{"reporting_entity_name": "Oscar Health", "reporting_entity_type": "Health Insurance Issuer", "plan_id": "74289NY277", "last_updated_on": "2024-12-23", "version": "1.0.0", "out_of_network": [{"name": "Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)", "billing_code_type": "CPT", "billing_code": "80048", "billing_code_type_version": "2022", "description": "Blood test, basic group of blood chemicals (Calcium, total)", "allowed_amounts": [{"tin": {"type": "ein", "value": "060646917"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.61, "providers": [{"billed_charge": 92.61, "npi": [1356331425]}]}]}, {"tin": {"type": "ein", "value": "111661359"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 157.0, "npi": [1386649804]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 28.04, "providers": [{"billed_charge": 277.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 7.19, "providers": [{"billed_charge": 51.0, "npi": [1366543795]}, {"billed_charge": 74.44, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 27.16, "providers": [{"billed_charge": 124.07, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 27.16, "providers": [{"billed_charge": 124.07, "npi": [1952332801, 1194832477]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 62.61, "providers": [{"billed_charge": 178.89, "npi": [1376587113, 1619341716, 1801992631]}]}, {"allowed_amount": 92.61, "providers": [{"billed_charge": 264.6, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "221487576"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 64.75, "providers": [{"billed_charge": 187.0, "npi": [1457456279]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 21.66, "providers": [{"billed_charge": 80.0, "npi": [1477596310]}]}]}]}, {"name": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count", "billing_code_type": "CPT", "billing_code": "85025", "billing_code_type_version": "2022", "description": "Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count", "allowed_amounts": [{"tin": {"type": "ein", "value": "042103881"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 52.13, "providers": [{"billed_charge": 70.0, "npi": [1548202641]}]}]}, {"tin": {"type": "ein", "value": "060646652"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 46.62, "providers": [{"billed_charge": 46.62, "npi": [1578778726]}]}]}, {"tin": {"type": "ein", "value": "060646917"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 61.21, "providers": [{"billed_charge": 71.93, "npi": [1356331425]}]}]}, {"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 6.6, "providers": [{"billed_charge": 31.08, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 41.2, "providers": [{"billed_charge": 167.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 6.6, "providers": [{"billed_charge": 30.0, "npi": [1366543795]}, {"billed_charge": 39.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "113558495"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 6.6, "providers": [{"billed_charge": 43.8, "npi": [1194744185]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 21.72, "providers": [{"billed_charge": 102.7, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 21.72, "providers": [{"billed_charge": 99.73, "npi": [1952332801]}, {"billed_charge": 102.7, "npi": [1780196345, 1194832477]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 21.72, "providers": [{"billed_charge": 89.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 48.51, "providers": [{"billed_charge": 138.61, "npi": [1619341716, 1801992631]}]}, {"allowed_amount": 92.61, "providers": [{"billed_charge": 264.6, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "203734391"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 6.6, "providers": [{"billed_charge": 23.31, "npi": [1053584482]}]}]}, {"tin": {"type": "ein", "value": "221487576"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 46.07, "providers": [{"billed_charge": 150.0, "npi": [1457456279]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.08, "providers": [{"billed_charge": 75.0, "npi": [1477596310]}]}]}, {"tin": {"type": "ein", "value": "660677706"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 35.1, "providers": [{"billed_charge": 35.1, "npi": [1467417865]}]}]}]}, {"name": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520)", "billing_code_type": "CPT", "billing_code": "80053", "billing_code_type_version": "2022", "description": "Blood test, comprehensive group of blood chemicals", "allowed_amounts": [{"tin": {"type": "ein", "value": "060646652"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.36, "providers": [{"billed_charge": 63.36, "npi": [1578778726]}]}]}, {"tin": {"type": "ein", "value": "111562701"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 260.0, "npi": [1366459570]}]}]}, {"tin": {"type": "ein", "value": "111630914"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 407.0, "npi": [1508845322]}]}]}, {"tin": {"type": "ein", "value": "111639818"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 331.0, "npi": [1093718728]}]}]}, {"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.98, "providers": [{"billed_charge": 42.24, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "112241326"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 260.0, "npi": [1285641514]}]}]}, {"tin": {"type": "ein", "value": "112868878"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 233.0, "npi": [1407877137]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.98, "providers": [{"billed_charge": 75.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "113558495"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.98, "providers": [{"billed_charge": 59.88, "npi": [1194744185]}]}]}, {"tin": {"type": "ein", "value": "131740118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 106.0, "npi": [1912992215]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 26.86, "providers": [{"billed_charge": 117.15, "npi": [1780196345, 1952332801]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 26.86, "providers": [{"billed_charge": 120.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 113.93, "providers": [{"billed_charge": 325.51, "npi": [1801992631]}]}, {"allowed_amount": 329.28, "providers": [{"billed_charge": 940.8, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "203734391"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.98, "providers": [{"billed_charge": 31.68, "npi": [1053584482]}]}]}, {"tin": {"type": "ein", "value": "621762537"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 730.8, "providers": [{"billed_charge": 2088.0, "npi": [1861439952]}]}]}, {"tin": {"type": "ein", "value": "660677706"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 95.08, "providers": [{"billed_charge": 95.08, "npi": [1467417865]}]}]}]}, {"name": "Computed tomography, abdomen and pelvis; with contrast material(s)", "billing_code_type": "CPT", "billing_code": "74177", "billing_code_type_version": "2022", "description": "CT scan of abdomen and pelvis with contrast", "allowed_amounts": [{"tin": {"type": "ein", "value": "043194547"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 231.0, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 231.0, "npi": [1043509151]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 153.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 437.0, "npi": [1881011930, 1851484091]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 460.21, "providers": [{"billed_charge": 3201.0, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2888.19, "providers": [{"billed_charge": 8251.96, "npi": [1801992631]}]}]}, {"tin": {"type": "ein", "value": "135562308"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 153.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 650.0, "npi": [1407097249, 1770921132, 1548250236, 1932463478]}]}, {"allowed_amount": 172.3, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 650.0, "npi": [1053774778]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1080.49, "providers": [{"billed_charge": 3135.0, "npi": [1477596310]}]}]}, {"tin": {"type": "ein", "value": "300868541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 142.3, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 256.0, "npi": [1801822721]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 153.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 447.44, "npi": [1962572024, 1578738852, 1952321036, 1437531191]}]}]}, {"tin": {"type": "ein", "value": "474131755"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 863.65, "providers": [{"billed_charge": 14312.0, "npi": [1538535158]}]}]}, {"tin": {"type": "ein", "value": "591226176"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 112.76, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1471.0, "npi": [1689641136]}]}]}, {"tin": {"type": "ein", "value": "824944510"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 99.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 320.0, "npi": [1982801700]}]}]}, {"tin": {"type": "ein", "value": "844522008"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 153.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1471.0, "npi": [1245274844, 1699980615]}]}, {"allowed_amount": 172.3, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1471.0, "npi": [1902865355]}]}]}]}, {"name": "Computed tomography, head or brain; without contrast material", "billing_code_type": "CPT", "billing_code": "70450", "billing_code_type_version": "2022", "description": "CT scan head or brain without contrast", "allowed_amounts": [{"tin": {"type": "ein", "value": "112548304"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 294.0, "npi": [1881729960]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 933.61, "providers": [{"billed_charge": 2800.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113437030"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 110.0, "npi": [1790971489]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 205.0, "npi": [1801917240]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 737.45, "providers": [{"billed_charge": 2353.0, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1154.09, "providers": [{"billed_charge": 3297.4, "npi": [1801992631]}]}, {"allowed_amount": 1703.82, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 4868.05, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "135562308"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 307.0, "npi": [1588690960, 1821527490]}]}]}, {"tin": {"type": "ein", "value": "221487576"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 487.4, "providers": [{"billed_charge": 2158.0, "npi": [1457456279]}]}]}, {"tin": {"type": "ein", "value": "300868541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 65.86, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 119.0, "npi": [1801822721]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 207.41, "npi": [1740421528, 1922361666, 1619268174]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 84.35, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 165.0, "npi": [1538503909]}]}]}, {"tin": {"type": "ein", "value": "474718253"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1199.28, "providers": [{"billed_charge": 2667.0, "npi": [1588141048]}]}]}, {"tin": {"type": "ein", "value": "620963389"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 88.76, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1306985171]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 417.27, "providers": [{"billed_charge": 1245.0, "npi": [1528052578]}]}]}, {"tin": {"type": "ein", "value": "621762537"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2835.0, "providers": [{"billed_charge": 8100.0, "npi": [1861439952]}]}]}, {"tin": {"type": "ein", "value": "810306157"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 64.6, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 256.0, "npi": [1851612782]}]}]}, {"tin": {"type": "ein", "value": "844522008"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 71.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 554.0, "npi": [1437560430]}]}, {"allowed_amount": 84.35, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 87.34, "npi": [1043279565]}, {"billed_charge": 554.0, "npi": [1043279565]}]}]}]}, {"name": "Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service", "billing_code_type": "CPT", "billing_code": "80307", "billing_code_type_version": "2022", "description": "Testing for presence of drug, by chemistry analyzers", "allowed_amounts": [{"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 173.95, "providers": [{"billed_charge": 706.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113558495"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 52.82, "providers": [{"billed_charge": 405.0, "npi": [1194744185]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 82.6, "providers": [{"billed_charge": 173.01, "npi": [1780196345]}, {"billed_charge": 190.26, "npi": [1770502635]}]}]}, {"tin": {"type": "ein", "value": "264257939"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 52.82, "providers": [{"billed_charge": 155.35, "npi": [1417283623]}]}]}, {"tin": {"type": "ein", "value": "465330784"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 52.82, "providers": [{"billed_charge": 155.0, "npi": [1932586427]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 198.61, "providers": [{"billed_charge": 360.0, "npi": [1528052578]}]}]}, {"tin": {"type": "ein", "value": "621762537"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 684.25, "providers": [{"billed_charge": 1955.0, "npi": [1861439952]}]}]}, {"tin": {"type": "ein", "value": "880241758"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 52.82, "providers": [{"billed_charge": 242.0, "npi": [1699782722]}]}]}]}, {"name": "Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only", "billing_code_type": "CPT", "billing_code": "93010", "billing_code_type_version": "2022", "description": "Routine electrocardiogram (ECG) using at least 12 leads with interpretation and report only", "allowed_amounts": [{"tin": {"type": "ein", "value": "020657245"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.52, "providers": [{"billed_charge": 116.0, "npi": [1760562409]}]}]}, {"tin": {"type": "ein", "value": "043662272"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 55.0, "npi": [1063485803]}]}]}, {"tin": {"type": "ein", "value": "051724745"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1962648022]}]}]}, {"tin": {"type": "ein", "value": "079466356"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1447283940]}]}]}, {"tin": {"type": "ein", "value": "099601938"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.98, "providers": [{"billed_charge": 55.0, "npi": [1295985265]}]}]}, {"tin": {"type": "ein", "value": "109701093"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1396783999]}]}]}, {"tin": {"type": "ein", "value": "112558775"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.64, "providers": [{"billed_charge": 40.0, "npi": [1013932250]}]}]}, {"tin": {"type": "ein", "value": "122461637"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1659374973]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 40.0, "npi": [1568880516, 1275621542]}]}]}, {"tin": {"type": "ein", "value": "135598093"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 12.98, "providers": [{"billed_charge": 70.0, "npi": [1023054202, 1023314895]}]}, {"allowed_amount": 13.77, "providers": [{"billed_charge": 70.0, "npi": [1528145075]}]}]}, {"tin": {"type": "ein", "value": "136647829"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1629135629]}]}]}, {"tin": {"type": "ein", "value": "264517010"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 30.0, "npi": [1861455412]}]}]}, {"tin": {"type": "ein", "value": "264709927"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 19.01, "providers": [{"billed_charge": 32.0, "npi": [1508161993]}]}]}, {"tin": {"type": "ein", "value": "271331099"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 18.0, "npi": [1265695837]}]}]}, {"tin": {"type": "ein", "value": "273957752"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 44.0, "npi": [1942470794]}]}]}, {"tin": {"type": "ein", "value": "274326648"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 12.01, "providers": [{"billed_charge": 22.0, "npi": [1265520043]}]}]}, {"tin": {"type": "ein", "value": "274384326"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 44.0, "npi": [1306834072, 1528267523, 1386668499, 1134279151]}]}, {"allowed_amount": 13.77, "providers": [{"billed_charge": 44.0, "npi": [1104995075]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 44.0, "npi": [1306834072, 1497778930, 1619054723, 1689672339]}]}, {"allowed_amount": 13.77, "providers": [{"billed_charge": 44.0, "npi": [1134514144, 1215916721]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.64, "providers": [{"billed_charge": 34.0, "npi": [1750499653]}]}]}, {"tin": {"type": "ein", "value": "462916323"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.38, "providers": [{"billed_charge": 55.0, "npi": [1538426242]}]}]}, {"tin": {"type": "ein", "value": "562662502"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 34.0, "npi": [1295738904]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 17.57, "providers": [{"billed_charge": 17.57, "npi": [1487064283]}]}]}, {"tin": {"type": "ein", "value": "813149464"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 44.0, "npi": [1568450062]}]}]}, {"tin": {"type": "ein", "value": "900883864"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 13.77, "providers": [{"billed_charge": 22.0, "npi": [1679739551]}]}]}]}, {"name": "Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report", "billing_code_type": "CPT", "billing_code": "93005", "billing_code_type_version": "2022", "description": "Routine electrocardiogram (ECG) using at least 12 leads with tracing", "allowed_amounts": [{"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 266.14, "providers": [{"billed_charge": 447.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 157.43, "providers": [{"billed_charge": 487.0, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 157.43, "providers": [{"billed_charge": 596.0, "npi": [1952332801, 1770502635, 1194832477]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 180.53, "providers": [{"billed_charge": 515.81, "npi": [1619341716, 1801992631]}]}, {"allowed_amount": 224.46, "providers": [{"billed_charge": 641.3, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 157.0, "providers": [{"billed_charge": 157.0, "npi": [1528052578]}]}]}, {"tin": {"type": "ein", "value": "621762537"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 613.55, "providers": [{"billed_charge": 1753.0, "npi": [1861439952]}]}]}]}, {"name": "Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making", "billing_code_type": "CPT", "billing_code": "99285", "billing_code_type_version": "2022", "description": "Emergency department visit with high level of medical decision making", "allowed_amounts": [{"tin": {"type": "ein", "value": "020657245"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 756.48, "providers": [{"billed_charge": 1516.0, "npi": [1760562409]}]}]}, {"tin": {"type": "ein", "value": "060646917"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 841.46, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3882.93, "npi": [1356331425]}]}]}, {"tin": {"type": "ein", "value": "060646973"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 291.47, "providers": [{"billed_charge": 595.0, "npi": [1083685721]}]}]}, {"tin": {"type": "ein", "value": "113066770"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 519.78, "providers": [{"billed_charge": 520.0, "npi": [1154359495]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1842.48, "providers": [{"billed_charge": 4434.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113495935"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 521.0, "providers": [{"billed_charge": 521.0, "npi": [1114556024]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 519.78, "providers": [{"billed_charge": 545.0, "npi": [1295822385]}]}, {"allowed_amount": 545.0, "providers": [{"billed_charge": 545.0, "npi": [1043669831]}]}, {"allowed_amount": 580.0, "providers": [{"billed_charge": 580.0, "npi": [1992238703]}]}]}, {"tin": {"type": "ein", "value": "133911072"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 491.0, "providers": [{"billed_charge": 491.0, "npi": [1245400035]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 820.48, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4224.0, "npi": [1952332801, 1780196345]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2066.44, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5904.1, "npi": [1427616002, 1619341716, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "135598093"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 720.0, "providers": [{"billed_charge": 720.0, "npi": [1801391602]}]}]}, {"tin": {"type": "ein", "value": "208013577"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 729.47, "providers": [{"billed_charge": 1454.0, "npi": [1538328737, 1629090634]}]}]}, {"tin": {"type": "ein", "value": "270124205"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 519.78, "providers": [{"billed_charge": 1650.37, "npi": [1629356266]}]}, {"allowed_amount": 756.48, "providers": [{"billed_charge": 1650.37, "npi": [1386768356]}]}]}, {"tin": {"type": "ein", "value": "352574944"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 252.14, "providers": [{"billed_charge": 3522.0, "npi": [1396279600]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 519.78, "providers": [{"billed_charge": 1211.0, "npi": [1487957429, 1952961302]}]}, {"allowed_amount": 756.48, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1211.0, "npi": [1073953568, 1588820450, 1568447530, 1639639180, 1285677583, 1407084213, 1104358647]}]}]}, {"tin": {"type": "ein", "value": "464837698"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 307.87, "providers": [{"billed_charge": 1650.37, "npi": [1275505976]}]}]}, {"tin": {"type": "ein", "value": "474131755"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 406.31, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4848.0, "npi": [1538535158]}]}]}, {"tin": {"type": "ein", "value": "595028924"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 756.48, "providers": [{"billed_charge": 1107.0, "npi": [1912439910]}]}]}]}, {"name": "Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making", "billing_code_type": "CPT", "billing_code": "99283", "billing_code_type_version": "2022", "description": "Emergency department visit with low level of medical decision making", "allowed_amounts": [{"tin": {"type": "ein", "value": "070724236"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 400.0, "npi": [1376834358]}]}]}, {"tin": {"type": "ein", "value": "079723837"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 400.0, "npi": [1205012622]}]}]}, {"tin": {"type": "ein", "value": "111630914"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2654.07, "providers": [{"billed_charge": 3190.0, "npi": [1508845322]}]}]}, {"tin": {"type": "ein", "value": "111639818"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 430.0, "npi": [1053678250]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2755.34, "npi": [1033224704]}]}, {"allowed_amount": 1352.85, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2572.0, "npi": [1972523348]}]}, {"allowed_amount": 1542.76, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2572.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "114762253"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 24.41, "providers": [{"billed_charge": 400.0, "npi": [1609308998]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 169.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 225.0, "npi": [1386925832]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2196.0, "npi": [1952332801, 1194832477, 1780196345]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4589.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1787.16, "providers": [{"billed_charge": 5106.17, "npi": [1801992631]}]}]}, {"tin": {"type": "ein", "value": "134111638"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 750.0, "providers": [{"billed_charge": 750.0, "npi": [1073525341]}]}]}, {"tin": {"type": "ein", "value": "135598093"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 280.0, "npi": [1740740521, 1982774162, 1417961707]}]}]}, {"tin": {"type": "ein", "value": "141338470"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4816.0, "npi": [1932182599]}]}]}, {"tin": {"type": "ein", "value": "203512079"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 169.37, "providers": [{"billed_charge": 683.0, "npi": [1982004305]}]}]}, {"tin": {"type": "ein", "value": "222768204"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 210.85, "providers": [{"billed_charge": 281.0, "npi": [1033345566]}]}]}, {"tin": {"type": "ein", "value": "222972317"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 292.0, "npi": [1457369753]}]}]}, {"tin": {"type": "ein", "value": "231352174"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 355.02, "providers": [{"billed_charge": 1085.0, "npi": [1225091697]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 577.0, "npi": [1164647145, 1164711438]}]}]}, {"tin": {"type": "ein", "value": "461707288"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 120.99, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 589.41, "npi": [1396451928]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 300.0, "npi": [1982619854]}]}]}, {"tin": {"type": "ein", "value": "473176549"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 181.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 683.0, "npi": [1356095772]}]}]}, {"tin": {"type": "ein", "value": "560976522"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 400.0, "npi": [1053583849]}]}]}, {"tin": {"type": "ein", "value": "592579938"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 190.2, "providers": [{"billed_charge": 250.0, "npi": [1114302858]}]}]}, {"tin": {"type": "ein", "value": "605649704"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 244.2, "providers": [{"billed_charge": 400.0, "npi": [1912287798]}]}]}, {"tin": {"type": "ein", "value": "822351057"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 169.37, "providers": [{"billed_charge": 600.0, "npi": [1417154733]}]}]}]}, {"name": "Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making", "billing_code_type": "CPT", "billing_code": "99284", "billing_code_type_version": "2022", "description": "Emergency department visit with moderate level of medical decision making", "allowed_amounts": [{"tin": {"type": "ein", "value": "020657245"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 1026.0, "npi": [1679923536]}]}]}, {"tin": {"type": "ein", "value": "042103881"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 228.11, "providers": [{"billed_charge": 1383.0, "npi": [1548202641]}]}, {"allowed_amount": 443.51, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1360.0, "npi": [1548202641]}]}]}, {"tin": {"type": "ein", "value": "043194547"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 284.0, "providers": [{"billed_charge": 284.0, "npi": [1700971330]}]}]}, {"tin": {"type": "ein", "value": "056805017"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1538664537]}]}]}, {"tin": {"type": "ein", "value": "058748883"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1356668800]}]}]}, {"tin": {"type": "ein", "value": "060646652"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 841.46, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1902.41, "npi": [1578778726]}]}]}, {"tin": {"type": "ein", "value": "067829827"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 750.0, "npi": [1225591159]}]}]}, {"tin": {"type": "ein", "value": "068726528"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 750.0, "npi": [1619237963]}]}]}, {"tin": {"type": "ein", "value": "070724236"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1376834358]}]}]}, {"tin": {"type": "ein", "value": "079723837"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1205012622]}]}]}, {"tin": {"type": "ein", "value": "082767730"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1104350495]}]}]}, {"tin": {"type": "ein", "value": "111631837"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 795.11, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1602.85, "npi": [1700886322]}]}]}, {"tin": {"type": "ein", "value": "111635081"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2100.0, "npi": [1093777492]}]}]}, {"tin": {"type": "ein", "value": "111639818"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 759.0, "npi": [1144373960, 1235428525]}]}]}, {"tin": {"type": "ein", "value": "113066770"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 360.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 360.0, "npi": [1538797667, 1215313812, 1740607068]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1773.39, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3854.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113495935"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 356.0, "npi": [1306378500]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 178.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 395.0, "npi": [1992729073]}]}, {"allowed_amount": 356.1, "providers": [{"billed_charge": 395.0, "npi": [1619260023]}]}, {"allowed_amount": 395.0, "providers": [{"billed_charge": 395.0, "npi": [1194248146, 1558579524, 1437249604]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 795.11, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2652.0, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "132655001"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 904.15, "providers": [{"billed_charge": 1816.5, "npi": [1073535027]}]}]}, {"tin": {"type": "ein", "value": "133911072"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 339.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 339.0, "npi": [1700204229, 1962662007]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 795.11, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2890.0, "npi": [1780196345, 1770502635, 1194832477, 1952332801]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 795.11, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5737.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1744.84, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4985.25, "npi": [1619341716, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "135562308"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1215043237]}]}]}, {"tin": {"type": "ein", "value": "135598093"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 490.0, "npi": [1326373580, 1518008887]}]}, {"allowed_amount": 490.0, "providers": [{"billed_charge": 490.0, "npi": [1801391602, 1558510669, 1750842126, 1962853309]}]}]}, {"tin": {"type": "ein", "value": "144230652"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1154780500]}]}]}, {"tin": {"type": "ein", "value": "208853938"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 700.0, "npi": [1366774697]}]}]}, {"tin": {"type": "ein", "value": "214411769"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1225590441]}]}]}, {"tin": {"type": "ein", "value": "221487576"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 554.39, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3036.0, "npi": [1457456279]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 440.07, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 947.0, "npi": [1477596310]}]}]}, {"tin": {"type": "ein", "value": "222768204"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 322.05, "providers": [{"billed_charge": 366.0, "npi": [1487880084, 1558893982]}]}]}, {"tin": {"type": "ein", "value": "222972317"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 558.0, "npi": [1982041398]}]}]}, {"tin": {"type": "ein", "value": "230469150"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 355.02, "providers": [{"billed_charge": 1840.0, "npi": [1356333579]}]}]}, {"tin": {"type": "ein", "value": "232669993"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 239.92, "providers": [{"billed_charge": 1037.0, "npi": [1053786319]}]}]}, {"tin": {"type": "ein", "value": "270124205"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 1118.21, "npi": [1629356266]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 806.0, "npi": [1073982088, 1538449467, 1225723364]}]}, {"allowed_amount": 512.22, "providers": [{"billed_charge": 806.0, "npi": [1700979887, 1285677583, 1013370550, 1396206744, 1962783357]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 509.0, "npi": [1063426492, 1891182630]}]}, {"allowed_amount": 509.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 509.0, "npi": [1568728582, 1588835722, 1659326841, 1295231546, 1134175839]}]}]}, {"tin": {"type": "ein", "value": "465073046"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 20000.0, "npi": [1457532996]}]}]}, {"tin": {"type": "ein", "value": "474718253"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 897.73, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1380.0, "npi": [1588141048]}]}]}, {"tin": {"type": "ein", "value": "474718253"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 174.32, "providers": [{"billed_charge": 449.0, "npi": [1881121606]}]}]}, {"tin": {"type": "ein", "value": "474735982"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1580.13, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4085.0, "npi": [1497115539]}]}]}, {"tin": {"type": "ein", "value": "500823599"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1134117856]}]}]}, {"tin": {"type": "ein", "value": "560976522"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1053583849]}]}]}, {"tin": {"type": "ein", "value": "611661781"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 520.0, "providers": [{"billed_charge": 520.0, "npi": [1033482518]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1000.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1000.0, "npi": [1528052578]}]}]}, {"tin": {"type": "ein", "value": "621266047"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 402.01, "providers": [{"billed_charge": 1161.0, "npi": [1154663821]}]}]}, {"tin": {"type": "ein", "value": "621762537"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1890.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5400.0, "npi": [1861439952]}]}]}, {"tin": {"type": "ein", "value": "625463651"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 512.22, "providers": [{"billed_charge": 750.0, "npi": [1528688710]}]}]}, {"tin": {"type": "ein", "value": "766461560"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 750.0, "npi": [1861924813]}]}]}, {"tin": {"type": "ein", "value": "810872075"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 365.97, "providers": [{"billed_charge": 996.0, "npi": [1295230597]}]}]}, {"tin": {"type": "ein", "value": "811666440"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 374.2, "providers": [{"billed_charge": 1475.0, "npi": [1992186829]}]}]}, {"tin": {"type": "ein", "value": "850708225"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 356.1, "providers": [{"billed_charge": 806.0, "npi": [1598923773]}]}]}]}, {"name": "General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)", "billing_code_type": "CPT", "billing_code": "80050", "billing_code_type_version": "2022", "description": "General health panel", "allowed_amounts": [{"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 148.96, "providers": [{"billed_charge": 189.96, "npi": [1598820235]}]}, {"allowed_amount": 149.16, "providers": [{"billed_charge": 189.96, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 34.38, "providers": [{"billed_charge": 247.0, "npi": [1366543795]}]}, {"allowed_amount": 148.96, "providers": [{"billed_charge": 217.0, "npi": [1366543795]}, {"billed_charge": 232.75, "npi": [1366543795]}]}, {"allowed_amount": 149.16, "providers": [{"billed_charge": 207.04, "npi": [1366543795]}, {"billed_charge": 217.0, "npi": [1366543795]}, {"billed_charge": 220.0, "npi": [1366543795]}, {"billed_charge": 256.19, "npi": [1366543795]}]}]}]}, {"name": "Ground mileage, per statute mile", "billing_code_type": "CPT", "billing_code": "A0425", "billing_code_type_version": "2022", "description": "Ground mileage, per statute mile", "allowed_amounts": [{"tin": {"type": "ein", "value": "111631837"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.0, "providers": [{"billed_charge": 11.0, "npi": [1700886322]}]}]}, {"tin": {"type": "ein", "value": "112125662"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 16.8, "providers": [{"billed_charge": 26.0, "npi": [1649356791]}]}]}, {"tin": {"type": "ein", "value": "112404466"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 28.0, "providers": [{"billed_charge": 35.0, "npi": [1003460890]}]}]}, {"tin": {"type": "ein", "value": "112420013"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 8.0, "providers": [{"billed_charge": 8.0, "npi": [1033343389]}]}]}, {"tin": {"type": "ein", "value": "113396823"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 18.06, "providers": [{"billed_charge": 18.06, "npi": [1063918688]}]}]}, {"tin": {"type": "ein", "value": "116000276"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 28.0, "providers": [{"billed_charge": 35.0, "npi": [1053050864]}]}]}, {"tin": {"type": "ein", "value": "116002957"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 28.0, "providers": [{"billed_charge": 35.0, "npi": [1124750328]}]}]}, {"tin": {"type": "ein", "value": "131624070"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 20.0, "providers": [{"billed_charge": 30.5, "npi": [1477616571]}]}]}, {"tin": {"type": "ein", "value": "132594228"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 12.0, "providers": [{"billed_charge": 12.0, "npi": [1679550982]}]}]}, {"tin": {"type": "ein", "value": "132655001"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 16.8, "providers": [{"billed_charge": 20.0, "npi": [1083715460]}]}, {"allowed_amount": 17.6, "providers": [{"billed_charge": 20.0, "npi": [1083715460]}]}, {"allowed_amount": 20.0, "providers": [{"billed_charge": 20.0, "npi": [1083715460]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 20.0, "providers": [{"billed_charge": 41.09, "npi": [1174628473]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 14.49, "providers": [{"billed_charge": 41.4, "npi": [1346614443]}]}, {"allowed_amount": 18.11, "providers": [{"billed_charge": 51.75, "npi": [1346614443]}]}]}, {"tin": {"type": "ein", "value": "226001809"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 33.6, "providers": [{"billed_charge": 40.0, "npi": [1528212537]}]}]}, {"tin": {"type": "ein", "value": "236003047"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 10.0, "providers": [{"billed_charge": 10.0, "npi": [1255468435]}]}]}, {"tin": {"type": "ein", "value": "860084388"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 20.0, "providers": [{"billed_charge": 25.37, "npi": [1962693697]}]}]}]}, {"name": "Hemoglobin; glycosylated (A1C)", "billing_code_type": "CPT", "billing_code": "83036", "billing_code_type_version": "2022", "description": "Hemoglobin A1C level", "allowed_amounts": [{"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.25, "providers": [{"billed_charge": 38.84, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.25, "providers": [{"billed_charge": 74.0, "npi": [1366543795]}]}, {"allowed_amount": 9.79, "providers": [{"billed_charge": 74.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 69.9, "providers": [{"billed_charge": 199.7, "npi": [1376587113, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "203734391"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 8.25, "providers": [{"billed_charge": 29.13, "npi": [1053584482]}]}]}]}, {"name": "Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450)", "billing_code_type": "CPT", "billing_code": "80076", "billing_code_type_version": "2022", "description": "Liver function blood test panel", "allowed_amounts": [{"tin": {"type": "ein", "value": "060646917"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 81.24, "providers": [{"billed_charge": 89.16, "npi": [1356331425]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 19.97, "providers": [{"billed_charge": 366.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 6.94, "providers": [{"billed_charge": 150.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.16, "providers": [{"billed_charge": 147.06, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.16, "providers": [{"billed_charge": 142.74, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 51.92, "providers": [{"billed_charge": 148.34, "npi": [1619341716, 1801992631]}]}, {"allowed_amount": 192.57, "providers": [{"billed_charge": 550.2, "npi": [1427616002]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 18.35, "providers": [{"billed_charge": 103.0, "npi": [1477596310]}]}]}]}, {"name": "Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon, biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium, curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture Fingers/toes, amputation, non-traumatic Gingiva/oral mucosa, biopsy Heart valve Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy - without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph node, biopsy Muscle, biopsy Nasal mucosa, biopsy Nasopharynx/oropharynx, biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or without tube, non-neoplastic Ovary, biopsy/wedge resection Parathyroid gland Peritoneum, biopsy Pituitary tumor Placenta, other than third trimester Pleura/pericardium - biopsy/tissue Polyp, cervical/endometrial Polyp, colorectal Polyp, stomach/small intestine Prostate, needle biopsy Prostate, TUR Salivary gland, biopsy Sinus, paranasal biopsy Skin, other than cyst/tag/debridement/plastic repair Small intestine, biopsy Soft tissue, other than tumor/mass/lipoma/debridement Spleen Stomach, biopsy Synovium Testis, other than tumor/biopsy/castration Thyroglossal duct/brachial cleft cyst Tongue, biopsy Tonsil, biopsy Trachea, biopsy Ureter, biopsy Urethra, biopsy Urinary bladder, biopsy Uterus, with or without tubes and ovaries, for prolapse Vagina, biopsy Vulva/labia, biopsy", "billing_code_type": "CPT", "billing_code": "88305", "billing_code_type_version": "2022", "description": "Pathology examination of tissue using a microscope, intermediate complexity", "allowed_amounts": [{"tin": {"type": "ein", "value": "043452130"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 67.94, "providers": [{"billed_charge": 260.0, "npi": [1093814394]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 260.0, "npi": [1295775385]}]}]}, {"tin": {"type": "ein", "value": "113272376"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 69.06, "providers": [{"billed_charge": 163.0, "npi": [1215921549]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 69.06, "providers": [{"billed_charge": 316.25, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 198.2, "providers": [{"billed_charge": 380.0, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "135598093"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 42.35, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1124223839]}]}]}, {"tin": {"type": "ein", "value": "161387862"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 67.94, "providers": [{"billed_charge": 206.65, "npi": [1003040403]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 206.65, "npi": [1255316121, 1841302908]}]}]}, {"tin": {"type": "ein", "value": "202506174"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 35.44, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 150.0, "npi": [1417924424]}]}]}, {"tin": {"type": "ein", "value": "205292168"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 33.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 65.0, "npi": [1487663860]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 160.0, "npi": [1487663860]}]}]}, {"tin": {"type": "ein", "value": "205405972"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 35.44, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 105.12, "npi": [1992812473]}]}]}, {"tin": {"type": "ein", "value": "205455398"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 69.06, "providers": [{"billed_charge": 284.0, "npi": [1134438427]}]}]}, {"tin": {"type": "ein", "value": "263783624"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 35.44, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 300.0, "npi": [1790712271]}]}]}, {"tin": {"type": "ein", "value": "264236145"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 67.94, "providers": [{"billed_charge": 470.0, "npi": [1437142171]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 470.0, "npi": [1437142171]}]}]}, {"tin": {"type": "ein", "value": "331168930"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 67.94, "providers": [{"billed_charge": 117.0, "npi": [1184814014]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 117.0, "npi": [1184814014]}]}]}, {"tin": {"type": "ein", "value": "453194060"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 35.44, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 120.0, "npi": [1659655124]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 250.0, "npi": [1659655124]}]}]}, {"tin": {"type": "ein", "value": "474035304"}, "billing_class": "professional", "service_codes": ["11"], "payments": [{"allowed_amount": 78.17, "providers": [{"billed_charge": 2400.0, "npi": [1801850631]}]}]}, {"tin": {"type": "ein", "value": "581910975"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 67.94, "providers": [{"billed_charge": 258.0, "npi": [1316112451, 1003919531]}]}, {"allowed_amount": 69.06, "providers": [{"billed_charge": 258.0, "npi": [1003919531, 1225444300]}]}]}, {"tin": {"type": "ein", "value": "593725585"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 33.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 64.0, "npi": [1740240753]}]}, {"allowed_amount": 35.44, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 82.0, "npi": [1447437355]}]}]}]}, {"name": "Lipase", "billing_code_type": "CPT", "billing_code": "83690", "billing_code_type_version": "2022", "description": "Lipase (fat enzyme) level", "allowed_amounts": [{"tin": {"type": "ein", "value": "060646917"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 66.54, "providers": [{"billed_charge": 165.74, "npi": [1356331425]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 18.78, "providers": [{"billed_charge": 184.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 5.86, "providers": [{"billed_charge": 37.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 39.28, "providers": [{"billed_charge": 81.69, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 39.28, "providers": [{"billed_charge": 79.33, "npi": [1952332801]}, {"billed_charge": 81.69, "npi": [1780196345]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 39.28, "providers": [{"billed_charge": 78.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 89.64, "providers": [{"billed_charge": 256.12, "npi": [1427616002, 1619341716, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 37.58, "providers": [{"billed_charge": 66.0, "npi": [1477596310]}]}]}, {"tin": {"type": "ein", "value": "474131755"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.54, "providers": [{"billed_charge": 521.0, "npi": [1538535158]}]}]}]}, {"name": "Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)", "billing_code_type": "CPT", "billing_code": "80061", "billing_code_type_version": "2022", "description": "Blood test, lipids (cholesterol and triglycerides)", "allowed_amounts": [{"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 11.38, "billing_code_modifier": ["90"], "providers": [{"billed_charge": 53.56, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 11.38, "providers": [{"billed_charge": 198.0, "npi": [1366543795]}]}, {"allowed_amount": 13.35, "providers": [{"billed_charge": 198.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 103.84, "providers": [{"billed_charge": 296.69, "npi": [1619341716]}]}]}, {"tin": {"type": "ein", "value": "203734391"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 11.38, "providers": [{"billed_charge": 40.17, "npi": [1053584482]}]}]}]}, {"name": "Magnesium", "billing_code_type": "CPT", "billing_code": "83735", "billing_code_type_version": "2022", "description": "Magnesium level", "allowed_amounts": [{"tin": {"type": "ein", "value": "060646652"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.38, "providers": [{"billed_charge": 69.0, "npi": [1578778726]}]}]}, {"tin": {"type": "ein", "value": "112019482"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 5.7, "providers": [{"billed_charge": 26.8, "npi": [1598820235]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 33.22, "providers": [{"billed_charge": 105.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113412370"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 5.7, "providers": [{"billed_charge": 35.0, "npi": [1366543795]}]}]}, {"tin": {"type": "ein", "value": "113558495"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 5.7, "providers": [{"billed_charge": 37.96, "npi": [1194744185]}]}]}, {"tin": {"type": "ein", "value": "131740120"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 30.06, "providers": [{"billed_charge": 205.42, "npi": [1881659274]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 30.06, "providers": [{"billed_charge": 142.74, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "133964321"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 30.06, "providers": [{"billed_charge": 76.0, "npi": [1932280666]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.4, "providers": [{"billed_charge": 124.0, "npi": [1427616002, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "134045724"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 18.48, "providers": [{"billed_charge": 47.45, "npi": [1548251218]}]}]}, {"tin": {"type": "ein", "value": "222617175"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 37.85, "providers": [{"billed_charge": 61.0, "npi": [1477596310]}]}]}]}, {"name": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.", "billing_code_type": "CPT", "billing_code": "99213", "billing_code_type_version": "2022", "description": "Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more", "allowed_amounts": [{"tin": {"type": "ein", "value": "020596679"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 87.94, "providers": [{"billed_charge": 215.0, "npi": [1821280579]}]}]}, {"tin": {"type": "ein", "value": "223487984"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 99.12, "providers": [{"billed_charge": 300.0, "npi": [1568858686]}]}, {"allowed_amount": 103.37, "providers": [{"billed_charge": 188.0, "npi": [1861912396]}]}]}, {"tin": {"type": "ein", "value": "261534174"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 99.12, "providers": [{"billed_charge": 170.0, "npi": [1205073079]}]}]}, {"tin": {"type": "ein", "value": "463370553"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 95.78, "providers": [{"billed_charge": 108.98, "npi": [1548692890]}]}]}, {"tin": {"type": "ein", "value": "463427848"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 113.84, "providers": [{"billed_charge": 196.29, "npi": [1942439625]}]}]}, {"tin": {"type": "ein", "value": "472516729"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 110.04, "providers": [{"billed_charge": 390.0, "npi": [1912305483]}]}]}, {"tin": {"type": "ein", "value": "570769093"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 105.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 105.0, "npi": [1902147176]}]}]}, {"tin": {"type": "ein", "value": "850850482"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 77.74, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 300.0, "npi": [1619599578]}]}]}, {"tin": {"type": "ein", "value": "853881812"}, "billing_class": "professional", "service_codes": ["10"], "payments": [{"allowed_amount": 200.0, "providers": [{"billed_charge": 200.0, "npi": [1336718618]}]}]}, {"tin": {"type": "ein", "value": "931654459"}, "billing_class": "professional", "service_codes": ["11"], "payments": [{"allowed_amount": 212.5, "providers": [{"billed_charge": 212.5, "npi": [1528521432]}]}]}]}, {"name": "Psychotherapy, 45 minutes with patient", "billing_code_type": "CPT", "billing_code": "90834", "billing_code_type_version": "2022", "description": "Psychotherapy, 45 minutes", "allowed_amounts": [{"tin": {"type": "ein", "value": "113198145"}, "billing_class": "professional", "service_codes": ["32"], "payments": [{"allowed_amount": 120.5, "providers": [{"billed_charge": 200.0, "npi": [1497537617]}]}]}, {"tin": {"type": "ein", "value": "814644120"}, "billing_class": "professional", "service_codes": ["02", "11"], "payments": [{"allowed_amount": 220.0, "providers": [{"billed_charge": 220.0, "npi": [1093266249]}]}]}, {"tin": {"type": "ein", "value": "842220939"}, "billing_class": "professional", "service_codes": ["11"], "payments": [{"allowed_amount": 150.0, "providers": [{"billed_charge": 150.0, "npi": [1508266123]}]}]}, {"tin": {"type": "ein", "value": "882808565"}, "billing_class": "professional", "service_codes": ["02"], "payments": [{"allowed_amount": 180.0, "providers": [{"billed_charge": 180.0, "npi": [1023477767]}]}]}]}, {"name": "Radiologic examination, chest; 2 views", "billing_code_type": "CPT", "billing_code": "71046", "billing_code_type_version": "2022", "description": "X-ray of chest, 2 views", "allowed_amounts": [{"tin": {"type": "ein", "value": "112548304"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 18.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 47.0, "npi": [1356764385]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 265.08, "providers": [{"billed_charge": 698.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 18.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 50.0, "npi": [1477787968, 1437682747]}]}]}, {"tin": {"type": "ein", "value": "133957095"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 133.21, "providers": [{"billed_charge": 763.0, "npi": [1952332801]}]}]}, {"tin": {"type": "ein", "value": "133971298"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 171.16, "providers": [{"billed_charge": 489.04, "npi": [1619341716, 1801992631]}]}]}, {"tin": {"type": "ein", "value": "135562308"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.47, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 77.0, "npi": [1578962031]}]}, {"allowed_amount": 18.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 77.0, "npi": [1730574096, 1902868730, 1972883155, 1427210095]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 18.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 57.0, "npi": [1548288566, 1649295999]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 18.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 43.0, "npi": [1942469192]}]}]}]}, {"name": "Radiologic examination, chest; single view", "billing_code_type": "CPT", "billing_code": "71045", "billing_code_type_version": "2022", "description": "X-ray of chest, 1 view", "allowed_amounts": [{"tin": {"type": "ein", "value": "112548304"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 13.03, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 42.0, "npi": [1154366698, 1457340556, 1568408599, 1538450010, 1053639484]}]}, {"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 42.0, "npi": [1538690458, 1063702579]}]}]}, {"tin": {"type": "ein", "value": "113243405"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 228.23, "providers": [{"billed_charge": 698.0, "npi": [1972523348]}]}]}, {"tin": {"type": "ein", "value": "113437030"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 23.0, "npi": [1720027790]}]}]}, {"tin": {"type": "ein", "value": "135562308"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 64.0, "npi": [1972860088]}]}]}, {"tin": {"type": "ein", "value": "264709927"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 23.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 41.0, "npi": [1003868365]}]}]}, {"tin": {"type": "ein", "value": "274181529"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 23.0, "npi": [1770780397]}]}]}, {"tin": {"type": "ein", "value": "274384326"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 48.0, "npi": [1407930092]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 48.0, "npi": [1497773568, 1518906726, 1134117831, 1487768073, 1407930092, 1316947724, 1780602003, 1942370390, 1548269848, 1023188158]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.03, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 35.0, "npi": [1922022565]}]}]}, {"tin": {"type": "ein", "value": "620963389"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 18.65, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 34.0, "npi": [1013987296]}]}]}, {"tin": {"type": "ein", "value": "621114867"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 162.0, "providers": [{"billed_charge": 162.0, "npi": [1528052578]}]}]}, {"tin": {"type": "ein", "value": "844522008"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 13.03, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 18.77, "npi": [1043279565]}, {"billed_charge": 153.0, "npi": [1043279565]}]}, {"allowed_amount": 15.32, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 153.0, "npi": [1548272396, 1437560430, 1891737904, 1851316954, 1093757502]}]}]}]}, {"name": "Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded.", "billing_code_type": "CPT", "billing_code": "99232", "billing_code_type_version": "2022", "description": "Subsequent hospital inpatient or observation care with high level of medical decision making, if using time, 35 minutes or more", "allowed_amounts": [{"tin": {"type": "ein", "value": "103728375"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 135.01, "providers": [{"billed_charge": 550.0, "npi": [1225447956]}]}]}, {"tin": {"type": "ein", "value": "112558775"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 255.0, "npi": [1992067565]}]}, {"allowed_amount": 135.01, "providers": [{"billed_charge": 255.0, "npi": [1831332329]}]}]}, {"tin": {"type": "ein", "value": "113437602"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 170.0, "npi": [1063837912, 1205102225, 1356429922]}]}, {"allowed_amount": 135.01, "providers": [{"billed_charge": 170.0, "npi": [1417372582]}]}]}, {"tin": {"type": "ein", "value": "131623978"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 135.25, "providers": [{"billed_charge": 245.0, "npi": [1760877617]}]}]}, {"tin": {"type": "ein", "value": "203007678"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 135.01, "providers": [{"billed_charge": 341.42, "npi": [1003089673]}]}]}, {"tin": {"type": "ein", "value": "264533071"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 105.88, "providers": [{"billed_charge": 402.5, "npi": [1043279565]}]}]}, {"tin": {"type": "ein", "value": "271331099"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 132.0, "npi": [1265695837]}]}]}, {"tin": {"type": "ein", "value": "274384326"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 322.0, "npi": [1831620426]}]}]}, {"tin": {"type": "ein", "value": "342010563"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 105.88, "providers": [{"billed_charge": 219.0, "npi": [1437424728, 1770856940, 1083057590]}]}]}, {"tin": {"type": "ein", "value": "453023019"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 322.0, "npi": [1306938576, 1427467240]}]}, {"allowed_amount": 135.25, "providers": [{"billed_charge": 322.0, "npi": [1225525389, 1952460479]}]}]}, {"tin": {"type": "ein", "value": "460873654"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 105.88, "providers": [{"billed_charge": 503.75, "npi": [1295975704]}]}]}, {"tin": {"type": "ein", "value": "462333282"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 329.0, "npi": [1487950762]}]}]}, {"tin": {"type": "ein", "value": "815443675"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 129.93, "providers": [{"billed_charge": 503.75, "npi": [1750340121]}]}]}, {"tin": {"type": "ein", "value": "854056308"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 135.01, "providers": [{"billed_charge": 150.0, "npi": [1053405084]}]}]}]}]}