{"reporting_entity_name": "Oscar Health", "reporting_entity_type": "Health Insurance Issuer", "plan_id": "11574IL001", "last_updated_on": "2025-05-23", "version": "1.0.0", "out_of_network": [{"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": "BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 155.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "350869066"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.44, "providers": [{"billed_charge": 284.0, "npi": [1306898960]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 23.69, "providers": [{"billed_charge": 112.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 23.69, "providers": [{"billed_charge": 196.0, "npi": [1427493246]}]}, {"allowed_amount": 24.44, "providers": [{"billed_charge": 202.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 150.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 145.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 85.0, "npi": [1548375082, 1558479212]}, {"billed_charge": 100.0, "npi": [1578670543]}]}, {"allowed_amount": 16.29, "providers": [{"billed_charge": 85.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 168.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362183812"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 124.0, "npi": [1558391706]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.29, "providers": [{"billed_charge": 304.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 133.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 197.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362643663"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 4.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 35.0, "npi": [1205829140]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 133.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364099076"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 26.7, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 26.7, "npi": [1558449587]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 260.0, "npi": [1487715645]}]}, {"allowed_amount": 16.29, "providers": [{"billed_charge": 269.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 195.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 20.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.29, "providers": [{"billed_charge": 277.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 156.0, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.79, "providers": [{"billed_charge": 133.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 54.8, "providers": [{"billed_charge": 126.0, "npi": [1952332991]}]}]}]}, {"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": "COMPREHENSIVE METABOLIC PANEL", "allowed_amounts": [{"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 210.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "350869066"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 41.64, "providers": [{"billed_charge": 565.0, "npi": [1306898960]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 40.36, "providers": [{"billed_charge": 379.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 40.36, "providers": [{"billed_charge": 456.0, "npi": [1427493246]}]}, {"allowed_amount": 41.64, "providers": [{"billed_charge": 470.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 324.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 210.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 210.0, "npi": [1548375082, 1558479212, 1578670543]}]}, {"allowed_amount": 15.77, "providers": [{"billed_charge": 215.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 393.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362183812"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 246.0, "npi": [1558391706]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.77, "providers": [{"billed_charge": 596.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 281.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 438.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362643663"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 4.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 35.0, "npi": [1205829140]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 281.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 670.0, "npi": [1487715645]}]}, {"allowed_amount": 15.77, "providers": [{"billed_charge": 694.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 355.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 316.25, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.21, "providers": [{"billed_charge": 1449.01, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 281.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "862358048"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.28, "providers": [{"billed_charge": 300.0, "npi": [1730166224]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 75.28, "providers": [{"billed_charge": 161.0, "npi": [1952332991]}]}]}]}, {"name": "Computed tomography, abdomen and pelvis; with contrast material(s)", "billing_code_type": "CPT", "billing_code": "74177", "billing_code_type_version": "2022", "description": "CT ABDOMEN & PELVIS W/CONTRAST MATERIAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "260540046"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 552.0, "npi": [1255508768]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 832.35, "providers": [{"billed_charge": 4324.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "351435368"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 146.13, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 215.0, "npi": [1396738639]}]}]}, {"tin": {"type": "ein", "value": "362177136"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 212.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 701.0, "npi": [1710038781]}]}]}, {"tin": {"type": "ein", "value": "362646425"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 516.0, "npi": [1194701730, 1891298600, 1194703819, 1538329677, 1679596241]}]}]}, {"tin": {"type": "ein", "value": "362771855"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 307.0, "npi": [1780789750]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19", "22", "21"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1374.0, "npi": [1326099722, 1821520875, 1972553261, 1174700942, 1235179409, 1922264373]}]}, {"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1374.0, "npi": [1518117514, 1831140292, 1598716052]}]}, {"allowed_amount": 212.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1374.0, "npi": [1821520875]}]}]}, {"tin": {"type": "ein", "value": "364038474"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 455.0, "npi": [1679528251]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 565.79, "providers": [{"billed_charge": 4938.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 565.79, "providers": [{"billed_charge": 6568.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 565.79, "providers": [{"billed_charge": 951.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 320.0, "npi": [1174702963]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1471.0, "npi": [1033342092]}]}, {"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1692.0, "npi": [1922365105]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 800.49, "providers": [{"billed_charge": 16103.17, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 565.79, "providers": [{"billed_charge": 5800.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "751459885"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 111.86, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1671.0, "npi": [1750815171]}]}]}, {"tin": {"type": "ein", "value": "920462136"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 131.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 423.0, "npi": [1720423312, 1942731757, 1689037855]}]}, {"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 423.0, "npi": [1932148608]}]}]}]}, {"name": "Computed tomography, head or brain; without contrast material", "billing_code_type": "CPT", "billing_code": "70450", "billing_code_type_version": "2022", "description": "CT HEAD/BRAIN W/O CONTRAST MATERIAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 293.25, "providers": [{"billed_charge": 2190.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "274591786"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 98.42, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 637.0, "npi": [1265636575]}]}]}, {"tin": {"type": "ein", "value": "350869066"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 674.65, "providers": [{"billed_charge": 904.0, "npi": [1306898960]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 653.86, "providers": [{"billed_charge": 1587.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "351435368"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 95.39, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 152.0, "npi": [1396738639]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 293.25, "providers": [{"billed_charge": 2900.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 302.57, "providers": [{"billed_charge": 1560.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362646425"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 53.91, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 185.0, "npi": [1194701730, 1194772590, 1083033278]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 219.0, "npi": [1245686898]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 293.25, "providers": [{"billed_charge": 2430.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 53.91, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 630.0, "npi": [1104802016, 1518117514, 1972553261, 1831280494]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 293.25, "providers": [{"billed_charge": 4114.0, "npi": [1487715645]}]}, {"allowed_amount": 302.57, "providers": [{"billed_charge": 4264.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "426004813"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 332.19, "providers": [{"billed_charge": 2720.0, "npi": [1376544320]}]}]}, {"tin": {"type": "ein", "value": "426004813"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 71.65, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 269.0, "npi": [1407832140]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 53.91, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1366739104, 1427019546, 1174702963]}]}, {"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1952530180]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 919.61, "providers": [{"billed_charge": 5120.07, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 293.25, "providers": [{"billed_charge": 2430.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "741680498"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 38.6, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 554.0, "npi": [1841202462]}]}]}, {"tin": {"type": "ein", "value": "751459885"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 51.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 608.0, "npi": [1750815171]}]}]}, {"tin": {"type": "ein", "value": "852007987"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 919.61, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 14780.7, "npi": [1144838947]}]}]}, {"tin": {"type": "ein", "value": "920462136"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 38.6, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1982973459]}]}, {"allowed_amount": 53.91, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1720423312, 1316965569, 1861982597, 1043228935]}]}, {"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1982973459]}]}, {"allowed_amount": 95.27, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1215200472]}]}]}, {"tin": {"type": "ein", "value": "922355855"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 653.86, "providers": [{"billed_charge": 2595.0, "npi": [1144914532]}]}]}]}, {"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": "ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY", "allowed_amounts": [{"tin": {"type": "ein", "value": "050540914"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.43, "providers": [{"billed_charge": 18.0, "npi": [1316946700]}]}]}, {"tin": {"type": "ein", "value": "362657618"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 12.43, "providers": [{"billed_charge": 28.0, "npi": [1184673089]}]}, {"allowed_amount": 12.83, "providers": [{"billed_charge": 28.0, "npi": [1184673089]}]}, {"allowed_amount": 24.6, "providers": [{"billed_charge": 28.0, "npi": [1588721328, 1437214947]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.43, "providers": [{"billed_charge": 57.0, "npi": [1497770762, 1285075820]}]}, {"allowed_amount": 12.83, "providers": [{"billed_charge": 57.0, "npi": [1497770762]}]}]}, {"tin": {"type": "ein", "value": "363884882"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.43, "providers": [{"billed_charge": 30.0, "npi": [1558355255]}]}]}, {"tin": {"type": "ein", "value": "364032998"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 8.54, "providers": [{"billed_charge": 37.0, "npi": [1083662894]}]}, {"allowed_amount": 24.6, "providers": [{"billed_charge": 37.0, "npi": [1083662894]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 21.0, "providers": [{"billed_charge": 21.0, "npi": [1730529132]}]}]}, {"tin": {"type": "ein", "value": "454158203"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 13.57, "providers": [{"billed_charge": 20.0, "npi": [1982727830]}]}, {"allowed_amount": 20.0, "providers": [{"billed_charge": 20.0, "npi": [1124036769]}]}]}, {"tin": {"type": "ein", "value": "611630276"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 14.0, "providers": [{"billed_charge": 18.0, "npi": [1821052416]}]}]}, {"tin": {"type": "ein", "value": "800607953"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.43, "providers": [{"billed_charge": 25.0, "npi": [1932147154]}]}, {"allowed_amount": 24.6, "providers": [{"billed_charge": 25.0, "npi": [1841295193, 1770882029, 1386683399]}]}]}]}, {"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": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R", "allowed_amounts": [{"tin": {"type": "ein", "value": "350869066"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 102.07, "providers": [{"billed_charge": 502.0, "npi": [1306898960]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.92, "providers": [{"billed_charge": 424.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 102.07, "providers": [{"billed_charge": 537.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.71, "providers": [{"billed_charge": 496.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.71, "providers": [{"billed_charge": 445.0, "npi": [1578670543]}, {"billed_charge": 505.0, "npi": [1558479212]}]}, {"allowed_amount": 101.85, "providers": [{"billed_charge": 425.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 101.85, "providers": [{"billed_charge": 598.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.71, "providers": [{"billed_charge": 582.0, "npi": [1487715645]}]}, {"allowed_amount": 101.85, "providers": [{"billed_charge": 548.0, "npi": [1265454391]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.71, "providers": [{"billed_charge": 498.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 83.95, "providers": [{"billed_charge": 430.51, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.71, "providers": [{"billed_charge": 423.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 224.78, "providers": [{"billed_charge": 283.0, "npi": [1952332991]}]}]}]}, {"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 HIGH MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 581.22, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2890.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 877.59, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3096.0, "npi": [1003918210]}]}, {"allowed_amount": 1308.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3096.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1308.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3901.0, "npi": [1427493246]}]}, {"allowed_amount": 1349.97, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4018.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 581.22, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3500.0, "npi": [1558479212]}]}, {"allowed_amount": 599.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3380.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362170833"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4090.0, "npi": [1235234535]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4023.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 539.0, "npi": [1164788717]}]}, {"allowed_amount": 295.8, "providers": [{"billed_charge": 539.0, "npi": [1710988654]}]}]}, {"tin": {"type": "ein", "value": "363186070"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 1239.0, "npi": [1992187074]}]}]}, {"tin": {"type": "ein", "value": "363279680"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 305.75, "providers": [{"billed_charge": 868.0, "npi": [1477947075]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 581.22, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4948.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364323723"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 1129.0, "npi": [1093762494]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 1052.0, "npi": [1023479920]}]}]}, {"tin": {"type": "ein", "value": "460819112"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 1860.0, "npi": [1053607424, 1659582146, 1902845027, 1700406980, 1023097706, 1336539022, 1306423504, 1912179185]}]}, {"allowed_amount": 305.75, "providers": [{"billed_charge": 1860.0, "npi": [1720548712, 1750969697, 1376107052]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 581.22, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2414.25, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "474944608"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 243.33, "providers": [{"billed_charge": 2263.0, "npi": [1275073355]}]}, {"allowed_amount": 287.42, "providers": [{"billed_charge": 2194.0, "npi": [1275073355]}]}, {"allowed_amount": 350.58, "providers": [{"billed_charge": 2194.0, "npi": [1578702361]}]}, {"allowed_amount": 361.72, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2263.0, "npi": [1720329121, 1073889242]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3630.0, "npi": [1164530465]}]}, {"allowed_amount": 581.22, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3630.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 286.69, "providers": [{"billed_charge": 1942.0, "npi": [1184647752, 1255428538, 1346866746]}]}, {"allowed_amount": 350.58, "providers": [{"billed_charge": 1942.0, "npi": [1932709946]}]}]}, {"tin": {"type": "ein", "value": "852007987"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 801.52, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 12950.0, "npi": [1144838947]}]}]}]}, {"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 LOW MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "272545727"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 128.33, "providers": [{"billed_charge": 171.0, "npi": [1205886041, 1275580565]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1736.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1645.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362170833"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 144.82, "providers": [{"billed_charge": 1480.0, "npi": [1235234535]}]}, {"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1480.0, "npi": [1235234535]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 220.92, "providers": [{"billed_charge": 1832.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 214.11, "providers": [{"billed_charge": 1410.0, "npi": [1760415939]}]}, {"allowed_amount": 353.14, "providers": [{"billed_charge": 1410.0, "npi": [1760415939]}]}, {"allowed_amount": 364.37, "providers": [{"billed_charge": 1550.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 214.11, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1769.0, "npi": [1487715645]}]}, {"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1769.0, "npi": [1487715645]}]}, {"allowed_amount": 364.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1834.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364755936"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 404.06, "providers": [{"billed_charge": 1402.96, "npi": [1598196206]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 91.41, "providers": [{"billed_charge": 189.0, "npi": [1881030963]}]}, {"allowed_amount": 108.81, "providers": [{"billed_charge": 189.0, "npi": [1295810356]}]}]}, {"tin": {"type": "ein", "value": "462388325"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 108.81, "providers": [{"billed_charge": 537.0, "npi": [1598487787]}]}]}, {"tin": {"type": "ein", "value": "471382605"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 245.42, "providers": [{"billed_charge": 611.0, "npi": [1972130482]}]}]}, {"tin": {"type": "ein", "value": "621801359"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 406.25, "providers": [{"billed_charge": 4969.76, "npi": [1174576698]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 214.11, "providers": [{"billed_charge": 1410.0, "npi": [1164530465]}]}, {"allowed_amount": 353.14, "providers": [{"billed_charge": 1410.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 91.41, "providers": [{"billed_charge": 874.0, "npi": [1184647752, 1477874154]}]}]}, {"tin": {"type": "ein", "value": "911780160"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 120.8, "providers": [{"billed_charge": 166.0, "npi": [1720327166]}]}]}]}, {"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 MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "263711283"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 212.65, "providers": [{"billed_charge": 874.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "311603722"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 357.57, "providers": [{"billed_charge": 1336.0, "npi": [1407368103]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 877.59, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2234.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 877.59, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2602.0, "npi": [1427493246]}]}, {"allowed_amount": 905.49, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2680.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2480.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1340.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2130.0, "npi": [1548375082]}, {"billed_charge": 2410.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3065.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362174823"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 144.82, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3393.0, "npi": [1932213600]}]}]}, {"tin": {"type": "ein", "value": "362183812"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2998.0, "npi": [1558391706]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1265465439]}]}, {"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3435.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 365.0, "npi": [1760774921]}]}, {"allowed_amount": 203.3, "providers": [{"billed_charge": 365.0, "npi": [1508810847]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1760415939]}]}, {"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "363279680"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 92.06, "providers": [{"billed_charge": 599.0, "npi": [1184966913]}]}]}, {"tin": {"type": "ein", "value": "363484281"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3435.0, "npi": [1407859655]}]}]}, {"tin": {"type": "ein", "value": "364109449"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 176.86, "providers": [{"billed_charge": 1228.0, "npi": [1023670247]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 364.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3475.0, "npi": [1487715645]}]}, {"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3353.0, "npi": [1487715645]}]}, {"allowed_amount": 501.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3475.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2311.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "364323723"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 760.0, "npi": [1629017108]}]}, {"allowed_amount": 229.44, "providers": [{"billed_charge": 760.0, "npi": [1275783706]}]}]}, {"tin": {"type": "ein", "value": "364576174"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 435.0, "npi": [1881272516]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1482.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 321.0, "npi": [1518193192]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 364.37, "providers": [{"billed_charge": 2027.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 203.3, "providers": [{"billed_charge": 717.0, "npi": [1003865403]}]}]}, {"tin": {"type": "ein", "value": "426004813"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 408.96, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2340.0, "npi": [1376544320]}]}]}, {"tin": {"type": "ein", "value": "426004813"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 216.41, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 589.0, "npi": [1487060612]}]}]}, {"tin": {"type": "ein", "value": "460819112"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 1261.0, "npi": [1053607424, 1902845027, 1831159748, 1083292007, 1023097706, 1376743914, 1225081037, 1326296732, 1649697855]}]}, {"allowed_amount": 212.65, "providers": [{"billed_charge": 1261.0, "npi": [1720548712, 1700406980, 1376107052, 1306423504]}]}]}, {"tin": {"type": "ein", "value": "474944608"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 233.54, "providers": [{"billed_charge": 1487.0, "npi": [1013151463, 1295728871]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 323.02, "providers": [{"billed_charge": 4160.21, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1164530465]}]}, {"allowed_amount": 364.37, "providers": [{"billed_charge": 2860.0, "npi": [1164530465]}]}, {"allowed_amount": 486.15, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2600.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "822218927"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 176.86, "providers": [{"billed_charge": 1280.0, "npi": [1922369677, 1649872367]}]}, {"allowed_amount": 212.65, "providers": [{"billed_charge": 1280.0, "npi": [1538264957]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 1307.0, "npi": [1346866746, 1366948820]}]}, {"allowed_amount": 212.65, "providers": [{"billed_charge": 1307.0, "npi": [1609238005, 1659711950]}]}]}, {"tin": {"type": "ein", "value": "851820894"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 374.2, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6759.2, "npi": [1831165653]}]}]}, {"tin": {"type": "ein", "value": "862358048"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 353.14, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2137.0, "npi": [1730166224]}]}]}, {"tin": {"type": "ein", "value": "862358048"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 197.04, "providers": [{"billed_charge": 1555.0, "npi": [1902398019]}]}]}, {"tin": {"type": "ein", "value": "922355855"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 877.59, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2567.0, "npi": [1144914532]}]}]}, {"tin": {"type": "ein", "value": "922417967"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 365.97, "providers": [{"billed_charge": 678.0, "npi": [1104218197]}]}, {"allowed_amount": 367.9, "providers": [{"billed_charge": 678.0, "npi": [1295361624]}]}]}, {"tin": {"type": "ein", "value": "931762867"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 179.58, "providers": [{"billed_charge": 832.0, "npi": [1871913251]}]}]}, {"tin": {"type": "ein", "value": "990175536"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 321.48, "providers": [{"billed_charge": 944.0, "npi": [1609006121]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1711.69, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2418.0, "npi": [1952332991]}]}]}]}, {"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": "362588241"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 12.7, "providers": [{"billed_charge": 16.0, "npi": [1720045099]}]}]}, {"tin": {"type": "ein", "value": "362606123"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 15.0, "providers": [{"billed_charge": 15.0, "npi": [1104811967]}]}]}, {"tin": {"type": "ein", "value": "362688847"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 9.52, "providers": [{"billed_charge": 60.0, "npi": [1336107838]}]}]}, {"tin": {"type": "ein", "value": "362780841"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 14.11, "providers": [{"billed_charge": 16.0, "npi": [1417013004]}]}]}, {"tin": {"type": "ein", "value": "363243177"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 7.62, "providers": [{"billed_charge": 32.89, "npi": [1962512236]}]}]}, {"tin": {"type": "ein", "value": "363266537"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 12.49, "providers": [{"billed_charge": 30.0, "npi": [1053530923]}]}]}, {"tin": {"type": "ein", "value": "363297824"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 5.68, "providers": [{"billed_charge": 17.5, "npi": [1962442798]}]}, {"allowed_amount": 9.25, "providers": [{"billed_charge": 17.5, "npi": [1962442798]}]}, {"allowed_amount": 10.43, "providers": [{"billed_charge": 17.5, "npi": [1962442798]}]}, {"allowed_amount": 17.5, "providers": [{"billed_charge": 17.5, "npi": [1962442798]}]}]}, {"tin": {"type": "ein", "value": "363556798"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 13.13, "providers": [{"billed_charge": 17.5, "npi": [1215940960]}]}]}, {"tin": {"type": "ein", "value": "366005897"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 9.52, "providers": [{"billed_charge": 20.4, "npi": [1417184987]}]}]}, {"tin": {"type": "ein", "value": "366006013"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 7.86, "providers": [{"billed_charge": 15.0, "npi": [1215988456]}]}, {"allowed_amount": 11.37, "providers": [{"billed_charge": 15.0, "npi": [1215988456]}]}]}, {"tin": {"type": "ein", "value": "366006016"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 15.0, "providers": [{"billed_charge": 15.0, "npi": [1578573267]}]}]}, {"tin": {"type": "ein", "value": "366006085"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 12.7, "providers": [{"billed_charge": 20.0, "npi": [1922057108]}]}]}, {"tin": {"type": "ein", "value": "366006108"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 16.56, "providers": [{"billed_charge": 16.88, "npi": [1881759652]}]}]}, {"tin": {"type": "ein", "value": "366006111"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 8.46, "providers": [{"billed_charge": 25.0, "npi": [1295891695]}]}]}, {"tin": {"type": "ein", "value": "366008171"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 10.88, "providers": [{"billed_charge": 14.74, "npi": [1710093372]}]}]}, {"tin": {"type": "ein", "value": "366008947"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 16.56, "providers": [{"billed_charge": 20.68, "npi": [1710947387]}]}]}, {"tin": {"type": "ein", "value": "366088568"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 15.0, "providers": [{"billed_charge": 15.0, "npi": [1760472070]}]}]}, {"tin": {"type": "ein", "value": "426004465"}, "billing_class": "professional", "service_codes": ["41"], "payments": [{"allowed_amount": 8.27, "providers": [{"billed_charge": 29.28, "npi": [1003691916]}]}]}]}, {"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": "LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM", "allowed_amounts": [{"tin": {"type": "ein", "value": "363947062"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 52.38, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 281.0, "npi": [1336382720, 1457380115]}]}, {"allowed_amount": 54.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 289.0, "npi": [1336382720]}]}]}, {"tin": {"type": "ein", "value": "364099076"}, "billing_class": "professional", "service_codes": ["22", "21"], "payments": [{"allowed_amount": 52.38, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 260.7, "npi": [1750644340, 1376621300, 1730267766, 1477703189, 1528354842, 1992202717, 1861790362]}]}, {"allowed_amount": 54.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 260.7, "npi": [1861790362, 1558449587, 1376621300, 1477703189]}]}]}, {"tin": {"type": "ein", "value": "461340420"}, "billing_class": "professional", "service_codes": ["22", "21"], "payments": [{"allowed_amount": 52.38, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 400.7, "npi": [1730180225, 1053459412, 1760462246, 1831355783]}]}]}]}, {"name": "Radiologic examination, chest; 2 views", "billing_code_type": "CPT", "billing_code": "71046", "billing_code_type_version": "2022", "description": "RADIOLOGIC EXAM CHEST 2 VIEWS", "allowed_amounts": [{"tin": {"type": "ein", "value": "260540046"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 55.0, "npi": [1619388576]}]}]}, {"tin": {"type": "ein", "value": "274591786"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 23.86, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1033400718]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 120.58, "providers": [{"billed_charge": 446.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "351435368"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 23.12, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 42.0, "npi": [1093772543, 1265425599]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.41, "providers": [{"billed_charge": 631.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.89, "providers": [{"billed_charge": 520.0, "npi": [1558479212]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.89, "providers": [{"billed_charge": 846.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362646425"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 50.0, "npi": [1336370824, 1588893473, 1083033278, 1346439015]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 7.03, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 35.0, "npi": [1619322252]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 130.0, "npi": [1376755272, 1326099722, 1821520875, 1972553261, 1821254830, 1174700942, 1235179409, 1598716052, 1922264373, 1023085941]}]}, {"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 130.0, "npi": [1235179409, 1326099722]}]}, {"allowed_amount": 17.16, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 130.0, "npi": [1821520875]}]}]}, {"tin": {"type": "ein", "value": "363484281"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.89, "providers": [{"billed_charge": 963.0, "npi": [1407859655]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.89, "providers": [{"billed_charge": 831.0, "npi": [1487715645]}]}, {"allowed_amount": 128.86, "providers": [{"billed_charge": 861.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 27.0, "npi": [1245463595]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 61.0, "npi": [1609825744, 1770656514]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 45.0, "npi": [1306871066]}]}, {"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 45.0, "npi": [1245223098]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 7.03, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 50.0, "npi": [1831168426]}]}, {"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 178.0, "npi": [1750344768, 1457364457, 1033342092, 1376561720, 1760404958]}]}, {"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1750344768, 1578526448]}]}, {"allowed_amount": 17.16, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1447757851]}]}, {"allowed_amount": 19.72, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 178.0, "npi": [1447757851]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.89, "providers": [{"billed_charge": 464.0, "npi": [1164530465]}]}, {"allowed_amount": 128.86, "providers": [{"billed_charge": 550.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "920462136"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 51.0, "npi": [1033451711, 1598851396, 1043228935, 1629575691, 1689037855]}]}, {"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 51.0, "npi": [1982973459]}]}]}]}, {"name": "Radiologic examination, chest; single view", "billing_code_type": "CPT", "billing_code": "71045", "billing_code_type_version": "2022", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [{"tin": {"type": "ein", "value": "260540046"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 44.0, "npi": [1437187366]}]}]}, {"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.21, "providers": [{"billed_charge": 420.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "274591786"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 14.15, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 176.0, "npi": [1689619439]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 80.67, "providers": [{"billed_charge": 365.0, "npi": [1427493246]}]}, {"allowed_amount": 83.23, "providers": [{"billed_charge": 376.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.21, "providers": [{"billed_charge": 496.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.21, "providers": [{"billed_charge": 707.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 89.98, "providers": [{"billed_charge": 550.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "362646425"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 45.0, "npi": [1194701730, 1891298600, 1629018890, 1194772590, 1336637628]}]}]}, {"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 32.0, "npi": [1932426327]}]}]}, {"tin": {"type": "ein", "value": "362771855"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1891734596]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.64, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 50.0, "npi": [1245694348]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "22", "21"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 122.0, "npi": [1104802016, 1821520875, 1821254830, 1831280494, 1235179409, 1922264373, 1346479102]}]}, {"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 122.0, "npi": [1104802016, 1396938148, 1376755272, 1518117514, 1972553261]}]}]}, {"tin": {"type": "ein", "value": "363665887"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 55.0, "npi": [1316038813]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 89.98, "providers": [{"billed_charge": 852.0, "npi": [1265454391]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 51.0, "npi": [1770656514, 1447355540]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1366739104, 1174702963, 1467470815]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.13, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 153.0, "npi": [1669899316]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.21, "providers": [{"billed_charge": 454.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "920462136"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 11.83, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 43.0, "npi": [1588616189]}]}, {"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 43.0, "npi": [1841273372, 1487148870]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 335.62, "providers": [{"billed_charge": 380.0, "npi": [1952332991]}]}]}]}, {"name": "Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)", "billing_code_type": "CPT", "billing_code": "77063", "billing_code_type_version": "2022", "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS BI", "allowed_amounts": [{"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 42.32, "providers": [{"billed_charge": 75.0, "npi": [1902880834]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["19", "22"], "payments": [{"allowed_amount": 42.32, "providers": [{"billed_charge": 169.0, "npi": [1710116579, 1396938148, 1831140292, 1376755272, 1821520875, 1972553261, 1174700942, 1831280494, 1063463511, 1407807993, 1346479102]}]}, {"allowed_amount": 43.66, "providers": [{"billed_charge": 169.0, "npi": [1972553261, 1063463511]}]}, {"allowed_amount": 91.01, "providers": [{"billed_charge": 169.0, "npi": [1821520875]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 42.32, "providers": [{"billed_charge": 186.0, "npi": [1033342092]}]}]}, {"tin": {"type": "ein", "value": "852880262"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 42.32, "providers": [{"billed_charge": 146.0, "npi": [1629130141]}]}]}]}, {"name": "Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed", "billing_code_type": "CPT", "billing_code": "77067", "billing_code_type_version": "2022", "description": "SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD", "allowed_amounts": [{"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 52.4, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 119.0, "npi": [1902880834]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["19", "22"], "payments": [{"allowed_amount": 52.4, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 315.0, "npi": [1710116579, 1831140292, 1396938148, 1376755272, 1821520875, 1972553261, 1174700942, 1831280494, 1063463511, 1407807993, 1346479102]}]}, {"allowed_amount": 54.06, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 315.0, "npi": [1972553261, 1063463511]}]}, {"allowed_amount": 71.29, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 315.0, "npi": [1821520875]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 52.4, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 276.0, "npi": [1033342092]}]}]}, {"tin": {"type": "ein", "value": "852880262"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 52.4, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 365.0, "npi": [1629130141]}]}]}]}, {"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 high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.", "billing_code_type": "CPT", "billing_code": "99233", "billing_code_type_version": "2022", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "362657618"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 132.74, "providers": [{"billed_charge": 218.0, "npi": [1942309125, 1891966982]}]}, {"allowed_amount": 137.94, "providers": [{"billed_charge": 218.0, "npi": [1891964441, 1225087547, 1265798847]}]}, {"allowed_amount": 147.09, "providers": [{"billed_charge": 218.0, "npi": [1801209671]}]}, {"allowed_amount": 151.77, "providers": [{"billed_charge": 218.0, "npi": [1114707007]}]}, {"allowed_amount": 157.37, "providers": [{"billed_charge": 218.0, "npi": [1831115229]}]}, {"allowed_amount": 165.48, "providers": [{"billed_charge": 218.0, "npi": [1477879880, 1942462106, 1114179702]}]}, {"allowed_amount": 170.16, "providers": [{"billed_charge": 218.0, "npi": [1134178056, 1043244668, 1891743100, 1174572119]}]}, {"allowed_amount": 175.57, "providers": [{"billed_charge": 218.0, "npi": [1346779196]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 138.15, "providers": [{"billed_charge": 586.0, "npi": [1730447038]}]}, {"allowed_amount": 152.52, "providers": [{"billed_charge": 586.0, "npi": [1558652248, 1770876146]}]}, {"allowed_amount": 160.38, "providers": [{"billed_charge": 586.0, "npi": [1700989712]}]}]}, {"tin": {"type": "ein", "value": "731670553"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 133.72, "providers": [{"billed_charge": 478.0, "npi": [1770523201]}]}, {"allowed_amount": 138.15, "providers": [{"billed_charge": 478.0, "npi": [1134436819]}]}]}, {"tin": {"type": "ein", "value": "811724358"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 160.38, "providers": [{"billed_charge": 307.0, "npi": [1073563581, 1194055863]}]}]}, {"tin": {"type": "ein", "value": "815006445"}, "billing_class": "professional", "service_codes": ["51"], "payments": [{"allowed_amount": 167.0, "providers": [{"billed_charge": 167.0, "npi": [1336697234]}]}]}, {"tin": {"type": "ein", "value": "990474457"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 152.52, "providers": [{"billed_charge": 683.0, "npi": [1669585956, 1053595934]}]}]}]}, {"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": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "200671848"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 95.01, "providers": [{"billed_charge": 150.0, "npi": [1659300796]}]}, {"allowed_amount": 98.03, "providers": [{"billed_charge": 150.0, "npi": [1659300796]}]}]}, {"tin": {"type": "ein", "value": "208536577"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 119.73, "providers": [{"billed_charge": 151.4, "npi": [1265060990]}]}]}, {"tin": {"type": "ein", "value": "362657618"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 86.15, "providers": [{"billed_charge": 151.0, "npi": [1891966982]}]}, {"allowed_amount": 88.25, "providers": [{"billed_charge": 151.0, "npi": [1346779196]}]}, {"allowed_amount": 111.73, "providers": [{"billed_charge": 151.0, "npi": [1568861094]}]}, {"allowed_amount": 115.28, "providers": [{"billed_charge": 151.0, "npi": [1356196331, 1598985525, 1114179702, 1942462106, 1114707007]}]}, {"allowed_amount": 119.73, "providers": [{"billed_charge": 151.0, "npi": [1801209671, 1174572119]}]}]}, {"tin": {"type": "ein", "value": "363330928"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 162.0, "providers": [{"billed_charge": 162.0, "npi": [1629046735]}]}]}, {"tin": {"type": "ein", "value": "363792031"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 111.73, "providers": [{"billed_charge": 200.0, "npi": [1891338216]}]}]}, {"tin": {"type": "ein", "value": "364138353"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 119.73, "providers": [{"billed_charge": 240.0, "npi": [1629232699]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 97.8, "providers": [{"billed_charge": 409.0, "npi": [1558652248]}]}]}, {"tin": {"type": "ein", "value": "752985259"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 119.73, "providers": [{"billed_charge": 150.0, "npi": [1730303439]}]}]}, {"tin": {"type": "ein", "value": "815006445"}, "billing_class": "professional", "service_codes": ["51"], "payments": [{"allowed_amount": 115.0, "providers": [{"billed_charge": 115.0, "npi": [1336697234]}]}]}, {"tin": {"type": "ein", "value": "923161798"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 111.73, "providers": [{"billed_charge": 200.0, "npi": [1164926556]}]}]}, {"tin": {"type": "ein", "value": "990474457"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 111.73, "providers": [{"billed_charge": 474.0, "npi": [1225081110]}]}]}]}, {"name": "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)", "billing_code_type": "CPT", "billing_code": "96375", "billing_code_type_version": "2022", "description": "THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 77.25, "providers": [{"billed_charge": 280.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 373.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 345.0, "npi": [1578670543]}]}, {"allowed_amount": 61.56, "providers": [{"billed_charge": 335.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 342.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 278.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 538.0, "npi": [1487715645]}]}, {"allowed_amount": 61.56, "providers": [{"billed_charge": 558.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 298.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 61.56, "providers": [{"billed_charge": 278.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 47.93, "providers": [{"billed_charge": 165.49, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 278.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "862358048"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 59.67, "providers": [{"billed_charge": 261.0, "npi": [1730166224]}]}]}]}, {"name": "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug", "billing_code_type": "CPT", "billing_code": "96374", "billing_code_type_version": "2022", "description": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "350869066"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 133.27, "providers": [{"billed_charge": 511.0, "npi": [1306898960]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 129.16, "providers": [{"billed_charge": 294.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 129.16, "providers": [{"billed_charge": 325.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 373.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 90.38, "providers": [{"billed_charge": 445.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 90.38, "providers": [{"billed_charge": 488.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 342.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 370.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 608.0, "npi": [1487715645]}]}, {"allowed_amount": 90.38, "providers": [{"billed_charge": 630.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 369.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 56.77, "providers": [{"billed_charge": 165.49, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 370.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "852007987"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 56.77, "providers": [{"billed_charge": 3550.96, "npi": [1144838947]}]}]}, {"tin": {"type": "ein", "value": "862358048"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.59, "providers": [{"billed_charge": 1034.0, "npi": [1730166224]}]}]}]}, {"name": "Troponin, quantitative", "billing_code_type": "CPT", "billing_code": "84484", "billing_code_type_version": "2022", "description": "ASSAY OF TROPONIN QUANTITATIVE", "allowed_amounts": [{"tin": {"type": "ein", "value": "262525968"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.0, "providers": [{"billed_charge": 245.0, "npi": [1124272547]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 58.23, "providers": [{"billed_charge": 169.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "352472136"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 58.23, "providers": [{"billed_charge": 274.0, "npi": [1427493246]}]}, {"allowed_amount": 60.08, "providers": [{"billed_charge": 282.0, "npi": [1427493246]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.0, "providers": [{"billed_charge": 213.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.0, "providers": [{"billed_charge": 155.0, "npi": [1558479212]}, {"billed_charge": 270.0, "npi": [1578670543]}]}, {"allowed_amount": 58.81, "providers": [{"billed_charge": 160.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362235165"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 58.81, "providers": [{"billed_charge": 412.0, "npi": [1205923539]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.0, "providers": [{"billed_charge": 365.0, "npi": [1487715645]}]}, {"allowed_amount": 58.81, "providers": [{"billed_charge": 378.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "621682203"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 89.52, "providers": [{"billed_charge": 1190.87, "npi": [1699726406]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.0, "providers": [{"billed_charge": 246.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "990262196"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 87.0, "providers": [{"billed_charge": 87.0, "npi": [1952332991]}]}]}]}, {"name": "Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy", "billing_code_type": "CPT", "billing_code": "81001", "billing_code_type_version": "2022", "description": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY", "allowed_amounts": [{"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.75, "providers": [{"billed_charge": 74.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 100.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 65.0, "npi": [1578670543]}]}, {"allowed_amount": 5.2, "providers": [{"billed_charge": 70.0, "npi": [1548375082]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 119.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362643663"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 4.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 21.0, "npi": [1205829140]}]}]}, {"tin": {"type": "ein", "value": "364195126"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 214.0, "npi": [1487715645]}]}, {"allowed_amount": 5.2, "providers": [{"billed_charge": 222.0, "npi": [1487715645]}]}]}, {"tin": {"type": "ein", "value": "364215081"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 3.62, "providers": [{"billed_charge": 50.0, "npi": [1144202003]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 8.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.2, "providers": [{"billed_charge": 161.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.04, "providers": [{"billed_charge": 119.0, "npi": [1164530465]}]}]}]}]}