{"reporting_entity_name": "Oscar Health", "reporting_entity_type": "Health Insurance Issuer", "plan_id": "11574IL001", "last_updated_on": "2026-05-23", "version": "2.0.0", "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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.62, "providers": [{"billed_charge": 75.86, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "205657908"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 10.28, "providers": [{"billed_charge": 48.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.29, "providers": [{"billed_charge": 155.0, "npi": [1588771919]}]}, {"allowed_amount": 16.72, "providers": [{"billed_charge": 160.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 135.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 9.3, "providers": [{"billed_charge": 90.0, "npi": [1164539730]}]}, {"allowed_amount": 9.55, "providers": [{"billed_charge": 95.0, "npi": [1164539730]}]}, {"allowed_amount": 16.72, "providers": [{"billed_charge": 90.0, "npi": [1447368071]}, {"billed_charge": 105.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.69, "providers": [{"billed_charge": 129.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 237.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 143.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.29, "providers": [{"billed_charge": 174.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 9.55, "providers": [{"billed_charge": 130.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 24.69, "providers": [{"billed_charge": 197.0, "npi": [1003864810]}]}, {"allowed_amount": 50.58, "providers": [{"billed_charge": 197.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 202.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 130.0, "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": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 181.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 202.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 20.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "371762682"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 130.0, "npi": [1407889652]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 291.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 25.09, "providers": [{"billed_charge": 166.48, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 156.0, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 130.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "840563230"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 75.41, "providers": [{"billed_charge": 172.0, "npi": [1992812333]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 428.3, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 14.1, "providers": [{"billed_charge": 55.0, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992115457"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 250.0, "npi": [1922846351]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.29, "providers": [{"billed_charge": 269.0, "npi": [1760220198]}]}, {"allowed_amount": 16.72, "providers": [{"billed_charge": 269.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.72, "providers": [{"billed_charge": 250.0, "npi": [1598503922]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 84.0, "providers": [{"billed_charge": 168.47, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.77, "providers": [{"billed_charge": 334.0, "npi": [1588771919]}]}, {"allowed_amount": 16.19, "providers": [{"billed_charge": 344.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 225.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 8.1, "providers": [{"billed_charge": 225.0, "npi": [1578670543]}]}, {"allowed_amount": 12.98, "providers": [{"billed_charge": 225.0, "npi": [1164539730]}]}, {"allowed_amount": 16.19, "providers": [{"billed_charge": 225.0, "npi": [1578670543, 1447368071]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 56.53, "providers": [{"billed_charge": 438.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 530.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 325.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.77, "providers": [{"billed_charge": 438.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 12.98, "providers": [{"billed_charge": 280.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 56.53, "providers": [{"billed_charge": 438.0, "npi": [1003864810]}]}, {"allowed_amount": 91.46, "providers": [{"billed_charge": 438.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 368.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 280.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364099076"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 31.3, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 31.3, "npi": [1558449587]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 438.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 368.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "371762682"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 280.0, "npi": [1407889652]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 552.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 42.74, "providers": [{"billed_charge": 219.9, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 316.25, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 280.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 630.96, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 27.63, "providers": [{"billed_charge": 74.0, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992115457"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 626.0, "npi": [1922846351]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 15.77, "providers": [{"billed_charge": 694.0, "npi": [1760220198]}]}, {"allowed_amount": 16.19, "providers": [{"billed_charge": 694.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 16.19, "providers": [{"billed_charge": 626.0, "npi": [1598503922]}]}]}]}, {"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": "333541786"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1671.0, "npi": [1609030410, 1205937547, 1225135890, 1033308531, 1376527382]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 6710.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 3700.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 8002.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2425.42, "providers": [{"billed_charge": 8642.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1374.0, "npi": [1821254830]}]}, {"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1374.0, "npi": [1376755272, 1972553261]}]}]}, {"tin": {"type": "ein", "value": "363525186"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 337.0, "npi": [1891745816]}]}]}, {"tin": {"type": "ein", "value": "371399888"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 362.0, "npi": [1891817961]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 881.6, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 7086.87, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 154.77, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 928.35, "npi": [1992090674]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "22", "21"], "payments": [{"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 320.0, "npi": [1578790309, 1033451711]}]}, {"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 320.0, "npi": [1861810632, 1457640328, 1548221609, 1659832244, 1134105877, 1164537627]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 2985.0, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 112.27, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 176.0, "npi": [1720252315]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 89.81, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1946.0, "npi": [1679955173]}]}, {"allowed_amount": 135.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1692.0, "npi": [1578526448]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 6100.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "814239184"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 139.56, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1064.0, "npi": [1184078081]}]}, {"allowed_amount": 212.23, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 1013.0, "npi": [1750519807]}]}]}, {"tin": {"type": "ein", "value": "860260959"}, "billing_class": "professional", "service_codes": ["22"], "payments": [{"allowed_amount": 57.95, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 275.1, "npi": [1376791343]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 831.21, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 15631.35, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 5118.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.26, "providers": [{"billed_charge": 9474.0, "npi": [1598503922]}]}]}]}, {"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": "333541786"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 608.0, "npi": [1609070945, 1215284898, 1376527382]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 310.6, "providers": [{"billed_charge": 3140.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 883.04, "providers": [{"billed_charge": 2600.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["22", "21"], "payments": [{"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 139.0, "npi": [1780686600]}]}, {"allowed_amount": 57.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 139.0, "npi": [1295239523, 1427584317, 1932426327]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 310.6, "providers": [{"billed_charge": 2500.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 57.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 630.0, "npi": [1518117514, 1922264373, 1972553261, 1831280494]}]}]}, {"tin": {"type": "ein", "value": "371399888"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 51.92, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 168.0, "npi": [1821550880]}]}, {"allowed_amount": 57.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 168.0, "npi": [1225565054]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 692.55, "billing_code_modifier": ["TC"], "providers": [{"billed_charge": 2764.09, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 41.54, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1235690827]}]}, {"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1376522177, 1508801697, 1134198278, 1376809194, 1225288236]}]}, {"allowed_amount": 57.1, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1508801697, 1669883898, 1659832244]}]}, {"allowed_amount": 98.3, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 180.0, "npi": [1235690827]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 55.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 637.0, "npi": [1659334134]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 310.6, "providers": [{"billed_charge": 2500.0, "npi": [1164530465]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 163.56, "providers": [{"billed_charge": 171.97, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 101.85, "providers": [{"billed_charge": 511.0, "npi": [1588771919]}]}, {"allowed_amount": 104.55, "providers": [{"billed_charge": 526.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 520.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 385.0, "npi": [1447368071]}, {"billed_charge": 485.0, "npi": [1578670543]}]}, {"allowed_amount": 207.59, "providers": [{"billed_charge": 485.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 207.59, "providers": [{"billed_charge": 285.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 595.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 340.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 207.59, "providers": [{"billed_charge": 475.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 207.59, "providers": [{"billed_charge": 435.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 516.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 475.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 155.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 101.85, "providers": [{"billed_charge": 450.0, "npi": [1164530465]}]}, {"allowed_amount": 104.55, "providers": [{"billed_charge": 475.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 714.82, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 101.85, "providers": [{"billed_charge": 603.0, "npi": [1760220198]}]}, {"allowed_amount": 104.55, "providers": [{"billed_charge": 603.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 104.55, "providers": [{"billed_charge": 548.0, "npi": [1598503922]}]}]}]}, {"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": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3945.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2910.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2560.0, "npi": [1447368071]}, {"billed_charge": 4240.0, "npi": [1578670543]}]}, {"allowed_amount": 1317.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2970.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1657.78, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5049.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 501.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5049.0, "npi": [1124025176]}]}, {"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5049.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1231.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5049.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3729.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 303.65, "providers": [{"billed_charge": 539.0, "npi": [1679947535, 1518283431]}]}]}, {"tin": {"type": "ein", "value": "363186070"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 243.33, "providers": [{"billed_charge": 1239.0, "npi": [1235621772]}]}, {"allowed_amount": 303.65, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1239.0, "npi": [1770233322, 1780245050, 1609370469]}]}]}, {"tin": {"type": "ein", "value": "363307038"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 303.65, "providers": [{"billed_charge": 1118.34, "npi": [1770894263]}]}]}, {"tin": {"type": "ein", "value": "364109449"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 295.8, "providers": [{"billed_charge": 2076.0, "npi": [1871933606]}]}, {"allowed_amount": 303.65, "providers": [{"billed_charge": 2076.0, "npi": [1699850768]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2192.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 233.61, "providers": [{"billed_charge": 1052.0, "npi": [1780320028]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 929.51, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2677.5, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "453211013"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 303.65, "providers": [{"billed_charge": 1345.0, "npi": [1225077837]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2414.25, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 303.65, "providers": [{"billed_charge": 701.0, "npi": [1679157275]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4390.0, "npi": [1164530465]}]}, {"allowed_amount": 599.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3990.0, "npi": [1164530465]}]}, {"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4390.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "810584939"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 627.52, "providers": [{"billed_charge": 1358.0, "npi": [1568193217]}]}]}, {"tin": {"type": "ein", "value": "822218927"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 303.65, "providers": [{"billed_charge": 1870.0, "npi": [1043692007]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 295.8, "providers": [{"billed_charge": 1942.0, "npi": [1679148829, 1285929414]}]}, {"allowed_amount": 303.65, "providers": [{"billed_charge": 1942.0, "npi": [1053999060, 1679148829]}]}]}, {"tin": {"type": "ein", "value": "841024906"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 597.23, "providers": [{"billed_charge": 2025.96, "npi": [1538509484]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1363.42, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 7080.15, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 599.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5129.0, "npi": [1760220198]}]}, {"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5129.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5377.0, "npi": [1598503922]}]}, {"allowed_amount": 615.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5377.0, "npi": [1598503922]}]}]}]}, {"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": "352074283"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 417.25, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1932.0, "npi": [1336205798]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 226.78, "providers": [{"billed_charge": 1520.0, "npi": [1467560128]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1825.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362174823"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 226.78, "providers": [{"billed_charge": 2349.0, "npi": [1932213600]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 1924.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362222696"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 606.38, "providers": [{"billed_charge": 1518.0, "npi": [1760542732]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1899.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 1700.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 949.5, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 755.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "383943890"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 104.26, "providers": [{"billed_charge": 195.0, "npi": [1720596166, 1033272943]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 104.26, "providers": [{"billed_charge": 874.0, "npi": [1326063736]}]}, {"allowed_amount": 156.16, "providers": [{"billed_charge": 874.0, "npi": [1659711950]}]}]}, {"tin": {"type": "ein", "value": "840563230"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 686.67, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1129.0, "npi": [1992812333]}]}]}, {"tin": {"type": "ein", "value": "911780160"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 104.26, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 166.0, "npi": [1801475348]}]}]}, {"tin": {"type": "ein", "value": "992115457"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 1286.0, "npi": [1922846351]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 1834.0, "npi": [1760220198]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 861.29, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 861.29, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 406.47, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2346.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 501.61, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2554.0, "npi": [1588771919]}]}, {"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2631.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1450.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 364.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1620.0, "npi": [1164539730]}]}, {"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2620.0, "npi": [1578670543]}]}, {"allowed_amount": 1231.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1620.0, "npi": [1164539730]}]}, {"allowed_amount": 1317.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1690.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3375.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362174823"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3495.0, "npi": [1932213600]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1317.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3150.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1231.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3607.0, "npi": [1003864810]}]}, {"allowed_amount": 1317.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3607.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2752.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 203.3, "providers": [{"billed_charge": 365.0, "npi": [1114224532]}]}, {"allowed_amount": 208.7, "providers": [{"billed_charge": 365.0, "npi": [1255560785, 1760060669, 1679514335]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3150.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364109449"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 154.25, "providers": [{"billed_charge": 1228.0, "npi": [1144661448]}]}, {"allowed_amount": 203.3, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1228.0, "npi": [1730491622]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3607.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2752.0, "npi": [1376644385]}]}, {"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2752.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 208.7, "providers": [{"billed_charge": 318.0, "npi": [1558985861]}]}]}, {"tin": {"type": "ein", "value": "371762682"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3150.0, "npi": [1407889652]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2128.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "383784101"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 236.98, "providers": [{"billed_charge": 738.0, "npi": [1982042370]}]}]}, {"tin": {"type": "ein", "value": "474944608"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 247.36, "providers": [{"billed_charge": 1581.0, "npi": [1336672955]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3150.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "822218927"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 154.25, "providers": [{"billed_charge": 1280.0, "npi": [1124862966]}]}, {"allowed_amount": 208.7, "providers": [{"billed_charge": 1280.0, "npi": [1033798442, 1265819924, 1821448663, 1346536380, 1205986718]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 208.7, "providers": [{"billed_charge": 1307.0, "npi": [1326063736, 1184647752, 1295862811]}]}]}, {"tin": {"type": "ein", "value": "840563230"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 1110.79, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1928.0, "npi": [1992812333]}]}]}, {"tin": {"type": "ein", "value": "872190065"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 187.32, "providers": [{"billed_charge": 1280.0, "npi": [1407623796]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 514.92, "providers": [{"billed_charge": 6509.13, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "911780160"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 208.7, "providers": [{"billed_charge": 293.0, "npi": [1669050647]}]}]}, {"tin": {"type": "ein", "value": "992115457"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2344.0, "npi": [1922846351]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 3475.0, "npi": [1760220198]}]}, {"allowed_amount": 514.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3475.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 374.03, "providers": [{"billed_charge": 2344.0, "npi": [1598503922]}]}]}]}, {"name": "Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique", "billing_code_type": "CPT", "billing_code": "87637", "billing_code_type_version": "2022", "description": "IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ", "allowed_amounts": [{"tin": {"type": "ein", "value": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 143.0, "providers": [{"billed_charge": 143.0, "npi": [1669236261]}]}, {"allowed_amount": 321.52, "providers": [{"billed_charge": 321.52, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 184.46, "providers": [{"billed_charge": 483.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 409.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362222696"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 122.35, "providers": [{"billed_charge": 417.0, "npi": [1760542732]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 515.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 567.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 515.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "863165150"}, "billing_class": "professional", "service_codes": ["81"], "payments": [{"allowed_amount": 158.57, "providers": [{"billed_charge": 214.0, "npi": [1467023499]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 570.52, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 568.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 189.35, "providers": [{"billed_charge": 568.0, "npi": [1598503922]}]}]}]}, {"name": "Injection, ketorolac tromethamine, per 15 mg", "billing_code_type": "CPT", "billing_code": "J1885", "billing_code_type_version": "2022", "description": "Injection, ketorolac tromethamine, per 15 mg", "allowed_amounts": [{"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 34.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 10.8, "providers": [{"billed_charge": 120.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 30.0, "npi": [1295882561]}, {"billed_charge": 40.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 2.75, "providers": [{"billed_charge": 2.75, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 12.81, "providers": [{"billed_charge": 14.63, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 59.31, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 76.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 12.64, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 4.17, "providers": [{"billed_charge": 4.17, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 33.17, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "840563230"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.85, "providers": [{"billed_charge": 34.75, "npi": [1992812333]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 53.7, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 11.09, "providers": [{"billed_charge": 26.34, "npi": [1598503922]}]}]}]}, {"name": "Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure)", "billing_code_type": "CPT", "billing_code": "96361", "billing_code_type_version": "2022", "description": "IV INFUSION HYDRATION EACH ADDITIONAL HOUR", "allowed_amounts": [{"tin": {"type": "ein", "value": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 84.82, "providers": [{"billed_charge": 257.86, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 66.74, "providers": [{"billed_charge": 256.0, "npi": [1588771919]}]}, {"allowed_amount": 68.51, "providers": [{"billed_charge": 264.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 225.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 245.0, "npi": [1578670543]}]}, {"allowed_amount": 106.43, "providers": [{"billed_charge": 175.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 458.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 195.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 97.28, "providers": [{"billed_charge": 414.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 355.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 318.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 474.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 131.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 303.75, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 66.74, "providers": [{"billed_charge": 355.0, "npi": [1164530465]}]}, {"allowed_amount": 68.51, "providers": [{"billed_charge": 355.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 68.51, "providers": [{"billed_charge": 230.7, "npi": [1760220198]}]}]}]}, {"name": "Lipase", "billing_code_type": "CPT", "billing_code": "83690", "billing_code_type_version": "2022", "description": "ASSAY OF LIPASE", "allowed_amounts": [{"tin": {"type": "ein", "value": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 56.42, "providers": [{"billed_charge": 68.35, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 198.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 140.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 140.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 240.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 42.75, "providers": [{"billed_charge": 233.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 57.81, "providers": [{"billed_charge": 160.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 76.57, "providers": [{"billed_charge": 337.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 287.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 106.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 287.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 138.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 158.25, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 160.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 17.68, "providers": [{"billed_charge": 48.0, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 43.89, "providers": [{"billed_charge": 454.0, "npi": [1598503922]}]}]}]}, {"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 moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.", "billing_code_type": "CPT", "billing_code": "99214", "billing_code_type_version": "2022", "description": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "270169972"}, "billing_class": "professional", "service_codes": ["11"], "payments": [{"allowed_amount": 171.31, "providers": [{"billed_charge": 224.0, "npi": [1487715264]}]}]}, {"tin": {"type": "ein", "value": "333252205"}, "billing_class": "professional", "service_codes": ["10"], "payments": [{"allowed_amount": 199.04, "providers": [{"billed_charge": 250.36, "npi": [1639350978]}]}]}, {"tin": {"type": "ein", "value": "362894128"}, "billing_class": "professional", "service_codes": ["02"], "payments": [{"allowed_amount": 147.0, "providers": [{"billed_charge": 262.0, "npi": [1710204706]}]}]}, {"tin": {"type": "ein", "value": "363488183"}, "billing_class": "professional", "service_codes": ["10", "22"], "payments": [{"allowed_amount": 143.64, "providers": [{"billed_charge": 365.0, "npi": [1801452552]}]}, {"allowed_amount": 149.92, "providers": [{"billed_charge": 365.0, "npi": [1376765685, 1538991476, 1194374637]}]}, {"allowed_amount": 150.9, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 365.0, "npi": [1033597729, 1215090725, 1861073256, 1891856621, 1104053677, 1841617008, 1801015672, 1629130174]}]}, {"allowed_amount": 157.18, "providers": [{"billed_charge": 365.0, "npi": [1801391479]}]}, {"allowed_amount": 161.36, "providers": [{"billed_charge": 334.0, "npi": [1821792193]}, {"billed_charge": 365.0, "npi": [1972885705]}]}, {"allowed_amount": 163.47, "providers": [{"billed_charge": 365.0, "npi": [1184918294]}]}]}, {"tin": {"type": "ein", "value": "611630276"}, "billing_class": "professional", "service_codes": ["20"], "payments": [{"allowed_amount": 157.57, "providers": [{"billed_charge": 204.0, "npi": [1780145904]}]}]}, {"tin": {"type": "ein", "value": "911780160"}, "billing_class": "professional", "service_codes": ["11"], "payments": [{"allowed_amount": 208.21, "providers": [{"billed_charge": 221.0, "npi": [1831582469]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 231.63, "providers": [{"billed_charge": 333.38, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "161601110"}, "billing_class": "professional", "service_codes": ["23", "22"], "payments": [{"allowed_amount": 19.06, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1437142239]}]}]}, {"tin": {"type": "ein", "value": "333541786"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 183.0, "npi": [1699162511]}]}, {"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 183.0, "npi": [1295179448]}]}]}, {"tin": {"type": "ein", "value": "351107009"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 124.41, "providers": [{"billed_charge": 468.0, "npi": [1003918210]}]}]}, {"tin": {"type": "ein", "value": "351435368"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 23.86, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 42.0, "npi": [1619960788]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 132.28, "providers": [{"billed_charge": 487.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 280.3, "providers": [{"billed_charge": 963.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 132.28, "providers": [{"billed_charge": 963.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["22", "19"], "payments": [{"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 43.0, "npi": [1780686600]}]}, {"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 43.0, "npi": [1831328038]}]}]}, {"tin": {"type": "ein", "value": "363097297"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 55.0, "npi": [1063404580, 1447239389]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 130.0, "npi": [1235179409, 1063463511]}]}, {"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 130.0, "npi": [1518117514, 1972553261, 1922264373, 1821254830]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 132.28, "providers": [{"billed_charge": 229.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 27.0, "npi": [1750321691]}]}]}, {"tin": {"type": "ein", "value": "371399888"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 44.0, "npi": [1437343696, 1891817961, 1982915302]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 45.0, "npi": [1841246790]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23", "19"], "payments": [{"allowed_amount": 15.63, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 196.0, "npi": [1750344768]}]}, {"allowed_amount": 16.05, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 216.0, "npi": [1841202462]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 128.86, "providers": [{"billed_charge": 550.0, "npi": [1164530465]}]}, {"allowed_amount": 132.28, "providers": [{"billed_charge": 550.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 132.28, "providers": [{"billed_charge": 861.0, "npi": [1760220198]}]}]}]}, {"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": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 44.0, "npi": [1255508768]}]}]}, {"tin": {"type": "ein", "value": "333541786"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 248.0, "npi": [1639107428, 1215284898, 1972739100, 1376527382]}]}, {"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 248.0, "npi": [1639107428, 1336161959, 1295179448, 1174812697, 1982662623]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 526.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 380.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 400.0, "npi": [1578670543]}, {"billed_charge": 490.0, "npi": [1447368071]}]}, {"allowed_amount": 198.11, "providers": [{"billed_charge": 465.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 707.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 728.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "362664075"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 32.0, "npi": [1528060910]}]}]}, {"tin": {"type": "ein", "value": "363482203"}, "billing_class": "professional", "service_codes": ["19"], "payments": [{"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 122.0, "npi": [1942731757]}]}]}, {"tin": {"type": "ein", "value": "371399888"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 37.0, "npi": [1891817961]}]}]}, {"tin": {"type": "ein", "value": "462494918"}, "billing_class": "professional", "service_codes": ["23", "22", "21"], "payments": [{"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1659934156, 1225288236, 1134198278, 1063774735]}]}, {"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1255537858, 1861810632, 1457640328, 1851353395, 1235286196, 1659832244, 1962518613]}]}, {"allowed_amount": 16.64, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 38.0, "npi": [1235690827]}]}]}, {"tin": {"type": "ein", "value": "473109067"}, "billing_class": "professional", "service_codes": ["23", "21"], "payments": [{"allowed_amount": 12.2, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 176.0, "npi": [1376561720, 1780652180]}]}, {"allowed_amount": 12.53, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 202.0, "npi": [1174766745, 1841202462]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 500.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "834708147"}, "billing_class": "professional", "service_codes": ["23"], "payments": [{"allowed_amount": 12.21, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 24.0, "npi": [1679148829]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 89.98, "providers": [{"billed_charge": 784.0, "npi": [1760220198]}]}, {"allowed_amount": 92.37, "providers": [{"billed_charge": 784.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.37, "providers": [{"billed_charge": 852.0, "npi": [1598503922]}]}]}]}, {"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": "331385787"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 157.37, "providers": [{"billed_charge": 225.0, "npi": [1649412370]}]}, {"allowed_amount": 165.48, "providers": [{"billed_charge": 225.0, "npi": [1225081110]}]}, {"allowed_amount": 173.96, "providers": [{"billed_charge": 225.0, "npi": [1649412370]}]}]}, {"tin": {"type": "ein", "value": "362657618"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 137.94, "providers": [{"billed_charge": 218.0, "npi": [1679896138, 1043244668]}]}]}, {"tin": {"type": "ein", "value": "364151684"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 173.96, "providers": [{"billed_charge": 185.0, "npi": [1154346609]}]}]}, {"tin": {"type": "ein", "value": "383745067"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 157.37, "providers": [{"billed_charge": 168.0, "npi": [1306855481]}]}]}, {"tin": {"type": "ein", "value": "473592653"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 167.77, "providers": [{"billed_charge": 350.0, "npi": [1346795671]}]}]}, {"tin": {"type": "ein", "value": "800147997"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 178.9, "providers": [{"billed_charge": 727.0, "npi": [1013272202]}]}]}, {"tin": {"type": "ein", "value": "943432525"}, "billing_class": "professional", "service_codes": ["21"], "payments": [{"allowed_amount": 160.0, "providers": [{"billed_charge": 160.0, "npi": [1851833644]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 150.48, "providers": [{"billed_charge": 150.48, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 396.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 295.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 500.0, "npi": [1578670543]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 425.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 239.1, "providers": [{"billed_charge": 393.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 305.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 252.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 298.0, "npi": [1376644385]}, {"billed_charge": 343.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 292.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "390816848"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 81.82, "providers": [{"billed_charge": 320.83, "npi": [1093768962]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 61.56, "providers": [{"billed_charge": 305.0, "npi": [1164530465]}]}, {"allowed_amount": 63.2, "providers": [{"billed_charge": 305.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 135.71, "providers": [{"billed_charge": 791.7, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 63.2, "providers": [{"billed_charge": 230.7, "npi": [1760220198]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 187.07, "providers": [{"billed_charge": 378.5, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 396.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 395.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 665.0, "npi": [1578670543]}]}, {"allowed_amount": 196.55, "providers": [{"billed_charge": 400.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 207.55, "providers": [{"billed_charge": 225.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 509.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362179779"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 90.38, "providers": [{"billed_charge": 431.0, "npi": [1124025176]}]}]}, {"tin": {"type": "ein", "value": "362513909"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 196.55, "providers": [{"billed_charge": 393.0, "npi": [1003864810]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 405.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 306.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 424.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 547.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 558.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 283.75, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 90.38, "providers": [{"billed_charge": 405.0, "npi": [1164530465]}]}, {"allowed_amount": 92.78, "providers": [{"billed_charge": 405.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "840563230"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 254.36, "providers": [{"billed_charge": 342.0, "npi": [1992812333]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 90.38, "providers": [{"billed_charge": 1053.45, "npi": [1760220198]}]}, {"allowed_amount": 92.78, "providers": [{"billed_charge": 1053.45, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 92.78, "providers": [{"billed_charge": 481.0, "npi": [1598503922]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 98.81, "providers": [{"billed_charge": 201.59, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 226.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362167920"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 210.0, "npi": [1629026364]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 130.0, "npi": [1447368071]}, {"billed_charge": 255.0, "npi": [1578670543]}]}, {"allowed_amount": 84.12, "providers": [{"billed_charge": 190.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362169179"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 84.12, "providers": [{"billed_charge": 244.0, "npi": [1851386692]}]}]}, {"tin": {"type": "ein", "value": "362170155"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 347.0, "npi": [1649370057]}]}]}, {"tin": {"type": "ein", "value": "362276984"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 84.12, "providers": [{"billed_charge": 245.0, "npi": [1265465439]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 279.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 245.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "366006541"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 32.0, "providers": [{"billed_charge": 32.0, "npi": [1588612832]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 58.81, "providers": [{"billed_charge": 246.0, "npi": [1164530465]}]}, {"allowed_amount": 60.37, "providers": [{"billed_charge": 245.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 58.81, "providers": [{"billed_charge": 378.0, "npi": [1760220198]}]}, {"allowed_amount": 60.37, "providers": [{"billed_charge": 378.0, "npi": [1760220198]}]}]}, {"tin": {"type": "ein", "value": "992367318"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 60.37, "providers": [{"billed_charge": 453.0, "npi": [1598503922]}]}]}]}, {"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": "150622079"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 12.47, "providers": [{"billed_charge": 41.07, "npi": [1669236261]}]}]}, {"tin": {"type": "ein", "value": "352074283"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 12.45, "providers": [{"billed_charge": 139.0, "npi": [1336205798]}]}]}, {"tin": {"type": "ein", "value": "362167869"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.2, "providers": [{"billed_charge": 103.0, "npi": [1588771919]}]}, {"allowed_amount": 5.34, "providers": [{"billed_charge": 106.0, "npi": [1588771919]}]}]}, {"tin": {"type": "ein", "value": "362169147"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 52.64, "providers": [{"billed_charge": 70.0, "npi": [1164539730]}]}]}, {"tin": {"type": "ein", "value": "362170840"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 175.0, "npi": [1295882561]}]}]}, {"tin": {"type": "ein", "value": "362596381"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 220.0, "npi": [1265577191]}]}]}, {"tin": {"type": "ein", "value": "363208390"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 120.0, "npi": [1760415939]}]}]}, {"tin": {"type": "ein", "value": "364244337"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 92.0, "npi": [1184705931]}]}]}, {"tin": {"type": "ein", "value": "364251846"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 220.0, "npi": [1376644385]}]}]}, {"tin": {"type": "ein", "value": "371762682"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 120.0, "npi": [1407889652]}]}]}, {"tin": {"type": "ein", "value": "376000511"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 169.0, "npi": [1861431751]}]}]}, {"tin": {"type": "ein", "value": "472313900"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 100.5, "npi": [1033214416]}]}]}, {"tin": {"type": "ein", "value": "651219504"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 120.0, "npi": [1164530465]}]}]}, {"tin": {"type": "ein", "value": "883850676"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 240.26, "npi": [1326765884]}]}]}, {"tin": {"type": "ein", "value": "933085834"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 22.0, "providers": [{"billed_charge": 22.0, "npi": [1275305013]}]}]}, {"tin": {"type": "ein", "value": "992115457"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.34, "providers": [{"billed_charge": 146.0, "npi": [1922846351]}]}]}, {"tin": {"type": "ein", "value": "992141118"}, "billing_class": "institutional", "service_codes": [null], "payments": [{"allowed_amount": 5.2, "providers": [{"billed_charge": 222.0, "npi": [1760220198]}]}]}]}]}