "name": "ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS", "billing_code_type": "CPT", "billing_code": "33948", "billing_code_type_version": "2020", "description": "ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 382.2, "providers": [ { "billed_charge": 1462.0, "npi": [ 1093167066 ] } ] }, { "allowed_amount": 628.37, "providers": [ { "billed_charge": 1462.0, "npi": [ 1124550272, 1639147077 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 382.2, "providers": [ { "billed_charge": 709.0, "npi": [ 1669698510, 1801089842, 1801910393 ] } ] } ] } ] }, { "name": "ELASTASE PANCREATIC FECAL QUAL/SEMI-QUANTITATIVE", "billing_code_type": "CPT", "billing_code": "82656", "billing_code_type_version": "2020", "description": "ELASTASE PANCREATIC FECAL QUAL/SEMI-QUANTITATIVE", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 8.07, "providers": [ { "billed_charge": 21.91, "npi": [ 1497423198 ] } ] } ] } ] }, { "name": "Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only", "billing_code_type": "CPT", "billing_code": "93010", "billing_code_type_version": "2020", "description": "Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only", "allowed_amounts": [ { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 69.0, "npi": [ 1003109554, 1003854738, 1164772372, 1235768342, 1295762169, 1376574863, 1467437913, 1679790612, 1912906041 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 111.0, "npi": [ 1003357864, 1154731388, 1285951632, 1336643717, 1447781638, 1528322112, 1841425824, 1932603305 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 79.0, "npi": [ 1003499070, 1033571799, 1073831871, 1104494897, 1386193803, 1396725453, 1477068575, 1497763163, 1598021867, 1598942146, 1639622889, 1780209049, 1902162381, 1972546794, 1982680310 ] }, { "billed_charge": 78.0, "npi": [ 1184464208 ] } ] }, { "allowed_amount": 39.5, "providers": [ { "billed_charge": 158.0, "npi": [ 1902162381 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1003873860, 1346875564, 1568048973, 1710320221 ] } ] } ] }, { "tin": { "type": "ein", "value": "824329577" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1013924695, 1326089475, 1366651507, 1689860355 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 46.0, "npi": [ 1013924760, 1174044457, 1255779310, 1598737421, 1689254435, 1881197671, 1952346207 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 46.0, "npi": [ 1053706051, 1376992057, 1952346207, 1982165478 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 71.0, "npi": [ 1013957844, 1043575178, 1053393892, 1164798385, 1447614391, 1518703461, 1578540340, 1891971578 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 71.0, "npi": [ 1053969782 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 32.0, "npi": [ 1023423845 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 36.0, "npi": [ 1376545053 ] }, { "billed_charge": 32.0, "npi": [ 1598340473 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 40.0, "npi": [ 1023580420, 1316143118, 1407539398, 1457881260, 1649282575 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 40.0, "npi": [ 1457881260 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 87.0, "npi": [ 1033571799, 1063478139, 1184654014 ] } ] } ] }, { "tin": { "type": "ein", "value": "991100562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 69.0, "npi": [ 1033678909, 1124442181, 1124542295, 1144739533, 1154070001, 1194266122, 1275257388, 1275646747, 1285444596, 1336319342, 1356345136, 1396254207, 1396561817, 1457474363, 1457712051, 1508330739, 1508491812, 1568611390, 1578055323, 1598858086, 1639480684, 1669600235, 1679546105, 1689860355, 1720407661, 1740824861, 1750479408, 1750817748, 1750900866, 1760917587, 1780078907, 1801464276, 1841752029, 1861788903, 1871506915, 1871682443 ] } ] } ] }, { "tin": { "type": "ein", "value": "561844262" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 26.0, "npi": [ 1043620719 ] } ] } ] }, { "tin": { "type": "ein", "value": "815256430" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1053375386 ] } ] } ] }, { "tin": { "type": "ein", "value": "470376487" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 40.92, "npi": [ 1053391912 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 75.0, "npi": [ 1053737692, 1114968518, 1174895007, 1184666265, 1235606138, 1275221483, 1346685856, 1407266968, 1417705450, 1467861310, 1477146678, 1487357109, 1528332939, 1538856448, 1609429570, 1609626712, 1629566385, 1629608492, 1659683175, 1740992239, 1891257234, 1922636919, 1942594429, 1962804104 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 75.0, "npi": [ 1184666265, 1609429570, 1629566385 ] } ] }, { "allowed_amount": 39.5, "providers": [ { "billed_charge": 150.0, "npi": [ 1235606138, 1407266968 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1053894873, 1174543276, 1265167431, 1386890697, 1427146125, 1437193927, 1538798459, 1548958648, 1629518014, 1689752636, 1972570943 ] } ] } ] }, { "tin": { "type": "ein", "value": "824486211" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 174.0, "npi": [ 1063031995, 1205375839, 1285253369, 1396164141, 1538395892 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 70.0, "npi": [ 1063107845, 1871315713, 1962634766 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1063708006, 1457881260, 1588700017, 1659383628, 1659422616, 1740209154, 1831776764, 1841427374, 1881089993, 1912947326, 1992267892 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1063917615, 1215190772, 1316044951, 1346621984, 1508205212, 1699160986, 1821627225, 1902003932, 1992267678 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 86.0, "npi": [ 1073143533, 1083104350, 1114668415, 1366566762, 1396077756, 1588602189, 1629023924, 1881089993, 1912134180, 1962962241 ] }, { "billed_charge": 79.0, "npi": [ 1164059473, 1184005910, 1447286372, 1457769218, 1619959103, 1629607809, 1700876695 ] } ] } ] }, { "tin": { "type": "ein", "value": "465660425" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1083627442 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1083966709, 1376635334, 1568412146 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 30.0, "npi": [ 1083971451, 1104207125, 1336602325, 1396348280, 1396589420, 1417488925, 1841170669, 1972080364 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 25.0, "npi": [ 1093009425, 1336433143, 1356358741, 1407114184, 1932561909 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 25.0, "npi": [ 1669698510, 1932561909 ] } ] } ] }, { "tin": { "type": "ein", "value": "581871713" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 150.0, "npi": [ 1093930208 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 150.0, "npi": [ 1093930208 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 111.0, "npi": [ 1104972207, 1720377237, 1730374166, 1831417278 ] } ] }, { "allowed_amount": 39.5, "providers": [ { "billed_charge": 222.0, "npi": [ 1629042999 ] } ] } ] }, { "tin": { "type": "ein", "value": "760841500" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 28.0, "npi": [ 1124035571, 1760616601 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 28.0, "npi": [ 1316359508, 1760616601 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1124420856, 1265491294, 1538138672, 1649278334, 1750159588 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 78.0, "npi": [ 1124654157, 1194959916, 1326545823, 1669406260, 1720440555, 1770214066, 1811428188, 1871067959, 1912938457, 1972965390 ] } ] } ] }, { "tin": { "type": "ein", "value": "591835473" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 71.4, "npi": [ 1134324056, 1497288369 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 30.0, "npi": [ 1134625726 ] } ] } ] }, { "tin": { "type": "ein", "value": "811558273" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1134869217, 1235344367, 1528297942 ] } ] } ] }, { "tin": { "type": "ein", "value": "823898488" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 23.0, "npi": [ 1144228966 ] } ] } ] }, { "tin": { "type": "ein", "value": "030446664" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 30.0, "npi": [ 1144307786 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 122.0, "npi": [ 1144535097, 1710974977 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 122.0, "npi": [ 1649708157 ] } ] } ] }, { "tin": { "type": "ein", "value": "621179254" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 53.0, "npi": [ 1144756800, 1982900437 ] } ] } ] }, { "tin": { "type": "ein", "value": "561763695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 49.0, "npi": [ 1154672426 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 56.0, "npi": [ 1174151591, 1205125960, 1285611053, 1336137371, 1336636042, 1508253022, 1578684437, 1578732335, 1730355785, 1750479408 ] } ] } ] }, { "tin": { "type": "ein", "value": "651057394" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 114.0, "npi": [ 1174542708 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 75.0, "npi": [ 1174569016, 1528164373 ] } ] } ] }, { "tin": { "type": "ein", "value": "581973570" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 31.0, "npi": [ 1194763789 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 31.0, "npi": [ 1760542047 ] } ] } ] }, { "tin": { "type": "ein", "value": "582234927" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 33.0, "npi": [ 1205126851 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 33.0, "npi": [ 1205126851, 1336357060 ] } ] } ] }, { "tin": { "type": "ein", "value": "843707279" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 30.0, "npi": [ 1205891397, 1891180352 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 30.0, "npi": [ 1881632099 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 25.85, "npi": [ 1215039714, 1255303897, 1386670073, 1932101904 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 31.0, "npi": [ 1215922299, 1487882429, 1811980055, 1831151174 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1215945969, 1386723310, 1528169190, 1578910378 ] } ] } ] }, { "tin": { "type": "ein", "value": "874714839" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 30.0, "npi": [ 1215990098, 1316947484, 1326250036, 1366470650, 1548297195 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 30.0, "npi": [ 1316947484, 1548297195 ] } ] } ] }, { "tin": { "type": "ein", "value": "582102607" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 68.0, "npi": [ 1225026255 ] } ] } ] }, { "tin": { "type": "ein", "value": "471988466" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 83.0, "npi": [ 1245685205, 1578925533 ] } ] } ] }, { "tin": { "type": "ein", "value": "272097600" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 21.0, "npi": [ 1255728747 ] } ] } ] }, { "tin": { "type": "ein", "value": "823859069" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1265655625 ] } ] } ] }, { "tin": { "type": "ein", "value": "580607088" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 97.0, "npi": [ 1295361145 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 97.0, "npi": [ 1295361145 ] } ] }, { "allowed_amount": 39.5, "providers": [ { "billed_charge": 194.0, "npi": [ 1295361145 ] } ] }, { "allowed_amount": 59.25, "providers": [ { "billed_charge": 291.0, "npi": [ 1295361145 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 36.0, "npi": [ 1295745149 ] } ] } ] }, { "tin": { "type": "ein", "value": "570935917" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 78.0, "npi": [ 1295990943 ] } ] } ] }, { "tin": { "type": "ein", "value": "260593928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 35.0, "npi": [ 1316961188 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 30.0, "npi": [ 1336140904, 1972881639 ] } ] } ] }, { "tin": { "type": "ein", "value": "232730785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 18.0, "providers": [ { "billed_charge": 18.0, "npi": [ 1346471596 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 15.6, "providers": [ { "billed_charge": 15.6, "npi": [ 1356760763, 1992966360 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 44.8, "npi": [ 1598752412 ] } ] } ] }, { "tin": { "type": "ein", "value": "581600356" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 61.0, "npi": [ 1386999225 ] } ] } ] }, { "tin": { "type": "ein", "value": "800639566" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 28.0, "npi": [ 1417263450 ] } ] } ] }, { "tin": { "type": "ein", "value": "464319695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 56.0, "npi": [ 1417983636 ] } ] } ] }, { "tin": { "type": "ein", "value": "994936877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 67.2, "npi": [ 1417987041 ] } ] } ] }, { "tin": { "type": "ein", "value": "475329008" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 30.0, "npi": [ 1457518813 ] } ] } ] }, { "tin": { "type": "ein", "value": "920101761" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 128.0, "npi": [ 1487920211, 1780720599 ] } ] } ] }, { "tin": { "type": "ein", "value": "831132382" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1508509860 ] } ] } ] }, { "tin": { "type": "ein", "value": "451846825" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 111.0, "npi": [ 1528322112 ] } ] } ] }, { "tin": { "type": "ein", "value": "680673354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 17.57, "providers": [ { "billed_charge": 17.57, "npi": [ 1558724401, 1699933846 ] } ] } ] }, { "tin": { "type": "ein", "value": "883514060" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 117.0, "npi": [ 1568049898, 1740869874, 1801359922, 1932355047 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 22.0, "npi": [ 1568994341 ] } ] } ] }, { "tin": { "type": "ein", "value": "620532345" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 5.71, "providers": [ { "billed_charge": 29.0, "npi": [ 1578632550 ] } ] } ] }, { "tin": { "type": "ein", "value": "411722554" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 73.0, "npi": [ 1578827671 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 34.0, "npi": [ 1588640643 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 46.0, "npi": [ 1588926588, 1699194597, 1790739928 ] } ] }, { "allowed_amount": 14.28, "providers": [ { "billed_charge": 46.0, "npi": [ 1972160547 ] } ] } ] }, { "tin": { "type": "ein", "value": "462537433" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 60.0, "npi": [ 1619380003 ] } ] } ] }, { "tin": { "type": "ein", "value": "646010232" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 72.7, "npi": [ 1649380536 ] } ] } ] }, { "tin": { "type": "ein", "value": "452765042" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1699010157, 1750159588, 1861631061 ] } ] } ] }, { "tin": { "type": "ein", "value": "911911869" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 38.0, "npi": [ 1700825817, 1881679363 ] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 75.0, "npi": [ 1710091426 ] } ] } ] }, { "tin": { "type": "ein", "value": "650622859" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 83.0, "npi": [ 1710113634 ] } ] } ] }, { "tin": { "type": "ein", "value": "462354804" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 34.0, "npi": [ 1720307853, 1972090116 ] } ] } ] }, { "tin": { "type": "ein", "value": "880687924" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1780250464 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 22.0, "npi": [ 1801281829, 1871579888 ] } ] } ] }, { "tin": { "type": "ein", "value": "611661781" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 58.0, "npi": [ 1801477542 ] } ] } ] }, { "tin": { "type": "ein", "value": "810584939" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 61.0, "npi": [ 1801852868 ] } ] } ] }, { "tin": { "type": "ein", "value": "593082909" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 57.0, "npi": [ 1821580986, 1922494137 ] } ] } ] }, { "tin": { "type": "ein", "value": "562398079" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 125.0, "npi": [ 1831401546 ] } ] } ] }, { "tin": { "type": "ein", "value": "264058719" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 46.0, "npi": [ 1841932076 ] } ] } ] }, { "tin": { "type": "ein", "value": "582629795" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 34.0, "npi": [ 1851719116 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 25.0, "npi": [ 1851719116 ] }, { "billed_charge": 34.0, "npi": [ 1851719116 ] } ] } ] }, { "tin": { "type": "ein", "value": "201921350" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 23.4, "npi": [ 1871502492 ] } ] } ] }, { "tin": { "type": "ein", "value": "455478172" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 62.0, "npi": [ 1912295411 ] } ] } ] }, { "tin": { "type": "ein", "value": "630739971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 26.0, "npi": [ 1922297399 ] } ] } ] }, { "tin": { "type": "ein", "value": "465034266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 86.0, "npi": [ 1962962241 ] } ] } ] }, { "tin": { "type": "ein", "value": "582307485" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 38.0, "npi": [ 1972547651 ] } ] }, { "allowed_amount": 19.75, "providers": [ { "billed_charge": 38.0, "npi": [ 1972547651 ] } ] } ] }, { "tin": { "type": "ein", "value": "710664686" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.75, "providers": [ { "billed_charge": 28.0, "npi": [ 1972659480 ] } ] } ] }, { "tin": { "type": "ein", "value": "203204949" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.28, "providers": [ { "billed_charge": 25.0, "npi": [ 1982275491 ] } ] } ] } ] }, { "name": "Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)", "billing_code_type": "CPT", "billing_code": "80051", "billing_code_type_version": "2020", "description": "Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.91, "providers": [ { "billed_charge": 157.66, "npi": [ 1245720820 ] } ] } ] } ] }, { "name": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "billing_code_type": "CPT", "billing_code": "99285", "billing_code_type_version": "2020", "description": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1488.0, "npi": [ 1003109554, 1003499070, 1003854738, 1033678909, 1043790249, 1053990788, 1124050141, 1164772372, 1184991879, 1194762625, 1205907680, 1235768342, 1285131839, 1306884374, 1346212792, 1376574863, 1457422842, 1467437913, 1598297483, 1669207601, 1679529465, 1720223415, 1720508567, 1740351113, 1740531516, 1801140769, 1871506915, 1881630515, 1912906041, 1922260066 ] }, { "billed_charge": 1482.0, "npi": [ 1679790612 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1415.0, "npi": [ 1003179946, 1013957844, 1043575178, 1053393892, 1083921274, 1164798385, 1205360476, 1316214687, 1447614391, 1548733801, 1568090116, 1578540340, 1891971578 ] } ] } ] }, { "tin": { "type": "ein", "value": "576000094" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 519.0, "npi": [ 1003250051 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1450.0, "npi": [ 1003357864, 1083713028, 1154731388, 1275851578, 1285951632, 1336643717, 1356087555, 1467035311, 1659412971, 1659557320, 1669625711, 1669729810, 1669867925, 1710993324, 1801213640, 1841425824, 1861426231, 1891227484, 1932603305, 1972967966 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1647.0, "npi": [ 1003499070, 1033571799, 1073831871, 1104494897, 1265493779, 1275552440, 1275802654, 1356629109, 1386193803, 1396725453, 1477068575, 1497763163, 1588967533, 1598021867, 1598942146, 1639622889, 1750042073, 1780209049, 1881238541, 1891895769, 1902162381, 1912947326, 1972546794, 1982680310, 1992017875 ] }, { "billed_charge": 1660.0, "npi": [ 1003862574 ] }, { "billed_charge": 1744.0, "npi": [ 1023117272, 1033206784, 1104800390, 1134272545, 1154061539, 1154770279, 1174768402, 1205179223, 1336584291, 1487092656, 1508534389, 1619165388, 1639185903, 1639594385, 1821376476, 1861719569 ] }, { "billed_charge": 1659.0, "npi": [ 1023472065, 1073297008, 1093912669, 1134507130, 1144751637, 1215468277, 1255755575, 1255794053, 1356508972, 1396179446, 1396756680, 1427404409, 1457871949, 1487092656, 1497786974, 1528168408, 1538943311, 1558536987, 1588057038, 1609221282, 1699138719, 1740235175, 1811467350, 1871938266, 1982991246 ] }, { "billed_charge": 1648.0, "npi": [ 1073782108, 1205899259, 1346507076, 1487945945, 1538691092, 1578821955, 1588084404, 1649699240, 1912163825, 1912431198 ] }, { "billed_charge": 1616.0, "npi": [ 1265623342, 1417530130 ] }, { "billed_charge": 1800.0, "npi": [ 1447823232 ] }, { "billed_charge": 1709.0, "npi": [ 1649473711 ] }, { "billed_charge": 1600.0, "npi": [ 1770800807 ] } ] } ] }, { "tin": { "type": "ein", "value": "991100562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1488.0, "npi": [ 1003499070, 1033678909, 1043790249, 1114670254, 1124442181, 1124542295, 1144739533, 1144812165, 1154070001, 1194266122, 1215599527, 1265057590, 1275257388, 1285444596, 1336319342, 1356345136, 1396254207, 1396561817, 1457474363, 1457712051, 1508330739, 1508491812, 1528097003, 1568611390, 1578055323, 1639480684, 1669600235, 1679546105, 1689860355, 1720407661, 1720471873, 1740824861, 1750479408, 1750817748, 1750900866, 1760917587, 1780078907, 1780277210, 1780970822, 1801464276, 1841752029, 1861788903, 1871506915, 1871682443, 1902919491 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1643.0, "npi": [ 1003514894 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1391.0, "npi": [ 1023294352, 1073349593, 1104182500, 1164981478, 1184664872, 1215463567, 1346858917, 1356780894, 1528094471, 1578371001, 1598488165, 1720580582, 1811255607, 1811794308, 1922628882, 1972564466, 1982874533 ] }, { "billed_charge": 1705.0, "npi": [ 1053762732 ] }, { "billed_charge": 1643.0, "npi": [ 1205356441 ] }, { "billed_charge": 1687.0, "npi": [ 1487188306 ] }, { "billed_charge": 1597.0, "npi": [ 1679511786 ] }, { "billed_charge": 1650.0, "npi": [ 1881114999 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1700.0, "npi": [ 1003565318, 1023219342, 1023657871, 1033776372, 1043306582, 1043418924, 1063751212, 1104326271, 1124689856, 1154704823, 1164059473, 1164914446, 1184005910, 1205994985, 1215357421, 1235335365, 1235657412, 1235794488, 1285083519, 1316390099, 1326091554, 1326878828, 1346788122, 1376265314, 1417325259, 1427568229, 1437690658, 1447286372, 1457476251, 1457769218, 1457971970, 1467487447, 1467834838, 1487141222, 1487822391, 1497011696, 1508090366, 1578149621, 1588011662, 1588014468, 1598343998, 1598962011, 1629333505, 1629607809, 1639376205, 1669105953, 1669425088, 1689423220, 1700876695, 1720055643, 1740209154, 1740355346, 1770232688, 1780571794, 1790363638, 1811375249, 1831725704, 1851404354, 1861910374, 1871506915, 1891361408, 1902631955, 1902878804, 1922131382, 1922749290, 1932571676, 1942676416, 1952343527, 1962402461, 1962667915, 1992066658 ] }, { "billed_charge": 1507.0, "npi": [ 1013657089, 1144539701, 1538835301 ] }, { "billed_charge": 1791.0, "npi": [ 1083104350, 1093298069, 1114668415, 1366566762, 1396077756, 1407418098, 1588602189, 1629023924, 1841684446, 1881089993, 1891925566, 1912134180, 1962962241 ] }, { "billed_charge": 1389.0, "npi": [ 1124490255, 1174244396, 1215357421, 1629333505, 1639185903, 1669677415, 1720473572, 1790363638 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 984.0, "npi": [ 1003848722, 1063414522, 1083084263, 1093959306, 1104166016, 1124606215, 1174047245, 1215984166, 1285337626, 1316352099, 1326350521, 1326744483, 1366760670, 1396784419, 1467490243, 1467498899, 1548016645, 1578144382, 1649594813, 1720338023, 1740741792, 1801835947, 1861158388, 1871122622, 1942632096, 1952732182, 1992236772 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1003873860, 1568048973, 1710320221 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1407105232, 1568048973, 1710320221, 1710965207, 1982281622 ] } ] } ] }, { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 900.0, "npi": [ 1003877523, 1013545391, 1417242298, 1730560137 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1450.0, "npi": [ 1013141118, 1104972207, 1255305322, 1306884754, 1447410600, 1578852513, 1629042999, 1720377237, 1730374166, 1790747699 ] } ] } ] }, { "tin": { "type": "ein", "value": "824329577" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1013924695, 1326089475, 1366651507, 1689860355 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1073500443, 1366651507, 1689860355, 1972554699 ] } ] } ] }, { "tin": { "type": "ein", "value": "880687924" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1023097326, 1346391299, 1477536811, 1780250464, 1902660426, 1942434535 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 868.0, "npi": [ 1023255858, 1316143118, 1649282575 ] } ] } ] }, { "tin": { "type": "ein", "value": "646010232" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 619.0, "npi": [ 1023538402 ] } ] } ] }, { "tin": { "type": "ein", "value": "824426629" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1023679743, 1346318011 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1705.0, "npi": [ 1033148226, 1063478139, 1184654014, 1184733735, 1346731635 ] } ] } ] }, { "tin": { "type": "ein", "value": "582636306" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1033308481, 1063760320, 1093004418, 1124206792, 1174059877, 1174908008, 1225529233, 1275287310, 1285329631, 1285746503, 1295524718, 1295979656, 1356864136, 1366822637, 1447741624, 1477768513, 1578925202, 1609239979, 1629573290, 1699353417, 1710649652, 1760645543, 1841644101, 1902098874, 1972085348, 1972097871 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 531.0, "npi": [ 1033560891, 1043496979, 1164973996 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1788.0, "npi": [ 1033792551, 1053737692, 1114968518, 1174895007, 1184666265, 1215557525, 1235153990, 1235606138, 1275221483, 1346685856, 1407266968, 1417705450, 1467861310, 1477146678, 1528332939, 1538856448, 1609429570, 1609626712, 1629566385, 1629608492, 1659370351, 1659683175, 1730720376, 1740570183, 1740992239, 1891257234, 1922636919, 1932426210, 1932456563, 1932876711, 1942594429, 1962804104, 1992143788 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1782.0, "npi": [ 1033869680, 1083974679, 1194959916, 1205355419, 1306208558, 1326545823, 1336675487, 1669406260, 1720440555, 1811428188, 1871067959, 1871609248, 1912938457, 1972965390 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1006.0, "npi": [ 1043505977, 1043700081, 1184253312, 1235299249, 1326497447, 1407331143, 1780325571, 1932464864, 1972797322 ] } ] } ] }, { "tin": { "type": "ein", "value": "931845364" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1053169730, 1073277349, 1245783653, 1326663642, 1518444256, 1538367644, 1558385732, 1679918320, 1790165827, 1821336629 ] } ] } ] }, { "tin": { "type": "ein", "value": "815256430" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1053375386 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1758.0, "npi": [ 1053393637, 1073995965, 1093918187, 1154304384, 1154439321, 1205842309, 1346422243, 1366425613, 1386627529, 1417301573, 1447389242, 1457091274, 1588245997, 1598127979, 1609066786, 1700271921, 1740262435, 1740579457, 1750363438, 1871119990, 1942332325, 1942480397 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 787.0, "npi": [ 1053706051, 1164047346, 1265896591, 1275092413, 1306159512, 1417376427, 1659661080, 1710516414, 1841759982, 1952346207, 1982165478 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1053894873, 1114979499, 1174543276, 1225520679, 1265167431, 1396909008, 1427146125, 1538798459, 1609889021, 1629518014, 1689752636, 1760123087, 1790731867, 1841369105, 1841880655, 1952322125, 1972570943, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1426.0, "npi": [ 1063107845, 1548786585, 1871315713, 1962634766 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1063708006, 1255530069, 1366528309, 1457881260, 1588700017, 1659383628, 1659422616, 1740209154, 1750646550, 1831776764, 1841427374, 1881089993, 1912947326, 1992267892 ] } ] } ] }, { "tin": { "type": "ein", "value": "621453389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1780.0, "npi": [ 1063773521, 1164630364, 1275534588, 1285640326, 1528358603, 1649201302, 1811421787, 1811518608, 1982966438 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1063917615, 1316044951, 1346621984, 1508205212, 1699160986, 1821627225, 1902003932, 1992267678 ] } ] } ] }, { "tin": { "type": "ein", "value": "520962668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1750.88, "npi": [ 1073976486 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1083966709, 1174543276, 1376635334, 1518182625, 1568412146, 1760497317 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 611.0, "npi": [ 1083971451, 1285611053, 1336602325, 1376574863, 1417488925, 1437357423, 1972080364 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1093270811, 1104804491, 1134652399, 1174151591, 1205125960, 1285611053, 1336137371, 1336636042, 1376958769, 1508253022, 1538621453, 1578684437, 1578732335, 1730355785, 1750479408, 1841654563 ] } ] } ] }, { "tin": { "type": "ein", "value": "832948687" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1114666708, 1154770279, 1316329238, 1548721566, 1609052307, 1679716559, 1710144324, 1811997794, 1821730474, 1881053585, 1952385254, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "651057394" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1967.0, "npi": [ 1114918117, 1174542708 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1124420856, 1265491294, 1326082298, 1396221313, 1538138672, 1538798459, 1649278334, 1700402013, 1982563706 ] } ] } ] }, { "tin": { "type": "ein", "value": "580973772" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 733.0, "npi": [ 1134159171 ] } ] } ] }, { "tin": { "type": "ein", "value": "811558273" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1134869217, 1528297942 ] } ] } ] }, { "tin": { "type": "ein", "value": "621179254" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1689.0, "npi": [ 1144756800, 1982900437 ] } ] } ] }, { "tin": { "type": "ein", "value": "561763695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1041.0, "npi": [ 1154672426 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1534.0, "npi": [ 1174569016, 1326089475, 1528164373, 1861572232, 1922045681 ] } ] } ] }, { "tin": { "type": "ein", "value": "391678306" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1220.0, "npi": [ 1174970545 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1687.0, "npi": [ 1184201428, 1447888300, 1518450691, 1730768789, 1891439469 ] }, { "billed_charge": 1968.0, "npi": [ 1346621984, 1891058269, 1962817650 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 958.49, "npi": [ 1194189498, 1417416447 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1194760744, 1215945969, 1346391299, 1386723310, 1528169190, 1578910378, 1811194483 ] } ] } ] }, { "tin": { "type": "ein", "value": "471463004" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1750.88, "npi": [ 1205152105 ] } ] } ] }, { "tin": { "type": "ein", "value": "824486211" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 3522.0, "npi": [ 1205375839, 1285253369, 1538395892 ] } ] } ] }, { "tin": { "type": "ein", "value": "582102607" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1667.0, "npi": [ 1225026255 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1667.0, "npi": [ 1720499007, 1982644845 ] } ] } ] }, { "tin": { "type": "ein", "value": "208550713" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1089.54, "npi": [ 1225415581, 1285676999, 1568959054 ] } ] } ] }, { "tin": { "type": "ein", "value": "471988466" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1638.0, "npi": [ 1245685205, 1295960581, 1891115465 ] } ] } ] }, { "tin": { "type": "ein", "value": "611262927" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 513.0, "npi": [ 1255390373 ] } ] } ] }, { "tin": { "type": "ein", "value": "994936877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1424.56, "npi": [ 1255406864, 1417987041, 1437192119 ] } ] } ] }, { "tin": { "type": "ein", "value": "300986476" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 867.75, "npi": [ 1255561866, 1285299578, 1538458518 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 290.33, "providers": [ { "billed_charge": 1659.0, "npi": [ 1255794053, 1427404409, 1457871949, 1497786974, 1528168408, 1558536987, 1699138719, 1740235175, 1811467350, 1982991246 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1659.0, "npi": [ 1538943311, 1871938266 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010601" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 636.0, "npi": [ 1265491294, 1568463206 ] } ] } ] }, { "tin": { "type": "ein", "value": "823859069" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1265655625 ] } ] } ] }, { "tin": { "type": "ein", "value": "413178803" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 984.0, "npi": [ 1306037486, 1487004230, 1578937702, 1669105953, 1740728823, 1811375249, 1841399961, 1841553328, 1891309357 ] } ] } ] }, { "tin": { "type": "ein", "value": "922099454" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 984.0, "npi": [ 1326547837, 1679523997, 1720262207, 1821559857, 1831904572, 1902127301 ] } ] } ] }, { "tin": { "type": "ein", "value": "752739406" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1705.0, "npi": [ 1356516272 ] } ] } ] }, { "tin": { "type": "ein", "value": "626014528" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1366499261, 1447667423, 1912052655 ] } ] } ] }, { "tin": { "type": "ein", "value": "823675091" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1366902215 ] } ] } ] }, { "tin": { "type": "ein", "value": "823125568" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1386056745 ] } ] } ] }, { "tin": { "type": "ein", "value": "581600356" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1344.0, "npi": [ 1386999225 ] } ] } ] }, { "tin": { "type": "ein", "value": "461120780" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2035.0, "npi": [ 1396004149 ] } ] } ] }, { "tin": { "type": "ein", "value": "621795048" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1780.0, "npi": [ 1396143871, 1760897854, 1790701209, 1902238769, 1922523703 ] } ] } ] }, { "tin": { "type": "ein", "value": "352528741" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 759.0, "npi": [ 1396306809 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 759.0, "npi": [ 1942466552 ] } ] } ] }, { "tin": { "type": "ein", "value": "271112877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1855.0, "npi": [ 1396515011 ] } ] } ] }, { "tin": { "type": "ein", "value": "465034266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2113.0, "npi": [ 1396716312, 1962962241 ] } ] } ] }, { "tin": { "type": "ein", "value": "841075994" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1388.0, "npi": [ 1407404783 ] } ] } ] }, { "tin": { "type": "ein", "value": "464319695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1870.0, "npi": [ 1417983636 ] } ] } ] }, { "tin": { "type": "ein", "value": "473053199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1437193927, 1528169190 ] } ] } ] }, { "tin": { "type": "ein", "value": "432020322" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1447711064, 1619423878, 1780625830 ] } ] } ] }, { "tin": { "type": "ein", "value": "475329008" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 611.0, "npi": [ 1457518813, 1649439134 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 787.0, "npi": [ 1457688392, 1518463801, 1588926588, 1790739928, 1972160547 ] } ] } ] }, { "tin": { "type": "ein", "value": "621586974" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1022.0, "npi": [ 1467035741, 1841224243 ] } ] } ] }, { "tin": { "type": "ein", "value": "883514060" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1467499806, 1568049898, 1740869874, 1801359922, 1891135240, 1932355047 ] } ] } ] }, { "tin": { "type": "ein", "value": "932421242" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1488.0, "npi": [ 1477316578 ] } ] } ] }, { "tin": { "type": "ein", "value": "920101761" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2624.0, "npi": [ 1487920211, 1780720599 ] } ] } ] }, { "tin": { "type": "ein", "value": "591835473" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1586.9, "npi": [ 1497288369, 1558411397, 1710467832 ] } ] } ] }, { "tin": { "type": "ein", "value": "831132382" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2331.0, "npi": [ 1508509860 ] } ] }, { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1629657119 ] } ] } ] }, { "tin": { "type": "ein", "value": "462439952" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1300.0, "npi": [ 1538332952 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 377.0, "providers": [ { "billed_charge": 377.0, "npi": [ 1538921580, 1760897854, 1922410620, 1932836749 ] } ] } ] }, { "tin": { "type": "ein", "value": "581330744" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 495.0, "npi": [ 1548212475 ] } ] } ] }, { "tin": { "type": "ein", "value": "922098941" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 984.0, "npi": [ 1548670383 ] } ] } ] }, { "tin": { "type": "ein", "value": "831057917" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 706.2, "npi": [ 1558711911, 1902148976 ] } ] } ] }, { "tin": { "type": "ein", "value": "471497384" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 647.0, "npi": [ 1568552198, 1811315153 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 440.0, "npi": [ 1568811941 ] } ] } ] }, { "tin": { "type": "ein", "value": "411722554" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 857.0, "npi": [ 1578827671 ] } ] } ] }, { "tin": { "type": "ein", "value": "650622859" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2266.0, "npi": [ 1619945169 ] }, { "billed_charge": 1747.0, "npi": [ 1710113634 ] }, { "billed_charge": 2453.0, "npi": [ 1851734198 ] } ] } ] }, { "tin": { "type": "ein", "value": "462099970" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1649774993 ] } ] } ] }, { "tin": { "type": "ein", "value": "452765042" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1649839994, 1699010157, 1750159588, 1861631061 ] } ] } ] }, { "tin": { "type": "ein", "value": "636000526" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 388.0, "providers": [ { "billed_charge": 388.0, "npi": [ 1689631236 ] } ] } ] }, { "tin": { "type": "ein", "value": "331631546" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 886.0, "npi": [ 1700161700 ] } ] } ] }, { "tin": { "type": "ein", "value": "412279037" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 394.0, "npi": [ 1730599770 ] } ] } ] }, { "tin": { "type": "ein", "value": "230465970" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 392.0, "providers": [ { "billed_charge": 392.0, "npi": [ 1750813952 ] } ] } ] }, { "tin": { "type": "ein", "value": "208709397" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 2331.0, "npi": [ 1760438832 ] } ] } ] }, { "tin": { "type": "ein", "value": "810584939" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1358.0, "npi": [ 1801852868 ] } ] } ] }, { "tin": { "type": "ein", "value": "825271507" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 1870.0, "npi": [ 1821559824 ] } ] } ] }, { "tin": { "type": "ein", "value": "562398079" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2496.0, "npi": [ 1831401546 ] } ] } ] }, { "tin": { "type": "ein", "value": "455478172" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1345.0, "npi": [ 1912295411 ] } ] } ] }, { "tin": { "type": "ein", "value": "593082909" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1969.0, "npi": [ 1922494137 ] } ] } ] }, { "tin": { "type": "ein", "value": "820989586" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 393.05, "providers": [ { "billed_charge": 922.0, "npi": [ 1992391346 ] } ] } ] } ] }, { "name": "EMERGENCY DEPARTMENT VISIT LOW MDM", "billing_code_type": "CPT", "billing_code": "99283", "billing_code_type_version": "2020", "description": "EMERGENCY DEPARTMENT VISIT LOW MDM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 653.0, "npi": [ 1003357864 ] } ] }, { "allowed_amount": 155.38, "providers": [ { "billed_charge": 653.0, "npi": [ 1710993324 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 171.0, "npi": [ 1013998277 ] } ] } ] }, { "tin": { "type": "ein", "value": "582102607" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 657.0, "npi": [ 1023247723 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 355.0, "npi": [ 1023255858, 1023580420, 1316143118, 1407539398, 1649282575 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 711.0, "npi": [ 1023472065, 1134507130, 1255755575, 1255794053, 1356508972, 1396756680, 1457871949, 1497786974, 1528168408, 1538943311, 1558536987, 1609221282, 1699138719, 1740235175, 1811467350, 1871938266, 1952855926 ] }, { "billed_charge": 710.0, "npi": [ 1033206784, 1104800390, 1154061539, 1174768402, 1205179223, 1336584291, 1487092656, 1508534389, 1821376476 ] }, { "billed_charge": 708.0, "npi": [ 1104494897, 1750042073, 1780209049 ] }, { "billed_charge": 641.0, "npi": [ 1366077562, 1396906368, 1801355607 ] }, { "billed_charge": 622.0, "npi": [ 1376002592 ] }, { "billed_charge": 617.0, "npi": [ 1639843568 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 631.0, "npi": [ 1023657871, 1124490255, 1154704823, 1164059473, 1235657412, 1285083519, 1346788122, 1467487447, 1487141222, 1518998210, 1629607809, 1669677415, 1689423220, 1700876695, 1720055643, 1740355346, 1790363638, 1902878804, 1942676416, 1962667915 ] }, { "billed_charge": 567.0, "npi": [ 1124490255, 1215357421, 1316390099, 1932571676 ] }, { "billed_charge": 723.0, "npi": [ 1366566762, 1629014030, 1629023924 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 199.0, "npi": [ 1043496979, 1255701728 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 390.0, "npi": [ 1043505977, 1043700081, 1184253312, 1235299249, 1386635902, 1407331143, 1780325571, 1932464864, 1972797322 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 695.0, "npi": [ 1053737692, 1235557281, 1235606138, 1346685856, 1407266968, 1477146678, 1538856448, 1891257234, 1932876711 ] } ] } ] }, { "tin": { "type": "ein", "value": "621453389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 799.0, "npi": [ 1053846352, 1164630364, 1649201302, 1811421787, 1982966438 ] } ] } ] }, { "tin": { "type": "ein", "value": "050524222" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 756.0, "npi": [ 1063218048 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 768.0, "npi": [ 1063478139, 1841604485 ] } ] } ] }, { "tin": { "type": "ein", "value": "660573658" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 206.0, "npi": [ 1063897023 ] } ] } ] }, { "tin": { "type": "ein", "value": "465660425" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 364.0, "npi": [ 1083627442, 1760497317 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 712.0, "npi": [ 1083974679 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 750.0, "npi": [ 1093270811, 1134652399, 1174151591, 1336137371, 1336636042, 1376958769, 1508253022, 1538621453, 1578684437, 1730355785, 1972966273 ] } ] } ] }, { "tin": { "type": "ein", "value": "430975390" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 224.18, "npi": [ 1093308892 ] } ] } ] }, { "tin": { "type": "ein", "value": "621795048" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 799.0, "npi": [ 1093952475, 1396143871, 1518313626, 1710330659 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 565.0, "npi": [ 1104182500, 1225415581, 1598488165 ] }, { "billed_charge": 686.0, "npi": [ 1538789383 ] } ] }, { "allowed_amount": 155.38, "providers": [ { "billed_charge": 565.0, "npi": [ 1811794308, 1972564466 ] }, { "billed_charge": 582.0, "npi": [ 1932737095 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 364.0, "npi": [ 1124420856, 1265491294, 1528395928 ] } ] } ] }, { "tin": { "type": "ein", "value": "274393711" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 171.0, "npi": [ 1134112618 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 571.0, "npi": [ 1174569016, 1922045681 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 387.11, "npi": [ 1194214726 ] } ] }, { "allowed_amount": 155.38, "providers": [ { "billed_charge": 387.11, "npi": [ 1730422999 ] } ] } ] }, { "tin": { "type": "ein", "value": "923364122" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 3318.87, "npi": [ 1215220660 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 364.0, "npi": [ 1215945969, 1346391299, 1811194483 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 226.0, "npi": [ 1235172834, 1467013045 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 180.0, "npi": [ 1235513003 ] } ] } ] }, { "tin": { "type": "ein", "value": "760729179" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 699.0, "npi": [ 1306254222 ] } ] } ] }, { "tin": { "type": "ein", "value": "832948687" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 750.0, "npi": [ 1316329238, 1538559315, 1548721566, 1881053585 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 218.0, "npi": [ 1336602325, 1376574863 ] } ] } ] }, { "tin": { "type": "ein", "value": "824426629" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 835.0, "npi": [ 1346318011 ] } ] } ] }, { "tin": { "type": "ein", "value": "823125568" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 750.0, "npi": [ 1386056745 ] } ] } ] }, { "tin": { "type": "ein", "value": "820945402" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 256.8, "npi": [ 1386373082, 1396714408 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 364.0, "npi": [ 1396727574, 1457843831, 1548958648, 1760123087, 1871657957 ] } ] } ] }, { "tin": { "type": "ein", "value": "341369963" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 138.0, "providers": [ { "billed_charge": 138.0, "npi": [ 1427285154 ] } ] } ] }, { "tin": { "type": "ein", "value": "474718253" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 336.0, "npi": [ 1437391984 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 509.0, "npi": [ 1457363285 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 835.0, "npi": [ 1457881260 ] } ] } ] }, { "tin": { "type": "ein", "value": "300986476" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 312.0, "npi": [ 1487141958 ] } ] } ] }, { "tin": { "type": "ein", "value": "742501542" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 527.48, "npi": [ 1487288767 ] } ] } ] }, { "tin": { "type": "ein", "value": "611665353" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 387.11, "npi": [ 1518057074 ] } ] } ] }, { "tin": { "type": "ein", "value": "581600356" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 543.0, "npi": [ 1528021094 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 104.34, "providers": [ { "billed_charge": 711.0, "npi": [ 1528168408, 1558536987 ] } ] }, { "allowed_amount": 155.38, "providers": [ { "billed_charge": 711.0, "npi": [ 1538943311 ] } ] } ] }, { "tin": { "type": "ein", "value": "473053199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 364.0, "npi": [ 1528395928 ] } ] } ] }, { "tin": { "type": "ein", "value": "931845364" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 750.0, "npi": [ 1538367644 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 403.0, "npi": [ 1548299829, 1689023137, 1730132481 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 510.0, "npi": [ 1548786585, 1922705730 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 835.0, "npi": [ 1558473223 ] } ] } ] }, { "tin": { "type": "ein", "value": "883514060" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 835.0, "npi": [ 1568049898 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010601" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 237.0, "npi": [ 1568463206 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 659.0, "npi": [ 1609066786 ] } ] } ] }, { "tin": { "type": "ein", "value": "580973772" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 471.0, "npi": [ 1629518014 ] } ] } ] }, { "tin": { "type": "ein", "value": "990675124" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 403.0, "npi": [ 1649249053 ] } ] } ] }, { "tin": { "type": "ein", "value": "270484506" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 315.0, "npi": [ 1649476888 ] } ] } ] }, { "tin": { "type": "ein", "value": "451621336" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 171.0, "npi": [ 1669413126 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 835.0, "npi": [ 1710965207 ] } ] } ] }, { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 602.0, "npi": [ 1720508567, 1881630515 ] } ] } ] }, { "tin": { "type": "ein", "value": "208045243" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 665.0, "npi": [ 1730411455 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 134.0, "providers": [ { "billed_charge": 134.0, "npi": [ 1730880683, 1861141442 ] } ] } ] }, { "tin": { "type": "ein", "value": "208104245" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 194.0, "npi": [ 1861680738 ] } ] } ] }, { "tin": { "type": "ein", "value": "570935917" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 390.0, "npi": [ 1922116870 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 653.0, "npi": [ 1942486105 ] } ] } ] }, { "tin": { "type": "ein", "value": "450226558" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 155.38, "providers": [ { "billed_charge": 347.0, "npi": [ 1952481723 ] } ] } ] } ] }, { "name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code": "99284", "billing_code_type_version": "2020", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1154.0, "npi": [ 1003164153, 1003338237, 1003443615, 1023657871, 1033776372, 1063751212, 1104326271, 1104342294, 1124490255, 1164059473, 1164914446, 1184005910, 1205994985, 1235335365, 1306960216, 1326091554, 1326878828, 1376265314, 1396725453, 1417169574, 1447286372, 1457769218, 1457971970, 1467487447, 1467834838, 1487141222, 1487763827, 1487822391, 1497011696, 1578149621, 1588014468, 1598343998, 1619916947, 1619959103, 1629607809, 1639376205, 1669105953, 1669425088, 1669677415, 1689423220, 1700876695, 1720055643, 1740209154, 1740355346, 1740728823, 1780571794, 1790363638, 1831431428, 1831725704, 1871506915, 1891361408, 1902878804, 1932402740, 1932571676, 1942512561, 1942676416, 1952343527, 1962402461, 1962667915, 1992976773 ] }, { "billed_charge": 953.0, "npi": [ 1063751212, 1124490255, 1215357421, 1316390099, 1417169574, 1427894617, 1588011662, 1588014468, 1669425088, 1669677415, 1760455455 ] }, { "billed_charge": 1229.0, "npi": [ 1083104350, 1093298069, 1114668415, 1396077756, 1407418098, 1629023924, 1841684446, 1881089993, 1891925566, 1912134180, 1962962241 ] }, { "billed_charge": 1037.0, "npi": [ 1407114291 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 981.0, "npi": [ 1003357864, 1043876410, 1083881791, 1093991796, 1154731388, 1164928768, 1215956958, 1275851578, 1306370853, 1336643717, 1356087555, 1417359902, 1437643806, 1447781638, 1588197339, 1659412971, 1659557320, 1669625711, 1669835328, 1669867925, 1730516543, 1770850190, 1801213640, 1902844137 ] } ] } ] }, { "tin": { "type": "ein", "value": "883514060" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1003377466, 1467499806, 1932355047 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1160.0, "npi": [ 1003499070, 1023472065, 1033571799, 1073297008, 1073831871, 1093912669, 1104494897, 1134507130, 1144751637, 1215468277, 1255755575, 1255794053, 1265493779, 1275552440, 1346858917, 1356508972, 1356629109, 1386193803, 1396179446, 1396725453, 1396756680, 1427404409, 1447411376, 1457871949, 1477068575, 1487092656, 1497763163, 1497786974, 1528168408, 1538943311, 1558536987, 1598021867, 1598942146, 1609221282, 1699138719, 1740235175, 1750042073, 1780209049, 1811467350, 1871938266, 1891895769, 1902162381, 1972546794, 1982680310, 1982991246 ] }, { "billed_charge": 1207.0, "npi": [ 1023117272, 1033206784, 1104800390, 1134272545, 1154061539, 1154770279, 1174768402, 1205179223, 1336584291, 1508534389, 1619165388, 1639185903, 1821376476, 1861719569 ] }, { "billed_charge": 1133.0, "npi": [ 1154874980, 1285896647, 1568411346, 1629365432, 1801355607 ] }, { "billed_charge": 1206.0, "npi": [ 1447823232, 1578022968, 1962847566 ] }, { "billed_charge": 1100.0, "npi": [ 1467778886 ] }, { "billed_charge": 1127.0, "npi": [ 1821190471, 1982286746 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 678.0, "npi": [ 1003848722, 1013055482, 1093959306, 1164821054, 1174047245, 1215984166, 1275573289, 1285407551, 1326744483, 1336552090, 1366760670, 1437403144, 1467490243, 1487066924, 1528647013, 1548299829, 1578144382, 1720338023, 1730132481, 1740741792, 1750775250, 1780624882, 1801835947, 1952077075, 1992236772 ] } ] } ] }, { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1026.0, "npi": [ 1003854738, 1184991879, 1306884374, 1376574863, 1467437913, 1669207601, 1679529465, 1720223415, 1740351113, 1740531516, 1801140769, 1881630515, 1912906041 ] }, { "billed_charge": 1023.0, "npi": [ 1124689674 ] } ] } ] }, { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 650.0, "npi": [ 1003877523, 1013545391, 1316552110, 1730560137 ] } ] } ] }, { "tin": { "type": "ein", "value": "050524222" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1537.0, "npi": [ 1013525849 ] } ] } ] }, { "tin": { "type": "ein", "value": "824329577" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1013924695, 1326089475, 1508392333, 1689860355, 1972554699 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 962.0, "npi": [ 1013957844, 1043575178, 1053393892, 1053737692, 1083921274, 1114237799, 1235188566, 1295305217, 1316214687, 1447614391, 1457363285, 1467031955, 1538320486, 1578540340, 1598247033, 1639058068, 1699734095, 1710621750, 1720567654 ] } ] } ] }, { "tin": { "type": "ein", "value": "880687924" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1023097326, 1326031865, 1861874612, 1902660426, 1942434535 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 414.0, "npi": [ 1023460938, 1083971451, 1184680472, 1285611053, 1336602325, 1376574863, 1417488925, 1437357423, 1972080364 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 596.0, "npi": [ 1023580420, 1316143118, 1407539398, 1457881260, 1649282575 ] } ] } ] }, { "tin": { "type": "ein", "value": "824426629" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1023679743, 1811997794 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1142.0, "npi": [ 1033148226, 1033571799, 1063478139, 1114194370, 1184654014, 1346731635, 1710242276, 1942267554 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1213.0, "npi": [ 1033792551, 1053737692, 1114968518, 1174895007, 1184666265, 1235557281, 1235606138, 1275221483, 1316143118, 1346685856, 1407266968, 1417705450, 1467861310, 1477146678, 1528332939, 1538856448, 1609429570, 1609626712, 1629566385, 1629608492, 1659370351, 1659683175, 1740570183, 1740992239, 1891257234, 1932426210, 1932456563, 1932876711, 1942594429, 1962804104 ] } ] } ] }, { "tin": { "type": "ein", "value": "582636306" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1033880133, 1043831449, 1225529233, 1275287310, 1306401260, 1386633832, 1427519735, 1487429171, 1497485064, 1528796182, 1548584055, 1578127882, 1609683705, 1689940249, 1699783936, 1831202357, 1871098004, 1902098874, 1952694671 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 688.0, "npi": [ 1043505977, 1043700081, 1184253312, 1235299249, 1326497447, 1386635902, 1407331143, 1780325571, 1932464864, 1972797322 ] } ] } ] }, { "tin": { "type": "ein", "value": "582102607" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1045.0, "npi": [ 1043509714, 1427379262, 1447664974, 1720499007, 1790164259, 1790731628, 1861415028, 1922460930 ] } ] } ] }, { "tin": { "type": "ein", "value": "991100562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1026.0, "npi": [ 1043790249, 1063435717, 1124442181, 1154070001, 1194266122, 1265057590, 1275257388, 1275646739, 1275646747, 1275988289, 1285444596, 1356345136, 1396254207, 1396738357, 1457474363, 1508330739, 1508491812, 1528097003, 1578055323, 1639480684, 1639619760, 1689860355, 1720407661, 1720571474, 1740824861, 1750817748, 1780970822, 1841752029, 1861788903, 1902919491, 1922027283, 1932402740 ] } ] } ] }, { "tin": { "type": "ein", "value": "931845364" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1053002170, 1073277349, 1093729485, 1205373214, 1326663642, 1538367644, 1558385732, 1679918320, 1790165827, 1821336629, 1861115420 ] } ] } ] }, { "tin": { "type": "ein", "value": "431735565" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 238.0, "providers": [ { "billed_charge": 238.0, "npi": [ 1053310896 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 981.0, "npi": [ 1053344853, 1184019101, 1285951632, 1689964751, 1720377237, 1821416066, 1871545947, 1871888362, 1942486105, 1992982482 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1211.0, "npi": [ 1053393637, 1073995965, 1093918187, 1154304384, 1154439321, 1205842309, 1346422243, 1366425613, 1386627529, 1417301573, 1447389242, 1457091274, 1588245997, 1598127979, 1609066786, 1700271921, 1740262435, 1740579457, 1750363438, 1871119990, 1942332325, 1942480397 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 540.0, "npi": [ 1053706051, 1437232188, 1538384680, 1538471339, 1619464351 ] } ] } ] }, { "tin": { "type": "ein", "value": "473053199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1053791434, 1104036359, 1437193927, 1528169190, 1528395928 ] } ] } ] }, { "tin": { "type": "ein", "value": "621453389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1195.0, "npi": [ 1053846352, 1063773521, 1164630364, 1275534588, 1285640326, 1811421787, 1982966438 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1053894873, 1083966709, 1114979499, 1215631981, 1225520679, 1295762169, 1326031865, 1326089475, 1386890697, 1396727574, 1396909008, 1417247073, 1427146125, 1457843831, 1518182625, 1538798459, 1578849444, 1578910378, 1598717639, 1629518014, 1700402013, 1760123087, 1790731867, 1790880144, 1841880655, 1972570943, 1992267892, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "413178803" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 678.0, "npi": [ 1053933499, 1225907504, 1386088052, 1578937702, 1740728823, 1770713919 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 967.0, "npi": [ 1063107845, 1548786585, 1871315713, 1962634766 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 958.0, "npi": [ 1063153021, 1073349593, 1104182500, 1164981478, 1215463567, 1225415581, 1346858917, 1528094471, 1578371001, 1720580582, 1720958390, 1811794308, 1922628882, 1932130416, 1972564466 ] }, { "billed_charge": 1124.0, "npi": [ 1063673622 ] }, { "billed_charge": 1161.0, "npi": [ 1083422901 ] }, { "billed_charge": 1023.0, "npi": [ 1104497932 ] }, { "billed_charge": 802.0, "npi": [ 1154673085 ] }, { "billed_charge": 1137.0, "npi": [ 1245272400, 1548496185, 1588001143 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1063708006, 1457881260, 1588700017, 1659383628, 1659422616, 1740209154, 1750646550, 1831776764, 1881089993, 1912947326, 1992267892 ] } ] } ] }, { "tin": { "type": "ein", "value": "752807737" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1266.0, "npi": [ 1073513529 ] } ] } ] }, { "tin": { "type": "ein", "value": "205411209" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1073576930, 1124420856, 1215906326, 1265491294, 1336224153, 1396221313, 1457843831, 1538138672, 1538798459, 1649278334, 1700402013, 1710144324, 1750159588, 1760123087, 1790731867, 1952322125, 1962497651, 1982563706 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1581.0, "npi": [ 1073633657 ] } ] }, { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1821627225 ] } ] } ] }, { "tin": { "type": "ein", "value": "465660425" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1083627442, 1114979499, 1235260696, 1356437040, 1386890697, 1700995354, 1760497317, 1770670259 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1083966709, 1235260696, 1295762169, 1376635334, 1528047016, 1568412146, 1760497317, 1841434255, 1922045681 ] } ] } ] }, { "tin": { "type": "ein", "value": "824435520" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 2392.0, "npi": [ 1093100331 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1093270811, 1104804491, 1134652399, 1174151591, 1205125960, 1285611053, 1336137371, 1336636042, 1376958769, 1508253022, 1538621453, 1578684437, 1578732335, 1730355785, 1750479408, 1972966273 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1513.0, "npi": [ 1093373771, 1548729478 ] } ] } ] }, { "tin": { "type": "ein", "value": "621795048" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1195.0, "npi": [ 1093952475, 1154354223, 1518313626, 1710330659, 1760897854, 1770022949, 1790701209, 1902238769, 1922523703 ] } ] } ] }, { "tin": { "type": "ein", "value": "462531047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1104208065, 1417510017, 1447755897, 1932989480, 1962766329 ] } ] } ] }, { "tin": { "type": "ein", "value": "994936877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 983.12, "npi": [ 1114027513, 1124678628 ] } ] } ] }, { "tin": { "type": "ein", "value": "311009777" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 771.0, "npi": [ 1114130739 ] } ] }, { "allowed_amount": 283.67, "providers": [ { "billed_charge": 771.0, "npi": [ 1801848338 ] } ] } ] }, { "tin": { "type": "ein", "value": "591281714" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1071.0, "npi": [ 1114367190, 1255825717 ] }, { "billed_charge": 1243.0, "npi": [ 1114487527, 1326930330, 1497462246, 1841949229 ] } ] } ] }, { "tin": { "type": "ein", "value": "832948687" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1114666708, 1154770279, 1316329238, 1427434414, 1538559315, 1548721566, 1609052307, 1700016284, 1710144324, 1821730474, 1881053585, 1902629389, 1952385254, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "580973772" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 570.0, "npi": [ 1114979499, 1629518014, 1851884068 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1058.0, "npi": [ 1124050141, 1174569016, 1528164373, 1861572232, 1902941685, 1922045681 ] }, { "billed_charge": 1059.0, "npi": [ 1922045681 ] } ] } ] }, { "tin": { "type": "ein", "value": "274393711" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 326.0, "npi": [ 1134112618 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 660.86, "npi": [ 1134709496, 1598261935, 1710449988, 1720237290, 1730167040 ] } ] } ] }, { "tin": { "type": "ein", "value": "752739406" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1142.0, "npi": [ 1134790033, 1356516272, 1992398465 ] }, { "billed_charge": 1096.0, "npi": [ 1255766341 ] } ] } ] }, { "tin": { "type": "ein", "value": "811558273" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1134869217, 1235344367, 1528297942 ] } ] } ] }, { "tin": { "type": "ein", "value": "593677604" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1025.0, "npi": [ 1154373751 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1141.0, "npi": [ 1154596773, 1194471060, 1205331170, 1215906326, 1336675487, 1346478542, 1437381266, 1487309514, 1548343593, 1619442753, 1619634896, 1629538822, 1659154011, 1669919353, 1770214066, 1811428188, 1811570864, 1871067959, 1871609248, 1881612067, 1962039933 ] } ] } ] }, { "tin": { "type": "ein", "value": "200495416" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 962.0, "npi": [ 1164471322 ] } ] } ] }, { "tin": { "type": "ein", "value": "922099454" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 678.0, "npi": [ 1174871834 ] } ] }, { "allowed_amount": 283.67, "providers": [ { "billed_charge": 678.0, "npi": [ 1215227301, 1275297178, 1417909268, 1609214345, 1912965575, 1932193505 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1194760744, 1215945969, 1346391299, 1386723310, 1528169190, 1578910378, 1811194483 ] } ] } ] }, { "tin": { "type": "ein", "value": "371865870" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1641.0, "npi": [ 1194785394 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 368.0, "npi": [ 1194793661, 1437736055 ] } ] } ] }, { "tin": { "type": "ein", "value": "824486211" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 2392.0, "npi": [ 1205375839 ] } ] }, { "allowed_amount": 283.67, "providers": [ { "billed_charge": 2392.0, "npi": [ 1750335063, 1841427374, 1942469580 ] } ] } ] }, { "tin": { "type": "ein", "value": "461229800" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1205873700, 1265491294 ] } ] } ] }, { "tin": { "type": "ein", "value": "626014528" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1000.0, "npi": [ 1205882834 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 286.0, "npi": [ 1215314067, 1811574460 ] } ] } ] }, { "tin": { "type": "ein", "value": "208550713" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 740.51, "npi": [ 1225415581, 1285676999, 1568959054 ] } ] } ] }, { "tin": { "type": "ein", "value": "350593390" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 315.0, "npi": [ 1225521214 ] } ] } ] }, { "tin": { "type": "ein", "value": "201722595" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 290.0, "npi": [ 1225534316 ] } ] } ] }, { "tin": { "type": "ein", "value": "581600356" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 922.0, "npi": [ 1225763469 ] } ] } ] }, { "tin": { "type": "ein", "value": "200336940" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 550.0, "npi": [ 1235145004 ] } ] } ] }, { "tin": { "type": "ein", "value": "471988466" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1096.0, "npi": [ 1245685205, 1477616456, 1780659128 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 195.09, "providers": [ { "billed_charge": 1160.0, "npi": [ 1255794053, 1427404409, 1457871949, 1497786974, 1528168408, 1558536987, 1699138719, 1740235175, 1811467350, 1952855926 ] } ] }, { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1160.0, "npi": [ 1538943311 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010601" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 415.0, "npi": [ 1265491294, 1568463206 ] } ] } ] }, { "tin": { "type": "ein", "value": "383647394" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 650.0, "npi": [ 1265608038 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1141.0, "npi": [ 1275943961, 1821416066 ] }, { "billed_charge": 1625.0, "npi": [ 1659612299, 1841852662, 1881154375, 1912389800, 1972225647 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 255.0, "providers": [ { "billed_charge": 255.0, "npi": [ 1285000190, 1538921580, 1699234377, 1730880683, 1861141442, 1922410620, 1932836749 ] } ] } ] }, { "tin": { "type": "ein", "value": "570935917" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 631.0, "npi": [ 1295990943 ] } ] } ] }, { "tin": { "type": "ein", "value": "454006393" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 482.0, "npi": [ 1316730294, 1699417022, 1699984302 ] } ] } ] }, { "tin": { "type": "ein", "value": "455497062" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 221.0, "providers": [ { "billed_charge": 221.0, "npi": [ 1326054909, 1558309823 ] } ] } ] }, { "tin": { "type": "ein", "value": "208709397" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1336130111 ] } ] } ] }, { "tin": { "type": "ein", "value": "473041726" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1336130111, 1356304844, 1548958648 ] } ] } ] }, { "tin": { "type": "ein", "value": "593082909" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1261.0, "npi": [ 1346726452, 1841403730, 1881790392 ] } ] } ] }, { "tin": { "type": "ein", "value": "932501469" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 607.0, "npi": [ 1356300834 ] } ] } ] }, { "tin": { "type": "ein", "value": "825271507" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1356504765, 1578813507 ] } ] } ] }, { "tin": { "type": "ein", "value": "432020322" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1280.0, "npi": [ 1366192627 ] } ] } ] }, { "tin": { "type": "ein", "value": "820945402" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 487.52, "npi": [ 1386373082, 1851884068 ] } ] } ] }, { "tin": { "type": "ein", "value": "852276567" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1140.0, "npi": [ 1396196622 ] } ] } ] }, { "tin": { "type": "ein", "value": "811390203" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1475.0, "npi": [ 1407140106 ] } ] } ] }, { "tin": { "type": "ein", "value": "932728074" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1693.0, "npi": [ 1457318602 ] } ] } ] }, { "tin": { "type": "ein", "value": "475329008" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 414.0, "npi": [ 1457518813, 1649439134 ] } ] } ] }, { "tin": { "type": "ein", "value": "823125568" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1280.0, "npi": [ 1467704320 ] } ] } ] }, { "tin": { "type": "ein", "value": "591835473" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1087.45, "npi": [ 1467947986, 1912972043 ] } ] } ] }, { "tin": { "type": "ein", "value": "470376487" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 806.3, "npi": [ 1487061529 ] } ] } ] }, { "tin": { "type": "ein", "value": "200545311" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 267.0, "providers": [ { "billed_charge": 267.0, "npi": [ 1487664835 ] } ] } ] }, { "tin": { "type": "ein", "value": "820989586" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1518975754, 1881357127, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "921582601" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1920.0, "npi": [ 1538149166 ] } ] } ] }, { "tin": { "type": "ein", "value": "310867547" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 582.0, "npi": [ 1548613102 ] } ] } ] }, { "tin": { "type": "ein", "value": "953154530" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 616.0, "npi": [ 1558371229 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1568048973, 1851823264, 1982281622 ] } ] } ] }, { "tin": { "type": "ein", "value": "621179254" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 1152.0, "npi": [ 1568807758 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 540.0, "npi": [ 1598715856, 1720024292 ] } ] } ] }, { "tin": { "type": "ein", "value": "061766026" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 200.0, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1598960544 ] } ] } ] }, { "tin": { "type": "ein", "value": "351361243" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.0, "providers": [ { "billed_charge": 185.0, "npi": [ 1609317809 ] } ] } ] }, { "tin": { "type": "ein", "value": "208104245" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 314.0, "npi": [ 1619915378 ] } ] } ] }, { "tin": { "type": "ein", "value": "264058719" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 267.0, "providers": [ { "billed_charge": 267.0, "npi": [ 1629203955 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 586.0, "npi": [ 1649278334 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 365.0, "npi": [ 1649327594 ] } ] } ] }, { "tin": { "type": "ein", "value": "471345819" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 368.0, "npi": [ 1649464421, 1871548073 ] } ] } ] }, { "tin": { "type": "ein", "value": "853861695" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 631.0, "npi": [ 1659393890, 1720621113 ] } ] } ] }, { "tin": { "type": "ein", "value": "270484506" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 470.0, "npi": [ 1669633137 ] } ] } ] }, { "tin": { "type": "ein", "value": "452765042" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1699010157, 1750159588, 1861631061 ] } ] } ] }, { "tin": { "type": "ein", "value": "823462523" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 790.0, "npi": [ 1699092312 ] } ] } ] }, { "tin": { "type": "ein", "value": "831132382" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1581.0, "npi": [ 1710636873 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 650.0, "npi": [ 1730560137 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 240.0, "providers": [ { "billed_charge": 240.0, "npi": [ 1730604331 ] } ] } ] }, { "tin": { "type": "ein", "value": "586002922" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 360.0, "npi": [ 1730766114 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 305.0, "npi": [ 1740599711 ] } ] } ] }, { "tin": { "type": "ein", "value": "200492277" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1145.0, "npi": [ 1740675974 ] } ] } ] }, { "tin": { "type": "ein", "value": "871759588" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 278.0, "providers": [ { "billed_charge": 278.0, "npi": [ 1750013314 ] } ] } ] }, { "tin": { "type": "ein", "value": "561903275" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 848.0, "npi": [ 1760429526 ] } ] } ] }, { "tin": { "type": "ein", "value": "465034266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1324.0, "npi": [ 1801050976 ] } ] } ] }, { "tin": { "type": "ein", "value": "364874748" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1641.0, "npi": [ 1801967047 ] } ] } ] }, { "tin": { "type": "ein", "value": "710664686" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 248.0, "providers": [ { "billed_charge": 248.0, "npi": [ 1932251097 ] } ] } ] }, { "tin": { "type": "ein", "value": "752684562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 1026.0, "npi": [ 1932603313 ] } ] } ] }, { "tin": { "type": "ein", "value": "351837309" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 833.0, "npi": [ 1952094724 ] } ] } ] }, { "tin": { "type": "ein", "value": "932501591" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 607.0, "npi": [ 1962962241 ] } ] } ] }, { "tin": { "type": "ein", "value": "823859069" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 283.67, "providers": [ { "billed_charge": 586.0, "npi": [ 1962993519 ] } ] } ] } ] }, { "name": "EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM", "billing_code_type": "CPT", "billing_code": "99282", "billing_code_type_version": "2020", "description": "EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 330.0, "npi": [ 1003443615, 1235335365 ] }, { "billed_charge": 406.0, "npi": [ 1205994985, 1427568229, 1487141222, 1598343998, 1962667915 ] }, { "billed_charge": 425.0, "npi": [ 1841684446 ] } ] } ] }, { "tin": { "type": "ein", "value": "473053199" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 204.0, "npi": [ 1073576930, 1417920794, 1427027325, 1861572232 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 237.0, "npi": [ 1083084263, 1740741792 ] } ] } ] }, { "tin": { "type": "ein", "value": "621453389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 532.0, "npi": [ 1114546579 ] } ] } ] }, { "tin": { "type": "ein", "value": "994936877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 339.28, "npi": [ 1124678628 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 516.0, "npi": [ 1184654014 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 231.0, "npi": [ 1235299249 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 478.0, "npi": [ 1245272400 ] }, { "billed_charge": 333.0, "npi": [ 1922628882 ] } ] } ] }, { "tin": { "type": "ein", "value": "486075762" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 70.0, "providers": [ { "billed_charge": 70.0, "npi": [ 1275235251 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 400.0, "npi": [ 1275552440, 1497763163 ] }, { "billed_charge": 416.0, "npi": [ 1336584291 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.0, "providers": [ { "billed_charge": 89.0, "npi": [ 1285000190 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 432.0, "npi": [ 1346685856 ] } ] } ] }, { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 357.0, "npi": [ 1376574863 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 559.0, "npi": [ 1457881260 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 204.0, "npi": [ 1619028255 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 524.0, "npi": [ 1659612299 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 187.0, "npi": [ 1720024292 ] } ] } ] }, { "tin": { "type": "ein", "value": "832948687" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 106.01, "providers": [ { "billed_charge": 440.0, "npi": [ 1881053585 ] } ] } ] } ] }, { "name": "Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody", "billing_code_type": "CPT", "billing_code": "86235", "billing_code_type_version": "2020", "description": "Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.55, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1033281126 ] }, { "billed_charge": 105.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 37.65, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 287.79, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 87.86, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 671.51, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 150.61, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 1151.16, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "FEDERALLY QUALIFIED HEALTH CENTER VISIT ESTAB PT", "billing_code_type": "HCPCS", "billing_code": "G0467", "billing_code_type_version": "2020", "description": "FEDERALLY QUALIFIED HEALTH CENTER VISIT ESTAB PT", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582001101" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 70.0, "providers": [ { "billed_charge": 278.0, "npi": [ 1164694089, 1205029352, 1225102908, 1508810227, 1659818623, 1932150422 ] } ] } ] }, { "tin": { "type": "ein", "value": "581394645" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 70.0, "providers": [ { "billed_charge": 210.0, "npi": [ 1295998722, 1730442229 ] } ] } ] } ] }, { "name": "Ferritin", "billing_code_type": "CPT", "billing_code": "82728", "billing_code_type_version": "2020", "description": "Ferritin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 85.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 13.63, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 20.45, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 40.89, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 82.95, "npi": [ 1194712083, 1801883780, 1821565045, 1851388748 ] }, { "billed_charge": 44.1, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 306.05, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.82, "providers": [ { "billed_charge": 170.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 72.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 82.95, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 34.08, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.54, "providers": [ { "billed_charge": 164.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21", "billing_code_type": "CPT", "billing_code": "81420", "billing_code_type_version": "2020", "description": "Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21", "allowed_amounts": [ { "tin": { "type": "ein", "value": "743238060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 802.33, "providers": [ { "billed_charge": 2000.0, "npi": [ 1346479169 ] } ] } ] }, { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 802.33, "providers": [ { "billed_charge": 2900.0, "npi": [ 1558672279 ] }, { "billed_charge": 3400.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "811082020" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 802.33, "providers": [ { "billed_charge": 3036.2, "npi": [ 1598314437 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 802.33, "providers": [ { "billed_charge": 1155.0, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood", "billing_code_type": "CPT", "billing_code": "81422", "billing_code_type_version": "2020", "description": "Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "743238060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 531.34, "providers": [ { "billed_charge": 999.0, "npi": [ 1346479169 ] } ] } ] }, { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 531.34, "providers": [ { "billed_charge": 999.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "811082020" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 531.34, "providers": [ { "billed_charge": 3036.2, "npi": [ 1598314437 ] } ] } ] } ] }, { "name": "Filter, disposable, used with positive airway pressure device", "billing_code_type": "HCPCS", "billing_code": "A7038", "billing_code_type_version": "2020", "description": "Filter, disposable, used with positive airway pressure device", "allowed_amounts": [ { "tin": { "type": "ein", "value": "510447627" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.64, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 13.0, "npi": [ 1033195110 ] } ] }, { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1033195110 ] } ] } ] }, { "tin": { "type": "ein", "value": "451810240" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.32, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 4.61, "npi": [ 1093339954 ] } ] } ] }, { "tin": { "type": "ein", "value": "200537780" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 40.99, "npi": [ 1104836493 ] } ] } ] }, { "tin": { "type": "ein", "value": "270110308" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.64, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1124251913 ] } ] }, { "allowed_amount": 12.64, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 12.64, "npi": [ 1124251913 ] } ] }, { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 30.24, "npi": [ 1124251913 ] }, { "billed_charge": 39.0, "npi": [ 1124251913 ] } ] } ] }, { "tin": { "type": "ein", "value": "593758015" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1184640393 ] } ] } ] }, { "tin": { "type": "ein", "value": "582117868" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1306403639 ] } ] } ] }, { "tin": { "type": "ein", "value": "593154523" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 55.68, "npi": [ 1346210275 ] } ] } ] }, { "tin": { "type": "ein", "value": "593223150" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.32, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 9.28, "npi": [ 1508846130 ] } ] }, { "allowed_amount": 11.6, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 46.4, "npi": [ 1508846130 ] } ] } ] }, { "tin": { "type": "ein", "value": "760653019" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 36.19, "npi": [ 1538471412 ] }, { "billed_charge": 39.0, "npi": [ 1538471412 ] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 30.24, "npi": [ 1740527654 ] } ] } ] }, { "tin": { "type": "ein", "value": "592852900" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 83.52, "npi": [ 1780763060 ] } ] } ] }, { "tin": { "type": "ein", "value": "571111621" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1801428776 ] } ] } ] }, { "tin": { "type": "ein", "value": "273319284" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 36.6, "npi": [ 1811206741 ] } ] } ] }, { "tin": { "type": "ein", "value": "621180379" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.92, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1851514558 ] } ] } ] } ] }, { "name": "FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST", "billing_code_type": "CPT", "billing_code": "88184", "billing_code_type_version": "2020", "description": "FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY 1ST", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 50.82, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 471.23, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 101.64, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 942.46, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA", "billing_code_type": "CPT", "billing_code": "88185", "billing_code_type_version": "2020", "description": "FLOW CYTOMETRY CELL SURF MARKER TECHL ONLY EA", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.78, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 302.7, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "FLOW CYTOMETRY INTERPJ 2-8 MARKERS", "billing_code_type": "CPT", "billing_code": "88187", "billing_code_type_version": "2020", "description": "FLOW CYTOMETRY INTERPJ 2-8 MARKERS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 23.93, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 214.0, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "FMR1 GENE ALYS EVAL TO DETECT ABNORMAL ALLELES", "billing_code_type": "CPT", "billing_code": "81243", "billing_code_type_version": "2020", "description": "FMR1 GENE ALYS EVAL TO DETECT ABNORMAL ALLELES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205446298" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 111.15, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1487632998 ] } ] } ] }, { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 111.15, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 436.0, "npi": [ 1558672279 ] }, { "billed_charge": 500.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "811082020" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 111.15, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 456.32, "npi": [ 1598314437 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 90.92, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 90.92, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 111.15, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 112.89, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "Folic acid; serum", "billing_code_type": "CPT", "billing_code": "82746", "billing_code_type_version": "2020", "description": "Folic acid; serum", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 105.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 14.7, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 117.6, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 22.05, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 44.1, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 44.1, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 80.68, "npi": [ 1174882948 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 49.27, "npi": [ 1639264575 ] }, { "billed_charge": 100.56, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 36.75, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.29, "providers": [ { "billed_charge": 92.4, "npi": [ 1801883780, 1851388748 ] } ] } ] } ] }, { "name": "GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G>A)", "billing_code_type": "CPT", "billing_code": "81251", "billing_code_type_version": "2020", "description": "GBA (glucosidase, beta, acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G>A)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 238.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 238.0, "npi": [ 1558672279 ] } ] }, { "allowed_amount": 250.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 250.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 75.32, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 75.32, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 93.52, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 93.52, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and", "billing_code_type": "CPT", "billing_code": "80050", "billing_code_type_version": "2020", "description": "General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621585063" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 71.0, "npi": [ 1003827858, 1063767093, 1134185358, 1194084681, 1326151655, 1396979233, 1457325862, 1497067045, 1558335844, 1578568648, 1588638910, 1619941119, 1659338044, 1750386819 ] } ] } ] }, { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 290.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 281.04, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 69.3, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "621612894" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 60.0, "npi": [ 1114977964 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 105.39, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 211.25, "npi": [ 1194769497 ] }, { "billed_charge": 265.33, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "453968854" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 120.0, "npi": [ 1215447990, 1790879310 ] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 44.2, "providers": [ { "billed_charge": 94.0, "npi": [ 1295061612 ] } ] } ] }, { "tin": { "type": "ein", "value": "334900298" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 129.0, "npi": [ 1326468604, 1497118285, 1659351906 ] } ] } ] }, { "tin": { "type": "ein", "value": "464227785" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 190.0, "npi": [ 1346391299 ] } ] } ] }, { "tin": { "type": "ein", "value": "621508884" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 44.2, "providers": [ { "billed_charge": 180.0, "npi": [ 1457147134 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.0, "providers": [ { "billed_charge": 49.0, "npi": [ 1487603817, 1689036048, 1821520453 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 168.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 119.4, "npi": [ 1639264575 ] }, { "billed_charge": 164.6, "npi": [ 1639264575 ] }, { "billed_charge": 179.55, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "582612685" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 70.0, "npi": [ 1669489084, 1679034995, 1740299650 ] } ] } ] }, { "tin": { "type": "ein", "value": "271198701" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 116.0, "npi": [ 1700820198 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 150.0, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "581646191" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 44.2, "providers": [ { "billed_charge": 247.0, "npi": [ 1811170566 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 125.8, "npi": [ 1821565045 ] }, { "billed_charge": 127.35, "npi": [ 1821565045 ] }, { "billed_charge": 134.06, "npi": [ 1821565045 ] }, { "billed_charge": 179.55, "npi": [ 1821565045 ] }, { "billed_charge": 214.06, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "582092768" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.0, "providers": [ { "billed_charge": 144.0, "npi": [ 1942392758 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 43.16, "providers": [ { "billed_charge": 43.91, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "Global fee urgent care centers", "billing_code_type": "HCPCS", "billing_code": "S9083", "billing_code_type_version": "2020", "description": "Global fee urgent care centers", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205277615" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.5, "providers": [ { "billed_charge": 200.0, "npi": [ 1023544301 ] } ] } ] }, { "tin": { "type": "ein", "value": "811941147" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 160.0, "providers": [ { "billed_charge": 160.0, "npi": [ 1063642296, 1306453980, 1447969522, 1639457716 ] } ] } ] }, { "tin": { "type": "ein", "value": "831551014" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.5, "providers": [ { "billed_charge": 165.3, "npi": [ 1184288920, 1326799024 ] } ] }, { "allowed_amount": 165.3, "providers": [ { "billed_charge": 165.3, "npi": [ 1861961534, 1912389800 ] } ] } ] }, { "tin": { "type": "ein", "value": "833622578" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.5, "providers": [ { "billed_charge": 176.0, "npi": [ 1194406330 ] } ] } ] }, { "tin": { "type": "ein", "value": "844255408" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 190.0, "providers": [ { "billed_charge": 300.0, "npi": [ 1194953638, 1821374380 ] } ] } ] }, { "tin": { "type": "ein", "value": "471625673" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 190.0, "providers": [ { "billed_charge": 503.0, "npi": [ 1336535814, 1457513186, 1518095462 ] }, { "billed_charge": 273.0, "npi": [ 1528591930, 1992805006 ] } ] } ] }, { "tin": { "type": "ein", "value": "814426958" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 190.0, "providers": [ { "billed_charge": 250.0, "npi": [ 1548461643, 1740394428 ] } ] } ] }, { "tin": { "type": "ein", "value": "271271347" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.5, "providers": [ { "billed_charge": 195.0, "npi": [ 1962237529 ] } ] } ] } ] }, { "name": "Gonadotropin; follicle stimulating hormone (FSH)", "billing_code_type": "CPT", "billing_code": "83001", "billing_code_type_version": "2020", "description": "Gonadotropin; follicle stimulating hormone (FSH)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 105.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 18.58, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 148.64, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 27.87, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 55.74, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 93.4, "npi": [ 1194769497 ] }, { "billed_charge": 149.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 112.35, "npi": [ 1306896253, 1801883780 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 13.01, "providers": [ { "billed_charge": 46.45, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "Ground mileage, per statute mile", "billing_code_type": "HCPCS", "billing_code": "A0425", "billing_code_type_version": "2020", "description": "Ground mileage, per statute mile", "allowed_amounts": [ { "tin": { "type": "ein", "value": "991130803" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 121.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 121.0, "npi": [ 1003706938 ] } ] } ] }, { "tin": { "type": "ein", "value": "990611768" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 59.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 181.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 412.5, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 243.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 552.5, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 261.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 476.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 454.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 826.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 462.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 840.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 623.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1134.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 709.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1290.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 995.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2262.5, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 1071.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2435.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 1078.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1960.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 1082.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1968.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 1146.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2084.0, "npi": [ 1003788852 ] } ] }, { "allowed_amount": 2469.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4490.0, "npi": [ 1003788852 ] } ] } ] }, { "tin": { "type": "ein", "value": "566001524" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 164.7, "npi": [ 1013949403 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011882" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.1, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 121.5, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 145.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 198.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 239.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 327.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 330.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 272.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 372.0, "npi": [ 1023063567 ] } ] }, { "allowed_amount": 273.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 373.5, "npi": [ 1023063567 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 330.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 330.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 840.0, "npi": [ 1134156045 ] } ] }, { "allowed_amount": 990.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2520.0, "npi": [ 1134156045 ] } ] } ] }, { "tin": { "type": "ein", "value": "263293246" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 151.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 552.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 179.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 652.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 180.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 656.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 680.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 265.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 964.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 270.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 984.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 271.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 988.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 300.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1092.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 332.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1208.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 333.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1212.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 423.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1540.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 528.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1920.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 570.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2076.0, "npi": [ 1023269321 ] } ] }, { "allowed_amount": 712.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2592.0, "npi": [ 1023269321 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000898" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 205.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 289.85, "npi": [ 1043390677 ] } ] } ] }, { "tin": { "type": "ein", "value": "561371972" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 157.75, "npi": [ 1053438697 ] } ] } ] }, { "tin": { "type": "ein", "value": "581249934" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 47.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 60.2, "npi": [ 1073659595 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 140.0, "npi": [ 1073659595 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000802" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1073683603 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000604" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 157.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 228.8, "npi": [ 1083624902 ] } ] } ] }, { "tin": { "type": "ein", "value": "621368669" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 224.0, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 238.0, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 333.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 424.2, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 348.7, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 443.8, "npi": [ 1093871618 ] } ] }, { "allowed_amount": 414.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 527.8, "npi": [ 1093871618 ] } ] } ] }, { "tin": { "type": "ein", "value": "620694743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1134131915 ] } ] } ] }, { "tin": { "type": "ein", "value": "586011374" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 25.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 32.2, "npi": [ 1134291842 ] } ] }, { "allowed_amount": 28.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 36.4, "npi": [ 1134291842 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000816" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 161.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 161.0, "npi": [ 1154401768 ] } ] } ] }, { "tin": { "type": "ein", "value": "331752989" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 1790.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1790.0, "npi": [ 1164389649 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363827" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 7.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 22.4, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 12.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 30.8, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 75.6, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 85.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 218.4, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 91.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 232.4, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 102.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 260.4, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 112.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 285.6, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 116.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 296.8, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 119.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 305.2, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 389.4, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1132.8, "npi": [ 1164445391 ] } ] }, { "allowed_amount": 484.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1232.0, "npi": [ 1164445391 ] } ] } ] }, { "tin": { "type": "ein", "value": "814571957" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 231.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 593.25, "npi": [ 1164966164 ] } ] } ] }, { "tin": { "type": "ein", "value": "994108358" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 272.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 372.0, "npi": [ 1174333470 ] } ] }, { "allowed_amount": 460.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 628.5, "npi": [ 1174333470 ] } ] } ] }, { "tin": { "type": "ein", "value": "464600407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 37.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 37.4, "npi": [ 1184037616 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 55.0, "npi": [ 1184037616 ] } ] }, { "allowed_amount": 528.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 528.0, "npi": [ 1184037616 ] } ] }, { "allowed_amount": 2948.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2948.0, "npi": [ 1184037616 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000829" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 93.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 110.5, "npi": [ 1184614208 ] } ] }, { "allowed_amount": 449.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 531.7, "npi": [ 1184614208 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000854" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 37.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 47.6, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 46.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 58.8, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 46.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 58.8, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 51.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 65.8, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 53.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 68.6, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 154.0, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 122.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 155.4, "npi": [ 1194762450 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1194762450 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000636" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 3.3, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 7.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 18.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 42.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 24.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 55.0, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 27.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 62.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 87.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 48.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 110.0, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 91.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 207.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 93.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 212.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 127.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 290.0, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 133.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 302.5, "npi": [ 1194797761 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 525.0, "npi": [ 1194797761 ] } ] } ] }, { "tin": { "type": "ein", "value": "237239334" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 200.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1183.0, "npi": [ 1194798082 ] } ] } ] }, { "tin": { "type": "ein", "value": "453801631" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 222.2, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 404.0, "npi": [ 1205112752 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000883" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 208.0, "npi": [ 1205932381 ] } ] }, { "allowed_amount": 199.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 235.3, "npi": [ 1205932381 ] } ] } ] }, { "tin": { "type": "ein", "value": "461615070" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 259.9, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 199.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 416.3, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 423.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 885.5, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 601.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1258.1, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 652.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1363.9, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 796.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1665.2, "npi": [ 1215368634 ] } ] }, { "allowed_amount": 1006.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2104.5, "npi": [ 1215368634 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000783" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 48.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 96.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 228.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 252.0, "npi": [ 1225193048 ] } ] }, { "allowed_amount": 308.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 336.0, "npi": [ 1225193048 ] } ] } ] }, { "tin": { "type": "ein", "value": "453827742" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 60.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 210.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 480.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 540.0, "npi": [ 1225305964 ] } ] }, { "allowed_amount": 1507.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4110.0, "npi": [ 1225305964 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000809" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 11.0, "npi": [ 1225436033 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 33.0, "npi": [ 1225436033 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1225436033 ] } ] } ] }, { "tin": { "type": "ein", "value": "646001544" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 198.0, "npi": [ 1245218742 ] } ] } ] }, { "tin": { "type": "ein", "value": "822125340" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 376.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 444.6, "npi": [ 1255859179 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 455.0, "npi": [ 1255859179 ] } ] }, { "allowed_amount": 528.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 624.0, "npi": [ 1255859179 ] } ] }, { "allowed_amount": 1166.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1378.0, "npi": [ 1255859179 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000902" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 83.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 121.6, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 84.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 123.2, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 89.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 129.6, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 112.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 163.2, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 113.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 164.8, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 124.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 180.8, "npi": [ 1265439137 ] } ] }, { "allowed_amount": 310.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 451.2, "npi": [ 1265439137 ] } ] } ] }, { "tin": { "type": "ein", "value": "450600978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 1001.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2706.34, "npi": [ 1275823122 ] } ] }, { "allowed_amount": 1320.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3568.8, "npi": [ 1275823122 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001495" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 3.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 4.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 23.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 31.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 25.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 34.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 25.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 34.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 26.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 27.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 37.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 34.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 46.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 40.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 55.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 41.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 57.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 57.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 78.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 73.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 100.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 75.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 103.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 79.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 86.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 118.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 95.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 130.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 96.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 107.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 147.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 202.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 276.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 249.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 340.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 258.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 352.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 260.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 355.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 265.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 361.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 279.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 381.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 291.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 397.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 293.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 400.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 294.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 402.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 295.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 403.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 405.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 298.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 406.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 298.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 406.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 301.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 411.0, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 311.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 424.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 342.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 466.5, "npi": [ 1285135715 ] } ] }, { "allowed_amount": 377.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 514.5, "npi": [ 1285135715 ] } ] } ] }, { "tin": { "type": "ein", "value": "261706720" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.8, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 24.8, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 27.2, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 27.2, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 30.4, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 30.4, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 57.6, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 57.6, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 116.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 116.8, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 117.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 117.6, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 118.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 118.4, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 142.4, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 142.4, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 146.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 146.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 152.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 152.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 188.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 188.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 249.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 249.6, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 280.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 280.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 285.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 285.6, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 312.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 312.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 342.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 342.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 348.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 348.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 350.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 350.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 582.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 582.4, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 583.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 583.2, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 591.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 591.2, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 816.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 816.8, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 824.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 824.0, "npi": [ 1295113868 ] } ] }, { "allowed_amount": 1616.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1616.0, "npi": [ 1295113868 ] } ] } ] }, { "tin": { "type": "ein", "value": "590737717" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 54.25, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 54.25, "npi": [ 1306896790 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000835" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 90.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 90.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 135.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1316052566 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 330.0, "npi": [ 1316052566 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000859" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 105.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 151.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 151.2, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 174.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 174.3, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 187.95, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 187.95, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 193.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 193.2, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 197.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 197.4, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 198.45, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 198.45, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 199.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 199.5, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 285.0, "npi": [ 1316154222 ] } ] }, { "allowed_amount": 217.35, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 217.35, "npi": [ 1316154222 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000873" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 105.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 193.25, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 241.56, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 223.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 408.64, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 442.86, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 298.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 545.52, "npi": [ 1326001108 ] } ] }, { "allowed_amount": 302.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 553.58, "npi": [ 1326001108 ] } ] } ] }, { "tin": { "type": "ein", "value": "582469468" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 2.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 3.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 3.3, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 4.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 7.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 10.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 9.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 13.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 15.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 15.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 12.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 16.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 18.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 19.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 15.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 21.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 18.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 25.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 25.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 34.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 26.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 43.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 34.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 46.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 36.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 49.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 52.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 42.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 58.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 42.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 58.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 60.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 49.5, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 67.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 49.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 67.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 50.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 69.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 53.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 73.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 75.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 75.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 75.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 56.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 76.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 58.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 79.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 59.4, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 81.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 63.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 87.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 90.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 67.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 91.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 71.5, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 97.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 74.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 102.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 75.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 103.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 81.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 111.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 135.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 135.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 100.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 136.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 107.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 147.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 112.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 153.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 137.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 187.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 141.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 193.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 195.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 150.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 205.5, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 225.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 182.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 249.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 255.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 270.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 200.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 273.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 300.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 341.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 465.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 378.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 516.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 506.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 690.0, "npi": [ 1326036161 ] } ] }, { "allowed_amount": 748.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1020.0, "npi": [ 1326036161 ] } ] } ] }, { "tin": { "type": "ein", "value": "591155275" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 26.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 28.8, "npi": [ 1326044793 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149128" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 4.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 14.21, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 42.62, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 46.18, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 15.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 49.73, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 69.18, "npi": [ 1326630153 ] }, { "billed_charge": 71.04, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 25.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 81.7, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 99.46, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 121.07, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 39.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 124.52, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 45.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 145.63, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 49.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 155.66, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 59.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 186.79, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 59.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 191.81, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 60.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 190.25, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 61.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 193.7, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 63.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 200.62, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 64.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 199.13, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 207.54, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 207.54, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 68.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 220.22, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 69.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 217.92, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 70.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 221.38, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 71.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 224.84, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 75.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 245.09, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 78.1, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 239.63, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 79.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 243.0, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 80.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 252.51, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 81.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 262.85, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 82.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 253.13, "npi": [ 1326630153 ] }, { "billed_charge": 259.43, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 84.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 266.34, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 85.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 269.8, "npi": [ 1326630153 ] }, { "billed_charge": 277.06, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 85.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 269.8, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 86.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 273.26, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 90.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 276.75, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 100.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 323.23, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 104.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 320.63, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 106.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 344.54, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 107.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 338.98, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 112.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 352.82, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 113.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 356.28, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 115.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 363.2, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 122.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 383.95, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 125.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 394.33, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 133.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 408.38, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 449.67, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 151.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 477.34, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 211.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 664.13, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 212.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 651.38, "npi": [ 1326630153 ] }, { "billed_charge": 667.59, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 212.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 667.59, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 213.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 654.75, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 215.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 661.5, "npi": [ 1326630153 ] }, { "billed_charge": 677.96, "npi": [ 1326630153 ] }, { "billed_charge": 696.19, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 216.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 681.42, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 224.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 724.61, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 273.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 861.29, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 299.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 918.0, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 342.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1075.75, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 841.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2646.14, "npi": [ 1326630153 ] }, { "billed_charge": 2717.28, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 952.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2995.49, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 991.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3200.35, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 1122.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3528.18, "npi": [ 1326630153 ] }, { "billed_charge": 3623.04, "npi": [ 1326630153 ] } ] }, { "allowed_amount": 1331.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4297.92, "npi": [ 1326630153 ] } ] } ] }, { "tin": { "type": "ein", "value": "824692084" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 12.1, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 16.5, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 40.5, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 67.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 91.5, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 70.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 96.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 74.8, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 102.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 81.4, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 111.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 1163.8, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1587.0, "npi": [ 1346744943 ] } ] }, { "allowed_amount": 1658.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2262.0, "npi": [ 1346744943 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000894" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 33.0, "npi": [ 1356447536 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1356447536 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 43.5, "npi": [ 1356447536 ] } ] }, { "allowed_amount": 34.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 46.5, "npi": [ 1356447536 ] } ] } ] }, { "tin": { "type": "ein", "value": "630725492" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 228.62, "npi": [ 1386710515 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000815" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 12.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 15.4, "npi": [ 1386824589 ] } ] }, { "allowed_amount": 82.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1386824589 ] } ] }, { "allowed_amount": 291.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 371.0, "npi": [ 1386824589 ] } ] }, { "allowed_amount": 389.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 495.6, "npi": [ 1386824589 ] } ] } ] }, { "tin": { "type": "ein", "value": "581282570" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 47.82, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 95.64, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 95.64, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 95.64, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 143.46, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 191.28, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 191.28, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 239.1, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 239.1, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 239.1, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 286.92, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 286.92, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 334.74, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 382.56, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 382.56, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 430.38, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 478.2, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 765.12, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 860.76, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 693.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3012.66, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 737.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 3203.94, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 1012.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4399.44, "npi": [ 1396950770 ] } ] }, { "allowed_amount": 1023.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4447.26, "npi": [ 1396950770 ] } ] } ] }, { "tin": { "type": "ein", "value": "263941348" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 9.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 14.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 16.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 19.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 19.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 20.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 20.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 15.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 22.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 16.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 20.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 30.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 23.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 33.6, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 43.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 44.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 46.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 46.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 48.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 36.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 52.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 37.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 54.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 56.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 40.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 59.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 41.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 60.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 64.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 46.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 67.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 51.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 75.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 52.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 76.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 80.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 56.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 81.6, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 57.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 83.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 61.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 89.6, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 72.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 105.6, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 78.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 113.6, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 80.3, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 116.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 128.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 91.3, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 132.8, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 103.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 150.4, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 192.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 178.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 259.2, "npi": [ 1407294028 ] } ] }, { "allowed_amount": 180.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 262.4, "npi": [ 1407294028 ] } ] } ] }, { "tin": { "type": "ein", "value": "753106281" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 2.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 3.75, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 18.73, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 28.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 48.7, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 54.32, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 70.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 119.87, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 83.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 142.35, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 97.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 166.7, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 104.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 177.94, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 111.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 189.17, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 130.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 222.89, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 299.68, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 237.6, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 404.57, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 254.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 432.66, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 257.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 438.28, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 260.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 443.9, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 278.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 473.87, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 293.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 500.09, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 368.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 627.46, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 529.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 900.91, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 543.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 925.26, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 545.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 929.01, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 704.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1198.72, "npi": [ 1407872153 ] } ] }, { "allowed_amount": 715.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1217.45, "npi": [ 1407872153 ] } ] } ] }, { "tin": { "type": "ein", "value": "581048752" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 157.5, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 116.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 159.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 202.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 276.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 233.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 318.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 250.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 342.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 253.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 345.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 257.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 351.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 266.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 363.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 278.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 379.5, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 293.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 400.5, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 298.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 406.5, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 299.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 408.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 323.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 441.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 325.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 444.0, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 335.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 457.5, "npi": [ 1427037522 ] } ] }, { "allowed_amount": 375.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 511.5, "npi": [ 1427037522 ] } ] } ] }, { "tin": { "type": "ein", "value": "586003349" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 98.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 98.7, "npi": [ 1427135540 ] } ] } ] }, { "tin": { "type": "ein", "value": "576000398" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 65.74, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 65.74, "npi": [ 1437142742 ] } ] } ] }, { "tin": { "type": "ein", "value": "630818351" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 291.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 397.5, "npi": [ 1437152212 ] } ] }, { "allowed_amount": 950.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1296.0, "npi": [ 1437152212 ] } ] } ] }, { "tin": { "type": "ein", "value": "741772120" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 86.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 147.41, "npi": [ 1437218062 ] } ] } ] }, { "tin": { "type": "ein", "value": "831214083" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 300.3, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 873.6, "npi": [ 1437778883 ] } ] }, { "allowed_amount": 382.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 974.4, "npi": [ 1437778883 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000446" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 653.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1366.2, "npi": [ 1447217484 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000822" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 4.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 5.8, "npi": [ 1477542983 ] } ] }, { "allowed_amount": 12.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 15.95, "npi": [ 1477542983 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 17.4, "npi": [ 1477542983 ] } ] } ] }, { "tin": { "type": "ein", "value": "453639743" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 35.7, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 35.7, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 20.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 20.0, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 71.4, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 30.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 107.1, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 107.1, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 107.1, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 142.8, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 142.8, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 142.8, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 178.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 178.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 178.5, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 214.2, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 249.9, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 249.9, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 285.6, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 285.6, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 321.3, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 321.3, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 392.7, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 464.1, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 714.0, "npi": [ 1477830164 ] } ] }, { "allowed_amount": 341.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1106.7, "npi": [ 1477830164 ] } ] } ] }, { "tin": { "type": "ein", "value": "272030893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 37.5, "npi": [ 1497075279 ] } ] }, { "allowed_amount": 321.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 438.0, "npi": [ 1497075279 ] } ] }, { "allowed_amount": 777.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1060.5, "npi": [ 1497075279 ] } ] } ] }, { "tin": { "type": "ein", "value": "581157005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 357.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 812.5, "npi": [ 1518718832 ] } ] } ] }, { "tin": { "type": "ein", "value": "934415873" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 279.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 558.8, "npi": [ 1518732643 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 154.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 182.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 208.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 221.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 234.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 351.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 308.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 364.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 352.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 416.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 396.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 468.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 407.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 481.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 440.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 520.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 462.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 546.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 484.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 572.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 517.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 611.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 528.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 624.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 539.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 637.0, "npi": [ 1538103049 ] } ] }, { "allowed_amount": 638.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 754.0, "npi": [ 1538103049 ] } ] } ] }, { "tin": { "type": "ein", "value": "581608892" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 17.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 108.8, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 18.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 115.6, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 190.4, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 204.0, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 35.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 217.6, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 42.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 265.2, "npi": [ 1538211081 ] } ] }, { "allowed_amount": 169.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1047.2, "npi": [ 1538211081 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000818" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 37.75, "npi": [ 1548329899 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 51.48, "npi": [ 1548329899 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 102.96, "npi": [ 1548329899 ] } ] } ] }, { "tin": { "type": "ein", "value": "586004467" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 39.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 72.0, "npi": [ 1558141671 ] } ] }, { "allowed_amount": 51.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 94.0, "npi": [ 1558141671 ] } ] }, { "allowed_amount": 157.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 286.0, "npi": [ 1558141671 ] } ] }, { "allowed_amount": 291.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 530.0, "npi": [ 1558141671 ] } ] }, { "allowed_amount": 1276.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2320.0, "npi": [ 1558141671 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 23.91, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 35.86, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 59.75, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 71.7, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 95.6, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 107.55, "npi": [ 1568569556 ] }, { "billed_charge": 107.56, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 119.51, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 131.45, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 131.45, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 131.45, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 143.41, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 155.35, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 167.3, "npi": [ 1568569556 ] }, { "billed_charge": 167.31, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 179.25, "npi": [ 1568569556 ] }, { "billed_charge": 179.26, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 191.2, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 227.05, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 262.91, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 275.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 298.75, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 286.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 310.71, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 322.65, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 330.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 358.51, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 418.25, "npi": [ 1568569556 ] } ] }, { "allowed_amount": 396.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 430.2, "npi": [ 1568569556 ] } ] } ] }, { "tin": { "type": "ein", "value": "582149691" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1568772689 ] } ] }, { "allowed_amount": 427.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 972.5, "npi": [ 1568772689 ] } ] }, { "allowed_amount": 238.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 542.5, "npi": [ 1609325018 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 275.0, "npi": [ 1790234102 ] } ] }, { "allowed_amount": 270.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 615.0, "npi": [ 1790234102 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1821308941 ] } ] }, { "allowed_amount": 291.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 662.5, "npi": [ 1821308941 ] } ] }, { "allowed_amount": 333.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 757.5, "npi": [ 1821308941 ] } ] }, { "allowed_amount": 474.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1077.5, "npi": [ 1821308941 ] } ] } ] }, { "tin": { "type": "ein", "value": "464991734" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 457.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 832.0, "npi": [ 1588084578 ] } ] } ] }, { "tin": { "type": "ein", "value": "842568754" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 70.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 211.2, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 74.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 224.4, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 397.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1191.3, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 403.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1211.1, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 462.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1386.0, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 558.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1676.4, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 564.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1692.9, "npi": [ 1588215628 ] } ] }, { "allowed_amount": 579.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1739.1, "npi": [ 1588215628 ] } ] } ] }, { "tin": { "type": "ein", "value": "452393528" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 44.0, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 225.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 315.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 360.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 405.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 294.8, "billing_code_modifier": [ "HR" ], "providers": [ { "billed_charge": 1206.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1575.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 980.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4009.5, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 1151.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 4711.5, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 1881.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 7695.0, "npi": [ 1639462476 ] } ] }, { "allowed_amount": 3355.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 13725.0, "npi": [ 1639462476 ] } ] } ] }, { "tin": { "type": "ein", "value": "472931229" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 200.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1639560832 ] } ] }, { "allowed_amount": 600.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 600.0, "npi": [ 1639560832 ] } ] }, { "allowed_amount": 762.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 762.0, "npi": [ 1639560832 ] } ] } ] }, { "tin": { "type": "ein", "value": "452735005" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 15.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 19.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 26.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 33.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 36.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 46.2, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 51.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 65.8, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 67.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 85.4, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 68.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 86.8, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 70.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 89.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 79.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 100.8, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 112.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 142.8, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 118.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 151.2, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 247.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 315.0, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 378.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 481.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 586.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 746.2, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 602.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 767.2, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 609.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 775.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 610.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 777.0, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 614.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 782.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 781.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 994.0, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1079.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1373.4, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1090.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1387.4, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1114.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1418.2, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1226.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1561.0, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1230.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1566.6, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1393.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1773.8, "npi": [ 1649558768 ] } ] }, { "allowed_amount": 1433.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1824.2, "npi": [ 1649558768 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000910" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 218.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 298.5, "npi": [ 1659435303 ] } ] } ] }, { "tin": { "type": "ein", "value": "581425000" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 33.71, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 74.92, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 50.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 86.16, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 62.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 106.76, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 62.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 106.76, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 106.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 181.68, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 148.5, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 252.86, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 262.22, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 179.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 305.3, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 202.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 344.63, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 254.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 432.66, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 255.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 434.54, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 259.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 442.03, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 260.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 443.9, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 261.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 445.77, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 282.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 481.36, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 447.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 762.31, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 543.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 925.26, "npi": [ 1669867487 ] } ] }, { "allowed_amount": 888.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1513.38, "npi": [ 1669867487 ] } ] } ] }, { "tin": { "type": "ein", "value": "596000627" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 119.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 119.9, "npi": [ 1679568943 ] } ] } ] }, { "tin": { "type": "ein", "value": "956000751" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 20.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 20.0, "npi": [ 1679579296 ] } ] } ] }, { "tin": { "type": "ein", "value": "582605844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 151.0, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 151.0, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 264.25, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 250.4, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 339.75, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 339.75, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 313.0, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 453.0, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 566.25, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 717.25, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 830.5, "npi": [ 1699769158 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 90.6, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 226.5, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 317.1, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 407.7, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 996.6, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 253.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1041.9, "npi": [ 1720300379 ] } ] }, { "allowed_amount": 1232.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 5479.04, "npi": [ 1720300379 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000904" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 215.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 343.0, "npi": [ 1699778530 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000790" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 291.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 344.5, "npi": [ 1699855049 ] } ] }, { "allowed_amount": 336.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 397.8, "npi": [ 1699855049 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000840" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 144.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 189.95, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 158.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 208.8, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 179.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 236.35, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 319.0, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 277.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 365.4, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 440.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 580.0, "npi": [ 1700877016 ] } ] }, { "allowed_amount": 453.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 597.4, "npi": [ 1700877016 ] } ] } ] }, { "tin": { "type": "ein", "value": "581097948" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 30.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1730133471 ] } ] }, { "allowed_amount": 32.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 32.0, "npi": [ 1730133471 ] } ] } ] }, { "tin": { "type": "ein", "value": "581923254" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 271.95, "npi": [ 1730156266 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 271.95, "npi": [ 1730156266 ] } ] } ] }, { "tin": { "type": "ein", "value": "824030857" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 54.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 14.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 54.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 15.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 58.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 19.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 75.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 23.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 88.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 24.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 92.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 28.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 109.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 113.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 30.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 117.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 121.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 126.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 45.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 172.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 61.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 235.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 74.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 285.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 86.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 331.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 93.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 357.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 95.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 365.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 105.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 403.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 162.8, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 621.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 193.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 739.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 199.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 760.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 200.2, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 764.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 204.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 781.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 798.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 798.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 210.1, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 802.2, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 245.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 936.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 256.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 978.6, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 277.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 1058.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 279.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1066.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 295.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1129.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 350.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1339.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 381.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1457.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 405.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1549.8, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 418.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1596.0, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 486.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 1856.4, "npi": [ 1730697335 ] } ] }, { "allowed_amount": 487.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1860.6, "npi": [ 1730697335 ] } ] } ] }, { "tin": { "type": "ein", "value": "853743288" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 1760.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 9920.0, "npi": [ 1730781014 ] } ] } ] }, { "tin": { "type": "ein", "value": "931965243" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1350.0, "npi": [ 1740069616 ] } ] } ] }, { "tin": { "type": "ein", "value": "822238883" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 7.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 16.8, "npi": [ 1740709393 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000878" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 49.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 67.5, "npi": [ 1750471272 ] } ] } ] }, { "tin": { "type": "ein", "value": "621642499" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 53.07, "npi": [ 1750688172 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 141.52, "npi": [ 1750688172 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 212.28, "npi": [ 1750688172 ] } ] }, { "allowed_amount": 638.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1623.42, "npi": [ 1750688172 ] } ] } ] }, { "tin": { "type": "ein", "value": "922991658" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 44.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1770272585 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000778" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 8.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1780644617 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000893" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 8.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1780668608 ] } ] }, { "allowed_amount": 26.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1780668608 ] } ] }, { "allowed_amount": 81.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 111.0, "npi": [ 1780668608 ] } ] }, { "allowed_amount": 107.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 147.0, "npi": [ 1780668608 ] } ] } ] }, { "tin": { "type": "ein", "value": "586002987" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 192.5, "npi": [ 1780969964 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 472.5, "npi": [ 1780969964 ] } ] }, { "allowed_amount": 374.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 595.0, "npi": [ 1780969964 ] } ] }, { "allowed_amount": 377.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 600.25, "npi": [ 1780969964 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 612.5, "npi": [ 1780969964 ] } ] }, { "allowed_amount": 396.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 630.0, "npi": [ 1780969964 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000906" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 52.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 57.6, "npi": [ 1790846665 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000826" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 35.2, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 44.8, "npi": [ 1790880474 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 56.0, "npi": [ 1790880474 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000825" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 62.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 74.1, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 104.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 123.5, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 108.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 128.7, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 157.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 185.9, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 257.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 304.2, "npi": [ 1801912597 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 351.0, "npi": [ 1801912597 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000799" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 135.0, "npi": [ 1801972625 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1801972625 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1801972625 ] } ] } ] }, { "tin": { "type": "ein", "value": "311836178" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 127.65, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 127.65, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 170.2, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 255.3, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 510.6, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 553.15, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 411.88, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 441.3, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 723.35, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 893.55, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1489.25, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 484.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1872.2, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 506.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1957.3, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 616.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2382.8, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 660.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2553.0, "npi": [ 1821028945 ] } ] }, { "allowed_amount": 704.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2723.2, "npi": [ 1821028945 ] } ] } ] }, { "tin": { "type": "ein", "value": "582164513" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 61.0, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 91.5, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 183.0, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 396.5, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 396.5, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 457.5, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 488.0, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 640.5, "npi": [ 1821141821 ] } ] }, { "allowed_amount": 253.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 701.5, "npi": [ 1821141821 ] } ] } ] }, { "tin": { "type": "ein", "value": "586001500" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 36.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 52.8, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 56.0, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 74.8, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 108.8, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 226.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 329.6, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 244.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 355.2, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 322.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 468.8, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 376.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 547.2, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 394.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 574.4, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 500.5, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 728.0, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 509.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 740.8, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 578.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 841.6, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 609.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 886.4, "npi": [ 1831154558 ] } ] }, { "allowed_amount": 675.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 982.4, "npi": [ 1831154558 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000844" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 270.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 350.55, "npi": [ 1831231216 ] } ] }, { "allowed_amount": 286.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 370.5, "npi": [ 1831231216 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000837" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 290.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 396.0, "npi": [ 1831260306 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000501" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 12.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 24.2, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 13.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 26.4, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 24.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 48.4, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 27.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 55.0, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 59.4, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 36.3, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 72.6, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 72.6, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 145.2, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 155.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 310.2, "npi": [ 1841276300 ] } ] }, { "allowed_amount": 339.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 679.8, "npi": [ 1841276300 ] } ] } ] }, { "tin": { "type": "ein", "value": "596000605" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1851400881 ] } ] } ] }, { "tin": { "type": "ein", "value": "630737822" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 638.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1073.0, "npi": [ 1851471932 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000913" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 190.8, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 119.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 196.2, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 206.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 338.4, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 238.7, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 390.6, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 396.0, "npi": [ 1871665174 ] } ] }, { "allowed_amount": 245.3, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 401.4, "npi": [ 1871665174 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000791" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 429.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 597.87, "npi": [ 1881859114 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000833" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 191.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 261.0, "npi": [ 1881861300 ] } ] } ] }, { "tin": { "type": "ein", "value": "271466450" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 153.4, "npi": [ 1881915155 ] } ] } ] }, { "tin": { "type": "ein", "value": "626000756" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 265.5, "npi": [ 1902800527 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000853" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 1353.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 2214.0, "npi": [ 1902890205 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000785" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 287.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 391.5, "npi": [ 1912086612 ] } ] } ] }, { "tin": { "type": "ein", "value": "586003047" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 37.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 40.8, "npi": [ 1932260007 ] } ] }, { "allowed_amount": 64.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 70.8, "npi": [ 1932260007 ] } ] }, { "allowed_amount": 149.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 163.2, "npi": [ 1932260007 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1932260007 ] } ] } ] }, { "tin": { "type": "ein", "value": "586010502" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 35.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 48.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 53.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 73.5, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 94.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 129.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 97.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 133.5, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 151.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 207.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 210.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 158.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 216.0, "npi": [ 1942310800 ] } ] }, { "allowed_amount": 617.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 841.5, "npi": [ 1942310800 ] } ] } ] }, { "tin": { "type": "ein", "value": "586012659" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 416.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 568.5, "npi": [ 1942386289 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000842" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 13.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 15.6, "npi": [ 1952363301 ] } ] }, { "allowed_amount": 46.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 54.6, "npi": [ 1952363301 ] } ] } ] }, { "tin": { "type": "ein", "value": "331880865" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 145.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 145.0, "npi": [ 1962273532 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000908" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 131.5, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 170.95, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 170.95, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 184.1, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 210.4, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 210.4, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 223.55, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 223.55, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 236.7, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 236.7, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 198.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 236.7, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 249.85, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 249.85, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 218.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 261.69, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 263.0, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 276.15, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 276.15, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 233.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 278.78, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 253.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 302.45, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 264.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 315.6, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 264.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 315.6, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 286.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 341.9, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 355.05, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 319.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 381.35, "npi": [ 1962444141 ] } ] }, { "allowed_amount": 363.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 433.95, "npi": [ 1962444141 ] } ] } ] }, { "tin": { "type": "ein", "value": "581036407" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 116.55, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 116.55, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 155.4, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 194.25, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 194.25, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 271.95, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 310.8, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 505.05, "npi": [ 1962452870 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 582.75, "npi": [ 1962452870 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 12.1, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 18.15, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 15.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 23.1, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 16.5, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 24.75, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 17.6, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 26.4, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 18.7, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 28.05, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 20.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 31.35, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 23.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 34.65, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 29.7, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 44.55, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 31.9, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 47.85, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 51.7, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 77.55, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 422.4, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 633.6, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 427.9, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 641.85, "npi": [ 1962478511 ] } ] }, { "allowed_amount": 721.6, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1082.4, "npi": [ 1962478511 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000865" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 23.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 31.5, "npi": [ 1962487942 ] } ] }, { "allowed_amount": 275.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 375.0, "npi": [ 1962487942 ] } ] }, { "allowed_amount": 346.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 472.5, "npi": [ 1962487942 ] } ] }, { "allowed_amount": 349.8, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 477.0, "npi": [ 1962487942 ] } ] }, { "allowed_amount": 359.7, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 490.5, "npi": [ 1962487942 ] } ] } ] }, { "tin": { "type": "ein", "value": "586009406" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 143.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 390.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 660.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 282.7, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 771.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 286.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 780.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 297.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 810.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 308.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 840.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 385.0, "billing_code_modifier": [ "EH" ], "providers": [ { "billed_charge": 1050.0, "npi": [ 1962593541 ] } ] }, { "allowed_amount": 440.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1962593541 ] } ] } ] }, { "tin": { "type": "ein", "value": "882026637" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 630.0, "npi": [ 1972248599 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000817" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 17.55, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 24.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 29.7, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 35.2, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 43.2, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 37.4, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 45.9, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 38.5, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 47.25, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 42.9, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 52.65, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 104.5, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 128.25, "npi": [ 1972608644 ] } ] }, { "allowed_amount": 147.4, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 180.9, "npi": [ 1972608644 ] } ] } ] }, { "tin": { "type": "ein", "value": "582612884" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 96.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 108.9, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 160.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 224.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 256.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 288.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 288.0, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 617.1, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 308.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1016.4, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 363.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 1197.9, "npi": [ 1982674636 ] } ] }, { "allowed_amount": 2057.0, "billing_code_modifier": [ "HH" ], "providers": [ { "billed_charge": 6788.1, "npi": [ 1982674636 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000845" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 280.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 300.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 176.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 320.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 187.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 340.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 380.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 400.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 400.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 420.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 231.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 420.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 242.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 440.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 264.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 480.0, "npi": [ 1982755138 ] } ] }, { "allowed_amount": 286.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 520.0, "npi": [ 1982755138 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000834" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 90.2, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 123.0, "npi": [ 1992715908 ] } ] } ] }, { "tin": { "type": "ein", "value": "586000836" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 11.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 12.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 25.3, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 27.6, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 33.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 48.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 44.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 48.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 45.1, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 49.2, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 60.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 55.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 60.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 72.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 66.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 72.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 84.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 77.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 84.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 96.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 88.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 96.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "PH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 99.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 110.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 121.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 132.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 143.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 156.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 154.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 165.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 209.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 228.0, "npi": [ 1992734867 ] } ] }, { "allowed_amount": 220.0, "billing_code_modifier": [ "RH" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1992734867 ] } ] } ] }, { "tin": { "type": "ein", "value": "536001131" }, "service_code": [ "41" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 11.0, "billing_code_modifier": [ "SH" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1992805022 ] } ] } ] } ] }, { "name": "HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant S", "billing_code_type": "CPT", "billing_code": "81257", "billing_code_type_version": "2020", "description": "HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndrome, HbH disease), gene analysis; common deletions or variant (eg, Southeast Asian, Thai, Filipino, Mediterranean, alpha3.7, alpha4.2, alpha20.5, Constant S", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 105.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 162.98, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 162.98, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 163.76, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 202.37, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)", "billing_code_type": "CPT", "billing_code": "81361", "billing_code_type_version": "2020", "description": "HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common variant(s) (eg, HbS, HbC, HbE)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.37, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 175.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.37, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 278.64, "npi": [ 1730481078 ] }, { "billed_charge": 345.95, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "Headgear used with positive airway pressure device", "billing_code_type": "HCPCS", "billing_code": "A7035", "billing_code_type_version": "2020", "description": "Headgear used with positive airway pressure device", "allowed_amounts": [ { "tin": { "type": "ein", "value": "510447627" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 33.6, "npi": [ 1033195110 ] } ] } ] }, { "tin": { "type": "ein", "value": "451810240" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 34.12, "npi": [ 1093339954 ] } ] } ] }, { "tin": { "type": "ein", "value": "270110308" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.2, "npi": [ 1124251913 ] } ] } ] }, { "tin": { "type": "ein", "value": "593758015" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.2, "npi": [ 1184640393 ] } ] } ] }, { "tin": { "type": "ein", "value": "582117868" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.2, "npi": [ 1306403639 ] } ] } ] }, { "tin": { "type": "ein", "value": "593154523" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 71.9, "npi": [ 1346210275 ] } ] } ] }, { "tin": { "type": "ein", "value": "593223150" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 71.9, "npi": [ 1508846130 ] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 47.7, "npi": [ 1740527654 ] } ] } ] }, { "tin": { "type": "ein", "value": "592852900" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 94.17, "npi": [ 1780763060 ] } ] } ] }, { "tin": { "type": "ein", "value": "800002984" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.2, "npi": [ 1790235844 ] } ] } ] }, { "tin": { "type": "ein", "value": "273319284" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 19.01, "npi": [ 1811206741 ] } ] } ] }, { "tin": { "type": "ein", "value": "621180379" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.11, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.2, "npi": [ 1851514558 ] } ] } ] } ] }, { "name": "HEMOGLOBIN GLYCOSYLATED A1C", "billing_code_type": "CPT", "billing_code": "83036", "billing_code_type_version": "2020", "description": "HEMOGLOBIN GLYCOSYLATED A1C", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 85.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 9.71, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 19.5, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 14.57, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 29.13, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 29.13, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 82.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 218.05, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 54.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 60.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 38.2, "npi": [ 1639264575 ] }, { "billed_charge": 69.3, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 24.28, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 55.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 33.75, "npi": [ 1821565045 ] }, { "billed_charge": 69.3, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 29.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 12.14, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.8, "providers": [ { "billed_charge": 117.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Hepatitis C antibody;", "billing_code_type": "CPT", "billing_code": "86803", "billing_code_type_version": "2020", "description": "Hepatitis C antibody;", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 150.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 21.41, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 42.81, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 42.81, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 171.75, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 320.64, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 96.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 57.5, "npi": [ 1639264575 ] }, { "billed_charge": 63.0, "npi": [ 1639264575 ] }, { "billed_charge": 112.35, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 49.95, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.99, "providers": [ { "billed_charge": 172.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S)", "billing_code_type": "CPT", "billing_code": "81255", "billing_code_type_version": "2020", "description": "HEXA (hexosaminidase A [alpha polypeptide]) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G>C, G269S)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 170.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 170.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 82.01, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 82.01, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 101.82, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 101.82, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN", "billing_code_type": "CPT", "billing_code": "99236", "billing_code_type_version": "2020", "description": "HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 329.61, "providers": [ { "billed_charge": 912.0, "npi": [ 1043300858 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 329.61, "providers": [ { "billed_charge": 1180.0, "npi": [ 1104990795 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 329.61, "providers": [ { "billed_charge": 1927.0, "npi": [ 1124522339, 1528332939, 1689641508, 1720026610, 1720032733, 1730200908 ] } ] }, { "allowed_amount": 372.97, "providers": [ { "billed_charge": 1927.0, "npi": [ 1629566385, 1689641508, 1720032733, 1821374380, 1932594850 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 372.97, "providers": [ { "billed_charge": 1180.0, "npi": [ 1407343981 ] } ] }, { "allowed_amount": 329.61, "providers": [ { "billed_charge": 1180.0, "npi": [ 1639139413 ] } ] } ] } ] }, { "name": "HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN", "billing_code_type": "CPT", "billing_code": "99239", "billing_code_type_version": "2020", "description": "HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "590637874" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 860.0, "npi": [ 1013295161 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 737.0, "npi": [ 1023066206, 1770169450 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 737.0, "npi": [ 1073008033, 1093896516, 1124605928, 1164650743, 1336587526, 1558352062, 1578978425, 1639127038, 1760045462, 1770169450, 1831196682, 1871024802, 1902827751 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 945.0, "npi": [ 1023423332, 1083009682, 1114968518, 1124522339, 1174895007, 1366735102, 1649502873, 1669858981, 1720026610, 1720032733, 1730200908, 1801453618, 1821374380, 1891845590, 1932580107, 1932594850 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 445.0, "npi": [ 1033343405, 1154340057, 1376962753 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 445.0, "npi": [ 1184914459, 1245596998, 1942722772, 1962444612 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 624.83, "npi": [ 1033383773, 1245734664, 1477730224, 1578982831, 1629604608, 1922088343, 1952806762 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 624.83, "npi": [ 1902122153 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 405.0, "npi": [ 1033646757, 1932769536 ] }, { "billed_charge": 454.0, "npi": [ 1144479726, 1164842621, 1346800331, 1366432544, 1447921812, 1578130894, 1588293492, 1598712549, 1629728027, 1639744667, 1699270041, 1699353573, 1740868835, 1841684198, 1871242461, 1871885194, 1891065546, 1912655713 ] }, { "billed_charge": 386.0, "npi": [ 1174273130, 1265817001, 1265826341, 1417577057, 1598883928, 1780115204 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 454.0, "npi": [ 1093978660, 1104350313, 1134172588, 1144726860, 1154854909, 1326074964, 1386909737, 1699268839, 1699353573, 1841605201, 1841829769, 1922310457 ] } ] } ] }, { "tin": { "type": "ein", "value": "203447115" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 301.0, "npi": [ 1063032340 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 301.0, "npi": [ 1114345972 ] } ] } ] }, { "tin": { "type": "ein", "value": "203279920" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 382.0, "npi": [ 1063497162, 1396326401, 1871167270 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 382.0, "npi": [ 1063508356, 1215513957, 1619943792 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 345.0, "npi": [ 1063851236, 1215590484, 1679130611, 1851929848, 1912430562 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 345.0, "npi": [ 1225009228, 1447927033, 1659875490, 1962612630 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 277.0, "npi": [ 1083222160, 1245694157 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 277.0, "npi": [ 1083222160, 1154629640, 1245694157, 1336778976, 1346675246, 1457980948, 1619218740, 1669621215, 1841501285, 1922758234 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 438.0, "npi": [ 1093292427 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 438.0, "npi": [ 1477948040 ] } ] } ] }, { "tin": { "type": "ein", "value": "832356574" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 304.0, "npi": [ 1093946923 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 592.0, "npi": [ 1104119817, 1104990795, 1164911376, 1275524654 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 592.0, "npi": [ 1639432156 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 232.0, "npi": [ 1104810167, 1760740716 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 232.0, "npi": [ 1447289913 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 630.0, "npi": [ 1114945979, 1184064867, 1609432566 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 270.24, "npi": [ 1124589023 ] } ] } ] }, { "tin": { "type": "ein", "value": "991566468" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 717.0, "npi": [ 1134436322, 1427037910, 1538470885 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 277.0, "npi": [ 1144258831, 1700851284 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 277.0, "npi": [ 1225520679, 1407823859, 1831323393, 1871158840 ] } ] } ] }, { "tin": { "type": "ein", "value": "911939739" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 332.0, "npi": [ 1144570581 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 592.0, "npi": [ 1154717601, 1578639951, 1730491317, 1912563149 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 592.0, "npi": [ 1790076008 ] } ] } ] }, { "tin": { "type": "ein", "value": "721597863" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 400.0, "npi": [ 1154958882 ] } ] } ] }, { "tin": { "type": "ein", "value": "204238269" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 1020.0, "npi": [ 1174521280, 1316945579 ] } ] } ] }, { "tin": { "type": "ein", "value": "912073120" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 434.0, "npi": [ 1225404510 ] } ] } ] }, { "tin": { "type": "ein", "value": "332241086" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 233.0, "npi": [ 1245619568 ] } ] } ] }, { "tin": { "type": "ein", "value": "452743899" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 277.0, "npi": [ 1265297873, 1396477808, 1457518813, 1568412146, 1649439134, 1669420261, 1861874612 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 445.0, "npi": [ 1306083258 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 445.0, "npi": [ 1720024292, 1972985273 ] } ] } ] }, { "tin": { "type": "ein", "value": "582639583" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 152.0, "providers": [ { "billed_charge": 152.0, "npi": [ 1306878251 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 367.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 1020.0, "npi": [ 1346735180, 1710940903 ] } ] } ] }, { "tin": { "type": "ein", "value": "822423015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 198.0, "npi": [ 1366447187 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 198.0, "npi": [ 1396716312 ] } ] } ] }, { "tin": { "type": "ein", "value": "920380998" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 748.0, "npi": [ 1376075101 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 748.0, "npi": [ 1649701343, 1679835649 ] } ] } ] }, { "tin": { "type": "ein", "value": "611665353" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 624.83, "npi": [ 1457485815 ] } ] } ] }, { "tin": { "type": "ein", "value": "582540964" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 366.0, "npi": [ 1477057461 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 221.78, "npi": [ 1477567279 ] } ] }, { "allowed_amount": 171.43, "providers": [ { "billed_charge": 221.78, "npi": [ 1801474374 ] } ] } ] }, { "tin": { "type": "ein", "value": "593555797" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 225.0, "npi": [ 1477725448 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 332.0, "npi": [ 1508718966, 1841796729 ] } ] } ] }, { "tin": { "type": "ein", "value": "931371454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 364.0, "npi": [ 1538118955 ] } ] } ] }, { "tin": { "type": "ein", "value": "932501469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 316.0, "npi": [ 1609491430 ] } ] }, { "allowed_amount": 182.7, "providers": [ { "billed_charge": 316.0, "npi": [ 1740576248 ] } ] } ] }, { "tin": { "type": "ein", "value": "582629795" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 346.0, "npi": [ 1689729055 ] } ] } ] }, { "tin": { "type": "ein", "value": "271813256" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 234.0, "npi": [ 1699762054 ] } ] } ] }, { "tin": { "type": "ein", "value": "454006393" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 495.0, "npi": [ 1730270158 ] } ] } ] }, { "tin": { "type": "ein", "value": "030417049" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 250.0, "npi": [ 1750876116 ] } ] } ] }, { "tin": { "type": "ein", "value": "465675991" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 277.0, "npi": [ 1750887675 ] } ] } ] }, { "tin": { "type": "ein", "value": "862411778" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 632.0, "npi": [ 1770840761 ] } ] } ] }, { "tin": { "type": "ein", "value": "582651479" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 175.0, "npi": [ 1770858953 ] } ] } ] }, { "tin": { "type": "ein", "value": "472111282" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 210.0, "npi": [ 1780629519 ] } ] } ] }, { "tin": { "type": "ein", "value": "272812143" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 200.0, "npi": [ 1821184540 ] } ] } ] }, { "tin": { "type": "ein", "value": "201190794" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 355.0, "npi": [ 1821438995 ] } ] } ] }, { "tin": { "type": "ein", "value": "874461181" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 350.0, "npi": [ 1831548536 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 218.0, "npi": [ 1841590908 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 171.43, "providers": [ { "billed_charge": 1020.0, "npi": [ 1871787408 ] } ] } ] }, { "tin": { "type": "ein", "value": "320325973" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 592.0, "npi": [ 1912141094 ] } ] } ] }, { "tin": { "type": "ein", "value": "260522515" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 182.7, "providers": [ { "billed_charge": 339.0, "npi": [ 1942243704 ] } ] } ] } ] }, { "name": "HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<", "billing_code_type": "CPT", "billing_code": "99238", "billing_code_type_version": "2020", "description": "HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<", "allowed_amounts": [ { "tin": { "type": "ein", "value": "451846825" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 171.0, "npi": [ 1003357864, 1356087555, 1528322112, 1922140706 ] } ] } ] }, { "tin": { "type": "ein", "value": "991566468" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 485.0, "npi": [ 1063677011 ] } ] } ] }, { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 696.0, "npi": [ 1073577631, 1285743278, 1538877683, 1639769979, 1669882668, 1710294491, 1710940903, 1720078504, 1730660093, 1821045808 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 642.0, "npi": [ 1083009682 ] } ] }, { "allowed_amount": 128.36, "providers": [ { "billed_charge": 642.0, "npi": [ 1083009682, 1114968518, 1669858981, 1720032733, 1821374380, 1932594850 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 406.0, "npi": [ 1083293138, 1104404227, 1568629699, 1639139413 ] } ] }, { "allowed_amount": 118.34, "providers": [ { "billed_charge": 406.0, "npi": [ 1639139413, 1669400438, 1740596493, 1972917185 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 504.0, "npi": [ 1093896516, 1174785216, 1306578059, 1548667934, 1831184944, 1831196682, 1902367816 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 308.0, "npi": [ 1093978660, 1477182418, 1790922847 ] }, { "billed_charge": 278.0, "npi": [ 1902332745 ] } ] }, { "allowed_amount": 128.36, "providers": [ { "billed_charge": 308.0, "npi": [ 1326493958, 1467764381, 1548899586, 1578025300, 1821220039, 1881614584 ] }, { "billed_charge": 265.0, "npi": [ 1609526862, 1619957826, 1841609351 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 196.0, "npi": [ 1104051119 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 430.0, "npi": [ 1114945979 ] } ] }, { "allowed_amount": 128.36, "providers": [ { "billed_charge": 430.0, "npi": [ 1790263150 ] } ] } ] }, { "tin": { "type": "ein", "value": "332672530" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 406.0, "npi": [ 1124508627 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 243.0, "npi": [ 1134435530, 1639673247 ] } ] }, { "allowed_amount": 118.34, "providers": [ { "billed_charge": 243.0, "npi": [ 1659422087, 1720665318, 1992783476 ] } ] } ] }, { "tin": { "type": "ein", "value": "834333066" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 214.0, "npi": [ 1134865918 ] } ] } ] }, { "tin": { "type": "ein", "value": "581020324" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 153.0, "npi": [ 1154970077 ] } ] } ] }, { "tin": { "type": "ein", "value": "203279920" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 261.0, "npi": [ 1174597546 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 141.0, "npi": [ 1174866503, 1639796196 ] } ] }, { "allowed_amount": 118.34, "providers": [ { "billed_charge": 141.0, "npi": [ 1265452791 ] } ] } ] }, { "tin": { "type": "ein", "value": "581311015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 135.0, "npi": [ 1215990098 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 223.0, "npi": [ 1285945428, 1689052136 ] } ] } ] }, { "tin": { "type": "ein", "value": "204553410" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 243.0, "npi": [ 1346808797 ] } ] } ] }, { "tin": { "type": "ein", "value": "626014528" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 203.0, "npi": [ 1366499261 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 314.0, "npi": [ 1376034215 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 314.0, "npi": [ 1407104862, 1558924944 ] } ] } ] }, { "tin": { "type": "ein", "value": "352297438" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 163.0, "npi": [ 1407188626, 1740716265 ] } ] } ] }, { "tin": { "type": "ein", "value": "822444447" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 163.0, "npi": [ 1427386689, 1821626201 ] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 182.0, "npi": [ 1437174570 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 696.0, "npi": [ 1437310117 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 223.0, "npi": [ 1477069805 ] } ] } ] }, { "tin": { "type": "ein", "value": "461921294" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 350.0, "npi": [ 1508044520 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 405.75, "npi": [ 1518449768 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 163.0, "npi": [ 1568434637 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 211.0, "npi": [ 1578026837 ] } ] } ] }, { "tin": { "type": "ein", "value": "582255198" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 129.0, "npi": [ 1588727614 ] } ] } ] }, { "tin": { "type": "ein", "value": "273597705" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 147.0, "npi": [ 1619984101 ] } ] } ] }, { "tin": { "type": "ein", "value": "462537433" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 211.0, "npi": [ 1659468668 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 223.0, "npi": [ 1669979266 ] } ] } ] }, { "tin": { "type": "ein", "value": "581734026" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 142.0, "npi": [ 1700970043 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 191.0, "npi": [ 1871579888 ] } ] } ] }, { "tin": { "type": "ein", "value": "273274203" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 142.0, "npi": [ 1881794162 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 128.36, "providers": [ { "billed_charge": 235.0, "npi": [ 1902447535 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 118.34, "providers": [ { "billed_charge": 442.29, "npi": [ 1982630059 ] } ] } ] } ] }, { "name": "IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM", "billing_code_type": "CPT", "billing_code": "87449", "billing_code_type_version": "2020", "description": "IAAD IA NOT OTHERWISE SPECIFIED EACH ORGANISM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 8.39, "providers": [ { "billed_charge": 35.94, "npi": [ 1497423198 ] } ] } ] } ] }, { "name": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "billing_code_type": "CPT", "billing_code": "87426", "billing_code_type_version": "2020", "description": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "394306781" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 61.83, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 106.0, "npi": [ 1154298784 ] } ] } ] } ] }, { "name": "IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS", "billing_code_type": "CPT", "billing_code": "87811", "billing_code_type_version": "2020", "description": "IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "473524701" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 70.0, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 70.0, "npi": [ 1134013923 ] } ] } ] } ] }, { "name": "IADNA CHLMYD TRCHMTS&NEISRA GONORR MULT AMP PRB", "billing_code_type": "CPT", "billing_code": "87494", "billing_code_type_version": "2020", "description": "IADNA CHLMYD TRCHMTS&NEISRA GONORR MULT AMP PRB", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 197.56, "npi": [ 1821206962 ] } ] } ] } ] }, { "name": "IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT", "billing_code_type": "CPT", "billing_code": "87624", "billing_code_type_version": "2020", "description": "IADNA HUMAN PAPILLOMAVIRUS HI-RSK TYP POOLD RSLT", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 110.0, "npi": [ 1104973080, 1366964397 ] } ] }, { "allowed_amount": 61.41, "providers": [ { "billed_charge": 110.0, "npi": [ 1821206962 ] } ] } ] } ] }, { "name": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "billing_code_type": "CPT", "billing_code": "87563", "billing_code_type_version": "2020", "description": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 280.72, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 31.25, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P)", "billing_code_type": "CPT", "billing_code": "81260", "billing_code_type_version": "2020", "description": "IKBKAP (inhibitor of kappa light polypeptide gene enhancer in B-cells, kinase complex-associated protein) (eg, familial dysautonomia) gene analysis, common variants (eg, 2507+6T>C, R696P)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 75.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 75.0, "npi": [ 1558672279 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 62.66, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 62.66, "npi": [ 1730481078 ] } ] }, { "allowed_amount": 77.79, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 77.79, "npi": [ 1730481078 ] } ] } ] } ] }, { "name": "IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE", "billing_code_type": "CPT", "billing_code": "88342", "billing_code_type_version": "2020", "description": "IMHCHEM/IMCYTCHM 1ST SINGLE ANTB STAIN PROCEDURE", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581910975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 248.0, "npi": [ 1003919531, 1225444300 ] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 80.45, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 94.0, "npi": [ 1013351782, 1083000285, 1093987695, 1629121686, 1750607313, 1902064389 ] } ] }, { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 114.54, "npi": [ 1013351782, 1083000285, 1093987695, 1629121686, 1750607313, 1902064389 ] } ] }, { "allowed_amount": 48.45, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 94.0, "npi": [ 1083680706 ] } ] }, { "allowed_amount": 160.9, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 188.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 225.82, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 229.08, "npi": [ 1750607313 ] } ] } ] }, { "tin": { "type": "ein", "value": "272341992" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 266.0, "npi": [ 1033120290 ] } ] } ] }, { "tin": { "type": "ein", "value": "650641688" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 155.0, "npi": [ 1063899821 ] } ] } ] }, { "tin": { "type": "ein", "value": "650819138" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 148.0, "npi": [ 1073791877, 1114364270 ] } ] } ] }, { "tin": { "type": "ein", "value": "581437914" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 127.0, "npi": [ 1104823301 ] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 180.0, "npi": [ 1164586707, 1659574127 ] }, { "billed_charge": 304.0, "npi": [ 1639911688 ] } ] } ] }, { "tin": { "type": "ein", "value": "800564919" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 55.56, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1285161919 ] } ] }, { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1679821094 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 451.64, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 996.0, "npi": [ 1306007018 ] } ] } ] }, { "tin": { "type": "ein", "value": "593725585" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 80.45, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 222.0, "npi": [ 1396408829, 1447437355 ] } ] }, { "allowed_amount": 22.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 95.0, "npi": [ 1740240753 ] } ] } ] }, { "tin": { "type": "ein", "value": "582082910" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 160.0, "npi": [ 1396708558, 1588870570, 1598975708 ] } ] } ] }, { "tin": { "type": "ein", "value": "621637129" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 191.8, "providers": [ { "billed_charge": 614.0, "npi": [ 1467433292 ] } ] } ] }, { "tin": { "type": "ein", "value": "581267100" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 148.0, "npi": [ 1679751978 ] } ] } ] }, { "tin": { "type": "ein", "value": "581749078" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1699837575 ] } ] } ] }, { "tin": { "type": "ein", "value": "259808526" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.91, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 165.0, "npi": [ 1740202290 ] } ] } ] }, { "tin": { "type": "ein", "value": "474903308" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 200.0, "npi": [ 1740733708 ] } ] } ] }, { "tin": { "type": "ein", "value": "582325457" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "providers": [ { "billed_charge": 260.0, "npi": [ 1821104704 ] } ] } ] } ] }, { "name": "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method", "billing_code_type": "CPT", "billing_code": "83516", "billing_code_type_version": "2020", "description": "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 8.07, "billing_code_modifier": [ "91" ], "providers": [ { "billed_charge": 61.69, "npi": [ 1245494517 ] }, { "billed_charge": 159.43, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 8.07, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 159.43, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 16.14, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 318.86, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified", "billing_code_type": "CPT", "billing_code": "83520", "billing_code_type_version": "2020", "description": "Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified", "allowed_amounts": [ { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.09, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 92.39, "npi": [ 1245494517 ] } ] }, { "allowed_amount": 24.18, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 184.78, "npi": [ 1245494517 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin", "billing_code_type": "CPT", "billing_code": "87324", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 8.39, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 22.76, "npi": [ 1497423198 ] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 8.39, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 20.0, "npi": [ 1659574127 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool", "billing_code_type": "CPT", "billing_code": "87338", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori, stool", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.07, "providers": [ { "billed_charge": 27.32, "npi": [ 1497423198 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.07, "providers": [ { "billed_charge": 232.05, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.07, "providers": [ { "billed_charge": 229.05, "npi": [ 1639911688 ] }, { "billed_charge": 24.0, "npi": [ 1659574127 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen", "billing_code_type": "CPT", "billing_code": "87340", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.23, "providers": [ { "billed_charge": 85.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.23, "providers": [ { "billed_charge": 96.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.23, "providers": [ { "billed_charge": 232.01, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.23, "providers": [ { "billed_charge": 36.16, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.23, "providers": [ { "billed_charge": 124.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-", "billing_code_type": "CPT", "billing_code": "87389", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 192.64, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 36.12, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 72.24, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 72.24, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 113.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 105.0, "npi": [ 1295726032 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 84.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "273575975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 28.9, "npi": [ 1639508757 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 73.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 16.86, "providers": [ { "billed_charge": 84.28, "npi": [ 1861994600 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay with direct optical observation; Influenza", "billing_code_type": "CPT", "billing_code": "87804", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay with direct optical observation; Influenza", "allowed_amounts": [ { "tin": { "type": "ein", "value": "473524701" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.96, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1134013923 ] } ] }, { "allowed_amount": 28.96, "billing_code_modifier": [ "QW", "59" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1134013923 ] } ] } ] }, { "tin": { "type": "ein", "value": "394306781" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.96, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1154298784 ] } ] }, { "allowed_amount": 28.96, "billing_code_modifier": [ "QW", "59" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1154298784 ] } ] } ] } ] }, { "name": "Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A", "billing_code_type": "CPT", "billing_code": "87880", "billing_code_type_version": "2020", "description": "Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A", "allowed_amounts": [ { "tin": { "type": "ein", "value": "473524701" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.93, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1134013923 ] } ] } ] }, { "tin": { "type": "ein", "value": "394306781" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.93, "billing_code_modifier": [ "QW" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1154298784 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique", "billing_code_type": "CPT", "billing_code": "87801", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621637129" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.14, "providers": [ { "billed_charge": 176.0, "npi": [ 1194676528 ] } ] }, { "allowed_amount": 98.28, "providers": [ { "billed_charge": 352.0, "npi": [ 1194676528 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.14, "providers": [ { "billed_charge": 381.8, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 147.42, "providers": [ { "billed_charge": 300.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.28, "providers": [ { "billed_charge": 240.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.14, "providers": [ { "billed_charge": 194.87, "npi": [ 1861913576 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism", "billing_code_type": "CPT", "billing_code": "87798", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism", "allowed_amounts": [ { "tin": { "type": "ein", "value": "561565047" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 589.51, "providers": [ { "billed_charge": 1445.28, "npi": [ 1073591822 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 105.28, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 73.69, "providers": [ { "billed_charge": 315.0, "npi": [ 1124407499, 1598383176 ] } ] }, { "allowed_amount": 442.13, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 1890.0, "npi": [ 1548385966, 1598383176 ] } ] }, { "allowed_amount": 442.13, "providers": [ { "billed_charge": 1890.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "931538878" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 294.76, "providers": [ { "billed_charge": 1320.0, "npi": [ 1124708532 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 26.85, "npi": [ 1134377781 ] }, { "billed_charge": 27.58, "npi": [ 1134377781 ] }, { "billed_charge": 28.25, "npi": [ 1134377781 ] }, { "billed_charge": 29.68, "npi": [ 1134377781 ] }, { "billed_charge": 31.25, "npi": [ 1134377781 ] }, { "billed_charge": 31.63, "npi": [ 1134377781 ] }, { "billed_charge": 32.65, "npi": [ 1134377781 ] }, { "billed_charge": 40.0, "npi": [ 1134377781 ] }, { "billed_charge": 40.42, "npi": [ 1134377781 ] }, { "billed_charge": 47.82, "npi": [ 1134377781 ] } ] }, { "allowed_amount": 49.13, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 55.16, "npi": [ 1134377781 ] }, { "billed_charge": 62.5, "npi": [ 1134377781 ] } ] }, { "allowed_amount": 73.69, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 94.9, "npi": [ 1134377781 ] } ] }, { "allowed_amount": 122.82, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 166.58, "npi": [ 1134377781 ] } ] }, { "allowed_amount": 196.5, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 219.13, "npi": [ 1134377781 ] }, { "billed_charge": 230.63, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 70.18, "npi": [ 1134538713 ] } ] }, { "allowed_amount": 319.32, "providers": [ { "billed_charge": 456.17, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "883965242" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 910.0, "npi": [ 1194448407 ] } ] } ] }, { "tin": { "type": "ein", "value": "621637129" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 245.63, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 880.0, "npi": [ 1194676528 ] } ] }, { "allowed_amount": 1228.15, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 4400.0, "npi": [ 1194676528 ] } ] } ] }, { "tin": { "type": "ein", "value": "923521003" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 689.0, "npi": [ 1245921329 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] }, { "allowed_amount": 49.13, "providers": [ { "billed_charge": 140.36, "npi": [ 1265206155 ] } ] }, { "allowed_amount": 73.69, "providers": [ { "billed_charge": 210.54, "npi": [ 1265206155 ] } ] }, { "allowed_amount": 147.38, "providers": [ { "billed_charge": 421.08, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 650.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 650.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 684.32, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "431580575" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 147.38, "providers": [ { "billed_charge": 315.84, "npi": [ 1396175196 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 294.76, "providers": [ { "billed_charge": 484.2, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 71.19, "npi": [ 1497423198 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 1200.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 547.4, "npi": [ 1518325562 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 547.43, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] }, { "allowed_amount": 73.69, "providers": [ { "billed_charge": 210.54, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 221.07, "providers": [ { "billed_charge": 394.76, "npi": [ 1659143899 ] } ] }, { "allowed_amount": 319.32, "providers": [ { "billed_charge": 570.21, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 98.25, "providers": [ { "billed_charge": 210.56, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 122.82, "providers": [ { "billed_charge": 263.2, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 147.38, "providers": [ { "billed_charge": 315.84, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 171.94, "providers": [ { "billed_charge": 368.48, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 196.5, "providers": [ { "billed_charge": 421.12, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 319.32, "providers": [ { "billed_charge": 684.32, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] }, { "allowed_amount": 49.13, "providers": [ { "billed_charge": 106.0, "npi": [ 1831851039 ] } ] }, { "allowed_amount": 319.32, "providers": [ { "billed_charge": 689.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.25, "providers": [ { "billed_charge": 220.0, "npi": [ 1841807849 ] } ] }, { "allowed_amount": 196.5, "providers": [ { "billed_charge": 440.0, "npi": [ 1841807849 ] } ] }, { "allowed_amount": 319.32, "providers": [ { "billed_charge": 715.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "863569910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "providers": [ { "billed_charge": 715.04, "npi": [ 1851966105 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 125.0, "npi": [ 1861913576 ] } ] }, { "allowed_amount": 221.07, "providers": [ { "billed_charge": 1125.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 319.32, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 912.34, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 221.07, "providers": [ { "billed_charge": 954.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87481", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Candida species, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "931538878" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 550.0, "npi": [ 1124708532 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "883965242" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 350.0, "npi": [ 1194448407 ] } ] } ] }, { "tin": { "type": "ein", "value": "923521003" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.25, "providers": [ { "billed_charge": 212.0, "npi": [ 1245921329 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 73.69, "providers": [ { "billed_charge": 210.54, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.25, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 250.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.25, "providers": [ { "billed_charge": 210.56, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "621687140" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1487657573 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 98.25, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 210.54, "npi": [ 1518325562 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1548385966, 1598383176 ] } ] }, { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 210.55, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 73.69, "providers": [ { "billed_charge": 210.54, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 219.31, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 73.69, "providers": [ { "billed_charge": 157.92, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 73.69, "providers": [ { "billed_charge": 159.0, "npi": [ 1831851039 ] } ] }, { "allowed_amount": 122.82, "providers": [ { "billed_charge": 265.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 275.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "863569910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 275.0, "npi": [ 1851966105 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 122.82, "providers": [ { "billed_charge": 725.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] }, { "allowed_amount": 98.25, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 280.72, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] }, { "allowed_amount": 122.82, "providers": [ { "billed_charge": 530.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87486", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia pneumoniae, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 27.39, "npi": [ 1134377781 ] }, { "billed_charge": 28.83, "npi": [ 1134377781 ] }, { "billed_charge": 31.63, "npi": [ 1134377781 ] }, { "billed_charge": 32.65, "npi": [ 1134377781 ] }, { "billed_charge": 40.41, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87491", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 100.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 280.72, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 31.25, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 122.82, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87496", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87511", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 31.25, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 50.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe tech", "billing_code_type": "CPT", "billing_code": "87506", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe tech", "allowed_amounts": [ { "tin": { "type": "ein", "value": "853877508" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 184.09, "providers": [ { "billed_charge": 495.0, "npi": [ 1497423198 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87529", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 140.36, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 50.0, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 140.36, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 105.28, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 84.22, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 140.36, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 105.28, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 105.28, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.13, "providers": [ { "billed_charge": 110.0, "npi": [ 1841807849 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87541", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 24.59, "npi": [ 1134377781 ] }, { "billed_charge": 25.88, "npi": [ 1134377781 ] }, { "billed_charge": 31.64, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87581", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 26.84, "npi": [ 1134377781 ] }, { "billed_charge": 27.58, "npi": [ 1134377781 ] }, { "billed_charge": 28.25, "npi": [ 1134377781 ] }, { "billed_charge": 31.63, "npi": [ 1134377781 ] }, { "billed_charge": 32.65, "npi": [ 1134377781 ] }, { "billed_charge": 40.41, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87591", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 100.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 280.72, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 31.25, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 122.82, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when perfor", "billing_code_type": "CPT", "billing_code": "87631", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when perfor", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.84, "providers": [ { "billed_charge": 285.26, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.84, "providers": [ { "billed_charge": 112.09, "npi": [ 1134377781 ] }, { "billed_charge": 120.64, "npi": [ 1134377781 ] }, { "billed_charge": 128.57, "npi": [ 1134377781 ] }, { "billed_charge": 194.36, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.84, "providers": [ { "billed_charge": 285.26, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.84, "providers": [ { "billed_charge": 285.26, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.84, "providers": [ { "billed_charge": 178.29, "npi": [ 1659143899 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when perfor", "billing_code_type": "CPT", "billing_code": "87633", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when perfor", "allowed_amounts": [ { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 291.75, "providers": [ { "billed_charge": 450.0, "npi": [ 1124407499 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 291.75, "providers": [ { "billed_charge": 1250.34, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 291.75, "providers": [ { "billed_charge": 479.3, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 52.64, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] }, { "allowed_amount": 291.75, "providers": [ { "billed_charge": 835.0, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 291.75, "providers": [ { "billed_charge": 625.0, "npi": [ 1841807849 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87640", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1124407499, 1548385966, 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "931538878" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 110.0, "npi": [ 1124708532 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 27.4, "npi": [ 1134377781 ] }, { "billed_charge": 28.83, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "883965242" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 70.0, "npi": [ 1194448407 ] } ] } ] }, { "tin": { "type": "ein", "value": "923521003" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1245921329 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "863569910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1851966105 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 115.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87641", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1124407499 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 27.4, "npi": [ 1134377781 ] }, { "billed_charge": 28.83, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "474795263" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1518325562 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 175.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87651", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 27.4, "npi": [ 1134377781 ] }, { "billed_charge": 27.59, "npi": [ 1134377781 ] }, { "billed_charge": 28.83, "npi": [ 1134377781 ] }, { "billed_charge": 29.68, "npi": [ 1134377781 ] }, { "billed_charge": 33.31, "npi": [ 1134377781 ] }, { "billed_charge": 40.0, "npi": [ 1134377781 ] }, { "billed_charge": 40.41, "npi": [ 1134377781 ] }, { "billed_charge": 47.82, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "863569910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1851966105 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 145.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87653", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "931538878" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 110.0, "npi": [ 1124708532 ] } ] } ] }, { "tin": { "type": "ein", "value": "883965242" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 70.0, "npi": [ 1194448407 ] } ] } ] }, { "tin": { "type": "ein", "value": "923521003" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1245921329 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1548385966, 1598383176 ] } ] }, { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 160.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] } ] }, { "tin": { "type": "ein", "value": "420680452" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 120.0, "npi": [ 1962485136 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique", "billing_code_type": "CPT", "billing_code": "87661", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 200.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 280.72, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1104631415 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 31.25, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.27, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "934122454" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1265206155 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.55, "providers": [ { "billed_charge": 111.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "621687140" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1487657573 ] } ] } ] }, { "tin": { "type": "ein", "value": "994655411" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1588498091 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 61.41, "providers": [ { "billed_charge": 119.68, "npi": [ 1821206962 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique", "billing_code_type": "CPT", "billing_code": "87500", "billing_code_type_version": "2020", "description": "Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 35.09, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "883965242" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.0, "npi": [ 1194448407 ] } ] } ] }, { "tin": { "type": "ein", "value": "923521003" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1245921329 ] } ] } ] }, { "tin": { "type": "ein", "value": "464163620" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 50.0, "npi": [ 1265854855 ] } ] } ] }, { "tin": { "type": "ein", "value": "800936483" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1326484569 ] } ] } ] }, { "tin": { "type": "ein", "value": "271333897" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1346571775 ] } ] } ] }, { "tin": { "type": "ein", "value": "815340198" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 40.35, "npi": [ 1407487465 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 50.0, "npi": [ 1508594136 ] } ] } ] }, { "tin": { "type": "ein", "value": "334777680" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 42.11, "npi": [ 1558150078 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 105.0, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "932835475" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 43.86, "npi": [ 1659143899 ] } ] } ] }, { "tin": { "type": "ein", "value": "811008582" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 52.64, "npi": [ 1659726487 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 53.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "852939150" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 55.0, "npi": [ 1841807849 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 175.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 70.18, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "365093619" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.56, "providers": [ { "billed_charge": 106.0, "npi": [ 1962266890 ] } ] } ] } ] }, { "name": "IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES", "billing_code_type": "CPT", "billing_code": "99254", "billing_code_type_version": "2020", "description": "IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 285.98, "providers": [ { "billed_charge": 394.0, "npi": [ 1003272485 ] } ] } ] }, { "tin": { "type": "ein", "value": "475656579" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 285.98, "providers": [ { "billed_charge": 597.0, "npi": [ 1003280108, 1760585061, 1881856078 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 285.98, "providers": [ { "billed_charge": 584.0, "npi": [ 1013281476 ] } ] }, { "allowed_amount": 234.96, "providers": [ { "billed_charge": 597.0, "npi": [ 1538414495, 1588293492 ] }, { "billed_charge": 584.0, "npi": [ 1649771569 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 406.0, "npi": [ 1083222160, 1154629640, 1619218740, 1922758234 ] } ] } ] }, { "tin": { "type": "ein", "value": "271198208" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 557.0, "npi": [ 1144750571 ] } ] } ] }, { "tin": { "type": "ein", "value": "582234927" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 557.0, "npi": [ 1205126851 ] } ] } ] }, { "tin": { "type": "ein", "value": "471104925" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 305.0, "npi": [ 1255398095 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 508.0, "npi": [ 1255891321, 1740507425 ] } ] }, { "allowed_amount": 285.98, "providers": [ { "billed_charge": 508.0, "npi": [ 1841523818 ] } ] } ] }, { "tin": { "type": "ein", "value": "460676654" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 459.0, "npi": [ 1285848689, 1750419487 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 285.98, "providers": [ { "billed_charge": 508.0, "npi": [ 1447250337 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259671" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 459.0, "npi": [ 1720266307 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 542.0, "npi": [ 1811429657, 1881197671 ] } ] } ] }, { "tin": { "type": "ein", "value": "320325973" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 285.98, "providers": [ { "billed_charge": 920.0, "npi": [ 1952697971 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 234.96, "providers": [ { "billed_charge": 416.0, "npi": [ 1952861916 ] } ] } ] } ] }, { "name": "Iron", "billing_code_type": "CPT", "billing_code": "83540", "billing_code_type_version": "2020", "description": "Iron", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 65.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 9.71, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 19.41, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 19.41, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 33.03, "npi": [ 1194712083, 1801883780, 1821565045, 1851388748 ] }, { "billed_charge": 33.04, "npi": [ 1801883780, 1851388748 ] }, { "billed_charge": 15.15, "npi": [ 1821565045 ] }, { "billed_charge": 19.25, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 145.57, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 226.8, "npi": [ 1376548271 ] }, { "billed_charge": 33.03, "npi": [ 1639264575 ] }, { "billed_charge": 33.04, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 24.5, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 20.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 16.18, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.53, "providers": [ { "billed_charge": 78.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Iron binding capacity", "billing_code_type": "CPT", "billing_code": "83550", "billing_code_type_version": "2020", "description": "Iron binding capacity", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 95.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 13.11, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 26.22, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 26.22, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 44.67, "npi": [ 1194712083, 1801883780, 1821565045, 1851388748 ] }, { "billed_charge": 44.66, "npi": [ 1801883780, 1851388748 ] }, { "billed_charge": 20.48, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 196.4, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.37, "providers": [ { "billed_charge": 174.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 33.1, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 44.66, "npi": [ 1639264575 ] }, { "billed_charge": 44.67, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 20.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.12, "providers": [ { "billed_charge": 21.85, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "Lactate dehydrogenase (LD), (LDH);", "billing_code_type": "CPT", "billing_code": "83615", "billing_code_type_version": "2020", "description": "Lactate dehydrogenase (LD), (LDH);", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 45.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 38.85, "npi": [ 1194712083, 1801883780 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 135.53, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 38.85, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 15.1, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.23, "providers": [ { "billed_charge": 73.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "billing_code_type": "CPT", "billing_code": "88304", "billing_code_type_version": "2020", "description": "LEVEL III SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 30.21, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.21, "npi": [ 1013351782, 1083000285, 1093987695 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.89, "npi": [ 1104001668, 1336106269 ] } ] } ] }, { "tin": { "type": "ein", "value": "800564919" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 192.0, "npi": [ 1275512923, 1518489673 ] } ] }, { "allowed_amount": 17.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 192.0, "npi": [ 1285161919 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 49.0, "npi": [ 1306007018 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 25.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 25.0, "npi": [ 1366418493 ] } ] } ] }, { "tin": { "type": "ein", "value": "582082910" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 110.0, "npi": [ 1396708558, 1588870570 ] } ] }, { "allowed_amount": 63.32, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 220.0, "npi": [ 1396708558, 1598975708 ] } ] } ] }, { "tin": { "type": "ein", "value": "582339211" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 7.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1679580286 ] } ] } ] }, { "tin": { "type": "ein", "value": "581749078" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 120.0, "npi": [ 1699837575 ] } ] } ] }, { "tin": { "type": "ein", "value": "259808526" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 142.0, "npi": [ 1740202290 ] } ] } ] }, { "tin": { "type": "ein", "value": "581763128" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 63.32, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1760793673 ] } ] }, { "allowed_amount": 31.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1851308225 ] } ] } ] } ] }, { "name": "LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "billing_code_type": "CPT", "billing_code": "88305", "billing_code_type_version": "2020", "description": "LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581910975" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 258.0, "npi": [ 1003919531, 1225444300, 1497915276 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 516.0, "npi": [ 1003919531, 1225444300, 1295085686 ] } ] }, { "allowed_amount": 137.34, "providers": [ { "billed_charge": 774.0, "npi": [ 1003919531, 1497915276 ] } ] }, { "allowed_amount": 228.9, "providers": [ { "billed_charge": 1290.0, "npi": [ 1003919531, 1225444300 ] } ] }, { "allowed_amount": 274.68, "providers": [ { "billed_charge": 1548.0, "npi": [ 1003919531 ] } ] }, { "allowed_amount": 23.81, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 93.0, "npi": [ 1225444300, 1295085686 ] } ] }, { "allowed_amount": 47.63, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 186.0, "npi": [ 1225444300, 1295085686 ] } ] }, { "allowed_amount": 71.44, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 279.0, "npi": [ 1225444300 ] } ] }, { "allowed_amount": 95.26, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 372.0, "npi": [ 1225444300, 1295085686 ] } ] }, { "allowed_amount": 119.07, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 465.0, "npi": [ 1295085686 ] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 23.81, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 101.9, "npi": [ 1013351782, 1083000285, 1629121686, 1659440741 ] } ] }, { "allowed_amount": 54.92, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1013351782, 1821206962 ] } ] }, { "allowed_amount": 21.97, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1083000285, 1083680706, 1629121686, 1659440741, 1932589561 ] } ] }, { "allowed_amount": 65.9, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 432.0, "npi": [ 1083000285, 1083680706, 1104973080 ] } ] }, { "allowed_amount": 43.93, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 288.0, "npi": [ 1093987695, 1104973080 ] } ] }, { "allowed_amount": 47.63, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 203.8, "npi": [ 1093987695 ] } ] }, { "allowed_amount": 87.86, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 576.0, "npi": [ 1104973080 ] } ] }, { "allowed_amount": 45.78, "providers": [ { "billed_charge": 245.9, "npi": [ 1366862203, 1457649139, 1891955688, 1962848671 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 491.8, "npi": [ 1366862203, 1891955688, 1962848671 ] } ] }, { "allowed_amount": 274.68, "providers": [ { "billed_charge": 1475.4, "npi": [ 1366862203 ] } ] }, { "allowed_amount": 549.36, "providers": [ { "billed_charge": 2950.8, "npi": [ 1770637266 ] } ] }, { "allowed_amount": 59.54, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 101.9, "npi": [ 1821206962 ] } ] }, { "allowed_amount": 109.83, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 288.0, "npi": [ 1821206962 ] } ] }, { "allowed_amount": 119.07, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 203.8, "npi": [ 1821206962 ] } ] }, { "allowed_amount": 343.35, "providers": [ { "billed_charge": 737.7, "npi": [ 1821206962 ] } ] }, { "allowed_amount": 457.8, "providers": [ { "billed_charge": 983.6, "npi": [ 1821206962 ] } ] } ] }, { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 101.9, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 101.9, "npi": [ 1013351782, 1083000285, 1093987695, 1629121686, 1821206962, 1902064389 ] } ] }, { "allowed_amount": 141.91, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1013351782, 1083000285, 1093987695, 1285620435, 1629121686, 1821206962, 1902064389 ] } ] }, { "allowed_amount": 203.8, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 203.8, "npi": [ 1013351782, 1750607313, 1902064389 ] } ] }, { "allowed_amount": 283.82, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 288.0, "npi": [ 1013351782, 1285620435, 1902064389 ] } ] }, { "allowed_amount": 305.7, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 305.7, "npi": [ 1013351782 ] } ] }, { "allowed_amount": 21.97, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 144.0, "npi": [ 1083680706, 1659440741 ] } ] }, { "allowed_amount": 611.4, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 611.4, "npi": [ 1093987695 ] } ] }, { "allowed_amount": 851.46, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 864.0, "npi": [ 1093987695 ] } ] }, { "allowed_amount": 407.6, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 407.6, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 567.64, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 576.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 713.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 713.3, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 993.37, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 1008.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1019.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1019.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1120.9, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1120.9, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1222.8, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1222.8, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1419.1, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 1440.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1561.01, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 1584.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 1702.92, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 1728.0, "npi": [ 1750607313 ] } ] }, { "allowed_amount": 509.5, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 509.5, "npi": [ 1902064389 ] } ] }, { "allowed_amount": 709.55, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 720.0, "npi": [ 1902064389 ] } ] } ] }, { "tin": { "type": "ein", "value": "582325457" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 275.0, "npi": [ 1023451663, 1043427636, 1053349712, 1053624049, 1124002712, 1275512295, 1578637542, 1609048412, 1679731095, 1760440481 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 550.0, "npi": [ 1023451663, 1053624049, 1124002712, 1275512295, 1578637542, 1760440481, 1821104704 ] } ] }, { "allowed_amount": 137.34, "providers": [ { "billed_charge": 825.0, "npi": [ 1053624049, 1578637542, 1760440481, 1982883138 ] } ] }, { "allowed_amount": 23.81, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 201.0, "npi": [ 1821104704 ] } ] }, { "allowed_amount": 47.63, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 402.0, "npi": [ 1821104704 ] } ] }, { "allowed_amount": 142.88, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1206.0, "npi": [ 1821104704 ] } ] } ] }, { "tin": { "type": "ein", "value": "753053660" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 220.0, "npi": [ 1033115902 ] } ] } ] }, { "tin": { "type": "ein", "value": "272341992" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 199.0, "npi": [ 1033120290 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 398.0, "npi": [ 1033120290 ] } ] } ] }, { "tin": { "type": "ein", "value": "030450086" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 460.0, "npi": [ 1053582353 ] } ] } ] }, { "tin": { "type": "ein", "value": "650641688" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 135.0, "npi": [ 1063899821, 1154300739 ] } ] } ] }, { "tin": { "type": "ein", "value": "650819138" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 163.0, "npi": [ 1073791877, 1114364270, 1841302882 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 326.0, "npi": [ 1073791877 ] } ] }, { "allowed_amount": 137.34, "providers": [ { "billed_charge": 489.0, "npi": [ 1073791877 ] } ] }, { "allowed_amount": 228.9, "providers": [ { "billed_charge": 815.0, "npi": [ 1073791877 ] } ] }, { "allowed_amount": 274.68, "providers": [ { "billed_charge": 978.0, "npi": [ 1073791877 ] } ] }, { "allowed_amount": 183.12, "providers": [ { "billed_charge": 652.0, "npi": [ 1114364270, 1841302882 ] } ] } ] }, { "tin": { "type": "ein", "value": "581714481" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 235.0, "npi": [ 1083609259 ] } ] }, { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 470.0, "npi": [ 1083609259 ] } ] } ] }, { "tin": { "type": "ein", "value": "581437914" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 208.0, "npi": [ 1104823301, 1396776084 ] } ] }, { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 416.0, "npi": [ 1104823301, 1164683132, 1417952086 ] } ] } ] }, { "tin": { "type": "ein", "value": "205455398" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 284.0, "npi": [ 1134438427 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 568.0, "npi": [ 1134438427 ] } ] } ] }, { "tin": { "type": "ein", "value": "581267100" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 117.0, "npi": [ 1134625577, 1679751978 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 234.0, "npi": [ 1134625577 ] } ] } ] }, { "tin": { "type": "ein", "value": "621729316" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 199.5, "npi": [ 1154696243 ] } ] } ] }, { "tin": { "type": "ein", "value": "352037910" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 122.0, "npi": [ 1164586707, 1184788747, 1356543441, 1659574127, 1962466565, 1982605820 ] }, { "billed_charge": 225.0, "npi": [ 1639911688 ] } ] }, { "allowed_amount": 91.56, "providers": [ { "billed_charge": 244.0, "npi": [ 1164586707, 1356543441, 1659574127, 1962466565, 1982605820 ] } ] }, { "allowed_amount": 137.34, "providers": [ { "billed_charge": 366.0, "npi": [ 1164586707, 1659574127 ] }, { "billed_charge": 675.0, "npi": [ 1639911688 ] } ] }, { "allowed_amount": 183.12, "providers": [ { "billed_charge": 488.0, "npi": [ 1164586707, 1184788747, 1659574127 ] } ] }, { "allowed_amount": 549.36, "providers": [ { "billed_charge": 1464.0, "npi": [ 1235398637 ] }, { "billed_charge": 2700.0, "npi": [ 1639911688 ] } ] }, { "allowed_amount": 274.68, "providers": [ { "billed_charge": 732.0, "npi": [ 1356543441 ] } ] } ] }, { "tin": { "type": "ein", "value": "621637129" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 204.0, "npi": [ 1194676528, 1467433292 ] } ] } ] }, { "tin": { "type": "ein", "value": "581763128" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 400.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 400.0, "npi": [ 1205010790 ] } ] }, { "allowed_amount": 100.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1760793673 ] } ] }, { "allowed_amount": 200.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1851308225 ] } ] } ] }, { "tin": { "type": "ein", "value": "636000526" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 95.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 95.0, "npi": [ 1205095346 ] } ] } ] }, { "tin": { "type": "ein", "value": "800564919" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 412.92, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1040.0, "npi": [ 1275512923 ] } ] }, { "allowed_amount": 59.54, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1285161919 ] } ] }, { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 260.0, "npi": [ 1679821094 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 149.0, "npi": [ 1306007018 ] } ] }, { "allowed_amount": 825.84, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1192.0, "npi": [ 1306007018 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 346.0, "npi": [ 1396191417, 1659715795 ] } ] } ] }, { "tin": { "type": "ein", "value": "593725585" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 228.9, "providers": [ { "billed_charge": 292.0, "npi": [ 1396408829 ] } ] } ] }, { "tin": { "type": "ein", "value": "582082910" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 190.0, "npi": [ 1396708558, 1588870570, 1598975708 ] } ] }, { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 380.0, "npi": [ 1396708558, 1588870570, 1598975708 ] } ] }, { "allowed_amount": 309.69, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 570.0, "npi": [ 1396708558 ] } ] }, { "allowed_amount": 412.92, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 760.0, "npi": [ 1588870570 ] } ] }, { "allowed_amount": 619.38, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1140.0, "npi": [ 1598975708 ] } ] } ] }, { "tin": { "type": "ein", "value": "582051358" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 334.0, "npi": [ 1427413954 ] } ] } ] }, { "tin": { "type": "ein", "value": "593725585" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 82.0, "billing_code_modifier": [ "TC" ], "providers": [ { "billed_charge": 82.0, "npi": [ 1447437355 ] } ] }, { "allowed_amount": 23.81, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 102.0, "npi": [ 1740240753 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 59.54, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 173.0, "npi": [ 1578656765 ] } ] } ] }, { "tin": { "type": "ein", "value": "270521604" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 520.0, "npi": [ 1609077742 ] } ] } ] }, { "tin": { "type": "ein", "value": "463666116" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 100.0, "npi": [ 1609306315 ] } ] } ] }, { "tin": { "type": "ein", "value": "582083505" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 388.0, "npi": [ 1639517055 ] } ] } ] }, { "tin": { "type": "ein", "value": "591680273" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 214.0, "npi": [ 1659475275 ] } ] } ] }, { "tin": { "type": "ein", "value": "582339211" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 23.81, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 98.0, "npi": [ 1679580286 ] } ] } ] }, { "tin": { "type": "ein", "value": "582339211" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 47.63, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 196.0, "npi": [ 1679580286 ] } ] } ] }, { "tin": { "type": "ein", "value": "581749078" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 175.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 350.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 309.69, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 525.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 412.92, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 700.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 516.15, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 875.0, "npi": [ 1699837575 ] } ] } ] }, { "tin": { "type": "ein", "value": "259808526" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 190.0, "npi": [ 1740202290 ] } ] }, { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 380.0, "npi": [ 1740202290 ] } ] }, { "allowed_amount": 309.69, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 570.0, "npi": [ 1740202290 ] } ] }, { "allowed_amount": 516.15, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 950.0, "npi": [ 1740202290 ] } ] } ] }, { "tin": { "type": "ein", "value": "481277597" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 206.46, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 300.0, "npi": [ 1760893697 ] } ] } ] }, { "tin": { "type": "ein", "value": "852606325" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 103.23, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 332.0, "npi": [ 1780869768 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 68.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 68.0, "npi": [ 1811063894 ] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 45.78, "providers": [ { "billed_charge": 250.0, "npi": [ 1962481820 ] } ] } ] } ] }, { "name": "LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "billing_code_type": "CPT", "billing_code": "88307", "billing_code_type_version": "2020", "description": "LEVEL V SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "621695507" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 221.9, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 221.9, "npi": [ 1013351782, 1083000285, 1093987695, 1629121686, 1750607313 ] } ] }, { "allowed_amount": 443.8, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 443.8, "npi": [ 1013351782, 1083000285 ] } ] } ] }, { "tin": { "type": "ein", "value": "581714481" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 355.0, "npi": [ 1083609259 ] } ] } ] }, { "tin": { "type": "ein", "value": "582082910" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 295.0, "npi": [ 1396708558, 1598975708 ] } ] } ] }, { "tin": { "type": "ein", "value": "800564919" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 680.49, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1404.0, "npi": [ 1518489673 ] } ] } ] }, { "tin": { "type": "ein", "value": "581749078" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 315.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 453.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 630.0, "npi": [ 1699837575 ] } ] }, { "allowed_amount": 1134.15, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1575.0, "npi": [ 1699837575 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 453.66, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1120.0, "npi": [ 1730345026 ] } ] } ] }, { "tin": { "type": "ein", "value": "259808526" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 281.0, "npi": [ 1740202290 ] } ] } ] }, { "tin": { "type": "ein", "value": "581763128" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 265.0, "npi": [ 1760793673 ] } ] } ] }, { "tin": { "type": "ein", "value": "852606325" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 226.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 430.0, "npi": [ 1780869768 ] } ] } ] } ] }, { "name": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "billing_code_type": "CPT", "billing_code": "80061", "billing_code_type_version": "2020", "description": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 75.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 13.39, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 27.0, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 107.12, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 20.09, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 40.17, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 40.17, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 90.75, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 102.9, "npi": [ 1306896253, 1801883780, 1821565045 ] }, { "billed_charge": 51.0, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "251008110" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 49.0, "npi": [ 1437272697 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 90.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 40.17, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 47.2, "npi": [ 1639264575 ] }, { "billed_charge": 102.9, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 33.48, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 55.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 40.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 26.78, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 16.74, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 9.37, "providers": [ { "billed_charge": 161.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Magnesium", "billing_code_type": "CPT", "billing_code": "83735", "billing_code_type_version": "2020", "description": "Magnesium", "allowed_amounts": [ { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 6.7, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 53.6, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "561565047" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 16.8, "npi": [ 1073591822 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 38.89, "npi": [ 1083698534 ] }, { "billed_charge": 38.97, "npi": [ 1083698534 ] }, { "billed_charge": 38.99, "npi": [ 1083698534 ] }, { "billed_charge": 36.1, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 10.05, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 20.1, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 20.1, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 38.85, "npi": [ 1376323998, 1487969341, 1801883780, 1821565045 ] }, { "billed_charge": 21.25, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 16.75, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 45.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 4.69, "providers": [ { "billed_charge": 81.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Microsomal antibodies (eg, thyroid or liver-kidney), each", "billing_code_type": "CPT", "billing_code": "86376", "billing_code_type_version": "2020", "description": "Microsomal antibodies (eg, thyroid or liver-kidney), each", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 200.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 43.65, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 43.65, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 131.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 77.84, "npi": [ 1245494517 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 36.38, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.19, "providers": [ { "billed_charge": 96.37, "npi": [ 1962489237 ] }, { "billed_charge": 96.41, "npi": [ 1962489237 ] } ] } ] } ] }, { "name": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 1", "billing_code_type": "CPT", "billing_code": "81400", "billing_code_type_version": "2020", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 1", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 85.69, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 2", "billing_code_type": "CPT", "billing_code": "81401", "billing_code_type_version": "2020", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 2", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 200.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 6", "billing_code_type": "CPT", "billing_code": "81405", "billing_code_type_version": "2020", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 6", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 155.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 155.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 9", "billing_code_type": "CPT", "billing_code": "81408", "billing_code_type_version": "2020", "description": "MOLECULAR PATHOLOGY PROCEDURE LEVEL 9", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1400.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 2225.0, "npi": [ 1558672279 ] }, { "billed_charge": 2300.0, "npi": [ 1558672279 ] } ] }, { "allowed_amount": 2800.0, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 4450.0, "npi": [ 1558672279 ] }, { "billed_charge": 4600.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "70551", "billing_code_type_version": "2020", "description": "MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1095.0, "npi": [ 1134101116, 1144410283, 1376800342, 1386976207, 1538167804, 1558302794, 1770534869, 1992768352 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 256.0, "npi": [ 1134689268, 1942733597 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 205.0, "npi": [ 1275522179 ] } ] } ] }, { "tin": { "type": "ein", "value": "611121623" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1285671255 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 299.0, "npi": [ 1306466412, 1326274291, 1679684872, 1700166733, 1740488527, 1801201090, 1841463452 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 180.0, "npi": [ 1306821525 ] } ] }, { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 381.0, "npi": [ 1306821525, 1942650122 ] } ] } ] }, { "tin": { "type": "ein", "value": "043674251" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 350.0, "npi": [ 1376800342 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 266.0, "npi": [ 1376809095 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 338.0, "npi": [ 1760461313, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 180.3, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 863.0, "npi": [ 1962501833 ] } ] } ] } ] }, { "name": "MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL", "billing_code_type": "CPT", "billing_code": "72141", "billing_code_type_version": "2020", "description": "MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.77, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1045.0, "npi": [ 1063498400, 1134101116, 1235352923, 1386976207, 1407072150, 1558302794, 1790760064, 1861455271 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.77, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 338.0, "npi": [ 1265791784, 1376809095, 1386050250, 1760461313, 1790168540 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.77, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 323.0, "npi": [ 1306466412, 1326274291, 1679684872 ] } ] } ] }, { "tin": { "type": "ein", "value": "582184858" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.77, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 411.0, "npi": [ 1447200399 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 132.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 132.0, "npi": [ 1619037025 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 194.77, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 356.0, "npi": [ 1902168149 ] } ] } ] } ] }, { "name": "MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code": "72148", "billing_code_type_version": "2020", "description": "MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 299.0, "npi": [ 1003841875, 1326274291, 1679684872 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 339.0, "npi": [ 1295199115, 1376809095, 1528046877, 1790168540, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 1147.0, "npi": [ 1558302794, 1598266884, 1649203316, 1790760064 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 230.0, "npi": [ 1740454412 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 320.0, "npi": [ 1780681072 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 181.16, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 333.0, "npi": [ 1902168149, 1922084748 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN", "billing_code_type": "CPT", "billing_code": "99215", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 698.0, "npi": [ 1033569090, 1487145033, 1518263466 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 435.0, "npi": [ 1265552657 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 576.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 365.0, "npi": [ 1366862492 ] } ] } ] }, { "tin": { "type": "ein", "value": "042911067" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 657.0, "npi": [ 1427552835 ] } ] } ] }, { "tin": { "type": "ein", "value": "833617354" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.14, "providers": [ { "billed_charge": 303.0, "npi": [ 1588772545 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 698.0, "npi": [ 1699882431 ] } ] } ] }, { "tin": { "type": "ein", "value": "874714839" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 395.0, "npi": [ 1922395664 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 365.0, "npi": [ 1932806072 ] } ] } ] }, { "tin": { "type": "ein", "value": "510141601" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.14, "providers": [ { "billed_charge": 400.0, "npi": [ 1942799531 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 217.4, "providers": [ { "billed_charge": 309.0, "npi": [ 1992056782 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "billing_code_type": "CPT", "billing_code": "99213", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 200.0, "npi": [ 1003351065, 1558042804, 1982331591 ] } ] } ] }, { "tin": { "type": "ein", "value": "362193608" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 214.41, "npi": [ 1013175322 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 107.34, "providers": [ { "billed_charge": 247.0, "npi": [ 1104487818, 1154977882 ] } ] }, { "allowed_amount": 99.47, "providers": [ { "billed_charge": 247.0, "npi": [ 1154977882, 1275313884, 1447040183, 1467852376, 1588194005, 1770325730, 1932661600 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 184.0, "npi": [ 1134306152, 1568924355, 1750956017 ] } ] } ] }, { "tin": { "type": "ein", "value": "460629729" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 375.0, "npi": [ 1184240137, 1528055027 ] } ] } ] }, { "tin": { "type": "ein", "value": "821505834" }, "service_code": [ "02" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "billing_code_modifier": [ "95" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1225144140 ] } ] } ] }, { "tin": { "type": "ein", "value": "202012765" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 191.0, "npi": [ 1225579741 ] }, { "billed_charge": 201.0, "npi": [ 1952435828 ] } ] } ] }, { "tin": { "type": "ein", "value": "200180690" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 203.0, "npi": [ 1275210510 ] } ] } ] }, { "tin": { "type": "ein", "value": "486075762" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 125.0, "npi": [ 1275235251 ] } ] } ] }, { "tin": { "type": "ein", "value": "475625504" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 230.0, "npi": [ 1326453796 ] } ] }, { "allowed_amount": 107.34, "providers": [ { "billed_charge": 230.0, "npi": [ 1447488564 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 290.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "882051065" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 107.34, "providers": [ { "billed_charge": 203.0, "npi": [ 1336582816 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 341.0, "npi": [ 1356516074 ] } ] } ] }, { "tin": { "type": "ein", "value": "460676654" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 213.0, "npi": [ 1356533145, 1780662361 ] } ] } ] }, { "tin": { "type": "ein", "value": "843754429" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 107.34, "providers": [ { "billed_charge": 152.0, "npi": [ 1356664007 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 457.3, "npi": [ 1518449768 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 122.0, "npi": [ 1538502752 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 192.0, "npi": [ 1538731690 ] } ] } ] }, { "tin": { "type": "ein", "value": "453072990" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 129.0, "npi": [ 1578558805 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 352.0, "npi": [ 1598196594 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 154.0, "npi": [ 1619924743 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 220.0, "npi": [ 1760476212 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 107.34, "providers": [ { "billed_charge": 352.0, "npi": [ 1841436060 ] } ] } ] }, { "tin": { "type": "ein", "value": "371140016" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 209.0, "npi": [ 1871021584 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 99.47, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 212.0, "npi": [ 1881089928 ] } ] } ] }, { "tin": { "type": "ein", "value": "510141601" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 107.34, "providers": [ { "billed_charge": 188.0, "npi": [ 1942799531 ] }, { "billed_charge": 194.0, "npi": [ 1942799531 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.47, "providers": [ { "billed_charge": 153.0, "npi": [ 1992056782 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN", "billing_code_type": "CPT", "billing_code": "99214", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 300.0, "npi": [ 1003351065 ] } ] } ] }, { "tin": { "type": "ein", "value": "272004035" }, "service_code": [ "02", "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "billing_code_modifier": [ "95" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1043302037 ] } ] }, { "allowed_amount": 146.49, "providers": [ { "billed_charge": 150.0, "npi": [ 1043302037 ] } ] } ] }, { "tin": { "type": "ein", "value": "453597157" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 476.0, "npi": [ 1043631773 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 291.0, "npi": [ 1043662463 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 350.0, "npi": [ 1104827997 ] } ] } ] }, { "tin": { "type": "ein", "value": "630925859" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 298.0, "npi": [ 1124017728 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 347.0, "npi": [ 1144297466, 1154804284, 1154977882, 1811746589 ] } ] } ] }, { "tin": { "type": "ein", "value": "812238385" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 160.0, "providers": [ { "billed_charge": 306.0, "npi": [ 1295764009 ] } ] } ] }, { "tin": { "type": "ein", "value": "853642663" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 200.0, "npi": [ 1346433521 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 271.0, "npi": [ 1497785232 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 645.0, "npi": [ 1518449768 ] } ] } ] }, { "tin": { "type": "ein", "value": "833617354" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 160.0, "providers": [ { "billed_charge": 245.0, "npi": [ 1588772545 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 271.0, "npi": [ 1598394900 ] } ] } ] }, { "tin": { "type": "ein", "value": "582314108" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 160.0, "npi": [ 1679795017 ] } ] } ] }, { "tin": { "type": "ein", "value": "812928518" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 275.0, "npi": [ 1710276035 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 498.0, "npi": [ 1720011257 ] } ] } ] }, { "tin": { "type": "ein", "value": "582091280" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 294.02, "npi": [ 1730780073 ] } ] } ] }, { "tin": { "type": "ein", "value": "371140016" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 308.0, "npi": [ 1760045827 ] } ] } ] }, { "tin": { "type": "ein", "value": "362193608" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 317.78, "npi": [ 1760832901 ] } ] } ] }, { "tin": { "type": "ein", "value": "262150540" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 646.3, "npi": [ 1861435364 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 146.49, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 498.0, "npi": [ 1871599332 ] } ] } ] }, { "tin": { "type": "ein", "value": "510141601" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 160.0, "providers": [ { "billed_charge": 269.0, "npi": [ 1942799531 ] }, { "billed_charge": 277.0, "npi": [ 1942799531 ] } ] } ] }, { "tin": { "type": "ein", "value": "203204949" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 135.0, "providers": [ { "billed_charge": 135.0, "npi": [ 1982275491 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 146.49, "providers": [ { "billed_charge": 218.0, "npi": [ 1992056782 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN", "billing_code_type": "CPT", "billing_code": "99212", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 53.95, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 114.0, "npi": [ 1134366834 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES", "billing_code_type": "CPT", "billing_code": "99205", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 278.67, "providers": [ { "billed_charge": 857.0, "npi": [ 1780970806, 1811352396 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES", "billing_code_type": "CPT", "billing_code": "99203", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "362193608" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 322.39, "npi": [ 1013175322, 1528098936 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 302.0, "npi": [ 1063897379, 1154977882, 1932661600 ] } ] } ] }, { "tin": { "type": "ein", "value": "460933667" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 225.0, "npi": [ 1225381148 ] } ] } ] }, { "tin": { "type": "ein", "value": "202012765" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 238.0, "npi": [ 1225579741 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 246.0, "npi": [ 1336644459 ] } ] } ] }, { "tin": { "type": "ein", "value": "843754429" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 162.68, "providers": [ { "billed_charge": 218.0, "npi": [ 1356664007 ] } ] } ] }, { "tin": { "type": "ein", "value": "882051065" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 162.68, "providers": [ { "billed_charge": 252.0, "npi": [ 1417216375 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 438.0, "npi": [ 1548559826, 1578880100, 1598196594 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 273.0, "npi": [ 1558153502 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 228.0, "npi": [ 1619924743 ] } ] } ] }, { "tin": { "type": "ein", "value": "042790699" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 124.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 968.0, "npi": [ 1740573476 ] } ] } ] }, { "tin": { "type": "ein", "value": "473501366" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 124.48, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 286.0, "npi": [ 1861998528 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 438.0, "npi": [ 1881799401 ] } ] } ] }, { "tin": { "type": "ein", "value": "475625504" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 124.48, "providers": [ { "billed_charge": 460.0, "npi": [ 1922833193 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES", "billing_code_type": "CPT", "billing_code": "99204", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "465754759" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 350.0, "npi": [ 1063918852 ] } ] } ] }, { "tin": { "type": "ein", "value": "473524701" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 332.0, "npi": [ 1134013923 ] } ] } ] }, { "tin": { "type": "ein", "value": "582636217" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 600.0, "npi": [ 1134151582 ] } ] } ] }, { "tin": { "type": "ein", "value": "394306781" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 468.0, "npi": [ 1154298784 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 845.0, "npi": [ 1518449768 ] } ] } ] }, { "tin": { "type": "ein", "value": "593337028" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 203.11, "providers": [ { "billed_charge": 770.0, "npi": [ 1710974977 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES", "billing_code_type": "CPT", "billing_code": "99202", "billing_code_type_version": "2020", "description": "OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "261491885" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 71.23, "providers": [ { "billed_charge": 183.0, "npi": [ 1659379998 ] } ] } ] } ] }, { "name": "ONC CLRCT CA ALYS CFDNA EPIG PTRN NGS >2500 DMR", "billing_code_type": "CPT", "billing_code": "0537U", "billing_code_type_version": "2020", "description": "ONC CLRCT CA ALYS CFDNA EPIG PTRN NGS >2500 DMR", "allowed_amounts": [ { "tin": { "type": "ein", "value": "883933025" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1046.5, "providers": [ { "billed_charge": 3680.0, "npi": [ 1023496775, 1538857099 ] } ] } ] } ] }, { "name": "Parathormone (parathyroid hormone)", "billing_code_type": "CPT", "billing_code": "83970", "billing_code_type_version": "2020", "description": "Parathormone (parathyroid hormone)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 123.84, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 927.41, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 172.2, "npi": [ 1376323998 ] }, { "billed_charge": 82.82, "npi": [ 1487969341 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 103.2, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 175.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 28.9, "providers": [ { "billed_charge": 496.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Phosphatase, alkaline;", "billing_code_type": "CPT", "billing_code": "84075", "billing_code_type_version": "2020", "description": "Phosphatase, alkaline;", "allowed_amounts": [ { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 116.25, "npi": [ 1245720820 ] } ] } ] } ] }, { "name": "Phosphorus inorganic (phosphate);", "billing_code_type": "CPT", "billing_code": "84100", "billing_code_type_version": "2020", "description": "Phosphorus inorganic (phosphate);", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.32, "providers": [ { "billed_charge": 45.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.32, "providers": [ { "billed_charge": 14.22, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.32, "providers": [ { "billed_charge": 106.51, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.32, "providers": [ { "billed_charge": 57.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Progesterone", "billing_code_type": "CPT", "billing_code": "84144", "billing_code_type_version": "2020", "description": "Progesterone", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 120.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 20.86, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 166.88, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 31.29, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 62.58, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 146.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 100.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 139.65, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 60.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 14.6, "providers": [ { "billed_charge": 52.15, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN", "billing_code_type": "CPT", "billing_code": "99418", "billing_code_type_version": "2020", "description": "PROLONGED INPATIENT/OBSERVATION EM SVC EA 15 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 60.22, "providers": [ { "billed_charge": 220.0, "npi": [ 1083222160, 1841501285, 1922758234 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 60.22, "providers": [ { "billed_charge": 117.0, "npi": [ 1841796729 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 60.22, "providers": [ { "billed_charge": 152.0, "npi": [ 1952310500 ] } ] }, { "allowed_amount": 180.65, "providers": [ { "billed_charge": 456.0, "npi": [ 1952310500 ] } ] } ] } ] }, { "name": "Prostate specific antigen (PSA); total", "billing_code_type": "CPT", "billing_code": "84153", "billing_code_type_version": "2020", "description": "Prostate specific antigen (PSA); total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 125.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 18.39, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 27.59, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 55.17, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 118.75, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 78.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 112.35, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.87, "providers": [ { "billed_charge": 62.5, "npi": [ 1821565045 ] } ] } ] } ] }, { "name": "Protein, total, except by refractometry; serum, plasma or whole blood", "billing_code_type": "CPT", "billing_code": "84155", "billing_code_type_version": "2020", "description": "Protein, total, except by refractometry; serum, plasma or whole blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.57, "providers": [ { "billed_charge": 40.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.57, "providers": [ { "billed_charge": 82.36, "npi": [ 1245720820 ] } ] } ] } ] }, { "name": "PSYC GENOMIC ALYS PANEL VARIANT ALYS 15 GENES", "billing_code_type": "CPT", "billing_code": "0345U", "billing_code_type_version": "2020", "description": "PSYC GENOMIC ALYS PANEL VARIANT ALYS 15 GENES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "271453375" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 935.26, "providers": [ { "billed_charge": 5500.0, "npi": [ 1235363052 ] } ] } ] } ] }, { "name": "PSYCHIATRIC DIAGNOSTIC EVALUATION", "billing_code_type": "CPT", "billing_code": "90791", "billing_code_type_version": "2020", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION", "allowed_amounts": [ { "tin": { "type": "ein", "value": "832675429" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 150.0, "providers": [ { "billed_charge": 150.0, "npi": [ 1235600834 ] } ] } ] } ] }, { "name": "PSYCHOTHERAPY W/PATIENT 30 MINUTES", "billing_code_type": "CPT", "billing_code": "90832", "billing_code_type_version": "2020", "description": "PSYCHOTHERAPY W/PATIENT 30 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "811366910" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 108.08, "providers": [ { "billed_charge": 220.83, "npi": [ 1235886250, 1437308681 ] } ] } ] }, { "tin": { "type": "ein", "value": "850539216" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 120.87, "providers": [ { "billed_charge": 205.0, "npi": [ 1346826674 ] } ] } ] } ] }, { "name": "PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN", "billing_code_type": "CPT", "billing_code": "90833", "billing_code_type_version": "2020", "description": "PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN", "allowed_amounts": [ { "tin": { "type": "ein", "value": "821505834" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.0, "providers": [ { "billed_charge": 100.0, "npi": [ 1225144140 ] } ] } ] }, { "tin": { "type": "ein", "value": "812238385" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.59, "providers": [ { "billed_charge": 201.0, "npi": [ 1295764009 ] } ] } ] }, { "tin": { "type": "ein", "value": "461921294" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 70.97, "providers": [ { "billed_charge": 70.97, "npi": [ 1548838428 ] } ] } ] }, { "tin": { "type": "ein", "value": "273284636" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.59, "providers": [ { "billed_charge": 140.0, "npi": [ 1649468166 ] } ] } ] }, { "tin": { "type": "ein", "value": "582651479" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.59, "providers": [ { "billed_charge": 130.9, "npi": [ 1770858953 ] } ] } ] }, { "tin": { "type": "ein", "value": "874461181" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 112.59, "providers": [ { "billed_charge": 300.0, "npi": [ 1831548536 ] } ] } ] } ] }, { "name": "RADEX ANKLE COMPLETE MINIMUM 3 VIEWS", "billing_code_type": "CPT", "billing_code": "73610", "billing_code_type_version": "2020", "description": "RADEX ANKLE COMPLETE MINIMUM 3 VIEWS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1003841875 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1043265937, 1902168149 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 47.0, "npi": [ 1114906245 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1134104334, 1841482478 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1174020127 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 141.0, "npi": [ 1184646499, 1235423187, 1518935022, 1538167804, 1558336834 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1316925654, 1346655982, 1386050250, 1811293525, 1831177179 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1346623667 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 38.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1609226851 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.14, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1891955803 ] } ] } ] } ] }, { "name": "RADEX FOOT COMPLETE MINIMUM 3 VIEWS", "billing_code_type": "CPT", "billing_code": "73630", "billing_code_type_version": "2020", "description": "RADEX FOOT COMPLETE MINIMUM 3 VIEWS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1003841875, 1306466412, 1740488527, 1912969130 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1578865721, 1700166733, 1740488527, 1801201090 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1114906245 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 133.0, "npi": [ 1114952330 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 133.0, "npi": [ 1144410283, 1235156894, 1396021648, 1417117268, 1891839718 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 133.0, "npi": [ 1861455271, 1962499418 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1275093825, 1720265861 ] } ] }, { "allowed_amount": 21.0, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 21.0, "npi": [ 1720265861 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 31.0, "npi": [ 1285711671 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 31.0, "npi": [ 1285711671, 1316925654 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1316925654, 1811293525 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1346655982, 1669675658, 1851633572, 1962456012 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1346623667 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 53.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 38.0, "npi": [ 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1437208246, 1609226851 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1538472543 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 33.0, "npi": [ 1609439066 ] } ] }, { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 33.0, "npi": [ 1609439066 ] } ] } ] }, { "tin": { "type": "ein", "value": "562303936" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1801002324 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 29.0, "npi": [ 1871973040 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 27.0, "npi": [ 1891955803 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.28, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1902168149 ] } ] } ] } ] }, { "name": "RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS", "billing_code_type": "CPT", "billing_code": "73030", "billing_code_type_version": "2020", "description": "RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 161.0, "npi": [ 1003806381, 1104058213, 1114994738, 1134101116, 1396969945, 1447613005, 1699928150, 1710431044, 1932170131 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1053304428, 1578865721, 1679684872, 1801201090 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 34.0, "npi": [ 1285711671, 1669675658, 1851633572 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1356873871 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 61.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1386645828 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1386714905 ] } ] } ] }, { "tin": { "type": "ein", "value": "560990409" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 46.0, "npi": [ 1609998541 ] } ] } ] }, { "tin": { "type": "ein", "value": "880119638" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 161.0, "npi": [ 1801017074 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1871625178 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.93, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 49.0, "npi": [ 1942650122 ] } ] } ] } ] }, { "name": "RADEX SPINE LUMBOSACRAL 2/3 VIEWS", "billing_code_type": "CPT", "billing_code": "72100", "billing_code_type_version": "2020", "description": "RADEX SPINE LUMBOSACRAL 2/3 VIEWS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 44.0, "npi": [ 1003841875, 1306466412, 1417272667, 1679684872, 1700166733, 1740488527, 1801201090, 1841463452 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 201.0, "npi": [ 1023543295, 1083875991, 1114956695, 1114994738, 1134101116, 1144410283, 1396761748, 1457617045, 1588710487, 1598266884, 1679553671, 1750599742, 1770534869, 1790879062, 1801186689, 1841216306, 1891839718, 1962499418, 1962923706 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1245712835 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 52.0, "npi": [ 1275512956, 1285711671, 1316925654, 1346668191, 1376809095, 1851633572, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 67.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "620803743" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 46.0, "npi": [ 1386954584 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 59.0, "npi": [ 1548286602, 1902168149, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 27.02, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 58.0, "npi": [ 1578725701 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 20.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 20.0, "npi": [ 1649443524 ] } ] } ] } ] }, { "name": "RADIOLOGIC EXAM ABDOMEN 1 VIEW", "billing_code_type": "CPT", "billing_code": "74018", "billing_code_type_version": "2020", "description": "RADIOLOGIC EXAM ABDOMEN 1 VIEW", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1003841875, 1417272667, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 169.0, "npi": [ 1114956695, 1144410283, 1255316873, 1346286317, 1386976207, 1497720148, 1508865510, 1538167804, 1740351543, 1861455271, 1962499418, 1982641916, 1992768352 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 34.0, "npi": [ 1154857514 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1164080222, 1588778344, 1891174553 ] } ] } ] }, { "tin": { "type": "ein", "value": "352528741" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 5.95, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1194168831 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1407344229 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1275597130, 1306895818, 1780669978 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1275996316, 1346700457, 1528557139, 1730530080, 1881987972 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 46.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1366592958, 1407384696 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 33.0, "npi": [ 1457795296 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1649474743, 1700842473, 1720212582, 1891288973 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 83.89, "npi": [ 1700220977, 1730114695 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 24.96, "npi": [ 1821444142 ] } ] } ] }, { "tin": { "type": "ein", "value": "820549580" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 25.0, "npi": [ 1831393164 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 47.0, "npi": [ 1972583805 ] } ] } ] } ] }, { "name": "RADIOLOGIC EXAM CHEST 2 VIEWS", "billing_code_type": "CPT", "billing_code": "71046", "billing_code_type_version": "2020", "description": "RADIOLOGIC EXAM CHEST 2 VIEWS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 216.0, "npi": [ 1003027285, 1023240561, 1023541430, 1023543295, 1063494425, 1073534483, 1134101116, 1144410283, 1184937021, 1215931027, 1235156894, 1245421692, 1255316873, 1306865639, 1386976207, 1508865510, 1518935022, 1538167804, 1558350512, 1578772364, 1588710487, 1639175888, 1669521803, 1679736284, 1699928150, 1710431044, 1720024680, 1750470563, 1750599742, 1760514574, 1770534869, 1801186689, 1811083959, 1881973550, 1932123155, 1932170131, 1962499418, 1972639615 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 44.0, "npi": [ 1003841875, 1053304428, 1275616849, 1326274291, 1417272667, 1578865721, 1679684872, 1700166733, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 51.0, "npi": [ 1023579224, 1033572425, 1174020127, 1235379017, 1528295854, 1770509523, 1912273483, 1932555117, 1962418764 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 41.0, "npi": [ 1043265937, 1134109762, 1447756960, 1548286602, 1902168149, 1922084748, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "620842484" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1063471019 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 56.0, "npi": [ 1063497006, 1134104334, 1275093825, 1396233565, 1477531648, 1477711919, 1669450284, 1720265861, 1821557141, 1841482478, 1871561803, 1912439159 ] } ] }, { "allowed_amount": 27.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 27.0, "npi": [ 1720265861 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 38.0, "npi": [ 1063533149 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 29.0, "npi": [ 1154731388, 1285951632, 1447781638, 1891227484, 1932603305 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 49.0, "npi": [ 1174573901, 1316978968, 1831534346 ] } ] } ] }, { "tin": { "type": "ein", "value": "591266388" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1215469036 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 34.0, "npi": [ 1225021413, 1255312146, 1376800342, 1932170131 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 216.0, "npi": [ 1235235086 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1235249392 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1245712835 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22", "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 50.0, "npi": [ 1275512956, 1285711671, 1316925654, 1346655982, 1346668191, 1376809095, 1457795296, 1528046877, 1538497300, 1669675658, 1760461313, 1811293525, 1831177179, 1891088670, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1285711671, 1295199115, 1831177179 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "21", "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1306895818, 1487898706, 1780669978 ] } ] } ] }, { "tin": { "type": "ein", "value": "620909696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 59.0, "npi": [ 1326046053 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 29.0, "npi": [ 1346731635 ] } ] } ] }, { "tin": { "type": "ein", "value": "392249320" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 32.55, "npi": [ 1396761631 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 42.0, "npi": [ 1417964040, 1942461009 ] } ] } ] }, { "tin": { "type": "ein", "value": "591226176" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 216.0, "npi": [ 1578539557 ] } ] } ] }, { "tin": { "type": "ein", "value": "582239077" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 59.0, "npi": [ 1578827044 ] } ] } ] }, { "tin": { "type": "ein", "value": "920177956" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 67.0, "npi": [ 1619159647 ] } ] } ] }, { "tin": { "type": "ein", "value": "310983140" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 54.0, "npi": [ 1669634242 ] } ] } ] }, { "tin": { "type": "ein", "value": "560954779" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 83.0, "npi": [ 1710103320 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 28.86, "npi": [ 1821444142 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 28.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 129.0, "npi": [ 1932143104 ] } ] } ] } ] }, { "name": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "billing_code_type": "CPT", "billing_code": "71045", "billing_code_type_version": "2020", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1003018342, 1003806381, 1023240561, 1023543295, 1033379151, 1043536139, 1063494425, 1063498400, 1083875991, 1093700957, 1114903408, 1114956695, 1114994738, 1134101116, 1144410283, 1164672556, 1184793226, 1184937021, 1194752683, 1205830726, 1215475132, 1215904677, 1215931027, 1225021413, 1225053036, 1235156894, 1235423187, 1245421692, 1255316873, 1255368353, 1295144137, 1306865639, 1336137165, 1336256148, 1346286317, 1376800342, 1386976207, 1396021648, 1396751426, 1396761748, 1396969945, 1417117268, 1437593381, 1447613005, 1508865510, 1518935022, 1538167804, 1548231541, 1548416704, 1558336834, 1558758607, 1568451508, 1568678225, 1588710487, 1598266017, 1598342461, 1609840412, 1679553671, 1679647267, 1679736284, 1689601502, 1699928150, 1710208988, 1710354352, 1710431044, 1720083967, 1740351543, 1750470563, 1760514574, 1760598924, 1760625362, 1770534869, 1770550667, 1790737328, 1790760064, 1790836583, 1801186689, 1841219508, 1861409740, 1861455271, 1861483182, 1891839718, 1891955803, 1902883168, 1922115492, 1932123155, 1932170131, 1932428455, 1962499418, 1962923706, 1972620730, 1972639615, 1982641916, 1992768352, 1992850556 ] } ] }, { "allowed_amount": 14.35, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1124002217, 1932170131 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1306865639, 1386976207, 1538167804, 1588710487, 1780970681, 1790737328, 1801186689, 1861483182, 1962499418 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1003841875, 1053304428, 1164049011, 1275616849, 1306466412, 1326274291, 1417272667, 1578865721, 1679684872, 1700166733, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1326274291, 1679684872, 1801201090 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1003846692, 1134252182, 1215029632, 1275996316, 1437208246, 1538472543, 1619236387, 1730441593, 1750763157, 1770601882, 1841370723, 1881987972, 1912273483, 1922033745, 1962418764 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1215029632, 1437208246, 1730441593, 1750763157, 1912273483, 1922033745, 1962418764 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1003846692, 1023579224, 1083054845, 1134252182, 1215029632, 1275851636, 1285121921, 1306307525, 1437105707, 1487281341, 1528295854, 1538472543, 1619236387, 1689659799, 1750763157, 1801857909, 1841370723, 1871152447, 1912273483 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 40.0, "npi": [ 1023579224, 1134252182, 1275851636, 1417232711, 1487281341, 1871152447 ] } ] } ] }, { "tin": { "type": "ein", "value": "951644042" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 26.0, "npi": [ 1003865783 ] } ] } ] }, { "tin": { "type": "ein", "value": "852141600" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.98, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 22.98, "npi": [ 1033439492, 1053748822, 1154321867, 1184056202, 1275589475, 1295725398, 1447218169, 1689885972, 1972777589 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 19.04, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 19.04, "npi": [ 1033679758, 1164410916, 1336436724, 1578551321, 1649443524 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 34.0, "npi": [ 1043265937, 1093178956, 1093940298, 1174631410, 1386645828, 1447756960, 1902168149, 1922084748, 1962651828 ] } ] } ] }, { "tin": { "type": "ein", "value": "262824776" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 32.0, "npi": [ 1063533149, 1245399575 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 41.0, "npi": [ 1083684765, 1295850386, 1881857332 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 26.0, "npi": [ 1083979710, 1437139540, 1598010910, 1649411422 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1114952330, 1114994738 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 48.82, "npi": [ 1124281175, 1992797377 ] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1144237405 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1194821488, 1316975816, 1821201898, 1962501833 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 83.89, "npi": [ 1144545609, 1699038547, 1730114695, 1730152323, 1922111020 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 23.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 23.0, "npi": [ 1154731388, 1710993324, 1972967966 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 34.0, "npi": [ 1154857514 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 22.0, "npi": [ 1184831471, 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "620909696" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 56.0, "npi": [ 1194352484 ] } ] } ] }, { "tin": { "type": "ein", "value": "332353320" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 28.0, "npi": [ 1235456039 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 29.0, "npi": [ 1255312146, 1447613005, 1467430082, 1548231541, 1639150741 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 22.0, "npi": [ 1639150741 ] } ] } ] }, { "tin": { "type": "ein", "value": "262157500" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1265829527 ] }, { "billed_charge": 27.0, "npi": [ 1295732089, 1477715597 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 47.0, "npi": [ 1275093825, 1477531648, 1508393901, 1659356947, 1972583805 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 47.0, "npi": [ 1295911808, 1326536103, 1396233565, 1477531648, 1477711919, 1508393901, 1578725701, 1598949570, 1669450284, 1720265861, 1821557141, 1841482478, 1871561803, 1912439159, 1942650122, 1972583805 ] } ] }, { "allowed_amount": 22.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 22.0, "npi": [ 1720265861, 1821557141 ] } ] } ] }, { "tin": { "type": "ein", "value": "710664686" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 22.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 22.0, "npi": [ 1275581027 ] } ] } ] }, { "tin": { "type": "ein", "value": "581075840" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1275597130, 1306895818, 1366427569, 1487898706, 1730365156, 1780669978 ] } ] }, { "allowed_amount": 24.06, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1275597130, 1306895818, 1487898706, 1780669978 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 41.0, "npi": [ 1285711671, 1295199115, 1457795296, 1538521687, 1669675658, 1790168540, 1831177179 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 41.0, "npi": [ 1285711671, 1316925654, 1346655982, 1346668191, 1376809095, 1386050250, 1457795296, 1528046877, 1538497300, 1811293525, 1831177179, 1851633572, 1891088670, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 38.0, "npi": [ 1366592958, 1407384696, 1467502088 ] } ] } ] }, { "tin": { "type": "ein", "value": "591289802" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 37.0, "npi": [ 1366650756 ] }, { "billed_charge": 29.0, "npi": [ 1659341139 ] } ] } ] }, { "tin": { "type": "ein", "value": "640863698" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1396165387 ] } ] } ] }, { "tin": { "type": "ein", "value": "920177956" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 63.0, "npi": [ 1396365607 ] } ] } ] }, { "tin": { "type": "ein", "value": "620853566" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1396761748 ] } ] }, { "allowed_amount": 24.0, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1821049420 ] } ] } ] }, { "tin": { "type": "ein", "value": "332391862" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 31.0, "npi": [ 1396770111 ] } ] } ] }, { "tin": { "type": "ein", "value": "591226176" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1417303405, 1588616338, 1619409737, 1871539163, 1922075530 ] } ] } ] }, { "tin": { "type": "ein", "value": "741680498" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 202.0, "npi": [ 1477505998 ] } ] } ] }, { "tin": { "type": "ein", "value": "570935917" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 54.0, "npi": [ 1518594969 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 31.0, "npi": [ 1518947522 ] } ] } ] }, { "tin": { "type": "ein", "value": "820945402" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 42.62, "npi": [ 1528300555, 1619396934 ] } ] } ] }, { "tin": { "type": "ein", "value": "451846825" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 14.35, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 23.0, "npi": [ 1528322112 ] } ] } ] }, { "tin": { "type": "ein", "value": "450226558" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 49.0, "npi": [ 1548279003 ] } ] } ] }, { "tin": { "type": "ein", "value": "311571290" }, "service_code": [ "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 39.0, "npi": [ 1558360511, 1982108346 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 43.0, "npi": [ 1659351666 ] } ] } ] }, { "tin": { "type": "ein", "value": "581839412" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 45.0, "npi": [ 1679709299 ] } ] } ] }, { "tin": { "type": "ein", "value": "630649108" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 44.0, "npi": [ 1679788525 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 30.0, "npi": [ 1689061574, 1689920464, 1750352522 ] } ] } ] }, { "tin": { "type": "ein", "value": "550840991" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 15.48, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 15.48, "npi": [ 1720347073 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 35.0, "npi": [ 1730316118 ] } ] } ] }, { "tin": { "type": "ein", "value": "824944510" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 32.0, "npi": [ 1770927287 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.03, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 24.03, "npi": [ 1821444142, 1831543487, 1851654263 ] } ] }, { "allowed_amount": 24.03, "billing_code_modifier": [ "26", "77" ], "providers": [ { "billed_charge": 24.03, "npi": [ 1831543487 ] } ] } ] }, { "tin": { "type": "ein", "value": "820549580" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 24.0, "npi": [ 1831393164, 1952571549 ] } ] } ] }, { "tin": { "type": "ein", "value": "208112143" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 60.0, "npi": [ 1851590186 ] } ] } ] }, { "tin": { "type": "ein", "value": "741688740" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 70.0, "npi": [ 1902868425 ] } ] } ] }, { "tin": { "type": "ein", "value": "630639615" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 29.0, "npi": [ 1952549644 ] } ] } ] }, { "tin": { "type": "ein", "value": "462021581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 24.06, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 36.0, "npi": [ 1992719181 ] } ] } ] } ] }, { "name": "Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (", "billing_code_type": "CPT", "billing_code": "80069", "billing_code_type_version": "2020", "description": "Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (", "allowed_amounts": [ { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.08, "providers": [ { "billed_charge": 45.39, "npi": [ 1376323998, 1487969341 ] }, { "billed_charge": 32.6, "npi": [ 1487969341 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.08, "providers": [ { "billed_charge": 45.39, "npi": [ 1639264575 ] } ] } ] } ] }, { "name": "Rheumatoid factor; quantitative", "billing_code_type": "CPT", "billing_code": "86431", "billing_code_type_version": "2020", "description": "Rheumatoid factor; quantitative", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 75.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 17.01, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 61.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 32.1, "npi": [ 1245494517 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 48.3, "npi": [ 1801883780 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.97, "providers": [ { "billed_charge": 37.51, "npi": [ 1962489237 ] }, { "billed_charge": 37.56, "npi": [ 1962489237 ] } ] } ] } ] }, { "name": "Rhythm ECG, 1-3 leads; interpretation and report only", "billing_code_type": "CPT", "billing_code": "93042", "billing_code_type_version": "2020", "description": "Rhythm ECG, 1-3 leads; interpretation and report only", "allowed_amounts": [ { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 17.96, "providers": [ { "billed_charge": 53.0, "npi": [ 1104804491 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 17.96, "providers": [ { "billed_charge": 63.0, "npi": [ 1184666265 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 17.96, "providers": [ { "billed_charge": 72.0, "npi": [ 1205842309, 1346422243, 1366425613, 1417301573, 1457091274, 1598127979, 1609066786, 1700271921, 1740262435, 1750363438, 1942332325 ] } ] } ] } ] }, { "name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code": "99233", "billing_code_type_version": "2020", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 463.0, "npi": [ 1003221482, 1033343405, 1043848955, 1154340057, 1285169532, 1346357019, 1366682577, 1689254435, 1730609306, 1760554703, 1760999478, 1932423704, 1952310500, 1962444612 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 463.0, "npi": [ 1053774851, 1114245834, 1154784809, 1184914459, 1538380464, 1710637475, 1740444504, 1871810465 ] } ] } ] }, { "tin": { "type": "ein", "value": "591784470" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 250.0, "npi": [ 1003360645 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 318.0, "npi": [ 1003380304, 1245771450, 1700364494, 1790946762, 1831464817 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 318.0, "npi": [ 1841814126 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 718.0, "npi": [ 1023066206, 1124605928, 1770169450, 1790849495 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 718.0, "npi": [ 1043896962, 1073008033, 1093896516, 1124605928, 1164650743, 1174785216, 1326595224, 1427405828, 1578978425, 1598405334, 1639127038, 1760045462, 1770169450, 1790849495, 1831196682, 1902367816, 1922238518 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 229.16, "npi": [ 1023091477, 1568487759 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 229.16, "npi": [ 1225352800, 1225535933, 1477567279 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 594.3, "npi": [ 1023197670, 1790665024 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 358.0, "npi": [ 1023697547 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 358.0, "npi": [ 1154473957, 1215590484, 1568985844, 1659784973, 1720665318, 1811182751, 1952503344 ] } ] } ] }, { "tin": { "type": "ein", "value": "510141601" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 372.0, "npi": [ 1033504394 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 224.0, "npi": [ 1053623025, 1457568511, 1639690662, 1952352494 ] } ] } ] }, { "tin": { "type": "ein", "value": "204238269" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 984.0, "npi": [ 1063485779 ] } ] } ] }, { "tin": { "type": "ein", "value": "030417049" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 260.0, "npi": [ 1073553608 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 258.0, "npi": [ 1083222160, 1154629640, 1336778976, 1346675246, 1457980948, 1619218740, 1922758234 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 258.0, "npi": [ 1154945475 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 572.0, "npi": [ 1083293138, 1144430141, 1447830963, 1568629699, 1639139413, 1790076008 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 572.0, "npi": [ 1578639951, 1609865088, 1669400438, 1730491317, 1740596493 ] } ] } ] }, { "tin": { "type": "ein", "value": "582540964" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 355.0, "npi": [ 1093334229, 1447879986 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 358.0, "npi": [ 1093372690, 1528229267 ] } ] } ] }, { "tin": { "type": "ein", "value": "811366910" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 372.44, "npi": [ 1093805228, 1265722094, 1316478290, 1356768329 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 439.0, "npi": [ 1093978660, 1104350313, 1134172588, 1154854909, 1386909737, 1699268839, 1730344094, 1790922847, 1841605201, 1922291251, 1922310457 ] }, { "billed_charge": 396.0, "npi": [ 1326534454 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 439.0, "npi": [ 1164842621, 1326538083, 1366432544, 1467764381, 1548899586, 1578130894, 1588293492, 1629728027, 1821220039, 1841684198, 1871242461, 1871885194 ] }, { "billed_charge": 377.0, "npi": [ 1174273130, 1619957826, 1780115204, 1801424122, 1851032023 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 572.0, "npi": [ 1104119817, 1104990795, 1164911376, 1174843221, 1245736172, 1275524654, 1568717734, 1598405334, 1922238518 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 572.0, "npi": [ 1104990795 ] } ] } ] }, { "tin": { "type": "ein", "value": "824225028" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 500.0, "npi": [ 1124258843 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 262.42, "npi": [ 1124589023 ] } ] } ] }, { "tin": { "type": "ein", "value": "581992673" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 220.74, "npi": [ 1134382088, 1255527339, 1609938133 ] } ] } ] }, { "tin": { "type": "ein", "value": "991566468" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 680.0, "npi": [ 1134436322, 1295050201, 1427037910, 1538470885 ] } ] } ] }, { "tin": { "type": "ein", "value": "412074363" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 204.0, "npi": [ 1144394883 ] }, { "billed_charge": 355.0, "npi": [ 1144394883 ] } ] } ] }, { "tin": { "type": "ein", "value": "883688910" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 280.0, "npi": [ 1144531641 ] } ] } ] }, { "tin": { "type": "ein", "value": "204553410" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 358.0, "npi": [ 1144780214 ] } ] } ] }, { "tin": { "type": "ein", "value": "721597863" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 319.0, "npi": [ 1154958882 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "billing_code_modifier": [ "GC" ], "providers": [ { "billed_charge": 280.0, "npi": [ 1154985893 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 280.0, "npi": [ 1811558125 ] } ] } ] }, { "tin": { "type": "ein", "value": "582491034" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 175.0, "providers": [ { "billed_charge": 175.0, "npi": [ 1164484911 ] } ] } ] }, { "tin": { "type": "ein", "value": "581586758" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 225.0, "npi": [ 1164530051, 1205395175, 1477612661 ] } ] } ] }, { "tin": { "type": "ein", "value": "320086186" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 300.0, "npi": [ 1184611600 ] } ] } ] }, { "tin": { "type": "ein", "value": "582234927" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 444.0, "npi": [ 1205126851 ] } ] } ] }, { "tin": { "type": "ein", "value": "822423015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 645.0, "npi": [ 1205919990, 1396716312 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 645.0, "npi": [ 1205919990, 1356970354, 1366447187, 1386927382, 1396716312 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 258.0, "npi": [ 1215302484, 1407823859, 1831323393, 1871158840 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 258.0, "npi": [ 1700851284 ] } ] } ] }, { "tin": { "type": "ein", "value": "311824946" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 346.74, "npi": [ 1215458104 ] } ] } ] }, { "tin": { "type": "ein", "value": "760841500" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 229.0, "npi": [ 1215945001 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 229.0, "npi": [ 1215945001 ] } ] } ] }, { "tin": { "type": "ein", "value": "821505834" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 150.0, "providers": [ { "billed_charge": 150.0, "npi": [ 1225144140 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 316.0, "npi": [ 1225281330, 1760219893 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 316.0, "npi": [ 1538838974 ] } ] } ] }, { "tin": { "type": "ein", "value": "912073120" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 450.0, "npi": [ 1225404510 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 318.0, "npi": [ 1275769135 ] } ] } ] }, { "tin": { "type": "ein", "value": "581020324" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 220.0, "npi": [ 1275994261 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 463.0, "npi": [ 1306083258 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 463.0, "npi": [ 1376034215 ] } ] } ] }, { "tin": { "type": "ein", "value": "581651447" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 232.0, "npi": [ 1306399043 ] } ] } ] }, { "tin": { "type": "ein", "value": "582639583" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 145.0, "providers": [ { "billed_charge": 145.0, "npi": [ 1306878251 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 380.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "260348793" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1346244985 ] } ] } ] }, { "tin": { "type": "ein", "value": "384008024" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 718.0, "npi": [ 1346812112, 1609430727 ] } ] } ] }, { "tin": { "type": "ein", "value": "873113031" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 199.0, "npi": [ 1376048967, 1629014030, 1750734323 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 199.0, "npi": [ 1609047844 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259435" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 358.0, "npi": [ 1376512897 ] } ] } ] }, { "tin": { "type": "ein", "value": "394697862" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 164.0, "providers": [ { "billed_charge": 164.0, "npi": [ 1386609055 ] } ] } ] }, { "tin": { "type": "ein", "value": "330734849" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 162.0, "providers": [ { "billed_charge": 162.0, "npi": [ 1396107520, 1538556592 ] } ] } ] }, { "tin": { "type": "ein", "value": "203279920" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 374.0, "npi": [ 1396326401 ] } ] } ] }, { "tin": { "type": "ein", "value": "452743899" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 258.0, "npi": [ 1396477808 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 358.0, "npi": [ 1407114184, 1588167365, 1659310761, 1801089842 ] } ] } ] }, { "tin": { "type": "ein", "value": "333772642" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 291.0, "npi": [ 1417277112 ] } ] } ] }, { "tin": { "type": "ein", "value": "931371454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 377.0, "npi": [ 1427021435 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 377.0, "npi": [ 1992026751 ] } ] } ] }, { "tin": { "type": "ein", "value": "260146811" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 150.0, "providers": [ { "billed_charge": 150.0, "npi": [ 1487821989, 1992745137, 1992751093 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 275.0, "npi": [ 1487882429 ] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 960.0, "npi": [ 1508112772 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 210.0, "npi": [ 1508279332 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 643.32, "npi": [ 1528553484 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 643.32, "npi": [ 1730279449 ] } ] } ] }, { "tin": { "type": "ein", "value": "561667838" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 439.0, "npi": [ 1558316554 ] } ] } ] }, { "tin": { "type": "ein", "value": "461921294" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 300.0, "npi": [ 1558992974, 1942833009 ] } ] }, { "allowed_amount": 165.96, "providers": [ { "billed_charge": 300.0, "npi": [ 1982183976 ] } ] } ] }, { "tin": { "type": "ein", "value": "204623957" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 120.0, "providers": [ { "billed_charge": 120.0, "npi": [ 1629418603, 1972985992 ] } ] } ] }, { "tin": { "type": "ein", "value": "570992104" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 190.0, "npi": [ 1639183544 ] } ] } ] }, { "tin": { "type": "ein", "value": "581254673" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.0, "providers": [ { "billed_charge": 165.0, "npi": [ 1639216344 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 920.0, "npi": [ 1649502873, 1932580107 ] } ] } ] }, { "tin": { "type": "ein", "value": "920380998" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 727.0, "npi": [ 1649701343 ] } ] } ] }, { "tin": { "type": "ein", "value": "582336054" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 575.0, "npi": [ 1649775594 ] } ] } ] }, { "tin": { "type": "ein", "value": "202110456" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1659311645 ] } ] } ] }, { "tin": { "type": "ein", "value": "581926426" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 315.0, "npi": [ 1659373611 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 240.0, "npi": [ 1669497947 ] } ] } ] }, { "tin": { "type": "ein", "value": "202252101" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 572.0, "npi": [ 1689065591 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 572.0, "npi": [ 1770927501 ] } ] } ] }, { "tin": { "type": "ein", "value": "272244677" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 329.64, "npi": [ 1689273930, 1730731456 ] } ] } ] }, { "tin": { "type": "ein", "value": "582629795" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 361.0, "npi": [ 1689729055 ] } ] } ] }, { "tin": { "type": "ein", "value": "271813256" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 235.0, "npi": [ 1699762054 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 318.0, "npi": [ 1700255544 ] } ] } ] }, { "tin": { "type": "ein", "value": "460881518" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 225.0, "npi": [ 1700896156 ] } ] } ] }, { "tin": { "type": "ein", "value": "911939739" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 342.0, "npi": [ 1750499513 ] } ] } ] }, { "tin": { "type": "ein", "value": "465675991" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 258.0, "npi": [ 1750887675 ] } ] } ] }, { "tin": { "type": "ein", "value": "475656579" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 439.0, "npi": [ 1760585061 ] } ] } ] }, { "tin": { "type": "ein", "value": "862411778" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 618.0, "npi": [ 1770840761 ] } ] } ] }, { "tin": { "type": "ein", "value": "582651479" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 200.0, "npi": [ 1770858953 ] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 175.0, "providers": [ { "billed_charge": 175.0, "npi": [ 1780146290 ] } ] } ] }, { "tin": { "type": "ein", "value": "363966745" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1811251762 ] } ] } ] }, { "tin": { "type": "ein", "value": "272812143" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 225.0, "npi": [ 1821184540 ] } ] }, { "allowed_amount": 185.15, "providers": [ { "billed_charge": 225.0, "npi": [ 1821184540 ] } ] } ] }, { "tin": { "type": "ein", "value": "134341532" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 229.0, "npi": [ 1841208279 ] } ] } ] }, { "tin": { "type": "ein", "value": "010594994" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 219.0, "npi": [ 1841590908 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 347.0, "npi": [ 1841796729 ] } ] } ] }, { "tin": { "type": "ein", "value": "333168508" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 718.0, "npi": [ 1902039530 ] } ] } ] }, { "tin": { "type": "ein", "value": "582379261" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 325.0, "npi": [ 1922452218 ] } ] } ] }, { "tin": { "type": "ein", "value": "561398929" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 439.0, "npi": [ 1932492568 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363243" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 185.15, "providers": [ { "billed_charge": 249.0, "npi": [ 1932737335 ] } ] } ] }, { "tin": { "type": "ein", "value": "271872248" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 165.96, "providers": [ { "billed_charge": 200.0, "npi": [ 1962856674 ] } ] } ] } ] }, { "name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code": "99232", "billing_code_type_version": "2020", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "461921294" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1003697103, 1386327922, 1548838428, 1558048777, 1558992974, 1811333784, 1891446662, 1942833009 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 200.0, "npi": [ 1023759198, 1912225210, 1982183976 ] } ] } ] }, { "tin": { "type": "ein", "value": "621658774" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 235.0, "npi": [ 1013275627, 1679708960 ] } ] } ] }, { "tin": { "type": "ein", "value": "200401785" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 500.0, "npi": [ 1023066206 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 500.0, "npi": [ 1043896962, 1093896516, 1164650743, 1174785216, 1194285783, 1326595224, 1336587526, 1477057461, 1548667934, 1558352062, 1598405334, 1760045462, 1770169450, 1831196682, 1871024802, 1902367816 ] } ] } ] }, { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 154.12, "npi": [ 1023143682, 1225535933, 1316562507, 1346954146, 1477567279 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 367.75, "npi": [ 1083061246 ] }, { "billed_charge": 154.12, "npi": [ 1801474374 ] } ] } ] }, { "tin": { "type": "ein", "value": "611922162" }, "service_code": [ "51", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 395.1, "npi": [ 1023197670, 1518449768, 1932082435 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 395.1, "npi": [ 1518449768, 1619381316, 1831128958 ] } ] } ] }, { "tin": { "type": "ein", "value": "272244677" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 219.08, "npi": [ 1033614102, 1396089181, 1730731456, 1861858623 ] } ] } ] }, { "tin": { "type": "ein", "value": "203566888" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 276.0, "npi": [ 1033646757, 1487975132, 1639579956, 1912513672, 1932769536 ] }, { "billed_charge": 307.0, "npi": [ 1144479726, 1326493958, 1326538083, 1346800331, 1366432544, 1386602407, 1427507243, 1447921812, 1467764381, 1518318989, 1548899586, 1578025300, 1578130894, 1588293492, 1598712549, 1629728027, 1639744667, 1699270041, 1699353573, 1700896156, 1801676762, 1841684198, 1871242461, 1871885194, 1922640531 ] }, { "billed_charge": 263.0, "npi": [ 1174273130, 1265817001, 1265826341, 1417577057, 1598883928, 1619957826, 1801424122, 1841609351, 1851032023 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 307.0, "npi": [ 1093978660, 1104350313, 1134172588, 1144726860, 1386909737, 1669164182, 1699268839, 1790488104, 1790922847, 1841605201, 1841829769, 1871092940, 1881108520, 1922310457 ] }, { "billed_charge": 276.0, "npi": [ 1326534454 ] } ] } ] }, { "tin": { "type": "ein", "value": "581300768" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 123.0, "npi": [ 1043218878, 1174191647, 1255174355, 1427390988 ] } ] } ] }, { "tin": { "type": "ein", "value": "273284636" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 125.0, "npi": [ 1043250079, 1649468166, 1972674190 ] } ] } ] }, { "tin": { "type": "ein", "value": "460667707" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 210.0, "npi": [ 1043267628 ] } ] } ] }, { "tin": { "type": "ein", "value": "205106086" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 238.0, "npi": [ 1043779143, 1134435530, 1225009228, 1366593154, 1447927033, 1497755706, 1598296717, 1992090864 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 238.0, "npi": [ 1235666298, 1407021652, 1548576648, 1659422087, 1659784973, 1679130611, 1720665318, 1760758569, 1811182751, 1851929848, 1952503344, 1992783476 ] } ] } ] }, { "tin": { "type": "ein", "value": "571004971" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 149.0, "npi": [ 1053623025, 1457568511, 1639690662, 1952352494 ] } ] } ] }, { "tin": { "type": "ein", "value": "203447115" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 204.0, "npi": [ 1063032340 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 204.0, "npi": [ 1114345972, 1659947174 ] } ] } ] }, { "tin": { "type": "ein", "value": "203279920" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 260.0, "npi": [ 1063497162, 1063508356, 1174597546, 1619943792 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 260.0, "npi": [ 1396326401, 1871167270 ] } ] } ] }, { "tin": { "type": "ein", "value": "510141601" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 253.0, "npi": [ 1063822880 ] }, { "billed_charge": 261.0, "npi": [ 1063822880 ] } ] } ] }, { "tin": { "type": "ein", "value": "030417049" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 142.0, "npi": [ 1073553608 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 142.0, "npi": [ 1093432528, 1740418177, 1750876116 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 308.0, "npi": [ 1083118004, 1104320811, 1669557195, 1790969780, 1801044342, 1952310500 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 308.0, "npi": [ 1154784809, 1245596998, 1548559826 ] } ] } ] }, { "tin": { "type": "ein", "value": "454611727" }, "service_code": [ "21", "61" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 183.0, "npi": [ 1083222160, 1245694157, 1336778976, 1619218740, 1841501285, 1922758234 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 183.0, "npi": [ 1154945475 ] } ] } ] }, { "tin": { "type": "ein", "value": "582540964" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 249.0, "npi": [ 1093334229 ] } ] } ] }, { "tin": { "type": "ein", "value": "811366910" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 267.19, "npi": [ 1093805228, 1306807359, 1356768329, 1427200898, 1912157249, 1932677523 ] } ] } ] }, { "tin": { "type": "ein", "value": "832356574" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 202.0, "npi": [ 1093946923 ] } ] } ] }, { "tin": { "type": "ein", "value": "413202312" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 398.0, "npi": [ 1104119817, 1104990795, 1164911376, 1649700378, 1790125813 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 221.0, "npi": [ 1104436484, 1174740344, 1811686611, 1821512328, 1831464817 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 221.0, "npi": [ 1952671067 ] } ] } ] }, { "tin": { "type": "ein", "value": "612104371" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 429.0, "npi": [ 1114945979, 1184064867 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 429.0, "npi": [ 1790263150 ] } ] } ] }, { "tin": { "type": "ein", "value": "464314740" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 120.0, "providers": [ { "billed_charge": 120.0, "npi": [ 1114970464 ] } ] } ] }, { "tin": { "type": "ein", "value": "581992673" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 146.74, "npi": [ 1134382088 ] } ] } ] }, { "tin": { "type": "ein", "value": "472503442" }, "service_code": [ "21", "22", "61" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 183.0, "npi": [ 1144258831, 1700851284 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 183.0, "npi": [ 1225520679, 1235134669, 1407823859, 1831323393, 1902309545 ] } ] } ] }, { "tin": { "type": "ein", "value": "271198208" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 204.0, "npi": [ 1144750571 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "billing_code_modifier": [ "GC" ], "providers": [ { "billed_charge": 224.82, "npi": [ 1154741015, 1588606701 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 308.0, "npi": [ 1306083258 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 308.0, "npi": [ 1679077234, 1720024292, 1972985273, 1992718100 ] } ] } ] }, { "tin": { "type": "ein", "value": "822423015" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 393.0, "npi": [ 1154741015, 1205919990, 1356970354, 1366447187, 1386927382 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 393.0, "npi": [ 1396716312, 1760416077 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "billing_code_modifier": [ "GC" ], "providers": [ { "billed_charge": 185.0, "npi": [ 1154985893, 1780037507 ] } ] } ] }, { "tin": { "type": "ein", "value": "814208547" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1164964243, 1750836805, 1811474828, 1942745575 ] } ] } ] }, { "tin": { "type": "ein", "value": "582379261" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 250.0, "npi": [ 1174637532, 1447365762, 1922452218 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 140.0, "npi": [ 1174866503, 1205533254, 1639796196, 1770860918 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "billing_code_modifier": [ "GC" ], "providers": [ { "billed_charge": 168.0, "npi": [ 1194176446 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 168.0, "npi": [ 1669497947, 1952861916 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 168.0, "npi": [ 1952861916 ] } ] } ] }, { "tin": { "type": "ein", "value": "844995668" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 184.0, "npi": [ 1194729582 ] } ] } ] }, { "tin": { "type": "ein", "value": "582234927" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 298.0, "npi": [ 1205126851 ] } ] } ] }, { "tin": { "type": "ein", "value": "582146852" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 225.0, "npi": [ 1215142401 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 225.0, "npi": [ 1376786871 ] } ] } ] }, { "tin": { "type": "ein", "value": "311824946" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 230.46, "npi": [ 1215458104, 1518905959 ] } ] } ] }, { "tin": { "type": "ein", "value": "760841500" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 160.0, "npi": [ 1215945001 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 212.0, "npi": [ 1225281330 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 212.0, "npi": [ 1750720660 ] } ] } ] }, { "tin": { "type": "ein", "value": "912160693" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 149.4, "npi": [ 1245219534 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 160.0, "npi": [ 1245345875, 1568434637 ] } ] } ] }, { "tin": { "type": "ein", "value": "263566828" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 182.0, "npi": [ 1245606805 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 182.0, "npi": [ 1437599883 ] } ] } ] }, { "tin": { "type": "ein", "value": "471104925" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 135.0, "npi": [ 1255398095 ] } ] } ] }, { "tin": { "type": "ein", "value": "874714839" }, "service_code": [ "61", "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 255.0, "npi": [ 1255695136, 1346762606 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 255.0, "npi": [ 1982224622 ] } ] } ] }, { "tin": { "type": "ein", "value": "922193137" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 398.0, "npi": [ 1275541567, 1669400438 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 431.67, "npi": [ 1285794115, 1477730224, 1578982831, 1932499589 ] } ] }, { "allowed_amount": 116.07, "providers": [ { "billed_charge": 431.67, "npi": [ 1356375315, 1528553484 ] } ] } ] }, { "tin": { "type": "ein", "value": "812238385" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 184.0, "npi": [ 1295764009 ] } ] } ] }, { "tin": { "type": "ein", "value": "825415284" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 186.0, "npi": [ 1306077300, 1730162926 ] } ] } ] }, { "tin": { "type": "ein", "value": "452743899" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 183.0, "npi": [ 1316982911, 1457518813, 1568412146, 1649439134 ] } ] } ] }, { "tin": { "type": "ein", "value": "203391625" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 255.0, "npi": [ 1336190776 ] } ] } ] }, { "tin": { "type": "ein", "value": "263412753" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 125.0, "npi": [ 1336324144 ] } ] } ] }, { "tin": { "type": "ein", "value": "202252101" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 398.0, "npi": [ 1336485150 ] } ] } ] }, { "tin": { "type": "ein", "value": "453694469" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 238.0, "npi": [ 1336644459, 1346533213, 1437512183, 1528229267, 1578609780, 1588690382, 1609003912, 1649327594 ] } ] } ] }, { "tin": { "type": "ein", "value": "201395801" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 141.0, "npi": [ 1336864362 ] } ] } ] }, { "tin": { "type": "ein", "value": "262037695" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 221.0, "npi": [ 1366884876, 1609183805, 1811425853 ] } ] } ] }, { "tin": { "type": "ein", "value": "233044978" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 125.0, "npi": [ 1386902856 ] } ] } ] }, { "tin": { "type": "ein", "value": "352297438" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 160.0, "npi": [ 1407188626, 1740716265 ] } ] } ] }, { "tin": { "type": "ein", "value": "453323892" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.0, "providers": [ { "billed_charge": 110.0, "npi": [ 1407963952 ] } ] } ] }, { "tin": { "type": "ein", "value": "582600830" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 105.0, "providers": [ { "billed_charge": 105.0, "npi": [ 1417031428 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 221.0, "npi": [ 1417193871 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 221.0, "npi": [ 1558347807, 1609453240 ] } ] } ] }, { "tin": { "type": "ein", "value": "922621391" }, "service_code": [ "61" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 105.0, "providers": [ { "billed_charge": 105.0, "npi": [ 1427036813 ] } ] } ] }, { "tin": { "type": "ein", "value": "822444447" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 160.0, "npi": [ 1427386689, 1821626201 ] } ] } ] }, { "tin": { "type": "ein", "value": "834390271" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 238.0, "npi": [ 1437390150 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "22", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 156.0, "npi": [ 1447289913 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 156.0, "npi": [ 1639824477, 1720069578 ] } ] } ] }, { "tin": { "type": "ein", "value": "581586758" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 155.0, "npi": [ 1477612661 ] } ] } ] }, { "tin": { "type": "ein", "value": "581109444" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 136.0, "npi": [ 1477873156 ] } ] } ] }, { "tin": { "type": "ein", "value": "260146811" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 120.0, "providers": [ { "billed_charge": 120.0, "npi": [ 1487821989, 1992745137 ] } ] } ] }, { "tin": { "type": "ein", "value": "581734026" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 142.0, "npi": [ 1497294532, 1912427592 ] } ] } ] }, { "tin": { "type": "ein", "value": "590637874" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 636.0, "npi": [ 1508112772 ] } ] } ] }, { "tin": { "type": "ein", "value": "261858563" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 145.0, "npi": [ 1508279332, 1902231327 ] } ] } ] }, { "tin": { "type": "ein", "value": "582569828" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 317.2, "npi": [ 1508444803, 1801058557, 1922394931 ] } ] } ] }, { "tin": { "type": "ein", "value": "582175978" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 230.0, "npi": [ 1508718966 ] } ] } ] }, { "tin": { "type": "ein", "value": "570605223" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 110.0, "providers": [ { "billed_charge": 110.0, "npi": [ 1528583614 ] } ] } ] }, { "tin": { "type": "ein", "value": "931371454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 252.0, "npi": [ 1538118955 ] } ] } ] }, { "tin": { "type": "ein", "value": "991566468" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 476.0, "npi": [ 1538470885 ] } ] } ] }, { "tin": { "type": "ein", "value": "330734849" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 113.0, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 113.0, "npi": [ 1538556592 ] } ] } ] }, { "tin": { "type": "ein", "value": "274393711" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1578676292 ] } ] } ] }, { "tin": { "type": "ein", "value": "581928247" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 250.0, "npi": [ 1578913000, 1629640040, 1831899848 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 308.0, "npi": [ 1588152409 ] } ] } ] }, { "tin": { "type": "ein", "value": "580973772" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 181.0, "npi": [ 1588397228 ] } ] } ] }, { "tin": { "type": "ein", "value": "582197074" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 120.0, "providers": [ { "billed_charge": 120.0, "npi": [ 1588626030 ] } ] } ] }, { "tin": { "type": "ein", "value": "273818647" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 190.0, "npi": [ 1619060365 ] } ] } ] }, { "tin": { "type": "ein", "value": "461380712" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.0, "providers": [ { "billed_charge": 115.0, "npi": [ 1619158730 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 150.0, "npi": [ 1619158730 ] } ] } ] }, { "tin": { "type": "ein", "value": "582352829" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 183.0, "npi": [ 1629072210 ] } ] } ] }, { "tin": { "type": "ein", "value": "204623957" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 85.0, "providers": [ { "billed_charge": 85.0, "npi": [ 1629418603 ] } ] } ] }, { "tin": { "type": "ein", "value": "630889615" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 90.0, "providers": [ { "billed_charge": 90.0, "npi": [ 1629513023 ] } ] } ] }, { "tin": { "type": "ein", "value": "264444385" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 130.0, "npi": [ 1639105620 ] } ] } ] }, { "tin": { "type": "ein", "value": "273597705" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "billing_code_modifier": [ "25" ], "providers": [ { "billed_charge": 147.0, "npi": [ 1639337306 ] } ] } ] }, { "tin": { "type": "ein", "value": "920380998" }, "service_code": [ "21", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 504.0, "npi": [ 1649701343 ] } ] } ] }, { "tin": { "type": "ein", "value": "581926426" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 230.0, "npi": [ 1659373611 ] } ] } ] }, { "tin": { "type": "ein", "value": "462537433" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 212.0, "npi": [ 1659468668 ] } ] } ] }, { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 689.0, "npi": [ 1669731451 ] } ] } ] }, { "tin": { "type": "ein", "value": "884001056" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 642.0, "npi": [ 1669858981 ] } ] } ] }, { "tin": { "type": "ein", "value": "580625140" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 171.0, "npi": [ 1679835649 ] } ] } ] }, { "tin": { "type": "ein", "value": "460881518" }, "service_code": [ "21", "61" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 175.0, "npi": [ 1700896156 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 175.0, "npi": [ 1700896156 ] } ] } ] }, { "tin": { "type": "ein", "value": "570992104" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 136.0, "npi": [ 1740859636, 1831301779 ] } ] } ] }, { "tin": { "type": "ein", "value": "475656579" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 307.0, "npi": [ 1760585061, 1881856078 ] } ] } ] }, { "tin": { "type": "ein", "value": "582651479" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 150.0, "npi": [ 1770858953 ] } ] } ] }, { "tin": { "type": "ein", "value": "472111282" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 200.0, "npi": [ 1780629519 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 689.0, "npi": [ 1780959932 ] } ] } ] }, { "tin": { "type": "ein", "value": "331105310" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 238.0, "npi": [ 1801910393 ] } ] } ] }, { "tin": { "type": "ein", "value": "881352492" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 245.0, "npi": [ 1811126741 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 245.0, "npi": [ 1811126741 ] } ] } ] }, { "tin": { "type": "ein", "value": "363966745" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 170.0, "npi": [ 1811251762 ] } ] } ] }, { "tin": { "type": "ein", "value": "874461181" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 475.0, "npi": [ 1831548536 ] } ] } ] }, { "tin": { "type": "ein", "value": "611665353" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 431.67, "npi": [ 1831621390 ] } ] } ] }, { "tin": { "type": "ein", "value": "332416654" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 136.0, "npi": [ 1831844208 ] } ] } ] }, { "tin": { "type": "ein", "value": "134341532" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 160.0, "npi": [ 1841208279 ] } ] } ] }, { "tin": { "type": "ein", "value": "582518112" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 80.0, "providers": [ { "billed_charge": 80.0, "npi": [ 1841368933 ] } ] } ] }, { "tin": { "type": "ein", "value": "582321454" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 230.0, "npi": [ 1841388782 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 189.0, "npi": [ 1871579888 ] } ] } ] }, { "tin": { "type": "ein", "value": "204553410" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 238.0, "npi": [ 1871857482 ] } ] } ] }, { "tin": { "type": "ein", "value": "582664650" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 187.5, "npi": [ 1891724449 ] } ] } ] }, { "tin": { "type": "ein", "value": "320325973" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 116.07, "providers": [ { "billed_charge": 398.0, "npi": [ 1912141094, 1952697971 ] } ] }, { "allowed_amount": 122.15, "providers": [ { "billed_charge": 398.0, "npi": [ 1912141094 ] } ] } ] }, { "tin": { "type": "ein", "value": "830729449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 175.0, "npi": [ 1922217926 ] } ] } ] }, { "tin": { "type": "ein", "value": "561398929" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 294.0, "npi": [ 1932492568 ] } ] } ] }, { "tin": { "type": "ein", "value": "582363243" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 178.0, "npi": [ 1932737335 ] } ] } ] }, { "tin": { "type": "ein", "value": "260522515" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 234.0, "npi": [ 1942243704 ] } ] } ] }, { "tin": { "type": "ein", "value": "465427625" }, "service_code": [ "51" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 165.0, "npi": [ 1942793773 ] } ] } ] }, { "tin": { "type": "ein", "value": "640964506" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.15, "providers": [ { "billed_charge": 125.0, "npi": [ 1982680104 ] } ] } ] } ] }, { "name": "SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES", "billing_code_type": "CPT", "billing_code": "99231", "billing_code_type_version": "2020", "description": "SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "591917016" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 95.4, "npi": [ 1023091477 ] } ] }, { "allowed_amount": 76.55, "providers": [ { "billed_charge": 95.4, "npi": [ 1346954146 ] } ] } ] }, { "tin": { "type": "ein", "value": "460667707" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 115.0, "npi": [ 1043267628 ] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 101.0, "npi": [ 1174866503 ] } ] } ] }, { "tin": { "type": "ein", "value": "570359174" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 115.0, "npi": [ 1184419350 ] } ] } ] }, { "tin": { "type": "ein", "value": "882051065" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 116.0, "npi": [ 1205332962, 1467632802, 1568698934, 1629501697, 1649207648, 1851387914, 1992152367 ] } ] } ] }, { "tin": { "type": "ein", "value": "912160693" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 94.1, "npi": [ 1245219534 ] } ] } ] }, { "tin": { "type": "ein", "value": "201722595" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 96.0, "npi": [ 1275737066, 1639521420, 1942278874 ] } ] } ] }, { "tin": { "type": "ein", "value": "460676654" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 115.0, "npi": [ 1285848689 ] } ] } ] }, { "tin": { "type": "ein", "value": "334900298" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 97.0, "npi": [ 1346620960 ] } ] } ] }, { "tin": { "type": "ein", "value": "451259435" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 150.0, "npi": [ 1366440372 ] } ] } ] }, { "tin": { "type": "ein", "value": "581537752" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 120.0, "npi": [ 1366778961 ] } ] }, { "allowed_amount": 76.55, "providers": [ { "billed_charge": 120.0, "npi": [ 1902352107 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 193.0, "npi": [ 1386888220 ] } ] }, { "allowed_amount": 67.68, "providers": [ { "billed_charge": 193.0, "npi": [ 1538334198 ] } ] } ] }, { "tin": { "type": "ein", "value": "352297438" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 87.0, "npi": [ 1407188626, 1740716265 ] } ] } ] }, { "tin": { "type": "ein", "value": "581627802" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 120.0, "npi": [ 1417193871 ] } ] } ] }, { "tin": { "type": "ein", "value": "834257679" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 147.0, "npi": [ 1497162309 ] } ] } ] }, { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 376.0, "npi": [ 1538877683 ] } ] } ] }, { "tin": { "type": "ein", "value": "822449007" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 87.0, "npi": [ 1548357213 ] } ] } ] }, { "tin": { "type": "ein", "value": "582197074" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 90.0, "npi": [ 1588626030 ] } ] } ] }, { "tin": { "type": "ein", "value": "883616696" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 84.0, "npi": [ 1619924743 ] } ] } ] }, { "tin": { "type": "ein", "value": "823551399" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 135.0, "npi": [ 1629002365 ] } ] } ] }, { "tin": { "type": "ein", "value": "261758203" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 81.0, "npi": [ 1649216649 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 97.0, "npi": [ 1669497947 ] } ] } ] }, { "tin": { "type": "ein", "value": "204700877" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 193.0, "npi": [ 1679077234, 1992718100 ] } ] } ] }, { "tin": { "type": "ein", "value": "582338025" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.68, "providers": [ { "billed_charge": 436.04, "npi": [ 1689656878, 1689682494 ] } ] } ] }, { "tin": { "type": "ein", "value": "465754759" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 65.0, "providers": [ { "billed_charge": 65.0, "npi": [ 1821041476 ] } ] } ] }, { "tin": { "type": "ein", "value": "562391560" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 131.0, "npi": [ 1821647124 ] } ] } ] }, { "tin": { "type": "ein", "value": "621400167" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 75.0, "providers": [ { "billed_charge": 75.0, "npi": [ 1861080343 ] } ] } ] }, { "tin": { "type": "ein", "value": "475625504" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 230.0, "npi": [ 1922833193 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.55, "providers": [ { "billed_charge": 267.06, "npi": [ 1932499589 ] } ] } ] } ] }, { "name": "SBSQ INTENSIVE CARE INFANT PBW 2,501-5,000 GRAMS", "billing_code_type": "CPT", "billing_code": "99480", "billing_code_type_version": "2020", "description": "SBSQ INTENSIVE CARE INFANT PBW 2,501-5,000 GRAMS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 212.52, "providers": [ { "billed_charge": 1256.0, "npi": [ 1043743552, 1356498174, 1477750818, 1669882668 ] } ] } ] }, { "tin": { "type": "ein", "value": "204238269" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 212.52, "providers": [ { "billed_charge": 1256.0, "npi": [ 1174521280 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 212.52, "providers": [ { "billed_charge": 1256.0, "npi": [ 1871787408 ] } ] } ] } ] }, { "name": "SBSQ INTENSIVE CARE LBW INFANT 1,500-2,500 GRAMS", "billing_code_type": "CPT", "billing_code": "99479", "billing_code_type_version": "2020", "description": "SBSQ INTENSIVE CARE LBW INFANT 1,500-2,500 GRAMS", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 292.98, "providers": [ { "billed_charge": 1309.0, "npi": [ 1225266745, 1356498174, 1366409146, 1477501047, 1497917157, 1669731451, 1710294491, 1710940903, 1821045808 ] } ] } ] } ] }, { "name": "SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES", "billing_code_type": "CPT", "billing_code": "99308", "billing_code_type_version": "2020", "description": "SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "881352492" }, "service_code": [ "31" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.45, "providers": [ { "billed_charge": 193.0, "npi": [ 1194051664 ] } ] } ] }, { "tin": { "type": "ein", "value": "993881698" }, "service_code": [ "31" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 84.0, "providers": [ { "billed_charge": 84.0, "npi": [ 1467390559 ] } ] } ] }, { "tin": { "type": "ein", "value": "460881518" }, "service_code": [ "31" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 115.45, "providers": [ { "billed_charge": 193.0, "npi": [ 1700896156 ] } ] } ] } ] }, { "name": "SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES", "billing_code_type": "CPT", "billing_code": "99309", "billing_code_type_version": "2020", "description": "SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES", "allowed_amounts": [ { "tin": { "type": "ein", "value": "273396768" }, "service_code": [ "32" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 164.0, "providers": [ { "billed_charge": 164.0, "npi": [ 1073512877, 1740629443, 1942851597 ] } ] } ] }, { "tin": { "type": "ein", "value": "333264278" }, "service_code": [ "32" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 168.39, "providers": [ { "billed_charge": 524.77, "npi": [ 1548159353, 1568968501, 1588285639, 1598384224, 1760054795, 1861032187 ] } ] } ] }, { "tin": { "type": "ein", "value": "814943031" }, "service_code": [ "32" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 168.39, "providers": [ { "billed_charge": 370.0, "npi": [ 1760076442 ] } ] } ] }, { "tin": { "type": "ein", "value": "993881698" }, "service_code": [ "32" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 122.0, "providers": [ { "billed_charge": 122.0, "npi": [ 1770958589 ] } ] } ] } ] }, { "name": "SC STD ANTMCRB AGT MICRODILUTION/AGAR DILUTION", "billing_code_type": "CPT", "billing_code": "87186", "billing_code_type_version": "2020", "description": "SC STD ANTMCRB AGT MICRODILUTION/AGAR DILUTION", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 100.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "260880495" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 20.0, "npi": [ 1134377781 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 8.65, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 41.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 88.2, "npi": [ 1639264575 ] }, { "billed_charge": 94.5, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471358089" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 50.0, "npi": [ 1861913576 ] } ] }, { "allowed_amount": 24.22, "providers": [ { "billed_charge": 200.0, "npi": [ 1861913576 ] } ] }, { "allowed_amount": 72.66, "providers": [ { "billed_charge": 600.0, "npi": [ 1861913576 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.06, "providers": [ { "billed_charge": 104.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "SCREENING DIGITAL BREAST TOMOSYNTHESIS BI", "billing_code_type": "CPT", "billing_code": "77063", "billing_code_type_version": "2020", "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS BI", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 88.0, "npi": [ 1053304428, 1447207782, 1700166733, 1811955255 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22", "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 213.0, "npi": [ 1083696561, 1164648309, 1184636052, 1184718272, 1275854226, 1316267404, 1326001835, 1356520704, 1366508442, 1417928060, 1477930162, 1750599742, 1891769741, 1982947354 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "19", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 136.0, "npi": [ 1114970829, 1124205356, 1346668191, 1447436894, 1851633572 ] } ] } ] }, { "tin": { "type": "ein", "value": "560946251" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 130.0, "npi": [ 1124042197 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 107.0, "npi": [ 1255420592, 1679566053, 1750361697 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 87.0, "npi": [ 1366592958 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 146.0, "npi": [ 1407274319 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1447756960, 1598793028, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "800023773" }, "service_code": [ "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 121.0, "npi": [ 1477729051 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 154.0, "npi": [ 1518942713, 1821209800, 1972583805 ] } ] } ] }, { "tin": { "type": "ein", "value": "462023006" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 100.0, "npi": [ 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "22", "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 134.0, "npi": [ 1831534346, 1881753291 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 78.73, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 94.0, "npi": [ 1841452968 ] } ] } ] } ] }, { "name": "SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD", "billing_code_type": "CPT", "billing_code": "77067", "billing_code_type_version": "2020", "description": "SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 162.0, "npi": [ 1053304428, 1447207782, 1700166733, 1811955255 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22", "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 316.0, "npi": [ 1083696561, 1164648309, 1184636052, 1184718272, 1275854226, 1316267404, 1326001835, 1356520704, 1366508442, 1417928060, 1477930162, 1750599742, 1891769741, 1982947354 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "19", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 174.0, "npi": [ 1114970829, 1124205356, 1346668191, 1447436894, 1851633572 ] } ] } ] }, { "tin": { "type": "ein", "value": "560946251" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 151.0, "npi": [ 1124042197 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 137.0, "npi": [ 1255420592, 1679566053, 1750361697 ] } ] } ] }, { "tin": { "type": "ein", "value": "570853635" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 108.0, "npi": [ 1366592958 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 184.0, "npi": [ 1407274319 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 215.0, "npi": [ 1447756960, 1598793028, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "800023773" }, "service_code": [ "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 143.0, "npi": [ 1477729051 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 195.0, "npi": [ 1518942713, 1821209800, 1972583805 ] } ] } ] }, { "tin": { "type": "ein", "value": "462023006" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 147.0, "npi": [ 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "470376487" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 209.64, "npi": [ 1750778189 ] } ] } ] }, { "tin": { "type": "ein", "value": "581440934" }, "service_code": [ "22", "19" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 170.0, "npi": [ 1831534346, 1881753291 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 100.05, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 119.0, "npi": [ 1841452968 ] } ] } ] } ] }, { "name": "Sedimentation rate, erythrocyte; automated", "billing_code_type": "CPT", "billing_code": "85652", "billing_code_type_version": "2020", "description": "Sedimentation rate, erythrocyte; automated", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 65.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 8.1, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 31.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 37.8, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 37.8, "npi": [ 1801883780, 1851388748 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.89, "providers": [ { "billed_charge": 8.0, "npi": [ 1831851039 ] } ] } ] } ] }, { "name": "Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service", "billing_code_type": "CPT", "billing_code": "99053", "billing_code_type_version": "2020", "description": "Service(s) provided between 10:00 PM and 8:00 AM at 24-hour facility, in addition to basic service", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 82.0, "npi": [ 1003338237, 1003565318, 1063751212, 1124490255, 1215357421, 1316390099, 1467834838, 1487763827, 1518998210, 1588011662, 1598343998, 1639185903, 1669677415, 1790363638, 1932402740, 1932571676, 1952343527, 1992976773 ] }, { "billed_charge": 88.0, "npi": [ 1083104350, 1114668415, 1629023924, 1841684446, 1881089993, 1912134180 ] } ] }, { "allowed_amount": 43.0, "providers": [ { "billed_charge": 43.0, "npi": [ 1023657871, 1033776372, 1104326271, 1164914446, 1235794488, 1306960216, 1326091554, 1457971970, 1487141222, 1578149621, 1689423220, 1720055643, 1740209154, 1740355346, 1780571794, 1831431428, 1871506915, 1891361408, 1902878804, 1942676416, 1962402461, 1962667915 ] } ] }, { "allowed_amount": 49.0, "providers": [ { "billed_charge": 49.0, "npi": [ 1154704823 ] } ] }, { "allowed_amount": 70.0, "providers": [ { "billed_charge": 70.0, "npi": [ 1164059473, 1184005910, 1447286372, 1457769218, 1619959103, 1629607809 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 68.0, "providers": [ { "billed_charge": 68.0, "npi": [ 1003499070, 1023472065, 1033571799, 1073297008, 1073831871, 1134507130, 1144751637, 1255755575, 1255794053, 1275552440, 1346858917, 1356508972, 1396179446, 1396756680, 1427404409, 1447411376, 1457871949, 1487092656, 1497763163, 1497786974, 1528168408, 1538943311, 1558536987, 1598021867, 1598942146, 1609221282, 1699138719, 1740235175, 1780209049, 1811467350, 1871938266, 1902162381, 1982991246 ] } ] }, { "allowed_amount": 77.0, "providers": [ { "billed_charge": 151.0, "npi": [ 1003862574, 1821190471 ] }, { "billed_charge": 110.0, "npi": [ 1154874980, 1366077562, 1396906368, 1487945945, 1649699240, 1801355607, 1912163825, 1912431198 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1003873860, 1346875564, 1710965207, 1982281622 ] } ] } ] }, { "tin": { "type": "ein", "value": "824329577" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1013924695, 1689860355 ] } ] } ] }, { "tin": { "type": "ein", "value": "646010232" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 50.0, "providers": [ { "billed_charge": 50.0, "npi": [ 1023538402 ] } ] } ] }, { "tin": { "type": "ein", "value": "824426629" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1023679743 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 67.0, "providers": [ { "billed_charge": 67.0, "npi": [ 1033792551, 1053737692, 1114968518, 1184666265, 1235606138, 1275221483, 1407266968, 1417705450, 1467861310, 1477146678, 1528332939, 1538856448, 1609429570, 1609626712, 1629566385, 1629608492, 1659370351, 1659683175, 1740992239, 1891257234, 1932876711, 1942594429, 1962804104 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 61.0, "providers": [ { "billed_charge": 61.0, "npi": [ 1043575178, 1053393892, 1295305217, 1447614391, 1467031955, 1639058068 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 20.0, "providers": [ { "billed_charge": 20.0, "npi": [ 1043876410, 1083713028, 1093991796, 1154731388, 1275851578, 1336643717, 1659412971, 1659557320, 1669867925, 1801213640, 1902844137, 1972967966 ] } ] } ] }, { "tin": { "type": "ein", "value": "581920755" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 20.0, "providers": [ { "billed_charge": 20.0, "npi": [ 1053344853, 1720377237, 1942486105 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 102.0, "npi": [ 1063107845, 1548786585, 1871315713 ] } ] }, { "allowed_amount": 65.45, "providers": [ { "billed_charge": 102.0, "npi": [ 1871841437 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 32.0, "providers": [ { "billed_charge": 32.0, "npi": [ 1063673622 ] } ] }, { "allowed_amount": 68.0, "providers": [ { "billed_charge": 68.0, "npi": [ 1487188306, 1548496185, 1588001143 ] } ] }, { "allowed_amount": 77.0, "providers": [ { "billed_charge": 159.0, "npi": [ 1881114999 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1063708006, 1457881260, 1588700017, 1659383628, 1740209154, 1831776764, 1881089993, 1912947326, 1992267892 ] } ] } ] }, { "tin": { "type": "ein", "value": "462439952" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 46.0, "providers": [ { "billed_charge": 46.0, "npi": [ 1083199442 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 106.0, "npi": [ 1093270811, 1134652399, 1174151591, 1205125960, 1285611053, 1336137371, 1336636042, 1376958769, 1508253022, 1538621453, 1578684437, 1578732335, 1730355785, 1750479408 ] } ] } ] }, { "tin": { "type": "ein", "value": "621696734" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 78.0, "npi": [ 1124050141, 1528164373, 1922045681 ] } ] } ] }, { "tin": { "type": "ein", "value": "593677604" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 105.0, "npi": [ 1154373751 ] } ] } ] }, { "tin": { "type": "ein", "value": "582228258" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 107.0, "npi": [ 1154596773, 1194959916, 1326545823, 1336675487, 1659154011, 1720440555, 1770214066, 1811428188, 1811570864, 1871067959, 1881612067, 1972965390 ] } ] } ] }, { "tin": { "type": "ein", "value": "200495416" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 61.0, "providers": [ { "billed_charge": 61.0, "npi": [ 1164471322 ] } ] } ] }, { "tin": { "type": "ein", "value": "471463004" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 125.38, "npi": [ 1205152105 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1215190772, 1558473223, 1992267678 ] } ] } ] }, { "tin": { "type": "ein", "value": "811558273" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1235344367 ] } ] } ] }, { "tin": { "type": "ein", "value": "591281714" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 92.0, "npi": [ 1255825717 ] } ] } ] }, { "tin": { "type": "ein", "value": "472478680" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 94.0, "npi": [ 1295762169, 1427146125, 1598717639, 1689752636, 1790880144, 1992391346 ] } ] } ] }, { "tin": { "type": "ein", "value": "880687924" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 94.0, "npi": [ 1326031865, 1477536811, 1780250464 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 135.0, "npi": [ 1366896409, 1447888300 ] } ] } ] }, { "tin": { "type": "ein", "value": "841888261" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 94.0, "npi": [ 1386723310 ] } ] } ] }, { "tin": { "type": "ein", "value": "920101761" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 155.0, "npi": [ 1487920211, 1780720599 ] } ] } ] }, { "tin": { "type": "ein", "value": "208550713" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 121.73, "npi": [ 1568959054 ] } ] } ] }, { "tin": { "type": "ein", "value": "650622859" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 77.0, "providers": [ { "billed_charge": 193.0, "npi": [ 1619945169 ] } ] } ] }, { "tin": { "type": "ein", "value": "621586974" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 75.0, "providers": [ { "billed_charge": 75.0, "npi": [ 1841224243 ] } ] } ] }, { "tin": { "type": "ein", "value": "883514060" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 56.0, "providers": [ { "billed_charge": 56.0, "npi": [ 1932355047 ] } ] } ] } ] }, { "name": "Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service", "billing_code_type": "CPT", "billing_code": "99051", "billing_code_type_version": "2020", "description": "Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service", "allowed_amounts": [ { "tin": { "type": "ein", "value": "473524701" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 47.0, "npi": [ 1003257593, 1033621776, 1043915168, 1134013923, 1134076334, 1205334737, 1215893821, 1235837253, 1326633942, 1427888346, 1467317149, 1477355212, 1497553085, 1497586630, 1629955638, 1669252656, 1750174223, 1770450975, 1801783261, 1861200750, 1881463479, 1881565125, 1891536298, 1922960632, 1952288789 ] } ] }, { "allowed_amount": 25.0, "providers": [ { "billed_charge": 47.0, "npi": [ 1225735897, 1689244063 ] } ] } ] }, { "tin": { "type": "ein", "value": "205277615" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 100.0, "npi": [ 1023544301, 1326868837, 1508235953, 1598264376 ] } ] } ] }, { "tin": { "type": "ein", "value": "205277615" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 100.0, "npi": [ 1023544301 ] } ] } ] }, { "tin": { "type": "ein", "value": "455103789" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 75.0, "npi": [ 1043848583 ] } ] } ] }, { "tin": { "type": "ein", "value": "833622578" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 100.0, "npi": [ 1073557211, 1194406330, 1558898163 ] } ] } ] }, { "tin": { "type": "ein", "value": "275099507" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.0, "providers": [ { "billed_charge": 20.0, "npi": [ 1093358905 ] } ] } ] }, { "tin": { "type": "ein", "value": "561667838" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 66.0, "npi": [ 1114936606 ] } ] } ] }, { "tin": { "type": "ein", "value": "463562590" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 100.0, "npi": [ 1124648290 ] } ] } ] }, { "tin": { "type": "ein", "value": "831072238" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 55.0, "npi": [ 1134549322, 1629154067 ] } ] } ] }, { "tin": { "type": "ein", "value": "852204789" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 45.0, "npi": [ 1164166922, 1194953638, 1821374380 ] } ] } ] }, { "tin": { "type": "ein", "value": "844255408" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 45.0, "npi": [ 1194953638, 1821374380 ] } ] } ] }, { "tin": { "type": "ein", "value": "270765528" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 110.0, "npi": [ 1366448904 ] } ] } ] }, { "tin": { "type": "ein", "value": "208870333" }, "service_code": [ "20" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 51.0, "npi": [ 1376642322 ] } ] } ] }, { "tin": { "type": "ein", "value": "454294269" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 30.0, "npi": [ 1386937282 ] } ] } ] }, { "tin": { "type": "ein", "value": "208019303" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 30.0, "npi": [ 1528537636 ] } ] } ] }, { "tin": { "type": "ein", "value": "581334402" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 21.25, "providers": [ { "billed_charge": 36.0, "npi": [ 1538923602 ] } ] } ] }, { "tin": { "type": "ein", "value": "582219660" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.0, "providers": [ { "billed_charge": 25.0, "npi": [ 1922050947 ] } ] } ] } ] }, { "name": "SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<", "billing_code_type": "CPT", "billing_code": "12001", "billing_code_type_version": "2020", "description": "SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 437.0, "npi": [ 1003338237, 1447286372 ] }, { "billed_charge": 426.0, "npi": [ 1629014030 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 398.0, "npi": [ 1053737692, 1235557281, 1235606138, 1407266968, 1528332939, 1609429570, 1629608492, 1740992239 ] } ] } ] }, { "tin": { "type": "ein", "value": "581634752" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 370.0, "npi": [ 1063107845 ] } ] } ] }, { "tin": { "type": "ein", "value": "991799354" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 607.0, "npi": [ 1073633657 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 356.0, "npi": [ 1083921274 ] } ] } ] }, { "tin": { "type": "ein", "value": "430975390" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 282.08, "providers": [ { "billed_charge": 282.08, "npi": [ 1093308892 ] } ] } ] }, { "tin": { "type": "ein", "value": "832948687" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 312.0, "npi": [ 1114666708 ] } ] } ] }, { "tin": { "type": "ein", "value": "843393326" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 312.0, "npi": [ 1134652399, 1336636042, 1538621453 ] } ] } ] }, { "tin": { "type": "ein", "value": "922122433" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 260.0, "providers": [ { "billed_charge": 260.0, "npi": [ 1164821054 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 687.0, "npi": [ 1184654014 ] } ] } ] }, { "tin": { "type": "ein", "value": "581795715" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 466.0, "npi": [ 1346422243, 1386627529, 1417301573, 1447389242 ] } ] } ] }, { "tin": { "type": "ein", "value": "621795048" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 338.0, "npi": [ 1518313626 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 345.0, "npi": [ 1598488165 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 342.0, "npi": [ 1609221282, 1871938266 ] } ] } ] }, { "tin": { "type": "ein", "value": "824329577" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 607.0, "npi": [ 1689860355 ] } ] } ] }, { "tin": { "type": "ein", "value": "991100562" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 381.9, "npi": [ 1689860355 ] }, { "billed_charge": 382.0, "npi": [ 1689860355 ] } ] } ] }, { "tin": { "type": "ein", "value": "261127014" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 215.06, "providers": [ { "billed_charge": 342.0, "npi": [ 1740235175 ] } ] } ] }, { "tin": { "type": "ein", "value": "931845364" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 312.0, "npi": [ 1821336629 ] } ] } ] }, { "tin": { "type": "ein", "value": "465664656" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 429.0, "npi": [ 1841434255 ] } ] } ] }, { "tin": { "type": "ein", "value": "650203499" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 454.0, "npi": [ 1841852662 ] } ] } ] }, { "tin": { "type": "ein", "value": "581943417" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 845.0, "npi": [ 1972967966 ] } ] } ] }, { "tin": { "type": "ein", "value": "272268928" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.82, "providers": [ { "billed_charge": 607.0, "npi": [ 1982281622 ] } ] } ] } ] }, { "name": "SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed", "billing_code_type": "CPT", "billing_code": "81329", "billing_code_type_version": "2020", "description": "SMN1 (survival of motor neuron 1, telomeric) (eg, spinal muscular atrophy) gene analysis; dosage/deletion analysis (eg, carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed", "allowed_amounts": [ { "tin": { "type": "ein", "value": "010894487" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 95.9, "billing_code_modifier": [ "59" ], "providers": [ { "billed_charge": 200.0, "npi": [ 1558672279 ] } ] } ] } ] }, { "name": "SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM", "billing_code_type": "CPT", "billing_code": "12002", "billing_code_type_version": "2020", "description": "SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "824361822" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 502.0, "npi": [ 1003854738 ] } ] } ] }, { "tin": { "type": "ein", "value": "752850785" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 827.0, "npi": [ 1033571799 ] } ] } ] }, { "tin": { "type": "ein", "value": "752903508" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 528.0, "npi": [ 1033792551, 1235606138, 1407266968, 1528332939, 1609429570 ] } ] } ] }, { "tin": { "type": "ein", "value": "352504339" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 545.0, "npi": [ 1043505977, 1386635902, 1972797322 ] } ] } ] }, { "tin": { "type": "ein", "value": "621130266" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 454.0, "npi": [ 1073297008 ] }, { "billed_charge": 468.0, "npi": [ 1497763163 ] }, { "billed_charge": 634.0, "npi": [ 1750042073 ] } ] } ] }, { "tin": { "type": "ein", "value": "475339746" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 207.0, "providers": [ { "billed_charge": 207.0, "npi": [ 1104207125, 1336602325 ] } ] } ] }, { "tin": { "type": "ein", "value": "311009777" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 571.0, "npi": [ 1114130739 ] } ] } ] }, { "tin": { "type": "ein", "value": "271369141" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 470.0, "npi": [ 1316214687 ] } ] } ] }, { "tin": { "type": "ein", "value": "650691102" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 577.0, "npi": [ 1417325259, 1962667915 ] } ] } ] }, { "tin": { "type": "ein", "value": "621266047" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 452.0, "npi": [ 1578371001, 1720958390 ] } ] } ] }, { "tin": { "type": "ein", "value": "455205723" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 797.0, "npi": [ 1659383628, 1740209154 ] } ] } ] }, { "tin": { "type": "ein", "value": "931845364" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 316.49, "providers": [ { "billed_charge": 410.0, "npi": [ 1821336629 ] } ] } ] } ] }, { "name": "SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<", "billing_code_type": "CPT", "billing_code": "99469", "billing_code_type_version": "2020", "description": "SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<", "allowed_amounts": [ { "tin": { "type": "ein", "value": "650592449" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 804.92, "providers": [ { "billed_charge": 3806.0, "npi": [ 1225266745, 1356498174, 1366409146, 1437364643, 1497917157, 1538455076, 1710294491, 1841298924, 1902806508, 1952309916, 1982038279 ] } ] } ] }, { "tin": { "type": "ein", "value": "592013191" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 804.92, "providers": [ { "billed_charge": 3806.0, "npi": [ 1720307598 ] } ] } ] } ] }, { "name": "Syphilis test, non-treponemal antibody; quantitative", "billing_code_type": "CPT", "billing_code": "86593", "billing_code_type_version": "2020", "description": "Syphilis test, non-treponemal antibody; quantitative", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.08, "providers": [ { "billed_charge": 13.2, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.08, "providers": [ { "billed_charge": 5.5, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "Testosterone; total", "billing_code_type": "CPT", "billing_code": "84403", "billing_code_type_version": "2020", "description": "Testosterone; total", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 55.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 25.81, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 38.72, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 77.43, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 77.43, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 141.64, "npi": [ 1174882948 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 105.05, "npi": [ 1194769497 ] }, { "billed_charge": 125.41, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 12.91, "providers": [ { "billed_charge": 481.0, "npi": [ 1396798229 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 122.59, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 162.75, "npi": [ 1639264575 ] }, { "billed_charge": 189.0, "npi": [ 1962489237 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 50.0, "npi": [ 1730582594 ] }, { "billed_charge": 60.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 18.07, "providers": [ { "billed_charge": 64.53, "npi": [ 1740715333 ] } ] } ] } ] }, { "name": "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular", "billing_code_type": "CPT", "billing_code": "96372", "billing_code_type_version": "2020", "description": "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular", "allowed_amounts": [ { "tin": { "type": "ein", "value": "460629729" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.24, "providers": [ { "billed_charge": 500.0, "npi": [ 1528055027 ] } ] } ] } ] }, { "name": "Thyroglobulin antibody", "billing_code_type": "CPT", "billing_code": "86800", "billing_code_type_version": "2020", "description": "Thyroglobulin antibody", "allowed_amounts": [ { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.14, "providers": [ { "billed_charge": 47.73, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.14, "providers": [ { "billed_charge": 149.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "200434866" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.14, "providers": [ { "billed_charge": 85.12, "npi": [ 1245494517 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.14, "providers": [ { "billed_charge": 107.14, "npi": [ 1962489237 ] } ] } ] } ] }, { "name": "Thyroid stimulating hormone (TSH)", "billing_code_type": "CPT", "billing_code": "84443", "billing_code_type_version": "2020", "description": "Thyroid stimulating hormone (TSH)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 110.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 16.8, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "872582895" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 34.0, "npi": [ 1043982002 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 25.2, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 50.4, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 50.4, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 91.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 84.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 50.4, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 53.5, "npi": [ 1639264575 ] }, { "billed_charge": 98.7, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 98.7, "npi": [ 1801883780, 1821565045 ] }, { "billed_charge": 133.21, "npi": [ 1801883780, 1821565045 ] }, { "billed_charge": 55.3, "npi": [ 1821565045 ] }, { "billed_charge": 62.01, "npi": [ 1821565045 ] }, { "billed_charge": 62.02, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 50.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "823146637" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 58.8, "npi": [ 1861994600 ] } ] } ] }, { "tin": { "type": "ein", "value": "208833340" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 26.0, "npi": [ 1922259753 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 11.76, "providers": [ { "billed_charge": 21.0, "npi": [ 1972971265 ] } ] } ] } ] }, { "name": "Thyroxine; free", "billing_code_type": "CPT", "billing_code": "84439", "billing_code_type_version": "2020", "description": "Thyroxine; free", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 50.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 13.53, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 27.06, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 27.06, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 78.17, "npi": [ 1194769497 ] }, { "billed_charge": 149.5, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 50.6, "npi": [ 1639264575 ] }, { "billed_charge": 106.05, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 30.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 22.55, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 71.54, "npi": [ 1801883780, 1821565045 ] }, { "billed_charge": 106.05, "npi": [ 1801883780, 1821565045 ] }, { "billed_charge": 29.7, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.31, "providers": [ { "billed_charge": 27.0, "npi": [ 1831851039 ] } ] } ] } ] }, { "name": "Transferase; alanine amino (ALT) (SGPT)", "billing_code_type": "CPT", "billing_code": "84460", "billing_code_type_version": "2020", "description": "Transferase; alanine amino (ALT) (SGPT)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.71, "providers": [ { "billed_charge": 118.91, "npi": [ 1245720820 ] } ] } ] } ] }, { "name": "Transferase; aspartate amino (AST) (SGOT)", "billing_code_type": "CPT", "billing_code": "84450", "billing_code_type_version": "2020", "description": "Transferase; aspartate amino (AST) (SGOT)", "allowed_amounts": [ { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.63, "providers": [ { "billed_charge": 116.25, "npi": [ 1245720820 ] } ] } ] } ] }, { "name": "Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension", "billing_code_type": "CPT", "billing_code": "86481", "billing_code_type_version": "2020", "description": "Tuberculosis test, cell mediated immunity antigen response measurement; enumeration of gamma interferon-producing T-cells in cell suspension", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 70.0, "providers": [ { "billed_charge": 300.0, "npi": [ 1134538713 ] } ] } ] } ] }, { "name": "Tubing with integrated heating element for use with positive airway pressure device", "billing_code_type": "HCPCS", "billing_code": "A4604", "billing_code_type_version": "2020", "description": "Tubing with integrated heating element for use with positive airway pressure device", "allowed_amounts": [ { "tin": { "type": "ein", "value": "510447627" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 75.04, "npi": [ 1033195110 ] } ] } ] }, { "tin": { "type": "ein", "value": "451810240" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 68.75, "npi": [ 1093339954 ] } ] } ] }, { "tin": { "type": "ein", "value": "200537780" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 86.03, "npi": [ 1104836493 ] } ] } ] }, { "tin": { "type": "ein", "value": "270110308" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 75.04, "npi": [ 1124251913 ] } ] } ] }, { "tin": { "type": "ein", "value": "593758015" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 134.0, "npi": [ 1184640393 ] } ] } ] }, { "tin": { "type": "ein", "value": "582117868" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 75.04, "npi": [ 1306403639 ] } ] } ] }, { "tin": { "type": "ein", "value": "593223150" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 120.8, "npi": [ 1508846130 ] } ] } ] }, { "tin": { "type": "ein", "value": "760653019" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 75.04, "npi": [ 1538471412 ] }, { "billed_charge": 87.39, "npi": [ 1538471412 ] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 80.0, "npi": [ 1740527654 ] } ] } ] }, { "tin": { "type": "ein", "value": "800002984" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 134.0, "npi": [ 1790235844 ] } ] } ] }, { "tin": { "type": "ein", "value": "571111621" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 134.0, "npi": [ 1801428776 ] } ] } ] }, { "tin": { "type": "ein", "value": "273319284" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 31.95, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 31.95, "npi": [ 1811206741 ] } ] } ] }, { "tin": { "type": "ein", "value": "621180379" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 33.61, "billing_code_modifier": [ "NU", "KX" ], "providers": [ { "billed_charge": 75.04, "npi": [ 1851514558 ] } ] } ] } ] }, { "name": "Urea nitrogen; quantitative", "billing_code_type": "CPT", "billing_code": "84520", "billing_code_type_version": "2020", "description": "Urea nitrogen; quantitative", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.77, "providers": [ { "billed_charge": 45.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "593205549" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.77, "providers": [ { "billed_charge": 88.63, "npi": [ 1245720820 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.77, "providers": [ { "billed_charge": 48.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Uric acid; blood", "billing_code_type": "CPT", "billing_code": "84550", "billing_code_type_version": "2020", "description": "Uric acid; blood", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 45.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 4.52, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 36.16, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 6.78, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 13.56, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 13.56, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 42.75, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 38.85, "npi": [ 1376323998, 1487969341 ] }, { "billed_charge": 21.25, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 22.4, "npi": [ 1639264575 ] }, { "billed_charge": 38.85, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 11.3, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 35.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.16, "providers": [ { "billed_charge": 55.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy", "billing_code_type": "CPT", "billing_code": "81001", "billing_code_type_version": "2020", "description": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 9.51, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 37.8, "npi": [ 1376323998, 1487969341 ] }, { "billed_charge": 26.3, "npi": [ 1487969341 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 52.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 26.4, "npi": [ 1639264575 ] }, { "billed_charge": 27.1, "npi": [ 1639264575 ] }, { "billed_charge": 27.4, "npi": [ 1639264575 ] }, { "billed_charge": 37.8, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "453194060" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 12.0, "npi": [ 1659655124 ] } ] } ] }, { "tin": { "type": "ein", "value": "862874977" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 10.0, "npi": [ 1831851039 ] } ] } ] }, { "tin": { "type": "ein", "value": "921600577" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 6.34, "npi": [ 1912787144 ] } ] } ] }, { "tin": { "type": "ein", "value": "352539778" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 3.96, "npi": [ 1972971265 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.22, "providers": [ { "billed_charge": 39.0, "npi": [ 1982606992 ] } ] } ] } ] }, { "name": "US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION", "billing_code_type": "CPT", "billing_code": "76700", "billing_code_type_version": "2020", "description": "US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 164.0, "npi": [ 1003841875, 1326274291, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "621828139" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 554.0, "npi": [ 1235235086 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 554.0, "npi": [ 1245261783, 1285841916, 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 133.0, "npi": [ 1598010910 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 107.73, "npi": [ 1821444142, 1831543487 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 99.29, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 183.0, "npi": [ 1922084748 ] } ] } ] } ] }, { "name": "US ABDOMINAL REAL TIME W/IMAGE LIMITED", "billing_code_type": "CPT", "billing_code": "76705", "billing_code_type_version": "2020", "description": "US ABDOMINAL REAL TIME W/IMAGE LIMITED", "allowed_amounts": [ { "tin": { "type": "ein", "value": "582030692" }, "service_code": [ "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 122.0, "npi": [ 1003253238, 1083143309, 1861951881 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 119.0, "npi": [ 1003841875, 1053304428, 1740488527, 1801201090, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 462.0, "npi": [ 1033379151, 1063494425, 1245261783, 1497720148, 1508865510, 1518935022, 1538167804, 1548231541, 1669458261, 1750599742, 1770534869, 1790737328, 1831360064, 1861483182, 1932123155, 1952628877, 1962499418, 1962923706, 1972550416 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "23", "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 138.0, "npi": [ 1043265937, 1598793028, 1902168149, 1922084748 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 150.0, "npi": [ 1063497006, 1871561803 ] } ] } ] }, { "tin": { "type": "ein", "value": "475419443" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 61.96, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 61.96, "npi": [ 1164410916 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22", "23", "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 133.0, "npi": [ 1275512956, 1285711671, 1346655982, 1386050250, 1457795296, 1669675658, 1811293525, 1851633572, 1891088670, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "581966881" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 105.0, "npi": [ 1285711671 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "21", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 240.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "853256127" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 98.0, "npi": [ 1598010910 ] } ] } ] }, { "tin": { "type": "ein", "value": "920177956" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 166.0, "npi": [ 1619159647 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 140.0, "npi": [ 1659351666 ] } ] } ] }, { "tin": { "type": "ein", "value": "800863895" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 267.88, "npi": [ 1699038547, 1750349676, 1871704825 ] } ] } ] }, { "tin": { "type": "ein", "value": "630577764" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 109.0, "npi": [ 1699725457 ] } ] } ] }, { "tin": { "type": "ein", "value": "630572355" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 75.0, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 75.0, "npi": [ 1710194071 ] } ] } ] }, { "tin": { "type": "ein", "value": "332353320" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 91.0, "npi": [ 1730407230 ] } ] } ] }, { "tin": { "type": "ein", "value": "800023773" }, "service_code": [ "21" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 112.0, "npi": [ 1740466424 ] } ] } ] }, { "tin": { "type": "ein", "value": "920101761" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 663.0, "npi": [ 1780720599 ] } ] } ] }, { "tin": { "type": "ein", "value": "464289822" }, "service_code": [ "21", "22", "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 78.87, "npi": [ 1821444142, 1831543487, 1851654263 ] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 92.0, "npi": [ 1841452968 ] } ] } ] }, { "tin": { "type": "ein", "value": "208112143" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 91.0, "npi": [ 1881973550 ] } ] } ] }, { "tin": { "type": "ein", "value": "630587021" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 76.83, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 123.0, "npi": [ 1902842347 ] } ] } ] } ] }, { "name": "US BREAST UNI REAL TIME WITH IMAGE LIMITED", "billing_code_type": "CPT", "billing_code": "76642", "billing_code_type_version": "2020", "description": "US BREAST UNI REAL TIME WITH IMAGE LIMITED", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 102.0, "npi": [ 1053304428, 1700166733, 1811955255 ] } ] }, { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 102.0, "npi": [ 1700166733, 1811955255 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 517.0, "npi": [ 1083696561, 1316267404 ] } ] }, { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 517.0, "npi": [ 1083696561, 1316267404, 1750599742 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 156.0, "npi": [ 1114970829, 1124205356, 1447436894 ] } ] }, { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 156.0, "npi": [ 1114970829, 1124205356, 1447436894 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 131.0, "npi": [ 1447756960 ] } ] } ] }, { "tin": { "type": "ein", "value": "800023773" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 175.0, "npi": [ 1477729051 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "LT" ], "providers": [ { "billed_charge": 175.0, "npi": [ 1659356947 ] } ] } ] }, { "tin": { "type": "ein", "value": "208031441" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.89, "billing_code_modifier": [ "26", "RT" ], "providers": [ { "billed_charge": 160.0, "npi": [ 208031441 ] } ] } ] } ] }, { "name": "US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM", "billing_code_type": "CPT", "billing_code": "76536", "billing_code_type_version": "2020", "description": "US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM", "allowed_amounts": [ { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 66.61, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 112.0, "npi": [ 1003841875, 1053304428, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 66.61, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 401.0, "npi": [ 1245261783, 1750599742, 1962923706 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 66.61, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 101.0, "npi": [ 1295199115, 1790168540, 1922050756 ] } ] } ] }, { "tin": { "type": "ein", "value": "620963389" }, "service_code": [ "22" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 66.61, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 127.0, "npi": [ 1447756960, 1922084748 ] } ] } ] } ] }, { "name": "US TRANSVAGINAL", "billing_code_type": "CPT", "billing_code": "76830", "billing_code_type_version": "2020", "description": "US TRANSVAGINAL", "allowed_amounts": [ { "tin": { "type": "ein", "value": "471497384" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 89.58, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 89.58, "npi": [ 1003203324 ] } ] } ] }, { "tin": { "type": "ein", "value": "205060581" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 139.0, "npi": [ 1003841875, 1306466412, 1326274291, 1740488527, 1841463452, 1912969130 ] } ] } ] }, { "tin": { "type": "ein", "value": "582244832" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 501.0, "npi": [ 1033379151, 1538336946, 1578772364, 1891839718, 1952628877 ] } ] } ] }, { "tin": { "type": "ein", "value": "581245030" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 179.0, "npi": [ 1063497006, 1477711919, 1508393901, 1770926156, 1972583805 ] } ] } ] }, { "tin": { "type": "ein", "value": "351344539" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 154.0, "npi": [ 1073856118 ] } ] } ] }, { "tin": { "type": "ein", "value": "823167668" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 157.0, "npi": [ 1316925654, 1811293525, 1831177179 ] } ] } ] }, { "tin": { "type": "ein", "value": "582078064" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 140.0, "npi": [ 1356898654 ] } ] } ] }, { "tin": { "type": "ein", "value": "631041806" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 110.0, "npi": [ 1750475331 ] } ] } ] }, { "tin": { "type": "ein", "value": "203174593" }, "service_code": [ "23" ], "billing_class": "institutional", "payments": [ { "allowed_amount": 91.67, "billing_code_modifier": [ "26" ], "providers": [ { "billed_charge": 140.0, "npi": [ 1932532900 ] } ] } ] } ] }, { "name": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "billing_code_type": "HCPCS", "billing_code": "G2211", "billing_code_type_version": "2020", "description": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "allowed_amounts": [ { "tin": { "type": "ein", "value": "042911067" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.85, "providers": [ { "billed_charge": 60.0, "npi": [ 1427552835 ] } ] } ] } ] }, { "name": "Vitamin D; 25 hydroxy, includes fraction(s), if performed", "billing_code_type": "CPT", "billing_code": "82306", "billing_code_type_version": "2020", "description": "Vitamin D; 25 hydroxy, includes fraction(s), if performed", "allowed_amounts": [ { "tin": { "type": "ein", "value": "112981841" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 150.0, "npi": [ 1033281126 ] } ] } ] }, { "tin": { "type": "ein", "value": "233079507" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 29.6, "npi": [ 1043271539 ] } ] } ] }, { "tin": { "type": "ein", "value": "853163633" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 236.8, "npi": [ 1063011898 ] } ] } ] }, { "tin": { "type": "ein", "value": "636004476" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 75.0, "npi": [ 1114161601 ] } ] } ] }, { "tin": { "type": "ein", "value": "823971792" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 44.4, "npi": [ 1114435492 ] } ] } ] }, { "tin": { "type": "ein", "value": "471359076" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 88.8, "npi": [ 1134538713 ] } ] } ] }, { "tin": { "type": "ein", "value": "831005259" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 88.8, "npi": [ 1174092548 ] } ] } ] }, { "tin": { "type": "ein", "value": "453205266" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 162.44, "npi": [ 1174882948 ] } ] } ] }, { "tin": { "type": "ein", "value": "742554159" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 99.0, "npi": [ 1194769497 ] } ] } ] }, { "tin": { "type": "ein", "value": "621802294" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 37.0, "npi": [ 1548370745 ] } ] } ] }, { "tin": { "type": "ein", "value": "821785874" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 88.8, "npi": [ 1598383176 ] } ] } ] }, { "tin": { "type": "ein", "value": "840611484" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 243.6, "npi": [ 1639264575 ] } ] } ] }, { "tin": { "type": "ein", "value": "471797576" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 40.0, "npi": [ 1730582594 ] } ] } ] }, { "tin": { "type": "ein", "value": "814697090" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 74.0, "npi": [ 1740715333 ] } ] } ] }, { "tin": { "type": "ein", "value": "271773152" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 85.0, "npi": [ 1790016921 ] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 243.6, "npi": [ 1801883780, 1821565045, 1851388748 ] }, { "billed_charge": 106.25, "npi": [ 1821565045 ] }, { "billed_charge": 110.35, "npi": [ 1821565045 ] } ] } ] }, { "tin": { "type": "ein", "value": "208833340" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 44.0, "npi": [ 1922259753 ] } ] } ] }, { "tin": { "type": "ein", "value": "943357013" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.72, "providers": [ { "billed_charge": 356.0, "npi": [ 1982606992 ] } ] } ] } ] } ], "last_updated_on": "2026-08-28", "version": "v2.0.0" }