{ "reporting_entity_name": "Centene Management Company LLC", "reporting_entity_type": "Third Party Administrator", "version": "2.0.0", "last_updated_on": "2026-10-30", "out_of_network": [{ "name": "RESIDENTIAL TREATMENT-PSYCHI", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1001", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "260605527" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 342175.50, "providers": [{ "billed_charge": 137060.00, "npi": [1962968529] } ] } ] }, { "tin": { "type": "ein", "value": "844910684" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9276.02, "providers": [{ "billed_charge": 22000.00, "npi": [1134808553] } ] } ] }, { "tin": { "type": "ein", "value": "471904183" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 299932.33, "providers": [{ "billed_charge": 112500.00, "npi": [1861879116] } ] } ] }, { "tin": { "type": "ein", "value": "932074861" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 97831.41, "providers": [{ "billed_charge": 209050.00, "npi": [1952165383] } ] } ] }, { "tin": { "type": "ein", "value": "811009718" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 7000.00, "providers": [{ "billed_charge": 10000.00, "npi": [1053929273] } ] } ] } ] }, { "name": "RESIDENTIAL TREATMENT - CHEM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1002", "description": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880957090" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 42083.84, "providers": [{ "billed_charge": 70400.00, "npi": [1013617919] } ] } ] }, { "tin": { "type": "ein", "value": "920261002" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 37057.75, "providers": [{ "billed_charge": 199800.00, "npi": [1326760596] } ] } ] }, { "tin": { "type": "ein", "value": "273086912" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 15000.00, "providers": [{ "billed_charge": 3600.00, "npi": [1124550850] } ] } ] } ] }, { "name": "TOBACCO NON-USER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1036F", "description": "CURRENT TOBACCO NON-USER (CAD, CAP, COPD, PV) (DM) (IBD)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810889110" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 207.88, "providers": [{ "billed_charge": 0.00, "npi": [1437516887] } ] } ] }, { "tin": { "type": "ein", "value": "362657618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1833.33, "providers": [{ "billed_charge": 0.00, "npi": [1801833983] } ] } ] }, { "tin": { "type": "ein", "value": "593214635" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1149.82, "providers": [{ "billed_charge": 0.00, "npi": [1225034234] } ] } ] }, { "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 338.30, "providers": [{ "billed_charge": 0.01, "npi": [1811122880] } ] } ] } ] }, { "name": "MED LIST DOCD IN RCRD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "1159F", "description": "MEDICATION LIST DOCUMENTED IN MEDICAL RECORD (COA)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "620864163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.83, "providers": [{ "billed_charge": 0.00, "npi": [1487604609] } ] } ] } ] }, { "name": "PSTAY/WARD", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "154", "description": "ROOM AND BOARD - WARD -PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "863769205" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 246170.10, "providers": [{ "billed_charge": 40000.00, "npi": [1053764456] } ] } ] }, { "tin": { "type": "ein", "value": "883269656" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 30001.74, "providers": [{ "billed_charge": 82500.00, "npi": [1730929803] } ] } ] } ] }, { "name": "Blood and Blood Products", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "19", "description": "Blood and Blood Products", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273129496" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 20058.36, "providers": [{ "billed_charge": 0.00, "npi": [1013210707] } ] } ] }, { "tin": { "type": "ein", "value": "473567567" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 6527.19, "providers": [{ "billed_charge": 0.00, "npi": [1063893428] } ] } ] } ] }, { "name": "PHARMACY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "250", "description": "PHARMACY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 399371.27, "providers": [{ "billed_charge": 594.73, "npi": [1982668133] } ] }, { "allowed_amount": 367876.56, "providers": [{ "billed_charge": 206.72, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 110147.78, "providers": [{ "billed_charge": 508.50, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1334307.91, "providers": [{ "billed_charge": 30598.56, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6522.00, "providers": [{ "billed_charge": 511.00, "npi": [1487771812] } ] }, { "allowed_amount": 12426.00, "providers": [{ "billed_charge": 0.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 96015.59, "providers": [{ "billed_charge": 305.38, "npi": [1740215219] } ] }, { "allowed_amount": 3079058.75, "providers": [{ "billed_charge": 7238.97, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "901074557" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 27889.53, "providers": [{ "billed_charge": 2205.30, "npi": [1265820179] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3262476.89, "providers": [{ "billed_charge": 9978.48, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "272150922" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 40299.00, "providers": [{ "billed_charge": 1690.92, "npi": [1609217157] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6957.98, "providers": [{ "billed_charge": 10.30, "npi": [1992798409] } ] }, { "allowed_amount": 8859.65, "providers": [{ "billed_charge": 454.35, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "852390012" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1163511.27, "providers": [{ "billed_charge": 6743.64, "npi": [1235162645] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3576126.08, "providers": [{ "billed_charge": 6636.00, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1053083.30, "providers": [{ "billed_charge": 4114.05, "npi": [1801821376] } ] }, { "allowed_amount": 71619.17, "providers": [{ "billed_charge": 346.36, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "853981372" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 87657.89, "providers": [{ "billed_charge": 126.09, "npi": [1790373769] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 467598.95, "providers": [{ "billed_charge": 4.32, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 57346.21, "providers": [{ "billed_charge": 1327.20, "npi": [1306299391] } ] } ] }, { "tin": { "type": "ein", "value": "203688688" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 9050.83, "providers": [{ "billed_charge": 419.85, "npi": [1811045594] } ] } ] } ] }, { "name": "DRUGS/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "259", "description": "PHARMACY - OTHER PHARMACY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 786352.35, "providers": [{ "billed_charge": 686.53, "npi": [1306938071] } ] }, { "allowed_amount": 129828.39, "providers": [{ "billed_charge": 12.79, "npi": [1306938071] } ] } ] } ] }, { "name": "IV THERAPY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "260", "description": "IV THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 165932.90, "providers": [{ "billed_charge": 11025.00, "npi": [1801821376] } ] }, { "allowed_amount": 70495.27, "providers": [{ "billed_charge": 961.50, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "390964813" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 49978.03, "providers": [{ "billed_charge": 5242.00, "npi": [1619079597] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 13227.96, "providers": [{ "billed_charge": 1032.00, "npi": [1861439952] } ] } ] } ] }, { "name": "MED-SUR SUPPLIES", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "270", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 103215.38, "providers": [{ "billed_charge": 1772.26, "npi": [1306299391] } ] } ] } ] }, { "name": "STERILE SUPPLY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "272", "description": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "941461843" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 64409.09, "providers": [{ "billed_charge": 8.45, "npi": [1740215219] } ] }, { "allowed_amount": 390.35, "providers": [{ "billed_charge": 364.00, "npi": [1740215219] } ] } ] } ] }, { "name": "LABORATORY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "300", "description": "LABORATORY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "576000934" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 188405.48, "providers": [{ "billed_charge": 4124.00, "npi": [1609807122] } ] }, { "allowed_amount": 35859.79, "providers": [{ "billed_charge": 0.00, "npi": [1609807122] } ] } ] }, { "tin": { "type": "ein", "value": "237293874" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17332.98, "providers": [{ "billed_charge": 799.25, "npi": [1417945627] } ] } ] }, { "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7012.98, "providers": [{ "billed_charge": 156.00, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 71295.00, "providers": [{ "billed_charge": 380.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "930386868" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3732.00, "providers": [{ "billed_charge": 548.00, "npi": [1477590198] } ] } ] }, { "tin": { "type": "ein", "value": "850105601" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24093.17, "providers": [{ "billed_charge": 458.00, "npi": [1215913470] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 44367.80, "providers": [{ "billed_charge": 20733.00, "npi": [1487771812] } ] }, { "allowed_amount": 54193.00, "providers": [{ "billed_charge": 11547.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "470484764" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 66397.77, "providers": [{ "billed_charge": 2322.20, "npi": [1508941097] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.90, "providers": [{ "billed_charge": 52.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "391835630" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 47338.32, "providers": [{ "billed_charge": 3299.30, "npi": [1922043744] } ] } ] }, { "tin": { "type": "ein", "value": "570314381" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 13125.33, "providers": [{ "billed_charge": 1055.00, "npi": [1134172000] } ] } ] }, { "tin": { "type": "ein", "value": "222592333" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 17335.33, "providers": [{ "billed_charge": 1494.00, "npi": [1447275037] } ] } ] }, { "tin": { "type": "ein", "value": "386006309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 27296.00, "providers": [{ "billed_charge": 1550.00, "npi": [1003878539] } ] } ] }, { "tin": { "type": "ein", "value": "364827272" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14827.83, "providers": [{ "billed_charge": 1605.42, "npi": [1073329223] } ] }, { "allowed_amount": 6084.00, "providers": [{ "billed_charge": 349.72, "npi": [1457895336] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2218.71, "providers": [{ "billed_charge": 283.22, "npi": [1356307581] } ] }, { "allowed_amount": 176575.82, "providers": [{ "billed_charge": 175.00, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 68627.56, "providers": [{ "billed_charge": 72.00, "npi": [1992798409] } ] }, { "allowed_amount": 86277.56, "providers": [{ "billed_charge": 647.00, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "486005089" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 495.83, "providers": [{ "billed_charge": 51.00, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "910564491" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4931.61, "providers": [{ "billed_charge": 624.47, "npi": [1952309098] } ] } ] }, { "tin": { "type": "ein", "value": "201729674" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 33481.58, "providers": [{ "billed_charge": 327.00, "npi": [1053360651] } ] }, { "allowed_amount": 11025.84, "providers": [{ "billed_charge": 315.00, "npi": [1053360651] } ] } ] }, { "tin": { "type": "ein", "value": "752922710" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 27781.54, "providers": [{ "billed_charge": 5649.00, "npi": [1588697296] } ] } ] }, { "tin": { "type": "ein", "value": "30219309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.38, "providers": [{ "billed_charge": 29.00, "npi": [1568419976] } ] } ] }, { "tin": { "type": "ein", "value": "133971298" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10186.12, "providers": [{ "billed_charge": 230.76, "npi": [1801992631] } ] } ] } ] }, { "name": "BODY MASS INDEX DOCD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3008F", "description": "BODY MASS INDEX (BMI), DOCUMENTED (PV)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810889110" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1770.29, "providers": [{ "billed_charge": 0.00, "npi": [1437516887] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10357.00, "providers": [{ "billed_charge": 0.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8990.55, "providers": [{ "billed_charge": 0.36, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3823.12, "providers": [{ "billed_charge": 0.23, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "362657618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4586.25, "providers": [{ "billed_charge": 0.00, "npi": [1801833983] } ] } ] }, { "tin": { "type": "ein", "value": "620864163" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 487.22, "providers": [{ "billed_charge": 0.00, "npi": [1487604609] } ] } ] }, { "tin": { "type": "ein", "value": "262909414" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 604.80, "providers": [{ "billed_charge": 0.05, "npi": [1811122880] } ] } ] } ] }, { "name": "LAB/CHEMISTRY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "LABORATORY - CHEMISTRY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "760545192" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 65277.90, "providers": [{ "billed_charge": 3109.00, "npi": [1184179194] } ] } ] }, { "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 647342.18, "providers": [{ "billed_charge": 16574.00, "npi": [1497859649] } ] }, { "allowed_amount": 43229.96, "providers": [{ "billed_charge": 10036.00, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "363488183" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14177.03, "providers": [{ "billed_charge": 1467.00, "npi": [1508956509] } ] } ] }, { "tin": { "type": "ein", "value": "742802643" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1880.42, "providers": [{ "billed_charge": 209.62, "npi": [1053317362] } ] } ] }, { "tin": { "type": "ein", "value": "460796114" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 27401.05, "providers": [{ "billed_charge": 0.00, "npi": [1144397134] } ] }, { "allowed_amount": 37390.49, "providers": [{ "billed_charge": 1123.00, "npi": [1144397134] } ] } ] }, { "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 91969.14, "providers": [{ "billed_charge": 4169.00, "npi": [1982668133] } ] }, { "allowed_amount": 416707.36, "providers": [{ "billed_charge": 8503.00, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "390964813" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24178.08, "providers": [{ "billed_charge": 631.00, "npi": [1619079597] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 80660.72, "providers": [{ "billed_charge": 9261.00, "npi": [1518960814] } ] }, { "allowed_amount": 48090.84, "providers": [{ "billed_charge": 4176.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 14055.74, "providers": [{ "billed_charge": 187.70, "npi": [1740215219] } ] }, { "allowed_amount": 1690554.79, "providers": [{ "billed_charge": 51099.10, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 27968.37, "providers": [{ "billed_charge": 669.75, "npi": [1770586794] } ] }, { "allowed_amount": 36178.06, "providers": [{ "billed_charge": 1152.00, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "362179779" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 60098.21, "providers": [{ "billed_charge": 2340.00, "npi": [1124025176] } ] }, { "allowed_amount": 29494.19, "providers": [{ "billed_charge": 2510.00, "npi": [1124025176] } ] } ] }, { "tin": { "type": "ein", "value": "203749695" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 33246.51, "providers": [{ "billed_charge": 4866.02, "npi": [1265568638] } ] } ] }, { "tin": { "type": "ein", "value": "390817515" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 381085.00, "providers": [{ "billed_charge": 3797.85, "npi": [1275583619] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1153.23, "providers": [{ "billed_charge": 351.15, "npi": [1356307581] } ] }, { "allowed_amount": 176575.82, "providers": [{ "billed_charge": 143.82, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 205156.13, "providers": [{ "billed_charge": 7418.00, "npi": [1992798409] } ] }, { "allowed_amount": 84466.17, "providers": [{ "billed_charge": 221.00, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "580566200" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8149.49, "providers": [{ "billed_charge": 129.00, "npi": [1144203563] } ] } ] }, { "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 34851.06, "providers": [{ "billed_charge": 6854.00, "npi": [1477531580] } ] }, { "allowed_amount": 18864.42, "providers": [{ "billed_charge": 0.00, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "880455713" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 29316.06, "providers": [{ "billed_charge": 1281.00, "npi": [1770626426] } ] }, { "allowed_amount": 41263.68, "providers": [{ "billed_charge": 14040.00, "npi": [1770626426] } ] } ] }, { "tin": { "type": "ein", "value": "876000525" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24215.54, "providers": [{ "billed_charge": 281.79, "npi": [1588656870] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2614791.16, "providers": [{ "billed_charge": 7100.41, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "942854057" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7053.13, "providers": [{ "billed_charge": 751.48, "npi": [1366452880] } ] } ] }, { "tin": { "type": "ein", "value": "436003859" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16641.48, "providers": [{ "billed_charge": 206.90, "npi": [1699769901] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 307088.58, "providers": [{ "billed_charge": 5006.00, "npi": [1144375056] } ] }, { "allowed_amount": 16724.04, "providers": [{ "billed_charge": 1513.00, "npi": [1558080861] } ] }, { "allowed_amount": 141843.64, "providers": [{ "billed_charge": 3108.00, "npi": [1144375056] } ] }, { "allowed_amount": 87878.97, "providers": [{ "billed_charge": 3552.00, "npi": [1558080861] } ] }, { "allowed_amount": 71597.70, "providers": [{ "billed_charge": 1461.00, "npi": [1740354851] } ] }, { "allowed_amount": 4724.66, "providers": [{ "billed_charge": 204.00, "npi": [1518012301] } ] } ] }, { "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2470379.68, "providers": [{ "billed_charge": 13734.53, "npi": [1912446865] } ] }, { "allowed_amount": 34419.98, "providers": [{ "billed_charge": 6977.25, "npi": [1306299391] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 13395.00, "providers": [{ "billed_charge": 14040.00, "npi": [1861439952] } ] }, { "allowed_amount": 56277.54, "providers": [{ "billed_charge": 14066.00, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "474717998" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 28728.00, "providers": [{ "billed_charge": 48.00, "npi": [1104295864] } ] } ] }, { "tin": { "type": "ein", "value": "352263845" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6202.00, "providers": [{ "billed_charge": 780.00, "npi": [1992735088] } ] } ] }, { "tin": { "type": "ein", "value": "860830701" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.99, "providers": [{ "billed_charge": 690.00, "npi": [1073576740] } ] } ] }, { "tin": { "type": "ein", "value": "911352172" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2663.81, "providers": [{ "billed_charge": 943.00, "npi": [1366556227] } ] } ] }, { "tin": { "type": "ein", "value": "746001118" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 504009.08, "providers": [{ "billed_charge": 9686.00, "npi": [1174582050] } ] }, { "allowed_amount": 53210.54, "providers": [{ "billed_charge": 2110.00, "npi": [1174582050] } ] } ] }, { "tin": { "type": "ein", "value": "810240726" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 83213.54, "providers": [{ "billed_charge": 5073.00, "npi": [1659475846] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 735900.48, "providers": [{ "billed_charge": 8084.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 17582.00, "providers": [{ "billed_charge": 11420.00, "npi": [1487771812] } ] }, { "allowed_amount": 101556.00, "providers": [{ "billed_charge": 21079.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "813040663" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10934.70, "providers": [{ "billed_charge": 1022.14, "npi": [1902366305] } ] } ] }, { "tin": { "type": "ein", "value": "113243405" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 58380.07, "providers": [{ "billed_charge": 1668.00, "npi": [1972523348] } ] }, { "allowed_amount": 175751.94, "providers": [{ "billed_charge": 4883.65, "npi": [1033224704] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2617341.90, "providers": [{ "billed_charge": 14638.13, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "362513909" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 39304.30, "providers": [{ "billed_charge": 13698.00, "npi": [1003864810] } ] } ] }, { "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 134130.53, "providers": [{ "billed_charge": 5847.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "621694180" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 53921.90, "providers": [{ "billed_charge": 6933.00, "npi": [1326085424] } ] } ] }, { "tin": { "type": "ein", "value": "742730328" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 119394.01, "providers": [{ "billed_charge": 6113.60, "npi": [1659525236] } ] }, { "allowed_amount": 4757.18, "providers": [{ "billed_charge": 227.09, "npi": [1659525236] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 740965.40, "providers": [{ "billed_charge": 2312.90, "npi": [1801821376] } ] }, { "allowed_amount": 914237.51, "providers": [{ "billed_charge": 40511.40, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "571098556" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7822.77, "providers": [{ "billed_charge": 1605.00, "npi": [1659435840] } ] } ] }, { "tin": { "type": "ein", "value": "366006541" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3000.00, "providers": [{ "billed_charge": 574.00, "npi": [1588612832] } ] }, { "allowed_amount": 75.00, "providers": [{ "billed_charge": 65.00, "npi": [1588612832] } ] } ] }, { "tin": { "type": "ein", "value": "314379441" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3352.04, "providers": [{ "billed_charge": 188.00, "npi": [1134152986] } ] } ] }, { "tin": { "type": "ein", "value": "910565539" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3256.87, "providers": [{ "billed_charge": 641.00, "npi": [1801851258] } ] } ] }, { "tin": { "type": "ein", "value": "953625072" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5973.61, "providers": [{ "billed_charge": 3471.54, "npi": [1609827153] } ] }, { "allowed_amount": 69059.56, "providers": [{ "billed_charge": 5901.17, "npi": [1609827153] } ] } ] }, { "tin": { "type": "ein", "value": "836000194" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24595.51, "providers": [{ "billed_charge": 2662.71, "npi": [1285621839] } ] } ] }, { "tin": { "type": "ein", "value": "43633263" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 846.00, "providers": [{ "billed_charge": 77.00, "npi": [1972503910] } ] } ] } ] }, { "name": "LAB/IMMUNOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "302", "description": "LABORATORY - IMMUNOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 742.02, "providers": [{ "billed_charge": 87.00, "npi": [1992798409] } ] } ] } ] }, { "name": "LAB/NR DIALYSIS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "304", "description": "LABORATORY - NON-ROUTINE DIALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770487672" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1037614.94, "providers": [{ "billed_charge": 199.86, "npi": [1386779270] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 7989910.11, "providers": [{ "billed_charge": 15240.22, "npi": [1386180859] } ] } ] } ] }, { "name": "LAB/HEMATOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "305", "description": "LABORATORY - HEMATOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 74080.67, "providers": [{ "billed_charge": 592.00, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 33740.59, "providers": [{ "billed_charge": 1722.00, "npi": [1497859649] } ] }, { "allowed_amount": 15278.98, "providers": [{ "billed_charge": 695.00, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 386379.87, "providers": [{ "billed_charge": 3959.10, "npi": [1801821376] } ] }, { "allowed_amount": 156771.49, "providers": [{ "billed_charge": 488.00, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 47416.56, "providers": [{ "billed_charge": 337.00, "npi": [1982668133] } ] }, { "allowed_amount": 41803.69, "providers": [{ "billed_charge": 426.00, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 282849.42, "providers": [{ "billed_charge": 4535.00, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 14221.00, "providers": [{ "billed_charge": 2448.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 647804.27, "providers": [{ "billed_charge": 4384.10, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "911858433" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 914.49, "providers": [{ "billed_charge": 281.42, "npi": [1356307581] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 44616.59, "providers": [{ "billed_charge": 326.00, "npi": [1992798409] } ] }, { "allowed_amount": 50889.06, "providers": [{ "billed_charge": 1607.00, "npi": [1992798409] } ] } ] } ] }, { "name": "LAB/BACT-MIRCO", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "306", "description": "LABORATORY - BACTERIOLOGY & MICROBIOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "362513909" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3496.79, "providers": [{ "billed_charge": 1382.00, "npi": [1003864810] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 15958.73, "providers": [{ "billed_charge": 1257.00, "npi": [1992798409] } ] } ] } ] }, { "name": "SYST BP LT 130 MM HG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3074F", "description": "MOST RECENT SYSTOLIC BLOOD PRESSURE LESS THAN 130 MM HG (DM), (HTN, CKD, CAD)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1301.98, "providers": [{ "billed_charge": 0.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 4128.16, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] }, { "allowed_amount": 452.47, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 280.00, "providers": [{ "billed_charge": 0.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6413.37, "providers": [{ "billed_charge": 0.24, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3338.48, "providers": [{ "billed_charge": 0.21, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "330645967" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.17, "providers": [{ "billed_charge": 0.00, "npi": [1649503319] } ] } ] }, { "tin": { "type": "ein", "value": "954322584" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 121.41, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] }, { "allowed_amount": 768.40, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] } ] }, { "tin": { "type": "ein", "value": "593259553" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.91, "providers": [{ "billed_charge": 0.00, "npi": [1669429577] } ] } ] } ] }, { "name": "DIAST BP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "3078F", "description": "MOST RECENT DIASTOLIC BLOOD PRESSURE LESS THAN 80 MM HG (HTN, CKD, CAD) (DM)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 387.08, "providers": [{ "billed_charge": 0.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3595.21, "providers": [{ "billed_charge": 0.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5795.65, "providers": [{ "billed_charge": 0.27, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2089.93, "providers": [{ "billed_charge": 0.15, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "954322584" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 104.88, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] }, { "allowed_amount": 1107.41, "providers": [{ "billed_charge": 0.00, "npi": [1710031588] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 67.36, "providers": [{ "billed_charge": 54.00, "npi": [1003863580] } ] }, { "allowed_amount": 5.97, "providers": [{ "billed_charge": 18.00, "npi": [1003863580] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7633.16, "providers": [{ "billed_charge": 964.00, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 279.08, "providers": [{ "billed_charge": 233.12, "npi": [1427034990] } ] }, { "allowed_amount": 1679.13, "providers": [{ "billed_charge": 947.05, "npi": [1578549044] } ] }, { "allowed_amount": 6786.63, "providers": [{ "billed_charge": 8610.87, "npi": [1720279805] } ] }, { "allowed_amount": 310.95, "providers": [{ "billed_charge": 335.11, "npi": [1861018574] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4083.08, "providers": [{ "billed_charge": 955.50, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4090.73, "providers": [{ "billed_charge": 1050.00, "npi": [1063497451] } ] }, { "allowed_amount": 3686.93, "providers": [{ "billed_charge": 498.93, "npi": [1538144910] } ] }, { "allowed_amount": 292.63, "providers": [{ "billed_charge": 69.30, "npi": [1932184322] } ] }, { "allowed_amount": 2739.35, "providers": [{ "billed_charge": 524.75, "npi": [1295726032] } ] } ] }, { "tin": { "type": "ein", "value": "364257926" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 668.06, "providers": [{ "billed_charge": 305.76, "npi": [1881630614] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8532.74, "providers": [{ "billed_charge": 2637.18, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 632.37, "providers": [{ "billed_charge": 550.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1933.00, "providers": [{ "billed_charge": 802.62, "npi": [1932145778] } ] } ] } ] }, { "name": "ULTRASOUND", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "402", "description": "OTHER IMAGING SERVICES - ULTRASOUND", "allowed_amounts": [{ "tin": { "type": "ein", "value": "111635088" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5970.00, "providers": [{ "billed_charge": 11158.00, "npi": [1659330173] } ] } ] }, { "tin": { "type": "ein", "value": "362174823" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4818.04, "providers": [{ "billed_charge": 3613.00, "npi": [1932213600] } ] } ] } ] }, { "name": "PHYSICAL THERP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "420", "description": "PHYSICAL THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "571145567" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6626.20, "providers": [{ "billed_charge": 10751.53, "npi": [1285699835] } ] } ] }, { "tin": { "type": "ein", "value": "263044485" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 296.00, "providers": [{ "billed_charge": 1462.00, "npi": [1316505043] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 92218.17, "providers": [{ "billed_charge": 9239.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 11547.48, "providers": [{ "billed_charge": 6084.83, "npi": [1851889463] } ] } ] }, { "tin": { "type": "ein", "value": "263694972" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 444.00, "providers": [{ "billed_charge": 1146.42, "npi": [1659511988] } ] } ] }, { "tin": { "type": "ein", "value": "770130154" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 38903.88, "providers": [{ "billed_charge": 0.00, "npi": [1093704249] } ] } ] }, { "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 750.00, "providers": [{ "billed_charge": 3504.00, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "208283421" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3920.02, "providers": [{ "billed_charge": 12704.00, "npi": [1427232818] } ] } ] }, { "tin": { "type": "ein", "value": "431802466" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 102965.00, "providers": [{ "billed_charge": 2210.00, "npi": [1033161849] } ] } ] }, { "tin": { "type": "ein", "value": "813784956" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24321.40, "providers": [{ "billed_charge": 1210.24, "npi": [1558954552] } ] } ] }, { "tin": { "type": "ein", "value": "721549752" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 106596.00, "providers": [{ "billed_charge": 12797.00, "npi": [1982289690] } ] } ] }, { "tin": { "type": "ein", "value": "832162308" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.20, "providers": [{ "billed_charge": 144.00, "npi": [1053885392] } ] } ] }, { "tin": { "type": "ein", "value": "590624424" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 18335.00, "providers": [{ "billed_charge": 4771.04, "npi": [1912964768] } ] } ] }, { "tin": { "type": "ein", "value": "270918901" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 352277.38, "providers": [{ "billed_charge": 5290.32, "npi": [1417280009] } ] } ] } ] }, { "name": "PHYS THERP/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "421", "description": "PHYSICAL THERAPY/VISIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871741881" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 19250.06, "providers": [{ "billed_charge": 2400.00, "npi": [1356014450] } ] } ] }, { "tin": { "type": "ein", "value": "205719568" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3150.03, "providers": [{ "billed_charge": 300.01, "npi": [1699008052] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 164500.14, "providers": [{ "billed_charge": 18700.03, "npi": [1437161452] } ] } ] }, { "tin": { "type": "ein", "value": "261202987" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 30882.75, "providers": [{ "billed_charge": 2400.00, "npi": [1073769543] } ] } ] } ] }, { "name": "OCCUPATION THER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "430", "description": "OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770130154" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 12967.96, "providers": [{ "billed_charge": 0.00, "npi": [1093704249] } ] } ] }, { "tin": { "type": "ein", "value": "431802466" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 168390.00, "providers": [{ "billed_charge": 4030.00, "npi": [1033161849] } ] } ] }, { "tin": { "type": "ein", "value": "721549752" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 54943.00, "providers": [{ "billed_charge": 10760.00, "npi": [1982289690] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 22905.98, "providers": [{ "billed_charge": 2020.00, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "274586141" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 7263.00, "providers": [{ "billed_charge": 4408.91, "npi": [1851889463] } ] } ] }, { "tin": { "type": "ein", "value": "270918901" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 456610.12, "providers": [{ "billed_charge": 6309.76, "npi": [1417280009] } ] } ] } ] }, { "name": "OCCUP THERP/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "431", "description": "OCCUPATIONAL THERAPY - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273129496" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 107402.34, "providers": [{ "billed_charge": 21000.00, "npi": [1013210707] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 22100.01, "providers": [{ "billed_charge": 1700.00, "npi": [1437161452] } ] } ] } ] }, { "name": "EMERG ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "450", "description": "EMERGENCY ROOM - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680396600" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 391096.37, "providers": [{ "billed_charge": 52839.50, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2388.33, "providers": [{ "billed_charge": 680.00, "npi": [1144375056] } ] }, { "allowed_amount": 14006.77, "providers": [{ "billed_charge": 10715.00, "npi": [1144375056] } ] } ] }, { "tin": { "type": "ein", "value": "990073524" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2233.00, "providers": [{ "billed_charge": 78.00, "npi": [1184612764] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 114908.00, "providers": [{ "billed_charge": 57477.00, "npi": [1487771812] } ] }, { "allowed_amount": 53580.80, "providers": [{ "billed_charge": 19408.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 439817.65, "providers": [{ "billed_charge": 97811.75, "npi": [1740215219] } ] } ] } ] }, { "name": "AMBUL SURG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "490", "description": "AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263075650" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 267545.85, "providers": [{ "billed_charge": 351957.54, "npi": [1134385701] } ] } ] } ] }, { "name": "RURAL/CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "521", "description": "FREE-STANDING CLINIC - RURAL HEALTH-CLINIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942699073" }, "service_code": ["22", "99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1750.35, "providers": [{ "billed_charge": 250.11, "npi": [1518089507] } ] }, { "allowed_amount": 2500.50, "providers": [{ "billed_charge": 250.14, "npi": [1518089507] } ] } ] } ] }, { "name": "URGENT CARE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "526", "description": "FREE-STANDING CLINIC - URGENT CARE CLINIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453583707" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1485.00, "providers": [{ "billed_charge": 621.00, "npi": [1326828575] } ] } ] } ] }, { "name": "SKILLED NURSE/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "551", "description": "SKILLED NURSING - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "463078070" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 25200.08, "providers": [{ "billed_charge": 2450.01, "npi": [1275975138] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 434265.75, "providers": [{ "billed_charge": 45900.04, "npi": [1437161452] } ] } ] }, { "tin": { "type": "ein", "value": "472783382" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 33980.75, "providers": [{ "billed_charge": 3552.03, "npi": [1295127256] } ] } ] }, { "tin": { "type": "ein", "value": "824386502" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 96643.83, "providers": [{ "billed_charge": 1760.00, "npi": [1811552680] } ] } ] }, { "tin": { "type": "ein", "value": "261202987" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 65430.80, "providers": [{ "billed_charge": 2250.03, "npi": [1073769543] } ] } ] }, { "tin": { "type": "ein", "value": "883475837" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 16620.23, "providers": [{ "billed_charge": 1583.49, "npi": [1104548478] } ] } ] }, { "tin": { "type": "ein", "value": "475058035" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 86830.36, "providers": [{ "billed_charge": 6650.01, "npi": [1679930119] } ] } ] }, { "tin": { "type": "ein", "value": "770616280" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2090.03, "providers": [{ "billed_charge": 750.00, "npi": [1750484085] } ] } ] }, { "tin": { "type": "ein", "value": "273129496" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 87194.41, "providers": [{ "billed_charge": 22000.00, "npi": [1013210707] } ] } ] }, { "tin": { "type": "ein", "value": "954548279" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 18877.74, "providers": [{ "billed_charge": 258.66, "npi": [1972893782] } ] } ] }, { "tin": { "type": "ein", "value": "853981372" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 48309.28, "providers": [{ "billed_charge": 240.00, "npi": [1790373769] } ] } ] }, { "tin": { "type": "ein", "value": "320232613" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9975.27, "providers": [{ "billed_charge": 4485.00, "npi": [1609044924] } ] } ] }, { "tin": { "type": "ein", "value": "473932987" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 22820.81, "providers": [{ "billed_charge": 2100.02, "npi": [1679951859] } ] } ] } ] }, { "name": "AIDE/HOME HEALTH/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "571", "description": "HOME HEALTH AIDE - VISIT CHARGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954548279" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 27804.77, "providers": [{ "billed_charge": 275.00, "npi": [1972893782] } ] } ] }, { "tin": { "type": "ein", "value": "853981372" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 183137.50, "providers": [{ "billed_charge": 1200.00, "npi": [1790373769] } ] } ] }, { "tin": { "type": "ein", "value": "841771224" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 53357.51, "providers": [{ "billed_charge": 11700.00, "npi": [1124684196] } ] } ] }, { "tin": { "type": "ein", "value": "651245571" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14490.07, "providers": [{ "billed_charge": 480.01, "npi": [1275644619] } ] } ] }, { "tin": { "type": "ein", "value": "203688688" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2585.62, "providers": [{ "billed_charge": 115.78, "npi": [1811045594] } ] } ] }, { "tin": { "type": "ein", "value": "824386502" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 236898.45, "providers": [{ "billed_charge": 1800.00, "npi": [1811552680] } ] } ] }, { "tin": { "type": "ein", "value": "883475837" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 31975.76, "providers": [{ "billed_charge": 1191.56, "npi": [1104548478] } ] } ] }, { "tin": { "type": "ein", "value": "475058035" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3420.01, "providers": [{ "billed_charge": 190.00, "npi": [1679930119] } ] } ] }, { "tin": { "type": "ein", "value": "943452048" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2650.08, "providers": [{ "billed_charge": 360.02, "npi": [1861634115] } ] } ] } ] }, { "name": "DRUG/EPO<10,000 UNITS", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "634", "description": "DRUGS REQ SPEC IDENTIFICATION - ERYTHROPOIETIN (EPO) LESS THAN 10,000 UNITS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1030257.30, "providers": [{ "billed_charge": 20592.00, "npi": [1124682166] } ] } ] } ] }, { "name": "DRUG/DETAIL CODE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "636", "description": "DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5562645.14, "providers": [{ "billed_charge": 40818.80, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "370960170" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1251563.13, "providers": [{ "billed_charge": 2684.75, "npi": [1497859649] } ] }, { "allowed_amount": 258738.42, "providers": [{ "billed_charge": 4221.25, "npi": [1497859649] } ] } ] }, { "tin": { "type": "ein", "value": "810864789" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 320547.06, "providers": [{ "billed_charge": 375.80, "npi": [1972535318] } ] }, { "allowed_amount": 7643.41, "providers": [{ "billed_charge": 33.70, "npi": [1972535318] } ] } ] }, { "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 555753.22, "providers": [{ "billed_charge": 16365.62, "npi": [1982668133] } ] }, { "allowed_amount": 94833.12, "providers": [{ "billed_charge": 152.40, "npi": [1982668133] } ] } ] }, { "tin": { "type": "ein", "value": "383990879" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 41293.08, "providers": [{ "billed_charge": 3253.00, "npi": [1689121188] } ] } ] }, { "tin": { "type": "ein", "value": "850105601" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 131390.97, "providers": [{ "billed_charge": 10656.00, "npi": [1215913470] } ] } ] }, { "tin": { "type": "ein", "value": "390964813" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 58818.38, "providers": [{ "billed_charge": 130.05, "npi": [1619079597] } ] } ] }, { "tin": { "type": "ein", "value": "840720309" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 503709.49, "providers": [{ "billed_charge": 3103.11, "npi": [1518960814] } ] } ] }, { "tin": { "type": "ein", "value": "941461843" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 239082.38, "providers": [{ "billed_charge": 10194.60, "npi": [1740215219] } ] }, { "allowed_amount": 569493.83, "providers": [{ "billed_charge": 5887.54, "npi": [1740215219] } ] } ] }, { "tin": { "type": "ein", "value": "820161600" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 235834.83, "providers": [{ "billed_charge": 1344.41, "npi": [1770586794] } ] } ] }, { "tin": { "type": "ein", "value": "340714593" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21969.00, "providers": [{ "billed_charge": 1427.60, "npi": [1902858152] } ] } ] }, { "tin": { "type": "ein", "value": "362179779" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 294200.53, "providers": [{ "billed_charge": 3342.25, "npi": [1124025176] } ] }, { "allowed_amount": 930204.89, "providers": [{ "billed_charge": 11081.00, "npi": [1124025176] } ] } ] }, { "tin": { "type": "ein", "value": "561936354" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16150.76, "providers": [{ "billed_charge": 25755.00, "npi": [1740208081] } ] } ] }, { "tin": { "type": "ein", "value": "820380784" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 784001.47, "providers": [{ "billed_charge": 15370.25, "npi": [1992798409] } ] } ] }, { "tin": { "type": "ein", "value": "751837454" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 69086.59, "providers": [{ "billed_charge": 166.19, "npi": [1447250253] } ] } ] }, { "tin": { "type": "ein", "value": "841179794" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 35959.33, "providers": [{ "billed_charge": 1431.41, "npi": [1477531580] } ] } ] }, { "tin": { "type": "ein", "value": "880455713" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 20060.49, "providers": [{ "billed_charge": 26.00, "npi": [1770626426] } ] } ] }, { "tin": { "type": "ein", "value": "852390012" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 482438.38, "providers": [{ "billed_charge": 3367.08, "npi": [1235162645] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 762662.58, "providers": [{ "billed_charge": 218330.09, "npi": [1689772592] } ] } ] }, { "tin": { "type": "ein", "value": "630845288" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 11497.00, "providers": [{ "billed_charge": 36.52, "npi": [1447221056] } ] } ] }, { "tin": { "type": "ein", "value": "941105628" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 16044.88, "providers": [{ "billed_charge": 25.20, "npi": [1144375056] } ] }, { "allowed_amount": 24530.80, "providers": [{ "billed_charge": 17.35, "npi": [1740354851] } ] } ] }, { "tin": { "type": "ein", "value": "910565889" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 24769.15, "providers": [{ "billed_charge": 200.10, "npi": [1487904546] } ] } ] }, { "tin": { "type": "ein", "value": "202848116" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 19117.03, "providers": [{ "billed_charge": 0.00, "npi": [1629138029] } ] }, { "allowed_amount": 415374.32, "providers": [{ "billed_charge": 0.00, "npi": [1629138029] } ] } ] }, { "tin": { "type": "ein", "value": "522093120" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 22847.54, "providers": [{ "billed_charge": 20.41, "npi": [1144291899] } ] } ] }, { "tin": { "type": "ein", "value": "880502320" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 329972.36, "providers": [{ "billed_charge": 49728.49, "npi": [1255360160] } ] } ] }, { "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 34442.26, "providers": [{ "billed_charge": 20758.50, "npi": [1306299391] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 24555984.16, "providers": [{ "billed_charge": 125642.55, "npi": [1386180859] } ] } ] }, { "tin": { "type": "ein", "value": "621762537" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 115115.74, "providers": [{ "billed_charge": 16490.80, "npi": [1861439952] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 278889.88, "providers": [{ "billed_charge": 181.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "590724459" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 233240.48, "providers": [{ "billed_charge": 23268.28, "npi": [1306938071] } ] }, { "allowed_amount": 129828.39, "providers": [{ "billed_charge": 5357.13, "npi": [1306938071] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1811733.98, "providers": [{ "billed_charge": 30535.31, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "340714585" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 201134.88, "providers": [{ "billed_charge": 3415.40, "npi": [1679525919] } ] } ] }, { "tin": { "type": "ein", "value": "204993360" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 30008.00, "providers": [{ "billed_charge": 2468.00, "npi": [1487771812] } ] }, { "allowed_amount": 60857.00, "providers": [{ "billed_charge": 4870.00, "npi": [1487771812] } ] } ] }, { "tin": { "type": "ein", "value": "113243405" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 92785.40, "providers": [{ "billed_charge": 389.52, "npi": [1033224704] } ] } ] }, { "tin": { "type": "ein", "value": "916001537" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 430041.88, "providers": [{ "billed_charge": 2798.66, "npi": [1326002049] } ] } ] }, { "tin": { "type": "ein", "value": "752918809" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 173488.00, "providers": [{ "billed_charge": 1624.00, "npi": [1932131489] } ] } ] }, { "tin": { "type": "ein", "value": "880213754" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 297297.95, "providers": [{ "billed_charge": 15453.50, "npi": [1124098421] } ] } ] }, { "tin": { "type": "ein", "value": "621694180" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 173045.94, "providers": [{ "billed_charge": 3663.31, "npi": [1326085424] } ] } ] }, { "tin": { "type": "ein", "value": "940562680" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 101673.74, "providers": [{ "billed_charge": 42820.38, "npi": [1740348929] } ] } ] }, { "tin": { "type": "ein", "value": "680396600" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 903710.98, "providers": [{ "billed_charge": 4968.99, "npi": [1801821376] } ] }, { "allowed_amount": 1516227.31, "providers": [{ "billed_charge": 554469.27, "npi": [1801821376] } ] } ] }, { "tin": { "type": "ein", "value": "381459362" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 5936.16, "providers": [{ "billed_charge": 49.25, "npi": [1306825997] } ] } ] }, { "tin": { "type": "ein", "value": "381976271" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 136798.17, "providers": [{ "billed_charge": 934.67, "npi": [1528031226] } ] } ] }, { "tin": { "type": "ein", "value": "390806367" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 445566.29, "providers": [{ "billed_charge": 1160.70, "npi": [1114920048] } ] } ] }, { "tin": { "type": "ein", "value": "621113737" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 392903.34, "providers": [{ "billed_charge": 7631.70, "npi": [1023055126] } ] } ] }, { "tin": { "type": "ein", "value": "916068143" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 110588.54, "providers": [{ "billed_charge": 162.00, "npi": [1134178999] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3681910.07, "providers": [{ "billed_charge": 616526.83, "npi": [1871543215] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 1 VIEW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952598917" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 277.65, "providers": [{ "billed_charge": 174.00, "npi": [1699776526] } ] }, { "allowed_amount": 30.84, "providers": [{ "billed_charge": 87.00, "npi": [1699776526] } ] }, { "allowed_amount": 52.83, "providers": [{ "billed_charge": 87.00, "npi": [1699776526] } ] } ] }, { "tin": { "type": "ein", "value": "834721282" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 762.00, "providers": [{ "billed_charge": 808.00, "npi": [1144872052] } ] }, { "allowed_amount": 5861.50, "providers": [{ "billed_charge": 3232.00, "npi": [1144872052] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1078.00, "providers": [{ "billed_charge": 648.00, "npi": [1053355792] } ] }, { "allowed_amount": 188.49, "providers": [{ "billed_charge": 324.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "941700729" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 755.06, "providers": [{ "billed_charge": 52.00, "npi": [1881646909] } ] }, { "allowed_amount": 16.17, "providers": [{ "billed_charge": 26.00, "npi": [1881646909] } ] } ] }, { "tin": { "type": "ein", "value": "952669833" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.80, "providers": [{ "billed_charge": 145.00, "npi": [1629156583] } ] }, { "allowed_amount": 1662.53, "providers": [{ "billed_charge": 232.00, "npi": [1629156583] } ] } ] }, { "tin": { "type": "ein", "value": "863087969" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 36.00, "providers": [{ "billed_charge": 45.00, "npi": [1003779596] } ] }, { "allowed_amount": 456.00, "providers": [{ "billed_charge": 225.00, "npi": [1003779596] } ] }, { "allowed_amount": 8.06, "providers": [{ "billed_charge": 45.00, "npi": [1003779596] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 2 VIEWS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "71046", "description": "RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.37, "providers": [{ "billed_charge": 197.24, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 58.40, "providers": [{ "billed_charge": 387.00, "npi": [1053355792] } ] }, { "allowed_amount": 90.30, "providers": [{ "billed_charge": 129.00, "npi": [1053355792] } ] } ] } ] }, { "name": "EKG/ECG", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "730", "description": "EKG/ECG - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680396600" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 24910.14, "providers": [{ "billed_charge": 695.00, "npi": [1801821376] } ] } ] } ] }, { "name": "MRI JNT OF LWR EXTRE W/O DYE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "73721", "description": "MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2581.51, "providers": [{ "billed_charge": 2581.51, "npi": [1386313740] } ] } ] } ] }, { "name": "CT ABD & PELV W/CONTRAST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "74177", "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4761.50, "providers": [{ "billed_charge": 7483.00, "npi": [1053355792] } ] }, { "allowed_amount": 200.07, "providers": [{ "billed_charge": 1069.00, "npi": [1053355792] } ] }, { "allowed_amount": 748.30, "providers": [{ "billed_charge": 1069.00, "npi": [1053355792] } ] } ] } ] }, { "name": "TRANSVAGINAL US, NON-OB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76830", "description": "ULTRASOUND, TRANSVAGINAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.90, "providers": [{ "billed_charge": 408.00, "npi": [1053355792] } ] } ] } ] }, { "name": "US EXAM, PELVIC, COMPLETE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "76856", "description": "ULTRASOUND, PELVIC (NONOBSTETRIC), REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 929.07, "providers": [{ "billed_charge": 1209.00, "npi": [1053355792] } ] } ] } ] }, { "name": "BREAST TOMOSYNTHESIS BI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77063", "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "951644042" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1556.44, "providers": [{ "billed_charge": 726.00, "npi": [1477502797] } ] } ] }, { "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15132.17, "providers": [{ "billed_charge": 4633.29, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10606.20, "providers": [{ "billed_charge": 9531.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "941700729" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2599.05, "providers": [{ "billed_charge": 1566.00, "npi": [1881646909] } ] } ] } ] }, { "name": "SCR MAMMO BI INCL CAD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77067", "description": "SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (", "allowed_amounts": [{ "tin": { "type": "ein", "value": "951644042" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1538.05, "providers": [{ "billed_charge": 969.10, "npi": [1477502797] } ] } ] }, { "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 15205.82, "providers": [{ "billed_charge": 10985.40, "npi": [1386313740] } ] } ] }, { "tin": { "type": "ein", "value": "952592769" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10013.48, "providers": [{ "billed_charge": 12096.00, "npi": [1053355792] } ] } ] }, { "tin": { "type": "ein", "value": "941700729" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 2933.11, "providers": [{ "billed_charge": 1890.00, "npi": [1881646909] } ] } ] } ] }, { "name": "DXA BONE DENSITY, AXIAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77080", "description": "DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP", "allowed_amounts": [{ "tin": { "type": "ein", "value": "275493321" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.26, "providers": [{ "billed_charge": 74.26, "npi": [1386313740] } ] } ] } ] }, { "name": "GUIDANCE FOR RADIAJ TX DLVR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77387", "description": "GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460753072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 97655.84, "providers": [{ "billed_charge": 7205.00, "npi": [1316280209] } ] } ] } ] }, { "name": "RADIATION TREATMENT DELIVERY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "77412", "description": "RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX", "allowed_amounts": [{ "tin": { "type": "ein", "value": "460753072" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 94638.90, "providers": [{ "billed_charge": 92400.00, "npi": [1316280209] } ] } ] } ] }, { "name": "Surface Radiation Therapy", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77436", "description": "Surface Radiation Therapy (SRT) treatment planning and simulation-aided field setting for superficial or orthovoltage radiation", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770440158" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.32, "providers": [{ "billed_charge": 558.00, "npi": [1861121741] } ] } ] } ] }, { "name": "Surface Radiation Therapy", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "77437", "description": "Surface Radiation Therapy (SRT) treatment delivery, using superficial or orthovoltage X-rays (less than or equal to 150 kV) for skin lesions or cancer", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770440158" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 521.74, "providers": [{ "billed_charge": 602.00, "npi": [1861121741] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 183.18, "providers": [{ "billed_charge": 149.50, "npi": [1730119553] } ] }, { "allowed_amount": 16760.40, "providers": [{ "billed_charge": 2067.15, "npi": [1730119553] } ] }, { "allowed_amount": 327.08, "providers": [{ "billed_charge": 497.38, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 330.00, "providers": [{ "billed_charge": 120.00, "npi": [1174113534] } ] }, { "allowed_amount": 20075.02, "providers": [{ "billed_charge": 540.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2825.25, "providers": [{ "billed_charge": 829.08, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2436.43, "providers": [{ "billed_charge": 65.52, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "330456095" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.80, "providers": [{ "billed_charge": 24.00, "npi": [1811081797] } ] } ] } ] }, { "name": "GENERAL HEALTH PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80050", "description": "GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1780.87, "providers": [{ "billed_charge": 1929.77, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 89665.17, "providers": [{ "billed_charge": 60528.82, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1217.91, "providers": [{ "billed_charge": 2121.13, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2344.19, "providers": [{ "billed_charge": 3964.91, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.77, "providers": [{ "billed_charge": 150.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 294.91, "providers": [{ "billed_charge": 317.18, "npi": [1932145778] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2834.19, "providers": [{ "billed_charge": 638.14, "npi": [1730119553] } ] }, { "allowed_amount": 638.38, "providers": [{ "billed_charge": 240.12, "npi": [1730119553] } ] }, { "allowed_amount": 29120.76, "providers": [{ "billed_charge": 1600.43, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5119.84, "providers": [{ "billed_charge": 1062.00, "npi": [1174113534] } ] }, { "allowed_amount": 24274.68, "providers": [{ "billed_charge": 954.00, "npi": [1174113534] } ] }, { "allowed_amount": 326.06, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2465.87, "providers": [{ "billed_charge": 817.61, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1002.93, "providers": [{ "billed_charge": 240.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "800151023" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 394.49, "providers": [{ "billed_charge": 16.35, "npi": [1316196892] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1602.34, "providers": [{ "billed_charge": 1894.28, "npi": [1356409379] } ] }, { "allowed_amount": 13415.08, "providers": [{ "billed_charge": 3294.40, "npi": [1356409379] } ] }, { "allowed_amount": 62.96, "providers": [{ "billed_charge": 164.72, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.20, "providers": [{ "billed_charge": 43.20, "npi": [1912991597] } ] }, { "allowed_amount": 41.38, "providers": [{ "billed_charge": 43.20, "npi": [1912991597] } ] }, { "allowed_amount": 167.62, "providers": [{ "billed_charge": 86.40, "npi": [1912991597] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.40, "providers": [{ "billed_charge": 69.82, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "330456095" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 196.00, "providers": [{ "billed_charge": 196.00, "npi": [1811081797] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 668.42, "providers": [{ "billed_charge": 1174.41, "npi": [1932145778] } ] } ] }, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 693.25, "providers": [{ "billed_charge": 115.59, "npi": [1972080752] } ] }, { "allowed_amount": 628.16, "providers": [{ "billed_charge": 308.24, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 151.91, "providers": [{ "billed_charge": 419.82, "npi": [1568431088] } ] }, { "allowed_amount": 521.20, "providers": [{ "billed_charge": 419.82, "npi": [1568431088] } ] }, { "allowed_amount": 422.53, "providers": [{ "billed_charge": 1119.52, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "751369692" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1914.33, "providers": [{ "billed_charge": 99.00, "npi": [1174659486] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1515.58, "providers": [{ "billed_charge": 517.44, "npi": [1427034990] } ] }, { "allowed_amount": 620.28, "providers": [{ "billed_charge": 369.60, "npi": [1578549044] } ] }, { "allowed_amount": 60939.30, "providers": [{ "billed_charge": 13712.16, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2318.06, "providers": [{ "billed_charge": 1586.85, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 609.73, "providers": [{ "billed_charge": 289.80, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4749.80, "providers": [{ "billed_charge": 3417.49, "npi": [1043256886] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 931.06, "providers": [{ "billed_charge": 164.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5007.13, "providers": [{ "billed_charge": 2648.31, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1863.09, "providers": [{ "billed_charge": 2490.60, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 139786.81, "providers": [{ "billed_charge": 30793.59, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1011.94, "providers": [{ "billed_charge": 385.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 394.06, "providers": [{ "billed_charge": 354.31, "npi": [1538144910] } ] }, { "allowed_amount": 3424.65, "providers": [{ "billed_charge": 2618.61, "npi": [1063497451] } ] }, { "allowed_amount": 106.97, "providers": [{ "billed_charge": 200.55, "npi": [1295726032] } ] } ] }, { "tin": { "type": "ein", "value": "364257926" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.44, "providers": [{ "billed_charge": 355.80, "npi": [1881630614] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6203.02, "providers": [{ "billed_charge": 7116.00, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 568.43, "providers": [{ "billed_charge": 242.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2025.27, "providers": [{ "billed_charge": 3202.20, "npi": [1932145778] } ] } ] } ] }, { "name": "RENAL FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80069", "description": "RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 441.78, "providers": [{ "billed_charge": 60.76, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8813.00, "providers": [{ "billed_charge": 2089.09, "npi": [1356409379] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2427.00, "providers": [{ "billed_charge": 400.40, "npi": [1720279805] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2116.22, "providers": [{ "billed_charge": 2670.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "813115799" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16424.28, "providers": [{ "billed_charge": 29822.40, "npi": [1306381694] } ] } ] }, { "tin": { "type": "ein", "value": "843172409" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37677.35, "providers": [{ "billed_charge": 138547.20, "npi": [1003437500] } ] } ] }, { "tin": { "type": "ein", "value": "452215107" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1587.95, "providers": [{ "billed_charge": 1864.20, "npi": [1801226543] } ] } ] }, { "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5828.15, "providers": [{ "billed_charge": 8000.00, "npi": [1952189086] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1973.18, "providers": [{ "billed_charge": 59.54, "npi": [1730119553] } ] }, { "allowed_amount": 757.63, "providers": [{ "billed_charge": 69.86, "npi": [1730119553] } ] }, { "allowed_amount": 261.73, "providers": [{ "billed_charge": 30.96, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 714.28, "providers": [{ "billed_charge": 120.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31201.86, "providers": [{ "billed_charge": 2056.32, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1487.21, "providers": [{ "billed_charge": 457.28, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 403.29, "providers": [{ "billed_charge": 145.98, "npi": [1356409379] } ] }, { "allowed_amount": 953.56, "providers": [{ "billed_charge": 48.66, "npi": [1356409379] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81003", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2157.14, "providers": [{ "billed_charge": 97.90, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.92, "providers": [{ "billed_charge": 50.52, "npi": [1356409379] } ] }, { "allowed_amount": 288.11, "providers": [{ "billed_charge": 33.68, "npi": [1356409379] } ] } ] } ] }, { "name": "FETAL CHRMOML ANEUPLOIDY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81420", "description": "FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811082020" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 759.05, "providers": [{ "billed_charge": 3036.20, "npi": [1598314437] } ] } ] } ] }, { "name": "NFCT DS BV RNA VAG FLU ALG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "81513", "description": "NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31808.21, "providers": [{ "billed_charge": 27955.76, "npi": [1720279805] } ] } ] } ] }, { "name": "HEMO/OP OR HOME", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "820", "description": "HEMODIALYSIS - OUTPT OR HOME - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3092915.70, "providers": [{ "billed_charge": 229358.50, "npi": [1912446865] } ] } ] } ] }, { "name": "MICROALBUMIN, QUANTITATIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82043", "description": "ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16519.40, "providers": [{ "billed_charge": 2487.45, "npi": [1720279805] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471423369" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2640965.30, "providers": [{ "billed_charge": 371179.25, "npi": [1124682166] } ] } ] }, { "tin": { "type": "ein", "value": "264687094" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 3597701.80, "providers": [{ "billed_charge": 241430.00, "npi": [1326282484] } ] } ] }, { "tin": { "type": "ein", "value": "863535292" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3130013.36, "providers": [{ "billed_charge": 186726.50, "npi": [1255016747] } ] } ] }, { "tin": { "type": "ein", "value": "921747520" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1331163.19, "providers": [{ "billed_charge": 151468.68, "npi": [1457037384] } ] } ] }, { "tin": { "type": "ein", "value": "921365464" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 441007.55, "providers": [{ "billed_charge": 30720.00, "npi": [1588445316] } ] } ] }, { "tin": { "type": "ein", "value": "204399694" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 198739.00, "providers": [{ "billed_charge": 293132.00, "npi": [1689693319] } ] } ] }, { "tin": { "type": "ein", "value": "237290564" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 22965.22, "providers": [{ "billed_charge": 96572.00, "npi": [1306299391] } ] } ] }, { "tin": { "type": "ein", "value": "932693873" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2867610.95, "providers": [{ "billed_charge": 181072.50, "npi": [1194502815] } ] } ] }, { "tin": { "type": "ein", "value": "203344171" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 77384.20, "providers": [{ "billed_charge": 202160.00, "npi": [1194916205] } ] } ] }, { "tin": { "type": "ein", "value": "931236337" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 3454232.85, "providers": [{ "billed_charge": 176640.00, "npi": [1386180859] } ] } ] } ] }, { "name": "ASSAY OF APOLIPOPROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82172", "description": "APOLIPOPROTEIN, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16791.33, "providers": [{ "billed_charge": 4811.51, "npi": [1720279805] } ] } ] } ] }, { "name": "BILIRUBIN, DIRECT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82248", "description": "BILIRUBIN; DIRECT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1731.04, "providers": [{ "billed_charge": 193.27, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1984.05, "providers": [{ "billed_charge": 1402.00, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 98059.96, "providers": [{ "billed_charge": 37710.40, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1542.92, "providers": [{ "billed_charge": 2033.43, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 537.55, "providers": [{ "billed_charge": 550.00, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23398.70, "providers": [{ "billed_charge": 1926.03, "npi": [1720279805] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.21, "providers": [{ "billed_charge": 125.43, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32172.51, "providers": [{ "billed_charge": 5594.68, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.16, "providers": [{ "billed_charge": 165.00, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9989.01, "providers": [{ "billed_charge": 2757.13, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 45229.21, "providers": [{ "billed_charge": 8683.22, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 679.22, "providers": [{ "billed_charge": 540.48, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.03, "providers": [{ "billed_charge": 55.50, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10370.27, "providers": [{ "billed_charge": 1389.15, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY IGA/IGD/IGG/IGM EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82784", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3863.49, "providers": [{ "billed_charge": 728.10, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.57, "providers": [{ "billed_charge": 29.95, "npi": [1356409379] } ] }, { "allowed_amount": 21995.65, "providers": [{ "billed_charge": 6529.10, "npi": [1356409379] } ] } ] } ] }, { "name": "GLUCOSE TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82950", "description": "GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 516.07, "providers": [{ "billed_charge": 183.40, "npi": [1720279805] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "82962", "description": "GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 12602.69, "providers": [{ "billed_charge": 2967.52, "npi": [1730119553] } ] }, { "allowed_amount": 552.14, "providers": [{ "billed_charge": 1395.88, "npi": [1730119553] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8578.35, "providers": [{ "billed_charge": 1836.55, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2564.27, "providers": [{ "billed_charge": 453.74, "npi": [1720279805] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455080644" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.35, "providers": [{ "billed_charge": 30.00, "npi": [1861413023] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3377.19, "providers": [{ "billed_charge": 1708.33, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1991.61, "providers": [{ "billed_charge": 1070.40, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122022.51, "providers": [{ "billed_charge": 18252.63, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 173.42, "providers": [{ "billed_charge": 65.81, "npi": [1295726032] } ] }, { "allowed_amount": 1556.10, "providers": [{ "billed_charge": 831.60, "npi": [1063497451] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6967.03, "providers": [{ "billed_charge": 2943.60, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.05, "providers": [{ "billed_charge": 154.00, "npi": [1548225428] } ] } ] }, { "tin": { "type": "ein", "value": "161387862" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1527.09, "providers": [{ "billed_charge": 1248.80, "npi": [1932145778] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 38071.43, "providers": [{ "billed_charge": 3374.85, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 260.22, "providers": [{ "billed_charge": 98.17, "npi": [1043256886] } ] } ] } ] }, { "name": "IRON BINDING TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83550", "description": "IRON BINDING CAPACITY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 847.05, "providers": [{ "billed_charge": 110.06, "npi": [1043256886] } ] } ] } ] }, { "name": "LACTATE (LD) (LDH) ENZYME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83615", "description": "LACTATE DEHYDROGENASE (LD), (LDH);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5711.03, "providers": [{ "billed_charge": 561.60, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF LIPASE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83690", "description": "LIPASE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 310.29, "providers": [{ "billed_charge": 155.48, "npi": [1730119553] } ] }, { "allowed_amount": 729.06, "providers": [{ "billed_charge": 211.54, "npi": [1730119553] } ] }, { "allowed_amount": 293.59, "providers": [{ "billed_charge": 116.61, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 486.84, "providers": [{ "billed_charge": 90.00, "npi": [1174113534] } ] }, { "allowed_amount": 3068.80, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] } ] } ] }, { "name": "ASSAY OF LIPOPROTEIN(A)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83695", "description": "LIPOPROTEIN (A)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26364.64, "providers": [{ "billed_charge": 4611.04, "npi": [1720279805] } ] } ] } ] }, { "name": "LIPOPROTEIN BLD QUAN PART", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83704", "description": "LIPOPROTEIN, BLOOD; QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S) (EG, BY NUCLEAR MAGNETIC RESONANC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1371.86, "providers": [{ "billed_charge": 924.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 219.90, "providers": [{ "billed_charge": 146.50, "npi": [1730119553] } ] }, { "allowed_amount": 698.29, "providers": [{ "billed_charge": 463.65, "npi": [1730119553] } ] }, { "allowed_amount": 23506.85, "providers": [{ "billed_charge": 2604.00, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 869.24, "providers": [{ "billed_charge": 168.00, "npi": [1174113534] } ] }, { "allowed_amount": 28493.44, "providers": [{ "billed_charge": 1140.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "751369692" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 131.79, "providers": [{ "billed_charge": 6.50, "npi": [1174659486] } ] }, { "allowed_amount": 1057.08, "providers": [{ "billed_charge": 52.00, "npi": [1174659486] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3009.09, "providers": [{ "billed_charge": 207.60, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23031.06, "providers": [{ "billed_charge": 3144.60, "npi": [1356409379] } ] }, { "allowed_amount": 168.00, "providers": [{ "billed_charge": 157.23, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF PARATHORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83970", "description": "PARATHORMONE (PARATHYROID HORMONE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1610.21, "providers": [{ "billed_charge": 866.88, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY FOR CALPROTECTIN FECAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "83993", "description": "CALPROTECTIN, FECAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.16, "providers": [{ "billed_charge": 70.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 239.63, "providers": [{ "billed_charge": 76.11, "npi": [1730119553] } ] }, { "allowed_amount": 12995.40, "providers": [{ "billed_charge": 267.30, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "751369692" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 890.75, "providers": [{ "billed_charge": 32.50, "npi": [1174659486] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6933.15, "providers": [{ "billed_charge": 823.68, "npi": [1356409379] } ] }, { "allowed_amount": 90.88, "providers": [{ "billed_charge": 37.44, "npi": [1356409379] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1081.01, "providers": [{ "billed_charge": 219.03, "npi": [1720279805] } ] } ] } ] }, { "name": "PROCALCITONIN (PCT)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84145", "description": "PROCALCITONIN (PCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2465.71, "providers": [{ "billed_charge": 269.08, "npi": [1730119553] } ] }, { "allowed_amount": 159.59, "providers": [{ "billed_charge": 67.27, "npi": [1730119553] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 985.51, "providers": [{ "billed_charge": 67.83, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24855.73, "providers": [{ "billed_charge": 7551.29, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF PROTEIN, URINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84156", "description": "PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1855.72, "providers": [{ "billed_charge": 144.20, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 872.06, "providers": [{ "billed_charge": 74.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1663.00, "providers": [{ "billed_charge": 209.00, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 268.31, "providers": [{ "billed_charge": 103.89, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7987.81, "providers": [{ "billed_charge": 2565.18, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1023.43, "providers": [{ "billed_charge": 407.59, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35679.11, "providers": [{ "billed_charge": 4167.24, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2602.69, "providers": [{ "billed_charge": 2283.32, "npi": [1043256886] } ] } ] }, { "tin": { "type": "ein", "value": "954524103" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.77, "providers": [{ "billed_charge": 49.50, "npi": [1548225428] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 27692.35, "providers": [{ "billed_charge": 7702.80, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1130.44, "providers": [{ "billed_charge": 940.44, "npi": [1043256886] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 39697.58, "providers": [{ "billed_charge": 6609.68, "npi": [1720279805] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2134.16, "providers": [{ "billed_charge": 533.61, "npi": [1720279805] } ] } ] } ] }, { "name": "ASSAY OF TROPONIN, QUANT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84484", "description": "TROPONIN, QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 606.42, "providers": [{ "billed_charge": 76.23, "npi": [1730119553] } ] }, { "allowed_amount": 345.70, "providers": [{ "billed_charge": 121.19, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1301.40, "providers": [{ "billed_charge": 105.00, "npi": [1174113534] } ] }, { "allowed_amount": 1475.80, "providers": [{ "billed_charge": 420.00, "npi": [1174113534] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3953.44, "providers": [{ "billed_charge": 300.58, "npi": [1720279805] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 597.63, "providers": [{ "billed_charge": 158.04, "npi": [1720279805] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2625.86, "providers": [{ "billed_charge": 476.48, "npi": [1730119553] } ] }, { "allowed_amount": 1583.61, "providers": [{ "billed_charge": 463.59, "npi": [1730119553] } ] }, { "allowed_amount": 29004.85, "providers": [{ "billed_charge": 1584.04, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 14598.53, "providers": [{ "billed_charge": 972.00, "npi": [1174113534] } ] }, { "allowed_amount": 5648.52, "providers": [{ "billed_charge": 1188.00, "npi": [1174113534] } ] }, { "allowed_amount": 333.56, "providers": [{ "billed_charge": 120.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "860872873" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 934.64, "providers": [{ "billed_charge": 399.12, "npi": [1538105366] } ] } ] }, { "tin": { "type": "ein", "value": "751049190" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 90.00, "providers": [{ "billed_charge": 24.60, "npi": [1265477707] } ] }, { "allowed_amount": 160.00, "providers": [{ "billed_charge": 24.60, "npi": [1265477707] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 635.15, "providers": [{ "billed_charge": 252.00, "npi": [1750348033] } ] } ] }, { "tin": { "type": "ein", "value": "800151023" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.09, "providers": [{ "billed_charge": 12.25, "npi": [1316196892] } ] }, { "allowed_amount": 18.46, "providers": [{ "billed_charge": 12.25, "npi": [1316196892] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1921.53, "providers": [{ "billed_charge": 1617.30, "npi": [1356409379] } ] }, { "allowed_amount": 19403.30, "providers": [{ "billed_charge": 4372.70, "npi": [1356409379] } ] }, { "allowed_amount": 5.60, "providers": [{ "billed_charge": 59.90, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.42, "providers": [{ "billed_charge": 63.60, "npi": [1912991597] } ] }, { "allowed_amount": 3277.06, "providers": [{ "billed_charge": 381.60, "npi": [1912991597] } ] }, { "allowed_amount": 236.80, "providers": [{ "billed_charge": 63.60, "npi": [1912991597] } ] } ] }, { "tin": { "type": "ein", "value": "952584668" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.86, "providers": [{ "billed_charge": 26.45, "npi": [1942257191] } ] }, { "allowed_amount": 77.18, "providers": [{ "billed_charge": 113.89, "npi": [1942257191] } ] }, { "allowed_amount": 801.75, "providers": [{ "billed_charge": 158.70, "npi": [1942257191] } ] } ] }, { "tin": { "type": "ein", "value": "330456095" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4841.40, "providers": [{ "billed_charge": 221.00, "npi": [1811081797] } ] }, { "allowed_amount": 33.60, "providers": [{ "billed_charge": 51.00, "npi": [1811081797] } ] } ] }, { "tin": { "type": "ein", "value": "830565295" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 293.65, "providers": [{ "billed_charge": 113.56, "npi": [1972080752] } ] }, { "allowed_amount": 141.75, "providers": [{ "billed_charge": 28.39, "npi": [1972080752] } ] } ] }, { "tin": { "type": "ein", "value": "952645519" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 347.80, "providers": [{ "billed_charge": 90.76, "npi": [1568431088] } ] }, { "allowed_amount": 437.20, "providers": [{ "billed_charge": 45.38, "npi": [1568431088] } ] }, { "allowed_amount": 72.63, "providers": [{ "billed_charge": 90.76, "npi": [1568431088] } ] } ] }, { "tin": { "type": "ein", "value": "751369692" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.25, "providers": [{ "billed_charge": 6.25, "npi": [1174659486] } ] }, { "allowed_amount": 1619.12, "providers": [{ "billed_charge": 56.25, "npi": [1174659486] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 308.32, "providers": [{ "billed_charge": 108.80, "npi": [1861018574] } ] }, { "allowed_amount": 51907.88, "providers": [{ "billed_charge": 9030.40, "npi": [1720279805] } ] }, { "allowed_amount": 1309.06, "providers": [{ "billed_charge": 598.40, "npi": [1578549044] } ] }, { "allowed_amount": 1433.23, "providers": [{ "billed_charge": 380.80, "npi": [1427034990] } ] } ] }, { "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 520.71, "providers": [{ "billed_charge": 327.90, "npi": [1609812445] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2360.38, "providers": [{ "billed_charge": 819.75, "npi": [1043256886] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85027", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.06, "providers": [{ "billed_charge": 17.94, "npi": [1730119553] } ] }, { "allowed_amount": 18833.00, "providers": [{ "billed_charge": 549.24, "npi": [1730119553] } ] }, { "allowed_amount": 58.10, "providers": [{ "billed_charge": 53.82, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 190.40, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] }, { "allowed_amount": 20263.09, "providers": [{ "billed_charge": 600.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8168.27, "providers": [{ "billed_charge": 2021.60, "npi": [1356409379] } ] } ] } ] }, { "name": "CCPD/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "851", "description": "CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921385442" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 5294885.73, "providers": [{ "billed_charge": 158676.00, "npi": [1649051475] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 170.30, "providers": [{ "billed_charge": 12.38, "npi": [1730119553] } ] }, { "allowed_amount": 6222.23, "providers": [{ "billed_charge": 157.82, "npi": [1730119553] } ] }, { "allowed_amount": 257.55, "providers": [{ "billed_charge": 37.14, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 467.40, "providers": [{ "billed_charge": 60.00, "npi": [1174113534] } ] }, { "allowed_amount": 3852.48, "providers": [{ "billed_charge": 240.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 954.62, "providers": [{ "billed_charge": 277.36, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8836.30, "providers": [{ "billed_charge": 718.80, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "330456095" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.80, "providers": [{ "billed_charge": 6.00, "npi": [1811081797] } ] }, { "allowed_amount": 14.40, "providers": [{ "billed_charge": 6.00, "npi": [1811081797] } ] } ] } ] }, { "name": "RBC SED RATE, AUTOMATED", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85652", "description": "SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 11935.84, "providers": [{ "billed_charge": 753.96, "npi": [1720279805] } ] } ] } ] }, { "name": "THROMBOPLASTIN TIME, PARTIAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "85730", "description": "THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23"], "billing_class": "professional", "payments": [{ "allowed_amount": 170.30, "providers": [{ "billed_charge": 19.43, "npi": [1730119553] } ] }, { "allowed_amount": 131.12, "providers": [{ "billed_charge": 19.43, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "853392173" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 226.40, "providers": [{ "billed_charge": 54.00, "npi": [1174113534] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2059.20, "providers": [{ "billed_charge": 140.40, "npi": [1356409379] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2869.77, "providers": [{ "billed_charge": 380.88, "npi": [1720279805] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES (ANA)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86039", "description": "ANTINUCLEAR ANTIBODIES (ANA); TITER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 81.32, "providers": [{ "billed_charge": 39.00, "npi": [1720279805] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10917.60, "providers": [{ "billed_charge": 1112.40, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 231.36, "providers": [{ "billed_charge": 78.62, "npi": [1356409379] } ] }, { "allowed_amount": 1226.73, "providers": [{ "billed_charge": 117.93, "npi": [1356409379] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN, HS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86141", "description": "C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4319.14, "providers": [{ "billed_charge": 589.29, "npi": [1720279805] } ] } ] } ] }, { "name": "FLUORESCENT ANTIBODY, SCREEN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86255", "description": "FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "431039532" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1560.84, "providers": [{ "billed_charge": 1200.72, "npi": [1609812445] } ] } ] } ] }, { "name": "TISS TRNSGLTMNASE EA IG CLAS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86364", "description": "TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 767.03, "providers": [{ "billed_charge": 158.80, "npi": [1720279805] } ] } ] } ] }, { "name": "MICROSOMAL ANTIBODY EACH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86376", "description": "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 910.79, "providers": [{ "billed_charge": 101.86, "npi": [1720279805] } ] } ] } ] }, { "name": "TB TEST CELL IMMUN MEASURE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86480", "description": "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17023.47, "providers": [{ "billed_charge": 13232.73, "npi": [1720279805] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86592", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1271.01, "providers": [{ "billed_charge": 104.65, "npi": [1720279805] } ] } ] } ] }, { "name": "HEP B SURFACE ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86706", "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1051.29, "providers": [{ "billed_charge": 150.36, "npi": [1720279805] } ] } ] } ] }, { "name": "RUBELLA ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86762", "description": "ANTIBODY; RUBELLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1682.41, "providers": [{ "billed_charge": 251.85, "npi": [1720279805] } ] } ] } ] }, { "name": "TREPONEMA PALLIDUM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86780", "description": "ANTIBODY; TREPONEMA PALLIDUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 26661.47, "providers": [{ "billed_charge": 4726.68, "npi": [1720279805] } ] } ] } ] }, { "name": "VARICELLA-ZOSTER ANTIBODY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86787", "description": "ANTIBODY; VARICELLA-ZOSTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 866.82, "providers": [{ "billed_charge": 235.47, "npi": [1720279805] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35035.85, "providers": [{ "billed_charge": 5594.40, "npi": [1720279805] } ] } ] } ] }, { "name": "RBC ANTIBODY SCREEN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86850", "description": "ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 428.03, "providers": [{ "billed_charge": 665.74, "npi": [1730119553] } ] }, { "allowed_amount": 2573.12, "providers": [{ "billed_charge": 1263.47, "npi": [1730119553] } ] }, { "allowed_amount": 431.85, "providers": [{ "billed_charge": 204.83, "npi": [1730119553] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC ABO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86900", "description": "BLOOD TYPING, SEROLOGIC; ABO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3931.10, "providers": [{ "billed_charge": 1126.28, "npi": [1730119553] } ] }, { "allowed_amount": 399.63, "providers": [{ "billed_charge": 181.51, "npi": [1730119553] } ] }, { "allowed_amount": 573.17, "providers": [{ "billed_charge": 165.55, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.91, "providers": [{ "billed_charge": 44.92, "npi": [1356409379] } ] }, { "allowed_amount": 781.38, "providers": [{ "billed_charge": 112.30, "npi": [1356409379] } ] }, { "allowed_amount": 12.81, "providers": [{ "billed_charge": 22.46, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.29, "providers": [{ "billed_charge": 234.60, "npi": [1912991597] } ] }, { "allowed_amount": 28.00, "providers": [{ "billed_charge": 30.00, "npi": [1912991597] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC RH(D)", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "86901", "description": "BLOOD TYPING, SEROLOGIC; RH (D)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "911879977" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3462.54, "providers": [{ "billed_charge": 722.88, "npi": [1730119553] } ] }, { "allowed_amount": 413.58, "providers": [{ "billed_charge": 122.43, "npi": [1730119553] } ] }, { "allowed_amount": 303.37, "providers": [{ "billed_charge": 122.43, "npi": [1730119553] } ] } ] }, { "tin": { "type": "ein", "value": "952697418" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.18, "providers": [{ "billed_charge": 74.88, "npi": [1356409379] } ] }, { "allowed_amount": 440.70, "providers": [{ "billed_charge": 112.32, "npi": [1356409379] } ] }, { "allowed_amount": 66.78, "providers": [{ "billed_charge": 56.16, "npi": [1356409379] } ] } ] }, { "tin": { "type": "ein", "value": "953501085" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.80, "providers": [{ "billed_charge": 12.30, "npi": [1912991597] } ] }, { "allowed_amount": 317.60, "providers": [{ "billed_charge": 144.60, "npi": [1912991597] } ] }, { "allowed_amount": 28.00, "providers": [{ "billed_charge": 30.00, "npi": [1912991597] } ] } ] } ] }, { "name": "CULTURE OTHR SPECIMN AEROBIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87070", "description": "CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 659.33, "providers": [{ "billed_charge": 331.87, "npi": [1720279805] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87077", "description": "CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3355.97, "providers": [{ "billed_charge": 966.89, "npi": [1720279805] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17331.64, "providers": [{ "billed_charge": 2881.50, "npi": [1720279805] } ] } ] }, { "tin": { "type": "ein", "value": "880099333" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.29, "providers": [{ "billed_charge": 291.92, "npi": [1043256886] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE MIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87186", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3978.90, "providers": [{ "billed_charge": 734.34, "npi": [1720279805] } ] } ] } ] }, { "name": "SMEAR, GRAM STAIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87205", "description": "SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 821.16, "providers": [{ "billed_charge": 181.06, "npi": [1720279805] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87340", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30794.56, "providers": [{ "billed_charge": 3543.68, "npi": [1720279805] } ] } ] } ] }, { "name": "HIV-1 AG W/HIV-1 & HIV-2 AB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87389", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 36288.07, "providers": [{ "billed_charge": 10744.50, "npi": [1720279805] } ] } ] } ] }, { "name": "CORONAVIRUS AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87426", "description": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461503904" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3824.63, "providers": [{ "billed_charge": 9711.00, "npi": [1588901532] } ] } ] } ] }, { "name": "SARSCOV & INF VIR A&B AG IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87428", "description": "IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330106028" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 799.71, "providers": [{ "billed_charge": 1185.00, "npi": [1285616177] } ] } ] } ] }, { "name": "CANDIDA, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87481", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12023.97, "providers": [{ "billed_charge": 8421.60, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 32045.70, "providers": [{ "billed_charge": 13755.84, "npi": [1720279805] } ] } ] } ] }, { "name": "CHYLMD PNEUM, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87486", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5466.00, "providers": [{ "billed_charge": 1543.96, "npi": [1790470763] } ] } ] } ] }, { "name": "CHYLMD TRACH, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87491", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5784.12, "providers": [{ "billed_charge": 1263.24, "npi": [1790470763] } ] } ] } ] }, { "name": "Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.", "billing_code_type": "CPT", "billing_code_type_version": "2026", "billing_code": "87494", "description": " Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 35817.54, "providers": [{ "billed_charge": 23334.85, "npi": [1720279805] } ] } ] } ] }, { "name": "GARDNER VAG, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87511", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1263.28, "providers": [{ "billed_charge": 350.90, "npi": [1790470763] } ] } ] } ] }, { "name": "HSV, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87529", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 421.08, "providers": [{ "billed_charge": 280.72, "npi": [1790470763] } ] } ] } ] }, { "name": "M. GENITALIUM AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87563", "description": "IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6925.54, "providers": [{ "billed_charge": 1473.78, "npi": [1790470763] } ] } ] } ] }, { "name": "M.PNEUMON, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87581", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6013.81, "providers": [{ "billed_charge": 1754.50, "npi": [1790470763] } ] } ] } ] }, { "name": "N.GONORRHOEAE, DNA, AMP PROB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87591", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6171.55, "providers": [{ "billed_charge": 1263.24, "npi": [1790470763] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87624", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 8085.31, "providers": [{ "billed_charge": 11790.72, "npi": [1720279805] } ] } ] } ] }, { "name": "RESP VIRUS 3-5 TARGETS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87631", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6788.76, "providers": [{ "billed_charge": 8272.54, "npi": [1790470763] } ] } ] } ] }, { "name": "SARS-COV-2 COVID-19 AMP PRB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87635", "description": "Infectious agent detection by nucleic acid (DNA or RNA); (SARS-CoV-2) [COVID-19], amplified probe te", "allowed_amounts": [{ "tin": { "type": "ein", "value": "861175591" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 3861.89, "providers": [{ "billed_charge": 4004.00, "npi": [1922124866] } ] } ] } ] }, { "name": "SARSCOV2 & INF A&B AMP PRB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87636", "description": "IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274666463" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 577.65, "providers": [{ "billed_charge": 1250.00, "npi": [1538466107] } ] } ] } ] }, { "name": "SARSCOV2&INF A&B&RSV AMP PRB", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87637", "description": "IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "334827543" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2560.99, "providers": [{ "billed_charge": 2560.00, "npi": [1538957709] } ] } ] } ] }, { "name": "STAPH A, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87640", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5606.24, "providers": [{ "billed_charge": 1193.06, "npi": [1790470763] } ] } ] } ] }, { "name": "STREP A, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87651", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1506.99, "providers": [{ "billed_charge": 491.26, "npi": [1790470763] } ] } ] } ] }, { "name": "STREP B, DNA, AMP PROBE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87653", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5214.10, "providers": [{ "billed_charge": 1122.88, "npi": [1790470763] } ] } ] } ] }, { "name": "TRICHOMONAS VAGINALIS AMPLIF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87661", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263147146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.97, "providers": [{ "billed_charge": 71.00, "npi": [1598906166] } ] } ] }, { "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4710.02, "providers": [{ "billed_charge": 1122.88, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 33821.62, "providers": [{ "billed_charge": 6927.92, "npi": [1720279805] } ] } ] } ] }, { "name": "DETECT AGENT NOS, DNA, AMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87798", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921249599" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15477.86, "providers": [{ "billed_charge": 8983.04, "npi": [1790470763] } ] } ] }, { "tin": { "type": "ein", "value": "621433252" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1324.75, "providers": [{ "billed_charge": 771.98, "npi": [1689639544] } ] } ] } ] }, { "name": "AGENT NOS ASSAY W/OPTIC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "87899", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; NOT OTHERWISE SPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 598.29, "providers": [{ "billed_charge": 168.75, "npi": [1720279805] } ] } ] } ] }, { "name": "CYTOPATH C/V AUTO FLUID REDO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88175", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 159.66, "providers": [{ "billed_charge": 558.84, "npi": [1427034990] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88305", "description": "LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200089497" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1856.84, "providers": [{ "billed_charge": 1820.00, "npi": [1235245291] } ] } ] }, { "tin": { "type": "ein", "value": "942547501" }, "service_code": ["22", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2145.88, "providers": [{ "billed_charge": 3920.00, "npi": [1598760985] } ] }, { "allowed_amount": 1614.00, "providers": [{ "billed_charge": 1080.00, "npi": [1598760985] } ] } ] }, { "tin": { "type": "ein", "value": "943166540" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2108.44, "providers": [{ "billed_charge": 900.00, "npi": [1083671713] } ] }, { "allowed_amount": 12077.01, "providers": [{ "billed_charge": 18385.00, "npi": [1083671713] } ] }, { "allowed_amount": 1528.40, "providers": [{ "billed_charge": 600.00, "npi": [1083671713] } ] } ] } ] }, { "name": "IMMUNOHISTO ANTIBODY SLIDE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88341", "description": "IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY STAIN PRO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943166540" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1979.93, "providers": [{ "billed_charge": 1794.00, "npi": [1083671713] } ] } ] } ] }, { "name": "IMMUNOHISTO ANTB 1ST STAIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "88342", "description": "IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943166540" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.88, "providers": [{ "billed_charge": 299.00, "npi": [1083671713] } ] }, { "allowed_amount": 3811.23, "providers": [{ "billed_charge": 2691.00, "npi": [1083671713] } ] }, { "allowed_amount": 1086.40, "providers": [{ "billed_charge": 299.00, "npi": [1083671713] } ] } ] } ] }, { "name": "BH/INTENS OP/PSYCH", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "905", "description": "INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832765931" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 396200.00, "providers": [{ "billed_charge": 119000.00, "npi": [1982175345] } ] } ] }, { "tin": { "type": "ein", "value": "872691481" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 74570.08, "providers": [{ "billed_charge": 31152.00, "npi": [1659054211] } ] } ] }, { "tin": { "type": "ein", "value": "204460514" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8795.75, "providers": [{ "billed_charge": 15300.00, "npi": [1679674865] } ] } ] }, { "tin": { "type": "ein", "value": "471674418" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 41432.60, "providers": [{ "billed_charge": 4070.00, "npi": [1083006944] } ] } ] }, { "tin": { "type": "ein", "value": "455053165" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6638.70, "providers": [{ "billed_charge": 4933.50, "npi": [1144563396] } ] } ] }, { "tin": { "type": "ein", "value": "261722556" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 6510.00, "providers": [{ "billed_charge": 3600.00, "npi": [1659013324] } ] } ] }, { "tin": { "type": "ein", "value": "822079025" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 21326.40, "providers": [{ "billed_charge": 33176.00, "npi": [1801370853] } ] } ] }, { "tin": { "type": "ein", "value": "332009934" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 36546.00, "providers": [{ "billed_charge": 99000.00, "npi": [1083427561] } ] } ] }, { "tin": { "type": "ein", "value": "842968604" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1400.00, "providers": [{ "billed_charge": 3159.00, "npi": [1235904798] } ] } ] }, { "tin": { "type": "ein", "value": "823168571" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 22130.80, "providers": [{ "billed_charge": 28500.00, "npi": [1477056166] } ] } ] }, { "tin": { "type": "ein", "value": "994587611" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 75612.36, "providers": [{ "billed_charge": 99000.00, "npi": [1336961853] } ] } ] }, { "tin": { "type": "ein", "value": "821224962" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 48643.58, "providers": [{ "billed_charge": 80500.00, "npi": [1194239426] } ] } ] }, { "tin": { "type": "ein", "value": "811009718" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 2100.00, "providers": [{ "billed_charge": 3000.00, "npi": [1194271270] } ] } ] }, { "tin": { "type": "ein", "value": "473567567" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 4954.01, "providers": [{ "billed_charge": 4615.00, "npi": [1063893428] } ] } ] }, { "tin": { "type": "ein", "value": "932390418" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 25327.74, "providers": [{ "billed_charge": 36000.00, "npi": [1386326478] } ] } ] }, { "tin": { "type": "ein", "value": "992032506" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 56087.31, "providers": [{ "billed_charge": 95865.00, "npi": [1972353100] } ] } ] }, { "tin": { "type": "ein", "value": "934467111" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 4406.16, "providers": [{ "billed_charge": 10485.00, "npi": [1629826276] } ] } ] } ] }, { "name": "BH/INTENS OP/CHEM DEP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "906", "description": "INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "921016061" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 8460.40, "providers": [{ "billed_charge": 44000.00, "npi": [1942919204] } ] } ] }, { "tin": { "type": "ein", "value": "940562680" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 46207.54, "providers": [{ "billed_charge": 18084.00, "npi": [1043358542] } ] } ] }, { "tin": { "type": "ein", "value": "330951143" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 7600.00, "providers": [{ "billed_charge": 16100.00, "npi": [1497132765] } ] } ] }, { "tin": { "type": "ein", "value": "994587611" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 106343.50, "providers": [{ "billed_charge": 31500.00, "npi": [1336961853] } ] } ] }, { "tin": { "type": "ein", "value": "831518224" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 4931.25, "providers": [{ "billed_charge": 21000.00, "npi": [1700420189] } ] } ] } ] }, { "name": "MENACWY-TT VACCINE IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90619", "description": "MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8057.95, "providers": [{ "billed_charge": 5472.00, "npi": [1659312593] } ] } ] } ] }, { "name": "9VHPV VACCINE 3 DOSE IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90651", "description": "HUMAN PAPILLOMAVIRUS VACCINE TYPES 6, 11, 16, 18, 31, 33, 45, 52, 58, NONAVALENT (9VHPV), 2 OR 3 DOS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7738.00, "providers": [{ "billed_charge": 9190.00, "npi": [1659312593] } ] } ] } ] }, { "name": "RV5 VACC 3 DOSE LIVE ORAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90680", "description": "ROTAVIRUS VACCINE, PENTAVALENT (RV5), 3 DOSE SCHEDULE, LIVE, FOR ORAL USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 148.00, "providers": [{ "billed_charge": 275.00, "npi": [1659312593] } ] } ] } ] }, { "name": "TDAP VACCINE 7 YRS/> IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90715", "description": "TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "271504911" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 216.52, "providers": [{ "billed_charge": 435.00, "npi": [1205167350] } ] } ] }, { "tin": { "type": "ein", "value": "462385459" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1858.00, "providers": [{ "billed_charge": 305.00, "npi": [1659312593] } ] } ] } ] }, { "name": "PSYCH DIAGNOSTIC EVALUATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90791", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871702628" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 8316.75, "providers": [{ "billed_charge": 15300.00, "npi": [1154994846] } ] }, { "allowed_amount": 162.00, "providers": [{ "billed_charge": 300.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 39829.38, "providers": [{ "billed_charge": 50494.34, "npi": [1972138238] } ] }, { "allowed_amount": 6512.00, "providers": [{ "billed_charge": 8277.93, "npi": [1972138238] } ] }, { "allowed_amount": 4070.00, "providers": [{ "billed_charge": 5187.91, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 25186.11, "providers": [{ "billed_charge": 39439.16, "npi": [1174292866] } ] }, { "allowed_amount": 850.07, "providers": [{ "billed_charge": 1316.72, "npi": [1174292866] } ] }, { "allowed_amount": 6707.01, "providers": [{ "billed_charge": 10533.76, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYCH DIAG EVAL W/MED SRVCS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90792", "description": "PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 29582.48, "providers": [{ "billed_charge": 29000.00, "npi": [1699146456] } ] }, { "allowed_amount": 200.00, "providers": [{ "billed_charge": 200.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6097.78, "providers": [{ "billed_charge": 10148.22, "npi": [1154697944] } ] }, { "allowed_amount": 2017.92, "providers": [{ "billed_charge": 3382.74, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 223.60, "providers": [{ "billed_charge": 444.76, "npi": [1174292866] } ] }, { "allowed_amount": 999.69, "providers": [{ "billed_charge": 1334.28, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYTX W PT 30 MINUTES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90832", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871702628" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 329.00, "providers": [{ "billed_charge": 750.00, "npi": [1154994846] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 30 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90833", "description": "PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 9011.61, "providers": [{ "billed_charge": 9000.00, "npi": [1518269372] } ] }, { "allowed_amount": 535.00, "providers": [{ "billed_charge": 500.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1127.90, "providers": [{ "billed_charge": 600.00, "npi": [1023125465] } ] }, { "allowed_amount": 34104.83, "providers": [{ "billed_charge": 19360.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "263872254" }, "service_code": ["52", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 987.43, "providers": [{ "billed_charge": 675.00, "npi": [1437389616] } ] }, { "allowed_amount": 15853.60, "providers": [{ "billed_charge": 3225.00, "npi": [1437389616] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 453.00, "providers": [{ "billed_charge": 203.00, "npi": [1902390537] } ] }, { "allowed_amount": 14195.56, "providers": [{ "billed_charge": 6496.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "562576649" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1501.00, "providers": [{ "billed_charge": 600.00, "npi": [1417373713] } ] } ] }, { "tin": { "type": "ein", "value": "590712405" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 803.32, "providers": [{ "billed_charge": 175.00, "npi": [1306012836] } ] } ] }, { "tin": { "type": "ein", "value": "611897007" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2022.66, "providers": [{ "billed_charge": 1286.75, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "941706811" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1527.00, "providers": [{ "billed_charge": 900.00, "npi": [1184785834] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 7185.03, "providers": [{ "billed_charge": 3770.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "825201238" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 749.97, "providers": [{ "billed_charge": 468.00, "npi": [1528693579] } ] }, { "allowed_amount": 10220.00, "providers": [{ "billed_charge": 4444.00, "npi": [1528693579] } ] } ] }, { "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3127.06, "providers": [{ "billed_charge": 1600.00, "npi": [1750584181] } ] }, { "allowed_amount": 6722.71, "providers": [{ "billed_charge": 3200.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "636727051" }, "service_code": ["22", "52"], "billing_class": "professional", "payments": [{ "allowed_amount": 716.36, "providers": [{ "billed_charge": 225.00, "npi": [1548586951] } ] }, { "allowed_amount": 279.26, "providers": [{ "billed_charge": 225.00, "npi": [1548586951] } ] } ] }, { "tin": { "type": "ein", "value": "882977235" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1492.80, "providers": [{ "billed_charge": 792.00, "npi": [1659003457] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.52, "providers": [{ "billed_charge": 201.84, "npi": [1972138238] } ] }, { "allowed_amount": 8228.08, "providers": [{ "billed_charge": 2744.06, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3666.38, "providers": [{ "billed_charge": 1934.90, "npi": [1174292866] } ] }, { "allowed_amount": 51883.80, "providers": [{ "billed_charge": 23570.60, "npi": [1174292866] } ] }, { "allowed_amount": 1545.44, "providers": [{ "billed_charge": 527.70, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "260522962" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3241.70, "providers": [{ "billed_charge": 1349.84, "npi": [1881894483] } ] } ] } ] }, { "name": "PSYTX W PT 45 MINUTES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90834", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 238848.39, "providers": [{ "billed_charge": 159290.00, "npi": [1699146456] } ] }, { "allowed_amount": 85.00, "providers": [{ "billed_charge": 85.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "953567895" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 727.37, "providers": [{ "billed_charge": 3663.66, "npi": [1548298532] } ] }, { "allowed_amount": 1898.62, "providers": [{ "billed_charge": 8897.46, "npi": [1548298532] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2719.50, "providers": [{ "billed_charge": 3885.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "12388703" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4800.00, "providers": [{ "billed_charge": 800.00, "npi": [1619060662] } ] } ] }, { "tin": { "type": "ein", "value": "569703699" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2563.20, "providers": [{ "billed_charge": 900.00, "npi": [1669507836] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2389.60, "providers": [{ "billed_charge": 3626.00, "npi": [1164512851] } ] }, { "allowed_amount": 4972.80, "providers": [{ "billed_charge": 6216.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "414409563" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3039.27, "providers": [{ "billed_charge": 1800.00, "npi": [1992714646] } ] } ] }, { "tin": { "type": "ein", "value": "943226225" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 37107.00, "providers": [{ "billed_charge": 3675.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "871702628" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 224.00, "providers": [{ "billed_charge": 250.00, "npi": [1154994846] } ] }, { "allowed_amount": 10312.00, "providers": [{ "billed_charge": 11750.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "800543544" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3009.00, "providers": [{ "billed_charge": 4550.00, "npi": [1609194497] } ] }, { "allowed_amount": 5494.00, "providers": [{ "billed_charge": 6500.00, "npi": [1609194497] } ] } ] }, { "tin": { "type": "ein", "value": "522437605" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 28658.80, "providers": [{ "billed_charge": 2600.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "863015188" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 798.00, "providers": [{ "billed_charge": 1310.00, "npi": [1144999327] } ] } ] }, { "tin": { "type": "ein", "value": "680273974" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 388.00, "providers": [{ "billed_charge": 485.00, "npi": [1669846986] } ] }, { "allowed_amount": 153.00, "providers": [{ "billed_charge": 485.00, "npi": [1669846986] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1621.89, "providers": [{ "billed_charge": 1621.80, "npi": [1972138238] } ] }, { "allowed_amount": 135.15, "providers": [{ "billed_charge": 135.15, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 24045.48, "providers": [{ "billed_charge": 27720.00, "npi": [1184199549] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 244.50, "providers": [{ "billed_charge": 1000.00, "npi": [1234567893] } ] }, { "allowed_amount": 9046.50, "providers": [{ "billed_charge": 5465.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2932.42, "providers": [{ "billed_charge": 3131.24, "npi": [1174292866] } ] }, { "allowed_amount": 1119.43, "providers": [{ "billed_charge": 1118.30, "npi": [1174292866] } ] }, { "allowed_amount": 8056.34, "providers": [{ "billed_charge": 8051.76, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 45 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90836", "description": "PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 12720.00, "providers": [{ "billed_charge": 11500.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "743140241" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 546.96, "providers": [{ "billed_charge": 336.17, "npi": [1326393711] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1587.91, "providers": [{ "billed_charge": 716.10, "npi": [1174292866] } ] }, { "allowed_amount": 22830.29, "providers": [{ "billed_charge": 12412.40, "npi": [1174292866] } ] } ] } ] }, { "name": "PSYTX W PT 60 MINUTES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90837", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 37914.00, "providers": [{ "billed_charge": 57000.00, "npi": [1518269372] } ] }, { "allowed_amount": 372.00, "providers": [{ "billed_charge": 600.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "462393939" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 11335.14, "providers": [{ "billed_charge": 8771.00, "npi": [1326417056] } ] }, { "allowed_amount": 1066.62, "providers": [{ "billed_charge": 716.00, "npi": [1326417056] } ] } ] }, { "tin": { "type": "ein", "value": "843608627" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 27300.00, "providers": [{ "billed_charge": 1050.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3410.80, "providers": [{ "billed_charge": 5130.00, "npi": [1023125465] } ] }, { "allowed_amount": 23218.58, "providers": [{ "billed_charge": 37800.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "452872078" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4314.36, "providers": [{ "billed_charge": 5750.00, "npi": [1427320605] } ] }, { "allowed_amount": 2224.33, "providers": [{ "billed_charge": 3000.00, "npi": [1427320605] } ] } ] }, { "tin": { "type": "ein", "value": "481263228" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.00, "providers": [{ "billed_charge": 700.00, "npi": [1093869588] } ] } ] }, { "tin": { "type": "ein", "value": "201346011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.83, "providers": [{ "billed_charge": 280.00, "npi": [1104943323] } ] } ] }, { "tin": { "type": "ein", "value": "474113758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1072.80, "providers": [{ "billed_charge": 1800.00, "npi": [1841655545] } ] } ] }, { "tin": { "type": "ein", "value": "883761074" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 347.68, "providers": [{ "billed_charge": 640.00, "npi": [1053030643] } ] }, { "allowed_amount": 695.36, "providers": [{ "billed_charge": 1280.00, "npi": [1053030643] } ] } ] }, { "tin": { "type": "ein", "value": "872835013" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1095.04, "providers": [{ "billed_charge": 1190.00, "npi": [1952089641] } ] }, { "allowed_amount": 895.04, "providers": [{ "billed_charge": 930.00, "npi": [1952089641] } ] } ] }, { "tin": { "type": "ein", "value": "475025949" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 377.34, "providers": [{ "billed_charge": 884.00, "npi": [1760854442] } ] } ] }, { "tin": { "type": "ein", "value": "994292534" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 993.33, "providers": [{ "billed_charge": 1250.00, "npi": [1760215263] } ] }, { "allowed_amount": 227.00, "providers": [{ "billed_charge": 250.00, "npi": [1760215263] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2091.80, "providers": [{ "billed_charge": 4884.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "872040799" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1050.00, "providers": [{ "billed_charge": 1050.00, "npi": [1134983232] } ] }, { "allowed_amount": 350.00, "providers": [{ "billed_charge": 350.00, "npi": [1134983232] } ] } ] }, { "tin": { "type": "ein", "value": "473179713" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 20540.33, "providers": [{ "billed_charge": 13640.00, "npi": [1356792626] } ] }, { "allowed_amount": 610.00, "providers": [{ "billed_charge": 660.00, "npi": [1356792626] } ] } ] }, { "tin": { "type": "ein", "value": "572696219" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7591.64, "providers": [{ "billed_charge": 9900.00, "npi": [1407042070] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 7571.20, "providers": [{ "billed_charge": 9464.00, "npi": [1164512851] } ] }, { "allowed_amount": 16521.40, "providers": [{ "billed_charge": 21840.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "814241628" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3267.00, "providers": [{ "billed_charge": 3885.00, "npi": [1932651817] } ] }, { "allowed_amount": 259.05, "providers": [{ "billed_charge": 370.00, "npi": [1932651817] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 873.60, "providers": [{ "billed_charge": 1092.00, "npi": [1578672184] } ] }, { "allowed_amount": 3412.58, "providers": [{ "billed_charge": 6006.00, "npi": [1578672184] } ] } ] }, { "tin": { "type": "ein", "value": "990671811" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3715.55, "providers": [{ "billed_charge": 4950.00, "npi": [1407888779] } ] }, { "allowed_amount": 339.00, "providers": [{ "billed_charge": 450.00, "npi": [1407888779] } ] } ] }, { "tin": { "type": "ein", "value": "873771599" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3235.00, "providers": [{ "billed_charge": 1515.00, "npi": [1477212645] } ] }, { "allowed_amount": 875.00, "providers": [{ "billed_charge": 525.00, "npi": [1477212645] } ] }, { "allowed_amount": 175.00, "providers": [{ "billed_charge": 175.00, "npi": [1477212645] } ] } ] }, { "tin": { "type": "ein", "value": "814850117" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 214.00, "providers": [{ "billed_charge": 450.00, "npi": [1821537242] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "49"], "billing_class": "professional", "payments": [{ "allowed_amount": 717.16, "providers": [{ "billed_charge": 400.00, "npi": [1234567893] } ] }, { "allowed_amount": 179.29, "providers": [{ "billed_charge": 540.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "474417413" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1616.00, "providers": [{ "billed_charge": 1350.00, "npi": [1174069439] } ] } ] }, { "tin": { "type": "ein", "value": "882461705" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4066.00, "providers": [{ "billed_charge": 1250.00, "npi": [1780322123] } ] } ] }, { "tin": { "type": "ein", "value": "833701490" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 4960.00, "providers": [{ "billed_charge": 4960.00, "npi": [1396202206] } ] } ] }, { "tin": { "type": "ein", "value": "862614829" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6987.61, "providers": [{ "billed_charge": 2300.00, "npi": [1831353986] } ] }, { "allowed_amount": 611.62, "providers": [{ "billed_charge": 700.00, "npi": [1831353986] } ] } ] }, { "tin": { "type": "ein", "value": "263447487" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 127.51, "providers": [{ "billed_charge": 250.00, "npi": [1215181300] } ] }, { "allowed_amount": 255.12, "providers": [{ "billed_charge": 500.00, "npi": [1215181300] } ] } ] }, { "tin": { "type": "ein", "value": "262812278" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3600.00, "providers": [{ "billed_charge": 600.00, "npi": [1265694954] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 440.00, "providers": [{ "billed_charge": 550.00, "npi": [1134309305] } ] }, { "allowed_amount": 30652.37, "providers": [{ "billed_charge": 45100.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "229454985" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 623.95, "providers": [{ "billed_charge": 675.00, "npi": [1598993263] } ] } ] }, { "tin": { "type": "ein", "value": "933051823" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 518.00, "providers": [{ "billed_charge": 700.00, "npi": [1598541435] } ] }, { "allowed_amount": 179.29, "providers": [{ "billed_charge": 350.00, "npi": [1598541435] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6548.00, "providers": [{ "billed_charge": 9000.00, "npi": [1902390537] } ] }, { "allowed_amount": 350.00, "providers": [{ "billed_charge": 500.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "260089066" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2024.58, "providers": [{ "billed_charge": 2528.00, "npi": [1417907940] } ] }, { "allowed_amount": 4619.80, "providers": [{ "billed_charge": 6320.00, "npi": [1417907940] } ] } ] }, { "tin": { "type": "ein", "value": "844779912" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1267.21, "providers": [{ "billed_charge": 1400.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "832675429" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4882.53, "providers": [{ "billed_charge": 9763.56, "npi": [1235600834] } ] }, { "allowed_amount": 6070.18, "providers": [{ "billed_charge": 11874.60, "npi": [1235600834] } ] }, { "allowed_amount": 5307.82, "providers": [{ "billed_charge": 10555.20, "npi": [1235600834] } ] } ] }, { "tin": { "type": "ein", "value": "551550407" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85783.56, "providers": [{ "billed_charge": 9250.00, "npi": [1083937627] } ] } ] }, { "tin": { "type": "ein", "value": "825065406" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1484.00, "providers": [{ "billed_charge": 220.00, "npi": [1225535545] } ] } ] }, { "tin": { "type": "ein", "value": "992998341" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.00, "providers": [{ "billed_charge": 210.00, "npi": [1922837574] } ] } ] }, { "tin": { "type": "ein", "value": "812483766" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1066.80, "providers": [{ "billed_charge": 1750.00, "npi": [1164967527] } ] }, { "allowed_amount": 304.80, "providers": [{ "billed_charge": 500.00, "npi": [1164967527] } ] } ] }, { "tin": { "type": "ein", "value": "843506537" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3718.00, "providers": [{ "billed_charge": 5000.00, "npi": [1275177982] } ] } ] }, { "tin": { "type": "ein", "value": "813784845" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 11021.00, "providers": [{ "billed_charge": 6550.00, "npi": [1316179906] } ] }, { "allowed_amount": 38666.00, "providers": [{ "billed_charge": 22650.00, "npi": [1316179906] } ] } ] }, { "tin": { "type": "ein", "value": "614071159" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.00, "providers": [{ "billed_charge": 390.00, "npi": [1720275738] } ] } ] }, { "tin": { "type": "ein", "value": "861456641" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4271.60, "providers": [{ "billed_charge": 4518.00, "npi": [1487324463] } ] } ] }, { "tin": { "type": "ein", "value": "934609608" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.92, "providers": [{ "billed_charge": 140.00, "npi": [1659132520] } ] } ] }, { "tin": { "type": "ein", "value": "474082201" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 167.00, "providers": [{ "billed_charge": 200.00, "npi": [1790115871] } ] }, { "allowed_amount": 4032.00, "providers": [{ "billed_charge": 800.00, "npi": [1790115871] } ] } ] }, { "tin": { "type": "ein", "value": "463372087" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 609.60, "providers": [{ "billed_charge": 1000.00, "npi": [1164617007] } ] }, { "allowed_amount": 8972.60, "providers": [{ "billed_charge": 13150.00, "npi": [1164617007] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.59, "providers": [{ "billed_charge": 925.74, "npi": [1154697944] } ] }, { "allowed_amount": 34295.59, "providers": [{ "billed_charge": 58321.62, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "941156581" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 268.00, "providers": [{ "billed_charge": 725.00, "npi": [1003267196] } ] }, { "allowed_amount": 874.00, "providers": [{ "billed_charge": 2175.00, "npi": [1003267196] } ] }, { "allowed_amount": 571.00, "providers": [{ "billed_charge": 1450.00, "npi": [1003267196] } ] } ] }, { "tin": { "type": "ein", "value": "845018873" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 109.18, "providers": [{ "billed_charge": 175.00, "npi": [1649805953] } ] }, { "allowed_amount": 148.36, "providers": [{ "billed_charge": 350.00, "npi": [1649805953] } ] } ] }, { "tin": { "type": "ein", "value": "813242970" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.51, "providers": [{ "billed_charge": 300.00, "npi": [1023508116] } ] } ] }, { "tin": { "type": "ein", "value": "843432588" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 6854.78, "providers": [{ "billed_charge": 3240.00, "npi": [1093452716] } ] } ] }, { "tin": { "type": "ein", "value": "852938829" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3995.46, "providers": [{ "billed_charge": 10800.00, "npi": [1245845932] } ] } ] }, { "tin": { "type": "ein", "value": "273781010" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4739.00, "providers": [{ "billed_charge": 7140.00, "npi": [1316238678] } ] }, { "allowed_amount": 1436.09, "providers": [{ "billed_charge": 2520.00, "npi": [1316238678] } ] } ] }, { "tin": { "type": "ein", "value": "861747274" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3431.87, "providers": [{ "billed_charge": 6860.88, "npi": [1164014874] } ] }, { "allowed_amount": 659.70, "providers": [{ "billed_charge": 1319.40, "npi": [1164014874] } ] }, { "allowed_amount": 1057.15, "providers": [{ "billed_charge": 2111.04, "npi": [1164014874] } ] } ] }, { "tin": { "type": "ein", "value": "833451302" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.08, "providers": [{ "billed_charge": 400.00, "npi": [1205392099] } ] }, { "allowed_amount": 1580.02, "providers": [{ "billed_charge": 2600.00, "npi": [1205392099] } ] } ] }, { "tin": { "type": "ein", "value": "844763002" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 88123.04, "providers": [{ "billed_charge": 13800.00, "npi": [1801486048] } ] } ] }, { "tin": { "type": "ein", "value": "932883334" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3392.08, "providers": [{ "billed_charge": 3840.00, "npi": [1710763834] } ] } ] }, { "tin": { "type": "ein", "value": "873630745" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 780.16, "providers": [{ "billed_charge": 200.00, "npi": [1891099164] } ] }, { "allowed_amount": 1755.36, "providers": [{ "billed_charge": 600.00, "npi": [1891099164] } ] } ] }, { "tin": { "type": "ein", "value": "822239719" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 9819.62, "providers": [{ "billed_charge": 3000.00, "npi": [1740332469] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1803.00, "providers": [{ "billed_charge": 2506.43, "npi": [1972138238] } ] }, { "allowed_amount": 6868.40, "providers": [{ "billed_charge": 8721.24, "npi": [1972138238] } ] }, { "allowed_amount": 34546.67, "providers": [{ "billed_charge": 48297.77, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "545920398" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7800.00, "providers": [{ "billed_charge": 1080.00, "npi": [1841462470] } ] } ] }, { "tin": { "type": "ein", "value": "991856271" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1421.98, "providers": [{ "billed_charge": 1440.00, "npi": [1770131799] } ] } ] }, { "tin": { "type": "ein", "value": "821228675" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2938.79, "providers": [{ "billed_charge": 1815.00, "npi": [1225563752] } ] } ] }, { "tin": { "type": "ein", "value": "205261930" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 931.38, "providers": [{ "billed_charge": 931.38, "npi": [1497705495] } ] } ] }, { "tin": { "type": "ein", "value": "271879320" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 11295.77, "providers": [{ "billed_charge": 11250.00, "npi": [1104522655] } ] }, { "allowed_amount": 2644.42, "providers": [{ "billed_charge": 3100.00, "npi": [1104522655] } ] } ] }, { "tin": { "type": "ein", "value": "134447376" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 20840.66, "providers": [{ "billed_charge": 7350.00, "npi": [1003027145] } ] } ] }, { "tin": { "type": "ein", "value": "841856765" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 367.80, "providers": [{ "billed_charge": 367.80, "npi": [1427671437] } ] }, { "allowed_amount": 5639.60, "providers": [{ "billed_charge": 5639.60, "npi": [1427671437] } ] } ] }, { "tin": { "type": "ein", "value": "473457354" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.75, "providers": [{ "billed_charge": 450.00, "npi": [1801385745] } ] }, { "allowed_amount": 12220.23, "providers": [{ "billed_charge": 16200.00, "npi": [1801385745] } ] } ] }, { "tin": { "type": "ein", "value": "553155709" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1215.00, "providers": [{ "billed_charge": 1350.00, "npi": [1326170309] } ] } ] }, { "tin": { "type": "ein", "value": "920865092" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2200.00, "providers": [{ "billed_charge": 550.00, "npi": [1740450840] } ] } ] }, { "tin": { "type": "ein", "value": "884179016" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1359.96, "providers": [{ "billed_charge": 1400.00, "npi": [1679266910] } ] } ] }, { "tin": { "type": "ein", "value": "204716497" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3600.00, "providers": [{ "billed_charge": 3600.00, "npi": [1548302995] } ] } ] }, { "tin": { "type": "ein", "value": "246258363" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.00, "providers": [{ "billed_charge": 200.00, "npi": [1932304276] } ] } ] }, { "tin": { "type": "ein", "value": "452060520" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 3160.04, "providers": [{ "billed_charge": 3400.00, "npi": [1306117981] } ] }, { "allowed_amount": 3665.04, "providers": [{ "billed_charge": 4000.00, "npi": [1306117981] } ] } ] }, { "tin": { "type": "ein", "value": "854252623" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 923.83, "providers": [{ "billed_charge": 1847.16, "npi": [1689260267] } ] }, { "allowed_amount": 4751.64, "providers": [{ "billed_charge": 9499.68, "npi": [1689260267] } ] } ] }, { "tin": { "type": "ein", "value": "861505050" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 8254.00, "providers": [{ "billed_charge": 12900.00, "npi": [1316499239] } ] }, { "allowed_amount": 3992.00, "providers": [{ "billed_charge": 6000.00, "npi": [1316499239] } ] } ] }, { "tin": { "type": "ein", "value": "922092996" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 104.93, "providers": [{ "billed_charge": 250.00, "npi": [1437848603] } ] }, { "allowed_amount": 124.98, "providers": [{ "billed_charge": 300.00, "npi": [1437848603] } ] }, { "allowed_amount": 186.00, "providers": [{ "billed_charge": 250.00, "npi": [1437848603] } ] } ] }, { "tin": { "type": "ein", "value": "861826692" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2112.11, "providers": [{ "billed_charge": 4222.08, "npi": [1790377489] } ] }, { "allowed_amount": 395.82, "providers": [{ "billed_charge": 791.64, "npi": [1790377489] } ] } ] }, { "tin": { "type": "ein", "value": "567376239" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 511.66, "providers": [{ "billed_charge": 1000.00, "npi": [1952437204] } ] } ] }, { "tin": { "type": "ein", "value": "871702628" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2528.04, "providers": [{ "billed_charge": 6300.00, "npi": [1154994846] } ] }, { "allowed_amount": 52696.52, "providers": [{ "billed_charge": 131100.00, "npi": [1154994846] } ] } ] }, { "tin": { "type": "ein", "value": "923873396" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13858.34, "providers": [{ "billed_charge": 5940.00, "npi": [1871310417] } ] } ] }, { "tin": { "type": "ein", "value": "800543544" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3915.00, "providers": [{ "billed_charge": 4884.00, "npi": [1609194497] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1783.00, "providers": [{ "billed_charge": 2460.00, "npi": [1184199549] } ] }, { "allowed_amount": 59168.39, "providers": [{ "billed_charge": 85690.00, "npi": [1184199549] } ] } ] }, { "tin": { "type": "ein", "value": "824523426" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 110199.20, "providers": [{ "billed_charge": 11050.00, "npi": [1578393260] } ] } ] }, { "tin": { "type": "ein", "value": "820767207" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 10113.86, "providers": [{ "billed_charge": 11920.00, "npi": [1962818484] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 28055.73, "providers": [{ "billed_charge": 35359.92, "npi": [1174292866] } ] }, { "allowed_amount": 300169.67, "providers": [{ "billed_charge": 381480.68, "npi": [1174292866] } ] }, { "allowed_amount": 81751.34, "providers": [{ "billed_charge": 105552.00, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "872475331" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 473.57, "providers": [{ "billed_charge": 600.00, "npi": [1982244273] } ] }, { "allowed_amount": 157.64, "providers": [{ "billed_charge": 200.00, "npi": [1982244273] } ] } ] } ] }, { "name": "PSYTX W PT W E/M 60 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90838", "description": "PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 567.00, "providers": [{ "billed_charge": 350.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 585.00, "providers": [{ "billed_charge": 319.14, "npi": [1174292866] } ] }, { "allowed_amount": 32721.65, "providers": [{ "billed_charge": 19148.40, "npi": [1174292866] } ] }, { "allowed_amount": 419.88, "providers": [{ "billed_charge": 319.14, "npi": [1174292866] } ] } ] } ] }, { "name": "FAMILY PSYTX W/O PT 50 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90846", "description": "FAMILY PSYCHOTHERAPY (WITHOUT THE PATIENT PRESENT), 50 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "144786002" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1500.00, "providers": [{ "billed_charge": 250.00, "npi": [1962431015] } ] } ] } ] }, { "name": "FAMILY PSYTX W/PT 50 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90847", "description": "FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT), 50 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "452872078" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1432.24, "providers": [{ "billed_charge": 1600.00, "npi": [1427320605] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.20, "providers": [{ "billed_charge": 125.57, "npi": [1972138238] } ] }, { "allowed_amount": 502.36, "providers": [{ "billed_charge": 502.28, "npi": [1972138238] } ] }, { "allowed_amount": 753.42, "providers": [{ "billed_charge": 753.42, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "832172264" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 18259.00, "providers": [{ "billed_charge": 18760.00, "npi": [1184199549] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 925.52, "providers": [{ "billed_charge": 500.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 4065.61, "providers": [{ "billed_charge": 4070.88, "npi": [1174292866] } ] }, { "allowed_amount": 901.16, "providers": [{ "billed_charge": 904.64, "npi": [1174292866] } ] } ] } ] }, { "name": "GROUP PSYCHOTHERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90853", "description": "GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954377221" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 797.50, "providers": [{ "billed_charge": 1914.00, "npi": [1750368999] } ] } ] } ] }, { "name": "TCRANIAL MAGN STIM TX DELI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "90868", "description": "THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "465717265" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3052.00, "providers": [{ "billed_charge": 6650.00, "npi": [1841605706] } ] } ] }, { "tin": { "type": "ein", "value": "611897007" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 54450.50, "providers": [{ "billed_charge": 88450.00, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "471687401" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1440.00, "providers": [{ "billed_charge": 1440.00, "npi": [1740560861] } ] } ] }, { "tin": { "type": "ein", "value": "273081619" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3954.56, "providers": [{ "billed_charge": 8000.00, "npi": [1912362567] } ] } ] }, { "tin": { "type": "ein", "value": "330539376" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6143.80, "providers": [{ "billed_charge": 16000.00, "npi": [1649217761] } ] } ] }, { "tin": { "type": "ein", "value": "453150297" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17139.05, "providers": [{ "billed_charge": 5000.00, "npi": [1851492847] } ] } ] }, { "tin": { "type": "ein", "value": "462113991" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26903.91, "providers": [{ "billed_charge": 63000.00, "npi": [1366857476] } ] } ] }, { "tin": { "type": "ein", "value": "330896173" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2981.08, "providers": [{ "billed_charge": 7650.00, "npi": [1912324443] } ] } ] } ] }, { "name": "PSTAY/REHAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "911", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "994587611" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 300618.96, "providers": [{ "billed_charge": 65000.00, "npi": [1336961853] } ] } ] } ] }, { "name": "PSTAY/PARTIAL HOSP", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "912", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "832765931" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 368100.00, "providers": [{ "billed_charge": 85500.00, "npi": [1982175345] } ] } ] }, { "tin": { "type": "ein", "value": "813894602" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 22634.41, "providers": [{ "billed_charge": 24000.00, "npi": [1083166912] } ] } ] }, { "tin": { "type": "ein", "value": "473393869" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 12600.00, "providers": [{ "billed_charge": 21000.00, "npi": [1508634759] } ] } ] }, { "tin": { "type": "ein", "value": "934120374" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 4273.68, "providers": [{ "billed_charge": 38000.00, "npi": [1639021587] } ] } ] }, { "tin": { "type": "ein", "value": "843648246" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 15528.00, "providers": [{ "billed_charge": 58200.00, "npi": [1801632351] } ] } ] } ] }, { "name": "PSYCHIATRIC CARE INTENSIVE 4", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "913", "description": "PSYCHIATRIC CARE INTENSIVE 4-6 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "872691481" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 90057.85, "providers": [{ "billed_charge": 29458.00, "npi": [1659054211] } ] } ] }, { "tin": { "type": "ein", "value": "882725292" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 142358.03, "providers": [{ "billed_charge": 34800.00, "npi": [1326773615] } ] } ] }, { "tin": { "type": "ein", "value": "900919196" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 158345.98, "providers": [{ "billed_charge": 99000.00, "npi": [1174924310] } ] } ] }, { "tin": { "type": "ein", "value": "331053010" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 168638.70, "providers": [{ "billed_charge": 99400.00, "npi": [1780004192] } ] } ] }, { "tin": { "type": "ein", "value": "992032506" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 9253.70, "providers": [{ "billed_charge": 15750.00, "npi": [1972353100] } ] } ] }, { "tin": { "type": "ein", "value": "455053165" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 30383.92, "providers": [{ "billed_charge": 12100.00, "npi": [1144563396] } ] } ] }, { "tin": { "type": "ein", "value": "934467111" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 1359.86, "providers": [{ "billed_charge": 7990.00, "npi": [1629826276] } ] } ] }, { "tin": { "type": "ein", "value": "621658494" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 10942.44, "providers": [{ "billed_charge": 1400.00, "npi": [1770090862] } ] } ] } ] }, { "name": "PSTAY/GROUP RX", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "915", "description": "PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "334032295" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 9362.67, "providers": [{ "billed_charge": 37200.00, "npi": [1437013414] } ] } ] }, { "tin": { "type": "ein", "value": "830999120" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 32485.02, "providers": [{ "billed_charge": 35406.00, "npi": [1437644457] } ] } ] }, { "tin": { "type": "ein", "value": "931476205" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 27438.60, "providers": [{ "billed_charge": 38850.00, "npi": [1952084451] } ] } ] } ] }, { "name": "SPEECH/HEARING THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "92507", "description": "TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461542880" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1140.48, "providers": [{ "billed_charge": 1920.00, "npi": [1538592746] } ] } ] }, { "tin": { "type": "ein", "value": "200483217" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 720.00, "providers": [{ "billed_charge": 1215.00, "npi": [1124044698] } ] } ] }, { "tin": { "type": "ein", "value": "461353024" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 431.92, "providers": [{ "billed_charge": 1350.00, "npi": [1386988723] } ] } ] }, { "tin": { "type": "ein", "value": "371740460" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2960.00, "providers": [{ "billed_charge": 4070.00, "npi": [1780015339] } ] } ] }, { "tin": { "type": "ein", "value": "874804768" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1439.82, "providers": [{ "billed_charge": 1560.00, "npi": [1669192282] } ] } ] }, { "tin": { "type": "ein", "value": "264829698" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11055.00, "providers": [{ "billed_charge": 2750.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ELECTROCARDIOGRAM REPORT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "93010", "description": "ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954373071" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 733.56, "providers": [{ "billed_charge": 720.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "840446259" }, "service_code": ["22", "11", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 115.20, "providers": [{ "billed_charge": 128.00, "npi": [1437271285] } ] }, { "allowed_amount": 230.40, "providers": [{ "billed_charge": 256.00, "npi": [1437271285] } ] }, { "allowed_amount": 460.80, "providers": [{ "billed_charge": 256.00, "npi": [1437271285] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6505.20, "providers": [{ "billed_charge": 321.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 51732.94, "providers": [{ "billed_charge": 3024.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "462690851" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1074.76, "providers": [{ "billed_charge": 60.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "770520285" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.03, "providers": [{ "billed_charge": 61.00, "npi": [1669575585] } ] }, { "allowed_amount": 219.36, "providers": [{ "billed_charge": 305.00, "npi": [1669575585] } ] }, { "allowed_amount": 995.77, "providers": [{ "billed_charge": 1708.00, "npi": [1669575585] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.00, "providers": [{ "billed_charge": 165.00, "npi": [1437292927] } ] }, { "allowed_amount": 110.00, "providers": [{ "billed_charge": 110.00, "npi": [1437292927] } ] }, { "allowed_amount": 602.60, "providers": [{ "billed_charge": 657.00, "npi": [1437292927] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4627.54, "providers": [{ "billed_charge": 352.00, "npi": [1861432627] } ] } ] } ] }, { "name": "CARDIAC REHAB/MONITOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "93798", "description": "PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL SERVICES FOR OUTPATIENT CARDIAC REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "931144835" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 334.67, "providers": [{ "billed_charge": 670.02, "npi": [1962587964] } ] } ] } ] }, { "name": "DRUG REHAB", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "944", "description": "OTHER THERAPEUTIC SERVICES - DRUG REHABILITATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582341219" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16022.00, "providers": [{ "billed_charge": 3480.00, "npi": [1487096038] } ] } ] } ] }, { "name": "IMMUNOTHERAPY INJECTIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "95117", "description": "PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O", "allowed_amounts": [{ "tin": { "type": "ein", "value": "264645786" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.46, "providers": [{ "billed_charge": 32.00, "npi": [1275776346] } ] } ] }, { "tin": { "type": "ein", "value": "205198148" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2111.04, "providers": [{ "billed_charge": 405.00, "npi": [1184805848] } ] } ] }, { "tin": { "type": "ein", "value": "330587303" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.61, "providers": [{ "billed_charge": 68.00, "npi": [1730180415] } ] } ] }, { "tin": { "type": "ein", "value": "590634433" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.08, "providers": [{ "billed_charge": 93.00, "npi": [1265585806] } ] } ] }, { "tin": { "type": "ein", "value": "860217027" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.10, "providers": [{ "billed_charge": 140.00, "npi": [1952468381] } ] } ] } ] }, { "name": "THER/PROPH/DIAG INJ SC/IM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "96372", "description": "THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2465.73, "providers": [{ "billed_charge": 1305.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 704.90, "providers": [{ "billed_charge": 600.00, "npi": [1659950475] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2126.99, "providers": [{ "billed_charge": 1617.00, "npi": [1457324204] } ] } ] } ] }, { "name": "HOT OR COLD PACKS THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97010", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; HOT OR COLD PACKS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1718.35, "providers": [{ "billed_charge": 170.00, "npi": [1952394603] } ] } ] } ] }, { "name": "MECHANICAL TRACTION THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97012", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 968.97, "providers": [{ "billed_charge": 143.68, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5902.42, "providers": [{ "billed_charge": 718.00, "npi": [1255790358] } ] } ] } ] }, { "name": "ELECTRIC STIMULATION THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97014", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "205161322" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1662.89, "providers": [{ "billed_charge": 330.00, "npi": [1871722108] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7136.05, "providers": [{ "billed_charge": 817.32, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 783.36, "providers": [{ "billed_charge": 151.92, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1257.94, "providers": [{ "billed_charge": 194.78, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6062.89, "providers": [{ "billed_charge": 740.00, "npi": [1255790358] } ] } ] } ] }, { "name": "VASOPNEUMATIC DEVICE THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97016", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; VASOPNEUMATIC DEVICES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "872553562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 205.22, "providers": [{ "billed_charge": 60.00, "npi": [1952060618] } ] } ] } ] }, { "name": "ULTRASOUND THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97035", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6115.04, "providers": [{ "billed_charge": 780.00, "npi": [1255790358] } ] } ] } ] }, { "name": "THERAPEUTIC EXERCISES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97110", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2444.37, "providers": [{ "billed_charge": 1360.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8699.85, "providers": [{ "billed_charge": 6365.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50682.61, "providers": [{ "billed_charge": 21431.31, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 523.91, "providers": [{ "billed_charge": 600.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "472863935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1280.02, "providers": [{ "billed_charge": 1696.00, "npi": [1114317062] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2381.76, "providers": [{ "billed_charge": 1876.00, "npi": [1609822030] } ] } ] }, { "tin": { "type": "ein", "value": "330576005" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 293.98, "providers": [{ "billed_charge": 225.00, "npi": [1629094420] } ] } ] }, { "tin": { "type": "ein", "value": "362691111" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2554.98, "providers": [{ "billed_charge": 1845.00, "npi": [1730136474] } ] } ] }, { "tin": { "type": "ein", "value": "810519858" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1602.27, "providers": [{ "billed_charge": 489.33, "npi": [1023057064] } ] } ] }, { "tin": { "type": "ein", "value": "431561943" }, "service_code": ["11", "04"], "billing_class": "professional", "payments": [{ "allowed_amount": 88.12, "providers": [{ "billed_charge": 140.00, "npi": [1740273218] } ] }, { "allowed_amount": 1141.20, "providers": [{ "billed_charge": 1120.00, "npi": [1740273218] } ] } ] }, { "tin": { "type": "ein", "value": "943149505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 521.25, "providers": [{ "billed_charge": 300.00, "npi": [1184669756] } ] } ] }, { "tin": { "type": "ein", "value": "994428451" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5579.78, "providers": [{ "billed_charge": 2718.75, "npi": [1720883275] } ] } ] }, { "tin": { "type": "ein", "value": "205161322" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2698.18, "providers": [{ "billed_charge": 1900.00, "npi": [1871722108] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19019.60, "providers": [{ "billed_charge": 6438.48, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1428.02, "providers": [{ "billed_charge": 530.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3810.68, "providers": [{ "billed_charge": 1166.57, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1522.22, "providers": [{ "billed_charge": 1040.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "850486358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 11208.48, "providers": [{ "billed_charge": 12630.00, "npi": [1659445443] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 12272.19, "providers": [{ "billed_charge": 6720.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6018.85, "providers": [{ "billed_charge": 1125.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "844236556" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4849.37, "providers": [{ "billed_charge": 4218.00, "npi": [1306354881] } ] } ] }, { "tin": { "type": "ein", "value": "943099040" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8282.93, "providers": [{ "billed_charge": 6680.00, "npi": [1750497913] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2117.37, "providers": [{ "billed_charge": 1462.00, "npi": [1184354896] } ] } ] }, { "tin": { "type": "ein", "value": "880103557" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2294.91, "providers": [{ "billed_charge": 1300.00, "npi": [1245228972] } ] } ] }, { "tin": { "type": "ein", "value": "812654505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1052.40, "providers": [{ "billed_charge": 809.60, "npi": [1326495508] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2082.08, "providers": [{ "billed_charge": 1200.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "475338439" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3293.74, "providers": [{ "billed_charge": 1927.24, "npi": [1619334992] } ] } ] }, { "tin": { "type": "ein", "value": "510415630" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.72, "providers": [{ "billed_charge": 110.00, "npi": [1639219868] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1661.79, "providers": [{ "billed_charge": 1250.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3170.90, "providers": [{ "billed_charge": 1802.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2618.06, "providers": [{ "billed_charge": 918.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3225.25, "providers": [{ "billed_charge": 1661.36, "npi": [1669501730] } ] } ] } ] }, { "name": "NEUROMUSCULAR REEDUCATION", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97112", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2630.67, "providers": [{ "billed_charge": 1440.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10414.44, "providers": [{ "billed_charge": 8586.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "852386629" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 407.07, "providers": [{ "billed_charge": 250.00, "npi": [1467179663] } ] } ] }, { "tin": { "type": "ein", "value": "680444175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2551.47, "providers": [{ "billed_charge": 1420.00, "npi": [1396759171] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 56609.41, "providers": [{ "billed_charge": 23076.99, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 415.41, "providers": [{ "billed_charge": 600.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "200629289" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 773.00, "providers": [{ "billed_charge": 348.00, "npi": [1538131917] } ] } ] }, { "tin": { "type": "ein", "value": "362691111" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1838.08, "providers": [{ "billed_charge": 1242.00, "npi": [1730136474] } ] } ] }, { "tin": { "type": "ein", "value": "431561943" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.20, "providers": [{ "billed_charge": 71.00, "npi": [1740273218] } ] } ] }, { "tin": { "type": "ein", "value": "994428451" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4203.72, "providers": [{ "billed_charge": 2415.00, "npi": [1720883275] } ] } ] }, { "tin": { "type": "ein", "value": "205161322" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 920.94, "providers": [{ "billed_charge": 300.00, "npi": [1871722108] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 17045.29, "providers": [{ "billed_charge": 7385.41, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "872553562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 205.22, "providers": [{ "billed_charge": 138.00, "npi": [1952060618] } ] } ] }, { "tin": { "type": "ein", "value": "813211599" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 413.98, "providers": [{ "billed_charge": 420.00, "npi": [1780037689] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3112.50, "providers": [{ "billed_charge": 1680.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1675.15, "providers": [{ "billed_charge": 2610.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "850486358" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1183.55, "providers": [{ "billed_charge": 937.50, "npi": [1659445443] } ] } ] }, { "tin": { "type": "ein", "value": "901144537" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1801.71, "providers": [{ "billed_charge": 1070.00, "npi": [1992371967] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4669.25, "providers": [{ "billed_charge": 694.68, "npi": [1255900296] } ] } ] }, { "tin": { "type": "ein", "value": "464845389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.66, "providers": [{ "billed_charge": 412.00, "npi": [1215309422] } ] } ] }, { "tin": { "type": "ein", "value": "474738547" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1309.56, "providers": [{ "billed_charge": 810.00, "npi": [1578592424] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13938.47, "providers": [{ "billed_charge": 10000.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "450946475" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2312.80, "providers": [{ "billed_charge": 3500.00, "npi": [1154613495] } ] } ] }, { "tin": { "type": "ein", "value": "510415630" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.72, "providers": [{ "billed_charge": 100.00, "npi": [1639219868] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1311.79, "providers": [{ "billed_charge": 875.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "204429046" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1087.66, "providers": [{ "billed_charge": 842.78, "npi": [1538110861] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3580.81, "providers": [{ "billed_charge": 1500.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2910.14, "providers": [{ "billed_charge": 2160.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3254.11, "providers": [{ "billed_charge": 2745.98, "npi": [1669501730] } ] } ] } ] }, { "name": "AQUATIC THERAPY/EXERCISES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97113", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 676.94, "providers": [{ "billed_charge": 487.80, "npi": [1992326730] } ] } ] } ] }, { "name": "GAIT TRAINING THERAPY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97116", "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1922.56, "providers": [{ "billed_charge": 840.00, "npi": [1689162166] } ] } ] } ] }, { "name": "MANUAL THERAPY 1/> REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97140", "description": "MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2416.41, "providers": [{ "billed_charge": 1360.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 562.51, "providers": [{ "billed_charge": 270.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "852386629" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 517.24, "providers": [{ "billed_charge": 250.00, "npi": [1467179663] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 9570.98, "providers": [{ "billed_charge": 4340.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25533.17, "providers": [{ "billed_charge": 7523.83, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 490.53, "providers": [{ "billed_charge": 555.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "472863935" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1220.55, "providers": [{ "billed_charge": 582.00, "npi": [1114317062] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5673.52, "providers": [{ "billed_charge": 1210.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "844236556" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3529.24, "providers": [{ "billed_charge": 1500.00, "npi": [1306354881] } ] } ] }, { "tin": { "type": "ein", "value": "200629289" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1380.00, "providers": [{ "billed_charge": 560.00, "npi": [1538131917] } ] } ] }, { "tin": { "type": "ein", "value": "943099040" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5859.78, "providers": [{ "billed_charge": 1450.00, "npi": [1750497913] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1790.66, "providers": [{ "billed_charge": 1054.00, "npi": [1609822030] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2459.43, "providers": [{ "billed_charge": 1539.00, "npi": [1184354896] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 384.00, "providers": [{ "billed_charge": 225.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "943149505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1092.39, "providers": [{ "billed_charge": 530.00, "npi": [1184669756] } ] } ] }, { "tin": { "type": "ein", "value": "994428451" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1538.39, "providers": [{ "billed_charge": 887.50, "npi": [1720883275] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 20118.14, "providers": [{ "billed_charge": 11735.36, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "475338439" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3424.00, "providers": [{ "billed_charge": 1787.24, "npi": [1619334992] } ] } ] }, { "tin": { "type": "ein", "value": "813211599" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 862.29, "providers": [{ "billed_charge": 592.00, "npi": [1780037689] } ] } ] }, { "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2169.45, "providers": [{ "billed_charge": 761.68, "npi": [1215558051] } ] } ] }, { "tin": { "type": "ein", "value": "510415630" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 164.60, "providers": [{ "billed_charge": 100.00, "npi": [1639219868] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2946.46, "providers": [{ "billed_charge": 1200.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3100.74, "providers": [{ "billed_charge": 1380.00, "npi": [1871610287] } ] } ] } ] }, { "name": "GROUP THERAPEUTIC PROCEDURES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97150", "description": "THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "203367209" }, "service_code": ["56", "51"], "billing_class": "professional", "payments": [{ "allowed_amount": 632.55, "providers": [{ "billed_charge": 816.00, "npi": [1295709822] } ] }, { "allowed_amount": 192.13, "providers": [{ "billed_charge": 240.00, "npi": [1295709822] } ] } ] } ] }, { "name": "BHV ID ASSMT BY PHYS/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97151", "description": "BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 12741.14, "providers": [{ "billed_charge": 10319.04, "npi": [1134800980] } ] }, { "allowed_amount": 401.30, "providers": [{ "billed_charge": 573.28, "npi": [1134800980] } ] } ] } ] }, { "name": "ADAPTIVE BEHAVIOR TX BY TECH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943393372" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1555.12, "providers": [{ "billed_charge": 1632.00, "npi": [1316375587] } ] } ] }, { "tin": { "type": "ein", "value": "203887488" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 212816.00, "providers": [{ "billed_charge": 67371.00, "npi": [1699153700] } ] } ] }, { "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 543327.45, "providers": [{ "billed_charge": 204412.50, "npi": [1174148118] } ] } ] }, { "tin": { "type": "ein", "value": "263494212" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 43995.00, "providers": [{ "billed_charge": 3300.00, "npi": [1942537733] } ] }, { "allowed_amount": 47250.00, "providers": [{ "billed_charge": 3937.50, "npi": [1942537733] } ] } ] }, { "tin": { "type": "ein", "value": "873968950" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 120932.00, "providers": [{ "billed_charge": 36900.00, "npi": [1386391050] } ] } ] }, { "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "99", "12", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 28108.29, "providers": [{ "billed_charge": 14716.88, "npi": [1134800980] } ] }, { "allowed_amount": 409342.95, "providers": [{ "billed_charge": 170073.24, "npi": [1134800980] } ] }, { "allowed_amount": 1904.00, "providers": [{ "billed_charge": 1450.96, "npi": [1134800980] } ] }, { "allowed_amount": 16976.18, "providers": [{ "billed_charge": 9120.32, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "432086187" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4459.95, "providers": [{ "billed_charge": 1235.52, "npi": [1861666737] } ] } ] }, { "tin": { "type": "ein", "value": "510633134" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 10001.64, "providers": [{ "billed_charge": 1870.00, "npi": [1780958025] } ] } ] }, { "tin": { "type": "ein", "value": "943068149" }, "service_code": ["12", "03"], "billing_class": "professional", "payments": [{ "allowed_amount": 2107.67, "providers": [{ "billed_charge": 1350.81, "npi": [1619255841] } ] }, { "allowed_amount": 42577.15, "providers": [{ "billed_charge": 25821.16, "npi": [1619255841] } ] } ] }, { "tin": { "type": "ein", "value": "264753045" }, "service_code": ["99", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 63461.50, "providers": [{ "billed_charge": 19040.00, "npi": [1588967236] } ] }, { "allowed_amount": 5831.75, "providers": [{ "billed_charge": 3605.00, "npi": [1588967236] } ] } ] }, { "tin": { "type": "ein", "value": "872827894" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 24929.37, "providers": [{ "billed_charge": 31160.00, "npi": [1336802586] } ] } ] }, { "tin": { "type": "ein", "value": "460953315" }, "service_code": ["99"], "billing_class": "professional", "payments": [{ "allowed_amount": 105955.00, "providers": [{ "billed_charge": 5085.00, "npi": [1811240237] } ] } ] }, { "tin": { "type": "ein", "value": "843365484" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 137515.70, "providers": [{ "billed_charge": 23266.32, "npi": [1336789122] } ] } ] }, { "tin": { "type": "ein", "value": "461151074" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 48113.00, "providers": [{ "billed_charge": 15450.00, "npi": [1962838409] } ] } ] }, { "tin": { "type": "ein", "value": "853597638" }, "service_code": ["12", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6389.28, "providers": [{ "billed_charge": 1175.00, "npi": [1376204339] } ] }, { "allowed_amount": 48018.20, "providers": [{ "billed_charge": 8777.50, "npi": [1376204339] } ] }, { "allowed_amount": 9192.00, "providers": [{ "billed_charge": 1200.00, "npi": [1376204339] } ] } ] }, { "tin": { "type": "ein", "value": "854033384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 137342.81, "providers": [{ "billed_charge": 16836.00, "npi": [1376213421] } ] } ] } ] }, { "name": "GRP ADAPT BHV TX BY TECH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97154", "description": "GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 200236.56, "providers": [{ "billed_charge": 10800.00, "npi": [1174148118] } ] } ] } ] }, { "name": "ADAPT BEHAVIOR TX PHYS/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97155", "description": "ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "113817437" }, "service_code": ["11", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3788.06, "providers": [{ "billed_charge": 4900.00, "npi": [1174148118] } ] }, { "allowed_amount": 119583.15, "providers": [{ "billed_charge": 30100.00, "npi": [1174148118] } ] } ] }, { "tin": { "type": "ein", "value": "872827894" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4469.84, "providers": [{ "billed_charge": 3850.00, "npi": [1336802586] } ] } ] }, { "tin": { "type": "ein", "value": "873968950" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 6621.00, "providers": [{ "billed_charge": 1645.00, "npi": [1386391050] } ] } ] }, { "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "99", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 536.41, "providers": [{ "billed_charge": 766.30, "npi": [1134800980] } ] }, { "allowed_amount": 8462.87, "providers": [{ "billed_charge": 10191.79, "npi": [1134800980] } ] }, { "allowed_amount": 8855.55, "providers": [{ "billed_charge": 8659.19, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "371749452" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.49, "providers": [{ "billed_charge": 52.50, "npi": [1497093355] } ] }, { "allowed_amount": 28.80, "providers": [{ "billed_charge": 48.00, "npi": [1497093355] } ] } ] }, { "tin": { "type": "ein", "value": "994342234" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 496.62, "providers": [{ "billed_charge": 384.00, "npi": [1104690858] } ] } ] }, { "tin": { "type": "ein", "value": "461151074" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3937.50, "providers": [{ "billed_charge": 1531.25, "npi": [1962838409] } ] } ] }, { "tin": { "type": "ein", "value": "853597638" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13319.32, "providers": [{ "billed_charge": 1853.00, "npi": [1376204339] } ] } ] }, { "tin": { "type": "ein", "value": "854033384" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23369.95, "providers": [{ "billed_charge": 2097.60, "npi": [1376213421] } ] } ] }, { "tin": { "type": "ein", "value": "943068149" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 530.78, "providers": [{ "billed_charge": 607.20, "npi": [1619255841] } ] } ] } ] }, { "name": "FAM ADAPT BHV TX GDN PHY/QHP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97156", "description": "FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "931776818" }, "service_code": ["11", "12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1349.36, "providers": [{ "billed_charge": 1226.08, "npi": [1134800980] } ] }, { "allowed_amount": 8788.00, "providers": [{ "billed_charge": 10728.20, "npi": [1134800980] } ] }, { "allowed_amount": 6773.77, "providers": [{ "billed_charge": 5134.21, "npi": [1134800980] } ] } ] }, { "tin": { "type": "ein", "value": "994342234" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1363.10, "providers": [{ "billed_charge": 576.00, "npi": [1104690858] } ] } ] } ] }, { "name": "PT EVAL LOW COMPLEX 20 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97161", "description": "PHYSICAL THERAPY EVALUATION: LOW COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY WITH NO PERSONAL ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4531.25, "providers": [{ "billed_charge": 2419.20, "npi": [1992326730] } ] } ] } ] }, { "name": "PT EVAL MOD COMPLEX 30 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97162", "description": "PHYSICAL THERAPY EVALUATION: MODERATE COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY OF PRESENT P", "allowed_amounts": [{ "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2422.61, "providers": [{ "billed_charge": 1266.37, "npi": [1992326730] } ] } ] } ] }, { "name": "THERAPEUTIC ACTIVITIES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97530", "description": "THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812879826" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2644.65, "providers": [{ "billed_charge": 1380.00, "npi": [1891145108] } ] } ] }, { "tin": { "type": "ein", "value": "330912929" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9668.51, "providers": [{ "billed_charge": 11136.00, "npi": [1952394603] } ] } ] }, { "tin": { "type": "ein", "value": "852386629" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 197.79, "providers": [{ "billed_charge": 300.00, "npi": [1467179663] } ] } ] }, { "tin": { "type": "ein", "value": "680444175" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1332.03, "providers": [{ "billed_charge": 1273.00, "npi": [1396759171] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 66495.25, "providers": [{ "billed_charge": 35206.58, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "990765975" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 415.41, "providers": [{ "billed_charge": 600.00, "npi": [1275385122] } ] } ] }, { "tin": { "type": "ein", "value": "464813023" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4063.67, "providers": [{ "billed_charge": 6240.00, "npi": [1083038764] } ] } ] }, { "tin": { "type": "ein", "value": "200629289" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1326.00, "providers": [{ "billed_charge": 672.00, "npi": [1538131917] } ] } ] }, { "tin": { "type": "ein", "value": "362691111" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2444.51, "providers": [{ "billed_charge": 1628.00, "npi": [1730136474] } ] } ] }, { "tin": { "type": "ein", "value": "810519858" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3127.23, "providers": [{ "billed_charge": 2966.57, "npi": [1023057064] } ] } ] }, { "tin": { "type": "ein", "value": "431561943" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1092.69, "providers": [{ "billed_charge": 1008.00, "npi": [1740273218] } ] } ] }, { "tin": { "type": "ein", "value": "205161322" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1668.82, "providers": [{ "billed_charge": 660.00, "npi": [1871722108] } ] } ] }, { "tin": { "type": "ein", "value": "205067091" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14476.33, "providers": [{ "billed_charge": 6461.40, "npi": [1285729509] } ] } ] }, { "tin": { "type": "ein", "value": "872553562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.95, "providers": [{ "billed_charge": 140.00, "npi": [1952060618] } ] } ] }, { "tin": { "type": "ein", "value": "884313758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 494.65, "providers": [{ "billed_charge": 378.00, "npi": [1891408100] } ] } ] }, { "tin": { "type": "ein", "value": "800485844" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2687.24, "providers": [{ "billed_charge": 3936.00, "npi": [1033446448] } ] } ] }, { "tin": { "type": "ein", "value": "901144537" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5093.97, "providers": [{ "billed_charge": 3976.00, "npi": [1992371967] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2719.35, "providers": [{ "billed_charge": 2640.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "463437639" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 938.79, "providers": [{ "billed_charge": 2522.88, "npi": [1215361688] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14495.93, "providers": [{ "billed_charge": 4067.20, "npi": [1255900296] } ] } ] }, { "tin": { "type": "ein", "value": "464845389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 815.30, "providers": [{ "billed_charge": 2457.00, "npi": [1215309422] } ] } ] }, { "tin": { "type": "ein", "value": "474738547" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.34, "providers": [{ "billed_charge": 450.00, "npi": [1578592424] } ] } ] }, { "tin": { "type": "ein", "value": "825160608" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4015.91, "providers": [{ "billed_charge": 2700.00, "npi": [1689162166] } ] } ] }, { "tin": { "type": "ein", "value": "882522504" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1314.50, "providers": [{ "billed_charge": 1027.00, "npi": [1184354896] } ] } ] }, { "tin": { "type": "ein", "value": "812654505" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 689.19, "providers": [{ "billed_charge": 380.88, "npi": [1326495508] } ] } ] }, { "tin": { "type": "ein", "value": "911928166" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.00, "providers": [{ "billed_charge": 84.06, "npi": [1902808470] } ] } ] }, { "tin": { "type": "ein", "value": "873190995" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2562.02, "providers": [{ "billed_charge": 1125.00, "npi": [1114678794] } ] } ] }, { "tin": { "type": "ein", "value": "943015532" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 585.91, "providers": [{ "billed_charge": 780.00, "npi": [1336295138] } ] } ] }, { "tin": { "type": "ein", "value": "510415630" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 256.72, "providers": [{ "billed_charge": 110.00, "npi": [1639219868] } ] } ] }, { "tin": { "type": "ein", "value": "710887990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2186.35, "providers": [{ "billed_charge": 2100.00, "npi": [1013981760] } ] } ] }, { "tin": { "type": "ein", "value": "680215262" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3528.11, "providers": [{ "billed_charge": 1380.00, "npi": [1871610287] } ] } ] }, { "tin": { "type": "ein", "value": "814831980" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2804.26, "providers": [{ "billed_charge": 1176.00, "npi": [1497279194] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2916.96, "providers": [{ "billed_charge": 2391.74, "npi": [1669501730] } ] } ] } ] }, { "name": "SELF CARE MNGMENT TRAINING", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97535", "description": "SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461353024" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 515.76, "providers": [{ "billed_charge": 300.00, "npi": [1386988723] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3809.25, "providers": [{ "billed_charge": 1094.02, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "20522060" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1698.27, "providers": [{ "billed_charge": 827.91, "npi": [1669501730] } ] } ] } ] }, { "name": "WOUND(S) CARE NON-SELECTIVE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97602", "description": "REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, WET-", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1138.17, "providers": [{ "billed_charge": 1425.00, "npi": [1770307274] } ] } ] } ] }, { "name": "MEDICAL NUTRITION, INDIV, IN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97802", "description": "MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853953549" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1480.76, "providers": [{ "billed_charge": 1901.50, "npi": [1558097824] } ] } ] } ] }, { "name": "MED NUTRITION, INDIV, SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "97803", "description": "MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE-TO-FACE WITH THE PATIENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853953549" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 17312.40, "providers": [{ "billed_charge": 35318.50, "npi": [1558097824] } ] } ] } ] }, { "name": "CHIROPRACT MANJ 1-2 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98940", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1896.89, "providers": [{ "billed_charge": 1368.59, "npi": [1215558051] } ] } ] } ] }, { "name": "CHIROPRACT MANJ 3-4 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98941", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12442.38, "providers": [{ "billed_charge": 7895.38, "npi": [1215558051] } ] } ] } ] }, { "name": "CHIROPRACTIC MANJ 5 REGIONS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "98942", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "562403146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 184.80, "providers": [{ "billed_charge": 184.80, "npi": [1215558051] } ] } ] } ] }, { "name": "MED SERV 10PM-8AM, 24 HR FAC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99053", "description": "SERVICE(S) PROVIDED BETWEEN 10:00 PM AND 8:00 AM AT 24-HOUR FACILITY, IN ADDITION TO BASIC SERVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6743.69, "providers": [{ "billed_charge": 877.66, "npi": [1588960413] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT NEW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99204", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 7290.04, "providers": [{ "billed_charge": 7000.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2408.96, "providers": [{ "billed_charge": 1835.76, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 439.74, "providers": [{ "billed_charge": 439.74, "npi": [1174292866] } ] }, { "allowed_amount": 15656.77, "providers": [{ "billed_charge": 13192.20, "npi": [1174292866] } ] }, { "allowed_amount": 1055.38, "providers": [{ "billed_charge": 879.48, "npi": [1174292866] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 65350.88, "providers": [{ "billed_charge": 62568.88, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "330539376" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3839.00, "providers": [{ "billed_charge": 4000.00, "npi": [1649217761] } ] }, { "allowed_amount": 745.70, "providers": [{ "billed_charge": 1200.00, "npi": [1649217761] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2717.07, "providers": [{ "billed_charge": 7354.00, "npi": [1871607762] } ] }, { "allowed_amount": 300.60, "providers": [{ "billed_charge": 655.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.27, "providers": [{ "billed_charge": 245.00, "npi": [1023125465] } ] }, { "allowed_amount": 3147.41, "providers": [{ "billed_charge": 3870.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 762.00, "providers": [{ "billed_charge": 1050.00, "npi": [1275581894] } ] }, { "allowed_amount": 10997.85, "providers": [{ "billed_charge": 18112.50, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "941458282" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 502.52, "providers": [{ "billed_charge": 575.46, "npi": [1780736736] } ] } ] }, { "tin": { "type": "ein", "value": "272872791" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1189.40, "providers": [{ "billed_charge": 1608.00, "npi": [1730491945] } ] } ] }, { "tin": { "type": "ein", "value": "270980618" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2446.86, "providers": [{ "billed_charge": 3941.00, "npi": [1578833059] } ] } ] }, { "tin": { "type": "ein", "value": "952657324" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 191.00, "providers": [{ "billed_charge": 201.32, "npi": [1649269747] } ] } ] }, { "tin": { "type": "ein", "value": "271504911" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 209.76, "providers": [{ "billed_charge": 406.00, "npi": [1205167350] } ] } ] }, { "tin": { "type": "ein", "value": "330107822" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 525.00, "providers": [{ "billed_charge": 375.00, "npi": [1073628228] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.45, "providers": [{ "billed_charge": 248.45, "npi": [1538297726] } ] }, { "allowed_amount": 2409.84, "providers": [{ "billed_charge": 3229.85, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "200160881" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 379.74, "providers": [{ "billed_charge": 666.00, "npi": [1245997279] } ] } ] }, { "tin": { "type": "ein", "value": "870737748" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 47.62, "providers": [{ "billed_charge": 248.45, "npi": [1881636108] } ] } ] }, { "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 135.26, "providers": [{ "billed_charge": 240.00, "npi": [1659950475] } ] } ] }, { "tin": { "type": "ein", "value": "291842867" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 13621.93, "providers": [{ "billed_charge": 7975.00, "npi": [1750584181] } ] }, { "allowed_amount": 6737.34, "providers": [{ "billed_charge": 4125.00, "npi": [1750584181] } ] } ] }, { "tin": { "type": "ein", "value": "770440158" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1531.78, "providers": [{ "billed_charge": 1959.00, "npi": [1861121741] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.70, "providers": [{ "billed_charge": 125.70, "npi": [1972138238] } ] }, { "allowed_amount": 275.34, "providers": [{ "billed_charge": 275.34, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2776.39, "providers": [{ "billed_charge": 1608.32, "npi": [1174292866] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99214", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453206217" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 535.00, "providers": [{ "billed_charge": 500.00, "npi": [1518269372] } ] }, { "allowed_amount": 32526.67, "providers": [{ "billed_charge": 31000.00, "npi": [1518269372] } ] } ] }, { "tin": { "type": "ein", "value": "330185031" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.49, "providers": [{ "billed_charge": 917.00, "npi": [1871607762] } ] } ] }, { "tin": { "type": "ein", "value": "421703993" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 33923.89, "providers": [{ "billed_charge": 41240.00, "npi": [1023125465] } ] }, { "allowed_amount": 2481.55, "providers": [{ "billed_charge": 3230.00, "npi": [1023125465] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 509.86, "providers": [{ "billed_charge": 186.42, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "852938829" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 899.15, "providers": [{ "billed_charge": 1000.00, "npi": [1245845932] } ] } ] }, { "tin": { "type": "ein", "value": "475260007" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1053.00, "providers": [{ "billed_charge": 810.00, "npi": [1184080681] } ] } ] }, { "tin": { "type": "ein", "value": "611897007" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1712.84, "providers": [{ "billed_charge": 1168.98, "npi": [1003394149] } ] } ] }, { "tin": { "type": "ein", "value": "954377221" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 10282.14, "providers": [{ "billed_charge": 8580.00, "npi": [1750368999] } ] } ] }, { "tin": { "type": "ein", "value": "941706811" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1663.00, "providers": [{ "billed_charge": 1500.00, "npi": [1184785834] } ] }, { "allowed_amount": 3465.53, "providers": [{ "billed_charge": 3500.00, "npi": [1184785834] } ] } ] }, { "tin": { "type": "ein", "value": "943281657" }, "service_code": ["22", "11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 17234.22, "providers": [{ "billed_charge": 19008.00, "npi": [1164512851] } ] }, { "allowed_amount": 1553.60, "providers": [{ "billed_charge": 1188.00, "npi": [1164512851] } ] }, { "allowed_amount": 278.15, "providers": [{ "billed_charge": 594.00, "npi": [1164512851] } ] } ] }, { "tin": { "type": "ein", "value": "273081619" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.14, "providers": [{ "billed_charge": 300.00, "npi": [1912362567] } ] }, { "allowed_amount": 2766.23, "providers": [{ "billed_charge": 3900.00, "npi": [1912362567] } ] } ] }, { "tin": { "type": "ein", "value": "825201238" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 10288.24, "providers": [{ "billed_charge": 9210.00, "npi": [1528693579] } ] } ] }, { "tin": { "type": "ein", "value": "237064656" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1783.00, "providers": [{ "billed_charge": 2180.00, "npi": [1508968967] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 996.72, "providers": [{ "billed_charge": 1050.90, "npi": [1538297726] } ] }, { "allowed_amount": 5282.55, "providers": [{ "billed_charge": 4904.20, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "363097297" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 290.70, "providers": [{ "billed_charge": 323.00, "npi": [1346235314] } ] }, { "allowed_amount": 214.20, "providers": [{ "billed_charge": 238.00, "npi": [1346235314] } ] } ] }, { "tin": { "type": "ein", "value": "870698478" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 297.78, "providers": [{ "billed_charge": 432.24, "npi": [1639314255] } ] } ] }, { "tin": { "type": "ein", "value": "882977235" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1855.13, "providers": [{ "billed_charge": 1760.00, "npi": [1659003457] } ] } ] }, { "tin": { "type": "ein", "value": "845020669" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 557.52, "providers": [{ "billed_charge": 355.68, "npi": [1972138238] } ] }, { "allowed_amount": 11285.33, "providers": [{ "billed_charge": 9840.52, "npi": [1972138238] } ] } ] }, { "tin": { "type": "ein", "value": "260522962" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3182.22, "providers": [{ "billed_charge": 2256.24, "npi": [1881894483] } ] }, { "allowed_amount": 224.64, "providers": [{ "billed_charge": 282.03, "npi": [1881894483] } ] } ] }, { "tin": { "type": "ein", "value": "454269024" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 837.00, "providers": [{ "billed_charge": 596.00, "npi": [1356685218] } ] }, { "allowed_amount": 1868.00, "providers": [{ "billed_charge": 1788.00, "npi": [1356685218] } ] } ] }, { "tin": { "type": "ein", "value": "330539376" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3868.58, "providers": [{ "billed_charge": 4500.00, "npi": [1649217761] } ] } ] }, { "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 19573.78, "providers": [{ "billed_charge": 21600.00, "npi": [1275581894] } ] }, { "allowed_amount": 283.76, "providers": [{ "billed_charge": 600.00, "npi": [1275581894] } ] } ] }, { "tin": { "type": "ein", "value": "202138632" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2647.44, "providers": [{ "billed_charge": 6240.00, "npi": [1134309305] } ] }, { "allowed_amount": 8478.03, "providers": [{ "billed_charge": 11520.00, "npi": [1134309305] } ] } ] }, { "tin": { "type": "ein", "value": "680360801" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 332.78, "providers": [{ "billed_charge": 670.00, "npi": [1841407665] } ] }, { "allowed_amount": 757.20, "providers": [{ "billed_charge": 1675.00, "npi": [1841407665] } ] }, { "allowed_amount": 1238.14, "providers": [{ "billed_charge": 2010.00, "npi": [1841407665] } ] } ] }, { "tin": { "type": "ein", "value": "830925715" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1203.00, "providers": [{ "billed_charge": 1000.00, "npi": [1902390537] } ] }, { "allowed_amount": 18490.56, "providers": [{ "billed_charge": 11500.00, "npi": [1902390537] } ] } ] }, { "tin": { "type": "ein", "value": "811464389" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4564.71, "providers": [{ "billed_charge": 5250.00, "npi": [1255790358] } ] } ] }, { "tin": { "type": "ein", "value": "832675429" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 527.70, "providers": [{ "billed_charge": 578.00, "npi": [1235600834] } ] }, { "allowed_amount": 873.25, "providers": [{ "billed_charge": 1156.00, "npi": [1235600834] } ] }, { "allowed_amount": 1947.80, "providers": [{ "billed_charge": 2601.00, "npi": [1235600834] } ] } ] }, { "tin": { "type": "ein", "value": "742109824" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1180.80, "providers": [{ "billed_charge": 1354.00, "npi": [1821157579] } ] } ] }, { "tin": { "type": "ein", "value": "911220843" }, "service_code": ["19"], "billing_class": "professional", "payments": [{ "allowed_amount": 617.37, "providers": [{ "billed_charge": 957.00, "npi": [1023041159] } ] } ] }, { "tin": { "type": "ein", "value": "872955332" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1051.05, "providers": [{ "billed_charge": 1230.00, "npi": [1972266732] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2496.17, "providers": [{ "billed_charge": 9438.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "752536818" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1649.17, "providers": [{ "billed_charge": 1905.76, "npi": [1003811639] } ] }, { "allowed_amount": 155.44, "providers": [{ "billed_charge": 238.22, "npi": [1003811639] } ] } ] }, { "tin": { "type": "ein", "value": "680273974" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 309.60, "providers": [{ "billed_charge": 387.00, "npi": [1669846986] } ] }, { "allowed_amount": 140.94, "providers": [{ "billed_charge": 387.00, "npi": [1669846986] } ] } ] }, { "tin": { "type": "ein", "value": "200374669" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 79566.29, "providers": [{ "billed_charge": 124679.28, "npi": [1154697944] } ] }, { "allowed_amount": 600.86, "providers": [{ "billed_charge": 751.08, "npi": [1154697944] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2917.61, "providers": [{ "billed_charge": 2023.00, "npi": [1174292866] } ] }, { "allowed_amount": 88659.72, "providers": [{ "billed_charge": 65603.00, "npi": [1174292866] } ] }, { "allowed_amount": 3572.22, "providers": [{ "billed_charge": 3179.00, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "941156581" }, "service_code": ["11", "20", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1027.00, "providers": [{ "billed_charge": 820.00, "npi": [1013950807] } ] }, { "allowed_amount": 4575.34, "providers": [{ "billed_charge": 4920.00, "npi": [1013950807] } ] }, { "allowed_amount": 391.00, "providers": [{ "billed_charge": 410.00, "npi": [1013950807] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["11", "22", "19", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1222.64, "providers": [{ "billed_charge": 1768.00, "npi": [1437292927] } ] }, { "allowed_amount": 2727.99, "providers": [{ "billed_charge": 4709.00, "npi": [1437292927] } ] }, { "allowed_amount": 2235.20, "providers": [{ "billed_charge": 1964.00, "npi": [1437292927] } ] }, { "allowed_amount": 4875.89, "providers": [{ "billed_charge": 1950.00, "npi": [1437292927] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99215", "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "872475176" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 628.20, "providers": [{ "billed_charge": 389.50, "npi": [1174292866] } ] }, { "allowed_amount": 2092.70, "providers": [{ "billed_charge": 1558.00, "npi": [1174292866] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 239.04, "providers": [{ "billed_charge": 1005.00, "npi": [1437292927] } ] }, { "allowed_amount": 229.00, "providers": [{ "billed_charge": 229.00, "npi": [1437292927] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943344928" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2035.96, "providers": [{ "billed_charge": 3058.00, "npi": [1568490597] } ] } ] }, { "tin": { "type": "ein", "value": "200758009" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2634.97, "providers": [{ "billed_charge": 4296.00, "npi": [1346313194] } ] } ] }, { "tin": { "type": "ein", "value": "770303129" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2095.25, "providers": [{ "billed_charge": 3500.00, "npi": [1356479877] } ] } ] }, { "tin": { "type": "ein", "value": "475397655" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5404.14, "providers": [{ "billed_charge": 6208.00, "npi": [1902279656] } ] } ] }, { "tin": { "type": "ein", "value": "900730395" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 463.60, "providers": [{ "billed_charge": 237.00, "npi": [1124374822] } ] } ] }, { "tin": { "type": "ein", "value": "261938693" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 37492.00, "providers": [{ "billed_charge": 12950.00, "npi": [1144493461] } ] } ] }, { "tin": { "type": "ein", "value": "611661781" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 619.60, "providers": [{ "billed_charge": 1200.00, "npi": [1386980985] } ] } ] }, { "tin": { "type": "ein", "value": "223894435" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 4489.20, "providers": [{ "billed_charge": 800.00, "npi": [1598938508] } ] } ] }, { "tin": { "type": "ein", "value": "881451385" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5764.66, "providers": [{ "billed_charge": 16016.00, "npi": [1265178065] } ] } ] }, { "tin": { "type": "ein", "value": "262134748" }, "service_code": ["61"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.16, "providers": [{ "billed_charge": 600.00, "npi": [1306019450] } ] } ] } ] }, { "name": "SUBSEQUENT HOSPITAL CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821308807" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6769.05, "providers": [{ "billed_charge": 8100.00, "npi": [1568992923] } ] } ] }, { "tin": { "type": "ein", "value": "873192478" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 4277.72, "providers": [{ "billed_charge": 1200.00, "npi": [1821755422] } ] } ] }, { "tin": { "type": "ein", "value": "222785804" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 5764.80, "providers": [{ "billed_charge": 7611.00, "npi": [1386739332] } ] } ] }, { "tin": { "type": "ein", "value": "475397655" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 576.16, "providers": [{ "billed_charge": 1120.00, "npi": [1902279656] } ] } ] }, { "tin": { "type": "ein", "value": "263872254" }, "service_code": ["52", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 10520.37, "providers": [{ "billed_charge": 2700.00, "npi": [1437389616] } ] }, { "allowed_amount": 677.68, "providers": [{ "billed_charge": 600.00, "npi": [1437389616] } ] } ] }, { "tin": { "type": "ein", "value": "274147588" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 5740.00, "providers": [{ "billed_charge": 868.00, "npi": [1386674869] } ] } ] }, { "tin": { "type": "ein", "value": "223894435" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 16230.94, "providers": [{ "billed_charge": 3600.00, "npi": [1598938508] } ] } ] }, { "tin": { "type": "ein", "value": "871458415" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 21509.04, "providers": [{ "billed_charge": 16225.05, "npi": [1801466826] } ] } ] }, { "tin": { "type": "ein", "value": "920479309" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 876.44, "providers": [{ "billed_charge": 2543.00, "npi": [1932824638] } ] } ] }, { "tin": { "type": "ein", "value": "953998577" }, "service_code": ["52", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2012.93, "providers": [{ "billed_charge": 3200.00, "npi": [1063540938] } ] }, { "allowed_amount": 219.11, "providers": [{ "billed_charge": 400.00, "npi": [1063540938] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2890.25, "providers": [{ "billed_charge": 3285.00, "npi": [1104889138] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800212487" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 4143.48, "providers": [{ "billed_charge": 5041.75, "npi": [1134355597] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 9074.19, "providers": [{ "billed_charge": 8658.00, "npi": [1326346438] } ] } ] }, { "tin": { "type": "ein", "value": "954534163" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 2634.40, "providers": [{ "billed_charge": 1755.00, "npi": [1184048712] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 6125.40, "providers": [{ "billed_charge": 6056.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "954873894" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 15587.70, "providers": [{ "billed_charge": 20332.26, "npi": [1235176702] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 30890.80, "providers": [{ "billed_charge": 28402.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 15457.91, "providers": [{ "billed_charge": 21353.58, "npi": [1588960413] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 21523.60, "providers": [{ "billed_charge": 23096.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 22692.95, "providers": [{ "billed_charge": 24854.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 24329.00, "providers": [{ "billed_charge": 24057.00, "npi": [1861432627] } ] } ] } ] }, { "name": "EMERGENCY DEPT VISIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99285", "description": "EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800212487" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5781.37, "providers": [{ "billed_charge": 10417.68, "npi": [1134355597] } ] } ] }, { "tin": { "type": "ein", "value": "952835184" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3888.61, "providers": [{ "billed_charge": 8792.00, "npi": [1689636730] } ] } ] }, { "tin": { "type": "ein", "value": "464467849" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 8504.90, "providers": [{ "billed_charge": 9598.00, "npi": [1649692716] } ] } ] }, { "tin": { "type": "ein", "value": "934387494" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 14685.65, "providers": [{ "billed_charge": 15549.00, "npi": [1912771569] } ] } ] }, { "tin": { "type": "ein", "value": "954534163" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17544.29, "providers": [{ "billed_charge": 20008.00, "npi": [1184048712] } ] } ] }, { "tin": { "type": "ein", "value": "320595156" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 16636.82, "providers": [{ "billed_charge": 16504.00, "npi": [1598362568] } ] } ] }, { "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 97000.97, "providers": [{ "billed_charge": 97601.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "274752989" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 15731.82, "providers": [{ "billed_charge": 29764.96, "npi": [1588960413] } ] } ] }, { "tin": { "type": "ein", "value": "462690851" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 17308.60, "providers": [{ "billed_charge": 18885.00, "npi": [1710315353] } ] } ] }, { "tin": { "type": "ein", "value": "943302301" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 22113.90, "providers": [{ "billed_charge": 24507.00, "npi": [1447288345] } ] } ] }, { "tin": { "type": "ein", "value": "954558726" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 7200.10, "providers": [{ "billed_charge": 8464.00, "npi": [1104889138] } ] } ] }, { "tin": { "type": "ein", "value": "770528560" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 32819.57, "providers": [{ "billed_charge": 33540.00, "npi": [1861432627] } ] } ] }, { "tin": { "type": "ein", "value": "871451688" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 5597.31, "providers": [{ "billed_charge": 6889.08, "npi": [1124698139] } ] } ] }, { "tin": { "type": "ein", "value": "943278555" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 13530.32, "providers": [{ "billed_charge": 13365.00, "npi": [1134110661] } ] } ] }, { "tin": { "type": "ein", "value": "942494000" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 21999.07, "providers": [{ "billed_charge": 26885.00, "npi": [1477508984] } ] }, { "allowed_amount": 2367.53, "providers": [{ "billed_charge": 2830.00, "npi": [1326346438] } ] }, { "allowed_amount": 12952.13, "providers": [{ "billed_charge": 28300.00, "npi": [1396044491] } ] } ] }, { "tin": { "type": "ein", "value": "954873894" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1291.70, "providers": [{ "billed_charge": 1722.27, "npi": [1235176702] } ] } ] }, { "tin": { "type": "ein", "value": "274096788" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 13937.38, "providers": [{ "billed_charge": 19347.12, "npi": [1972953230] } ] } ] } ] }, { "name": "CRITICAL CARE, FIRST HOUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99291", "description": "CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "825362420" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 908.00, "providers": [{ "billed_charge": 1667.00, "npi": [1306311576] } ] } ] }, { "tin": { "type": "ein", "value": "823371276" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 8612.53, "providers": [{ "billed_charge": 55180.91, "npi": [1023522554] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99308", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "853351517" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 397.50, "providers": [{ "billed_charge": 450.00, "npi": [1356944235] } ] } ] } ] }, { "name": "NURSING FAC CARE SUBSEQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99309", "description": "SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821938082" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 1618.98, "providers": [{ "billed_charge": 1980.00, "npi": [1497265565] } ] } ] }, { "tin": { "type": "ein", "value": "842599550" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 20398.20, "providers": [{ "billed_charge": 6000.00, "npi": [1447806278] } ] } ] }, { "tin": { "type": "ein", "value": "883982344" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 434.64, "providers": [{ "billed_charge": 504.00, "npi": [1669192472] } ] } ] } ] }, { "name": "Under Other Evaluation and Management Services", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99459", "description": "Under Other Evaluation and Management Services", "allowed_amounts": [{ "tin": { "type": "ein", "value": "263147146" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 744.62, "providers": [{ "billed_charge": 222.00, "npi": [1598906166] } ] } ] } ] }, { "name": "PED CRIT CARE AGE 2-5 SUBSQ", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "99476", "description": "SUBSEQUENT INPATIENT PEDIATRIC CRITICAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A CRITIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "232592835" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 236375.80, "providers": [{ "billed_charge": 243606.00, "npi": [1497850291] } ] } ] } ] }, { "name": "TUBING FOR BREAST PUMP REPLA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4281", "description": "TUBING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1969.70, "providers": [{ "billed_charge": 421.42, "npi": [1477222834] } ] } ] } ] }, { "name": "ADAPTER FOR BREAST PUMP REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4282", "description": "ADAPTER FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2127.09, "providers": [{ "billed_charge": 540.64, "npi": [1477222834] } ] } ] } ] }, { "name": "CAP BRST PUMP BOTLE REPLCMNT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4283", "description": "CAP FOR BREAST PUMP BOTTLE, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2074.83, "providers": [{ "billed_charge": 119.46, "npi": [1477222834] } ] } ] } ] }, { "name": "BRST SHIELD&SPLSH PROTCTR PU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4284", "description": "BREAST SHIELD AND SPLASH PROTECTOR FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2195.35, "providers": [{ "billed_charge": 200.86, "npi": [1477222834] } ] } ] } ] }, { "name": "POLYCARBATE BOTTLE BRST PUMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4285", "description": "POLYCARBONATE BOTTLE FOR USE WITH BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1939.55, "providers": [{ "billed_charge": 186.78, "npi": [1477222834] } ] } ] } ] }, { "name": "LOCKING RING BRST PUMP REPLC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4286", "description": "LOCKING RING FOR BREAST PUMP, REPLACEMENT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2357.37, "providers": [{ "billed_charge": 164.89, "npi": [1477222834] } ] } ] } ] }, { "name": "Disposable collection and storage bag for breast milk, any size, any type, each", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4287", "description": "Disposable collection and storage bag for breast milk, any size, any type, each", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6844.90, "providers": [{ "billed_charge": 3557.40, "npi": [1477222834] } ] } ] } ] }, { "name": "INTERMIT URIN CATH; COUDE TI", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4352", "description": "INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "332155824" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3080.80, "providers": [{ "billed_charge": 2350.00, "npi": [1093525552] } ] } ] } ] }, { "name": "ELEC STIM SPPLS 2 LD PER MTH", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4595", "description": "ELECTRICAL STIMULATOR SUPPLIES, 2 LEAD, PER MONTH, (E.G., TENS, NMES)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841451963" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1284.09, "providers": [{ "billed_charge": 1416.87, "npi": [1770511552] } ] } ] } ] }, { "name": "TUBING W/INTGR HEAT ELEM W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4604", "description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11530.85, "providers": [{ "billed_charge": 1861.90, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2599.76, "providers": [{ "billed_charge": 625.00, "npi": [1144767542] } ] } ] } ] }, { "name": "FULL FCE MASK POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7030", "description": "FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5223.35, "providers": [{ "billed_charge": 2021.26, "npi": [1477222834] } ] } ] } ] }, { "name": "FCE MASK INTERFCE REPL FULL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7031", "description": "FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4929.24, "providers": [{ "billed_charge": 1974.33, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 233.34, "providers": [{ "billed_charge": 280.00, "npi": [1144767542] } ] } ] } ] }, { "name": "CUSHN NASAL MASK INTF REPL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7032", "description": "CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2105.68, "providers": [{ "billed_charge": 1103.40, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 49.86, "providers": [{ "billed_charge": 100.00, "npi": [1144767542] } ] } ] } ] }, { "name": "PILLW NASL CANNULA TYPE INTF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7033", "description": "PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2184.89, "providers": [{ "billed_charge": 1010.70, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2140.70, "providers": [{ "billed_charge": 2555.00, "npi": [1144767542] } ] } ] } ] }, { "name": "NASL INTERFCE POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7034", "description": "NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 337.59, "providers": [{ "billed_charge": 201.36, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6892.16, "providers": [{ "billed_charge": 1880.24, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3312.47, "providers": [{ "billed_charge": 1815.00, "npi": [1144767542] } ] } ] } ] }, { "name": "HEADGEAR USED W/POS ARWAY PR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7035", "description": "HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3670.99, "providers": [{ "billed_charge": 742.83, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8506.49, "providers": [{ "billed_charge": 775.95, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1483.07, "providers": [{ "billed_charge": 310.00, "npi": [1144767542] } ] } ] } ] }, { "name": "TUBING USED W/POS ARWAY PRES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7037", "description": "TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 804.82, "providers": [{ "billed_charge": 131.40, "npi": [1174749972] } ] } ] } ] }, { "name": "FLTR DISPBL W/POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7038", "description": "FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4392.34, "providers": [{ "billed_charge": 578.75, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 17326.21, "providers": [{ "billed_charge": 1033.93, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5918.26, "providers": [{ "billed_charge": 1674.00, "npi": [1144767542] } ] } ] } ] }, { "name": "WATR CHAMB HUMDIFIR USED W/P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7046", "description": "WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3712.39, "providers": [{ "billed_charge": 244.42, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 162.29, "providers": [{ "billed_charge": 15.00, "npi": [1144767542] } ] } ] } ] }, { "name": "INJ GADOTERATE MEGLMNE 0.1ML", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9575", "description": "INJECTION, GADOTERATE MEGLUMINE, 0.1 ML", "allowed_amounts": [{ "tin": { "type": "ein", "value": "956419205" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1966.64, "providers": [{ "billed_charge": 1984.64, "npi": [1932121514] } ] } ] } ] }, { "name": "HOS BED SEMI-ELEC W/O RAIL/M", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0295", "description": "HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITHOUT SIDE RAILS, WITHOUT MATTRESS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "861528117" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 881.85, "providers": [{ "billed_charge": 390.00, "npi": [1487239562] } ] } ] } ] }, { "name": "HUMDIFIR HEAT USED W/POS ARW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0562", "description": "HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 21348.25, "providers": [{ "billed_charge": 7117.67, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3022.00, "providers": [{ "billed_charge": 1006.44, "npi": [1477222834] } ] } ] } ] }, { "name": "NEBULIZER WITH COMPRESSOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0570", "description": "NEBULIZER, WITH COMPRESSOR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 154.39, "providers": [{ "billed_charge": 181.79, "npi": [1174749972] } ] } ] } ] }, { "name": "CONTINUOUS POS AIRWAY PRESSU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0601", "description": "CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "770573175" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 18868.15, "providers": [{ "billed_charge": 19494.10, "npi": [1174749972] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6195.07, "providers": [{ "billed_charge": 5142.58, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "452683127" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.83, "providers": [{ "billed_charge": 65.00, "npi": [1144767542] } ] } ] } ] }, { "name": "BREAST PUMP ELECTRIC ANY TYP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0603", "description": "BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11289.94, "providers": [{ "billed_charge": 8805.50, "npi": [1477222834] } ] } ] } ] }, { "name": "O2 CONC 85%/>02 CONC PRSC FL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1390", "description": "OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2352.38, "providers": [{ "billed_charge": 1520.92, "npi": [1477222834] } ] } ] } ] }, { "name": "SCR CERV/VAG AUTO&MNL RSCR P", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0145", "description": "SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "870737749" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 921.14, "providers": [{ "billed_charge": 931.40, "npi": [1427034990] } ] } ] } ] }, { "name": "E-STIM 1/>NOT WND CARE PART", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0283", "description": "ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A", "allowed_amounts": [{ "tin": { "type": "ein", "value": "994428451" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5904.57, "providers": [{ "billed_charge": 870.00, "npi": [1720883275] } ] } ] }, { "tin": { "type": "ein", "value": "943015532" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 261.19, "providers": [{ "billed_charge": 68.16, "npi": [1336295138] } ] } ] }, { "tin": { "type": "ein", "value": "460486182" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1270.62, "providers": [{ "billed_charge": 540.00, "npi": [1558512327] } ] } ] }, { "tin": { "type": "ein", "value": "821526564" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5618.68, "providers": [{ "billed_charge": 268.80, "npi": [1255900296] } ] } ] } ] }, { "name": "DIR SNS RN HH/HOSPICE SET EA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0299", "description": "DIRECT SKILLED NURSING SERVICES OF A REGISTERED NURSE (RN) IN THE HOME HEALTH OR HOSPICE SETTING, EA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13116.20, "providers": [{ "billed_charge": 12112.50, "npi": [1770307274] } ] } ] } ] }, { "name": "INTENS CARD REHAB; W/WO ECG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0422", "description": "INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING WITH EXERCISE, PER SESSI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "874036448" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 730.23, "providers": [{ "billed_charge": 720.00, "npi": [1184385684] } ] } ] } ] }, { "name": "INTENS CARD REHAB; W/WO ECG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0423", "description": "INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING; WITHOUT EXERCISE, PER S", "allowed_amounts": [{ "tin": { "type": "ein", "value": "874036448" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 608.40, "providers": [{ "billed_charge": 360.00, "npi": [1184385684] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 1-7", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0480", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453717894" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 824.98, "providers": [{ "billed_charge": 1584.00, "npi": [1730466590] } ] } ] }, { "tin": { "type": "ein", "value": "843172409" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 25636.47, "providers": [{ "billed_charge": 41593.50, "npi": [1003437500] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 8-1", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0481", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "813115799" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20223.32, "providers": [{ "billed_charge": 21370.80, "npi": [1306381694] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 22/", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0483", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "920971049" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7009.70, "providers": [{ "billed_charge": 19800.00, "npi": [1952189086] } ] } ] } ] }, { "name": "MED ASST TX METHADONE;WEEKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2067", "description": "MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "462568903" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 9160.50, "providers": [{ "billed_charge": 11304.00, "npi": [1841356490] } ] }, { "allowed_amount": 7955.90, "providers": [{ "billed_charge": 10362.00, "npi": [1740346303] } ] } ] } ] }, { "name": "VISIT CPLX INHERENT E&M ASSO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2211", "description": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "262998718" }, "service_code": ["22", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1244.00, "providers": [{ "billed_charge": 159.00, "npi": [1376709535] } ] }, { "allowed_amount": 589.00, "providers": [{ "billed_charge": 58.00, "npi": [1376709535] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 2733.76, "providers": [{ "billed_charge": 533.61, "npi": [1538297726] } ] }, { "allowed_amount": 1859.21, "providers": [{ "billed_charge": 296.45, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "954373071" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 858.00, "providers": [{ "billed_charge": 90.00, "npi": [1235107566] } ] } ] }, { "tin": { "type": "ein", "value": "770465765" }, "service_code": ["22", "11", "19", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 801.04, "providers": [{ "billed_charge": 159.00, "npi": [1437292927] } ] }, { "allowed_amount": 1244.35, "providers": [{ "billed_charge": 318.00, "npi": [1437292927] } ] }, { "allowed_amount": 229.00, "providers": [{ "billed_charge": 86.00, "npi": [1437292927] } ] }, { "allowed_amount": 150.00, "providers": [{ "billed_charge": 86.00, "npi": [1437292927] } ] } ] } ] }, { "name": "BMI DOC ABV NML PARAM & F/U", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G8417", "description": "BMI IS DOCUMENTED ABOVE NORMAL PARAMETERS AND A FOLLOW-UP PLAN IS DOCUMENTED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8523.00, "providers": [{ "billed_charge": 0.00, "npi": [1275581894] } ] } ] } ] }, { "name": "ELIG CLIN DOC M UPDTD REC PT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G8427", "description": "ELIGIBLE CLINICIAN ATTESTS TO DOCUMENTING IN THE MEDICAL RECORD THEY OBTAINED, UPDATED, OR REVIEWED ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "900110660" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 158.23, "providers": [{ "billed_charge": 0.01, "npi": [1528150562] } ] } ] } ] }, { "name": "SCR DEPR DOC NEG A F/U PLAN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G8510", "description": "SCREENING FOR DEPRESSION IS DOCUMENTED AS NEGATIVE, A FOLLOW-UP PLAN IS NOT REQUIRED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "900110660" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.55, "providers": [{ "billed_charge": 0.02, "npi": [1528150562] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC;METHDONE ADM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0020", "description": "ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330234191" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 892.80, "providers": [{ "billed_charge": 744.00, "npi": [1316040223] } ] } ] } ] }, { "name": "MENTL HLTH SVC PLAN DVLP NON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0032", "description": "MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NONPHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464150758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7507.50, "providers": [{ "billed_charge": 3213.00, "npi": [1871915678] } ] } ] } ] }, { "name": "THERAPEUTIC BEHAVIORAL SRVC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H2019", "description": "THERAPEUTIC BEHAVIORAL SERVICES, PER 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "270407388" }, "service_code": ["11", "12", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 7014.90, "providers": [{ "billed_charge": 3989.85, "npi": [1134467657] } ] }, { "allowed_amount": 6649.46, "providers": [{ "billed_charge": 4680.00, "npi": [1134467657] } ] }, { "allowed_amount": 35820.83, "providers": [{ "billed_charge": 18130.20, "npi": [1134467657] } ] } ] }, { "tin": { "type": "ein", "value": "330599891" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1130.50, "providers": [{ "billed_charge": 260.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "464150758" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 83998.94, "providers": [{ "billed_charge": 18480.00, "npi": [1871915678] } ] } ] }, { "tin": { "type": "ein", "value": "871819080" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7856.00, "providers": [{ "billed_charge": 4800.00, "npi": [1326778648] } ] } ] } ] }, { "name": "BOTULINUM TOXIN TYPE A PER U", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0585", "description": "INJECTION, ONABOTULINUMTOXINA, 1 UNIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330102201" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 35527.40, "providers": [{ "billed_charge": 22620.00, "npi": [1003860537] } ] } ] } ] }, { "name": "INJ CEFTRIAXONE SODM PER 250", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0696", "description": "INJECTION, CEFTRIAXONE SODIUM, PER 250 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274694772" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1120.00, "providers": [{ "billed_charge": 1164.00, "npi": [1982900973] } ] } ] } ] }, { "name": "INJ TESTOSTERONE CYPION 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1071", "description": "INJECTION, TESTOSTERONE CYPIONATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "863038792" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 801.12, "providers": [{ "billed_charge": 67.20, "npi": [1659950475] } ] } ] } ] }, { "name": "INJ TRIAMCINOLON ACETONID NO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3301", "description": "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330645967" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.72, "providers": [{ "billed_charge": 72.00, "npi": [1649503319] } ] } ] } ] }, { "name": "INJ VIT B-12 CYNOCOBLMN TO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3420", "description": "INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1,000 MCG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330652678" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1756.20, "providers": [{ "billed_charge": 140.00, "npi": [1275581894] } ] } ] } ] }, { "name": "UNCLASSIFIED DRUGS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3490", "description": "UNCLASSIFIED DRUGS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822331839" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4046.13, "providers": [{ "billed_charge": 1060.00, "npi": [1447774344] } ] } ] }, { "tin": { "type": "ein", "value": "474634585" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3217.81, "providers": [{ "billed_charge": 5849.73, "npi": [1194185421] } ] } ] }, { "tin": { "type": "ein", "value": "843662617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 429.61, "providers": [{ "billed_charge": 550.00, "npi": [1457324204] } ] } ] }, { "tin": { "type": "ein", "value": "831448655" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 948.62, "providers": [{ "billed_charge": 900.00, "npi": [1588253678] } ] } ] } ] }, { "name": "HOME INFUS TX CATH CARE SIMP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S5498", "description": "HOME INFUSION THERAPY, CATHETER CARE/MAINTENANCE, SIMPLE (SINGLE LUMEN), INCLUDES ADMINISTRATIVE SER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "330307672" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2059.17, "providers": [{ "billed_charge": 750.00, "npi": [1699396655] } ] } ] } ] }, { "name": "GLBAL FEE URGNT CARE CENTERS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9083", "description": "GLOBAL FEE URGENT CARE CENTERS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471758444" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 180.00, "providers": [{ "billed_charge": 616.00, "npi": [1679970891] } ] } ] }, { "tin": { "type": "ein", "value": "463164188" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 5655.00, "providers": [{ "billed_charge": 12952.00, "npi": [1134546575] } ] } ] }, { "tin": { "type": "ein", "value": "934895258" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 5304.63, "providers": [{ "billed_charge": 6700.00, "npi": [1114798071] } ] } ] }, { "tin": { "type": "ein", "value": "593209688" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 211.00, "providers": [{ "billed_charge": 326.00, "npi": [1073565610] } ] } ] }, { "tin": { "type": "ein", "value": "10790511" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1899.00, "providers": [{ "billed_charge": 4480.00, "npi": [1033195474] } ] } ] } ] }, { "name": "SERVICES PROV AN URGENT CARE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9088", "description": "SERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR SERVICE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208785833" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1262.87, "providers": [{ "billed_charge": 200.00, "npi": [1013163914] } ] } ] } ] }, { "name": "NRS CARE HOM; REGISTERED NUR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9123", "description": "NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331893598" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 14137.71, "providers": [{ "billed_charge": 9975.00, "npi": [1770307274] } ] } ] } ] }, { "name": "NRS CARE THE HOME LPN PER HR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9124", "description": "NURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "272187916" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 50734.81, "providers": [{ "billed_charge": 53280.00, "npi": [1548685910] } ] } ] } ] }, { "name": "HOME TX; ENTERAL NUTRITION;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9340", "description": "HOME THERAPY; ENTERAL NUTRITION; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE COORD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "942847303" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3300.00, "providers": [{ "billed_charge": 110.00, "npi": [1316940646] } ] } ] } ] }, { "name": "INTNSVE OP PSYC SVC PER DIEM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9480", "description": "INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "680344702" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 19666.20, "providers": [{ "billed_charge": 34914.00, "npi": [1962482513] } ] } ] } ] }, { "name": "HIT ANTIBIOTIC/ANTIFUNGAL; Q", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9500", "description": "HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 24 HOURS; ADMINISTRA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "274694772" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 79670.00, "providers": [{ "billed_charge": 7150.00, "npi": [1982900973] } ] } ] }, { "tin": { "type": "ein", "value": "330307672" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 50107.87, "providers": [{ "billed_charge": 13818.00, "npi": [1699396655] } ] } ] } ] }, { "name": "TELEHEALTH TRANS MIN PROF SR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "T1014", "description": "TELEHEALTH TRANSMISSION, PER MINUTE, PROFESSIONAL SERVICES BILL SEPARATELY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "943281657" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 17019.33, "providers": [{ "billed_charge": 292.67, "npi": [1164512851] } ] } ] } ] }, { "name": "SNF PDPM HIPPS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "ZZZZZ", "description": "SNF PDPM HIPPS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "474591265" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 28925.75, "providers": [{ "billed_charge": 0.00, "npi": [1699146456] } ] } ] }, { "tin": { "type": "ein", "value": "202536458" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.96, "providers": [{ "billed_charge": 0.00, "npi": [1477222834] } ] } ] }, { "tin": { "type": "ein", "value": "870737749" }, "service_code": ["11", "02", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 917.01, "providers": [{ "billed_charge": 0.00, "npi": [1720279805] } ] }, { "allowed_amount": 6034.45, "providers": [{ "billed_charge": 0.00, "npi": [1538297726] } ] }, { "allowed_amount": 1196.72, "providers": [{ "billed_charge": 0.00, "npi": [1538297726] } ] } ] }, { "tin": { "type": "ein", "value": "455513255" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2477.40, "providers": [{ "billed_charge": 0.00, "npi": [1992326730] } ] } ] }, { "tin": { "type": "ein", "value": "840175870" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1042.52, "providers": [{ "billed_charge": 0.00, "npi": [1609822030] } ] } ] }, { "tin": { "type": "ein", "value": "872475176" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 24031.72, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] }, { "allowed_amount": 1995.39, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] }, { "allowed_amount": 1472.48, "providers": [{ "billed_charge": 0.00, "npi": [1174292866] } ] } ] } ] } ] }