{"reporting_entity_name":"Capital Health Plan Inc.","reporting_entity_type":"health insurance issuer","plan_name":"Commercial","plan_id_type":"ein","plan_id":"59-1830622","plan_market_type":"group","last_updated_on":"2026-07-31","version":"1.0.0","out_of_network":[{"name":"Digitize image of specimen","billing_code_type":"CPT","billing_code_type_version":"2023","billing_code":"0753T","description":"dgtz gls mcrscp sld level iv","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1891782470]}]}]}]},{"name":"Surgical cleaning of wound","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"11042","description":"dbrdmt subq tis 1st 20sqcm/<","allowed_amounts":[{"tin":{"Type":"ein","value":"814081877"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":63.23,"providers":[{"billed_charge":175.00,"npi":[1922852581]}]}]}]},{"name":"Blood draw from vein","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"36415","description":"coll venous bld venipuncture","allowed_amounts":[{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":23.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":11.36,"providers":[{"billed_charge":23.00,"npi":[1538108725]}]}]}]},{"name":"Elbow nerve surgery","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"64718","description":"revise ulnar nerve at elbow","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":888.15,"billing_code_modifier":["79","LT","RT"],"providers":[{"billed_charge":2645.00,"npi":[1164764445,1972570885]}]}]}]},{"name":"Surgery reduce nerve pressure","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"64721","description":"carpal tunnel surgery","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":370.27,"billing_code_modifier":["51","59","79","LT","RT"],"providers":[{"billed_charge":2104.00,"npi":[1164764445]}]}]},{"tin":{"Type":"ein","value":"591286000"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":740.53,"billing_code_modifier":["59","LT","RT"],"providers":[{"billed_charge":2104.00,"npi":[1164764445]}]}]}]},{"name":"Metabolic blood tests","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"80048","description":"basic metabolic pnl total ca","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":16.60,"providers":[{"billed_charge":345.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":20.74,"providers":[{"billed_charge":345.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":258.75,"providers":[{"billed_charge":345.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":61.00,"npi":[1538108725]}]}]}]},{"name":"Metabolic blood tests","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"80053","description":"comprehen metabolic panel","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":525.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":367.50,"providers":[{"billed_charge":525.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":393.75,"providers":[{"billed_charge":525.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":13.20,"providers":[{"billed_charge":525.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":20.74,"providers":[{"billed_charge":452.00,"npi":[1841351566]}]},{"allowed_amount":20.74,"providers":[{"billed_charge":525.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":367.50,"providers":[{"billed_charge":525.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":393.75,"providers":[{"billed_charge":525.00,"npi":[1285621631]}]}]}]},{"name":"Urine analysis","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"81001","description":"urinalysis auto w/scope","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.22,"billing_code_modifier":["59"],"providers":[{"billed_charge":59.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":44.25,"providers":[{"billed_charge":59.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["59"],"providers":[{"billed_charge":36.00,"npi":[1538108725]}]}]}]},{"name":"Genetic test on breast tissue","billing_code_type":"CPT","billing_code_type_version":"2015","billing_code":"81519","description":"oncology breast mrna","allowed_amounts":[{"tin":{"Type":"ein","value":"770552594"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":3863.00,"providers":[{"billed_charge":4620.00,"npi":[1215003603]}]}]},{"tin":{"Type":"ein","value":"770552594"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":4620.00,"providers":[{"billed_charge":4620.00,"npi":[1215003603]}]}]}]},{"name":"Colon cancer screening","billing_code_type":"CPT","billing_code_type_version":"2016","billing_code":"81528","description":"oncology colorectal scr","allowed_amounts":[{"tin":{"Type":"ein","value":"463095174"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":524.00,"providers":[{"billed_charge":681.00,"npi":[1629407069]}]}]},{"tin":{"Type":"ein","value":"463095174"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":636.09,"providers":[{"billed_charge":681.00,"npi":[1629407069]}]}]}]},{"name":"Blood test for bilirubin","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82248","description":"bilirubin direct","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":63.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":44.10,"providers":[{"billed_charge":63.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":47.25,"providers":[{"billed_charge":63.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.28,"providers":[{"billed_charge":63.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":9.85,"providers":[{"billed_charge":63.00,"npi":[1841351566]}]}]}]},{"name":"Test for vitamin D deficiency","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82306","description":"vitamin d 25 hydroxy","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":58.09,"providers":[{"billed_charge":362.00,"npi":[1841351566]}]}]}]},{"name":"Kidney function test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82570","description":"assay of urine creatinine","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.48,"providers":[{"billed_charge":101.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":10.15,"billing_code_modifier":["59","90","91"],"providers":[{"billed_charge":101.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":75.75,"providers":[{"billed_charge":101.00,"npi":[1285621631]}]}]}]},{"name":"Test of vitamin B12 deficiency","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82607","description":"vitamin b-12","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":29.58,"billing_code_modifier":["90"],"providers":[{"billed_charge":227.00,"npi":[1841351566]}]}]}]},{"name":"Ferritin protein test for iron","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82728","description":"assay of ferritin","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":26.73,"providers":[{"billed_charge":187.00,"npi":[1841351566]}]}]}]},{"name":"Immune deficiency test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82784","description":"assay iga/igd/igg/igm each","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.08,"providers":[{"billed_charge":137.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":17.58,"providers":[{"billed_charge":137.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":18.25,"billing_code_modifier":["90"],"providers":[{"billed_charge":137.00,"npi":[1841351566]}]}]}]},{"name":"Fasting blood sugar test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"82947","description":"assay glucose blood quant","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["59","91","QW"],"providers":[{"billed_charge":43.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["59","91","QW"],"providers":[{"billed_charge":47.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["59","91","QW"],"providers":[{"billed_charge":51.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":14.01,"billing_code_modifier":["QW"],"providers":[{"billed_charge":43.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":27.43,"billing_code_modifier":["QW"],"providers":[{"billed_charge":43.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":30.10,"billing_code_modifier":["91","QW"],"providers":[{"billed_charge":43.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":32.25,"billing_code_modifier":["91","GW","QW"],"providers":[{"billed_charge":43.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":38.25,"billing_code_modifier":["91"],"providers":[{"billed_charge":51.00,"npi":[1891782470]}]}]}]},{"name":"Blood sugar (glucose) test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"83036","description":"hemoglobin glycosylated a1c","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":19.04,"providers":[{"billed_charge":139.00,"npi":[1841351566]}]}]}]},{"name":"Magnesium testing","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"83735","description":"assay of magnesium","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":100.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":70.00,"providers":[{"billed_charge":100.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":75.00,"providers":[{"billed_charge":100.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":90.36,"providers":[{"billed_charge":100.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":70.00,"providers":[{"billed_charge":100.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":75.00,"providers":[{"billed_charge":100.00,"npi":[1285621631]}]}]}]},{"name":"Phosphorus trace element test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"84100","description":"assay of phosphorus","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":5.93,"providers":[{"billed_charge":55.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":9.30,"providers":[{"billed_charge":55.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":38.50,"providers":[{"billed_charge":55.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":41.25,"providers":[{"billed_charge":55.00,"npi":[1285621631]}]}]}]},{"name":"Total urine protein test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"84156","description":"assay of protein urine","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":4.59,"providers":[{"billed_charge":67.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":7.19,"billing_code_modifier":["90"],"providers":[{"billed_charge":67.00,"npi":[1841351566]}]}]}]},{"name":"Thyroid hormone test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"84443","description":"assay thyroid stim hormone","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":21.00,"providers":[{"billed_charge":276.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":32.96,"providers":[{"billed_charge":276.00,"npi":[1841351566]}]}]}]},{"name":"Complete blood count (CBC)","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"85025","description":"complete cbc w/auto diff wbc","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":99.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":69.30,"providers":[{"billed_charge":99.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":74.25,"providers":[{"billed_charge":99.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":9.71,"providers":[{"billed_charge":99.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":13.70,"providers":[{"billed_charge":99.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":14.70,"providers":[{"billed_charge":99.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":15.26,"providers":[{"billed_charge":99.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":69.30,"providers":[{"billed_charge":99.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":74.25,"providers":[{"billed_charge":99.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":48.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":9.71,"providers":[{"billed_charge":48.00,"npi":[1538108725]}]}]}]},{"name":"Complete blood count (CBC)","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"85027","description":"complete cbc automated","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":108.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":97.59,"providers":[{"billed_charge":108.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":8.09,"providers":[{"billed_charge":108.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.70,"providers":[{"billed_charge":108.00,"npi":[1841351566]}]}]}]},{"name":"Doctor evaluates blood smear","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"85060","description":"blood smear interpretation","allowed_amounts":[{"tin":{"Type":"ein","value":"800564919"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":28.34,"providers":[{"billed_charge":125.00,"npi":[1184782500]}]}]}]},{"name":"Test prothrombin clotting time","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"85610","description":"prothrombin time","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":7.70,"providers":[{"billed_charge":76.00,"npi":[1841351566]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":57.00,"providers":[{"billed_charge":76.00,"npi":[1841351566]}]}]}]},{"name":"Blood test for inflammation","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"86140","description":"c-reactive protein","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":10.15,"providers":[{"billed_charge":103.00,"npi":[1841351566]}]}]}]},{"name":"Blood autoimmune test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"86850","description":"rbc antibody screen","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":30.40,"providers":[{"billed_charge":103.00,"npi":[1841351566]}]}]}]},{"name":"Blood typing","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"86900","description":"blood typing serologic abo","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":5.85,"providers":[{"billed_charge":66.00,"npi":[1841351566]}]}]}]},{"name":"Rh blood typing","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"86901","description":"blood typing serologic rh(d)","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":5.85,"providers":[{"billed_charge":94.00,"npi":[1841351566]}]}]}]},{"name":"Test for Candida infection","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87481","description":"candida dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"billing_code_modifier":["91"],"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test to confirm Chlamydia","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87491","description":"chlmyd trach dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Cytomegalovirus (CMV) test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87496","description":"cytomeg dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test human herpesvirus 6","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87532","description":"hhv-6 dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for STD bacteria","billing_code_type":"CPT","billing_code_type_version":"2020","billing_code":"87563","description":"m. genitalium amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for gonorrhea infection","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87591","description":"n.gonorrhoeae dna amp prob","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for Staph infection","billing_code_type":"CPT","billing_code_type_version":"2007","billing_code":"87640","description":"staph a dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"billing_code_modifier":["59"],"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for strep throat","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87651","description":"strep a dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for strep infection","billing_code_type":"CPT","billing_code_type_version":"2007","billing_code":"87653","description":"strep b dna amp probe","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test to confirm parasite","billing_code_type":"CPT","billing_code_type_version":"2014","billing_code":"87661","description":"trichomonas vaginalis amplif","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test of infection type","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87798","description":"detect agent nos dna amp","allowed_amounts":[{"tin":{"Type":"ein","value":"462439971"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":43.86,"billing_code_modifier":["91"],"providers":[{"billed_charge":71.00,"npi":[1235190356]}]}]}]},{"name":"Test for flu virus","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87804","description":"influenza assay w/optic","allowed_amounts":[{"tin":{"Type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":17.58,"billing_code_modifier":["59","QW"],"providers":[{"billed_charge":35.00,"npi":[1255197828,1497553085]}]}]}]},{"name":"Pathology exam of body tissue","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"88304","description":"tissue exam by pathologist","allowed_amounts":[{"tin":{"Type":"ein","value":"800564919"},"service_code":["21","22"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":13.29,"billing_code_modifier":["26"],"providers":[{"billed_charge":192.00,"npi":[1184782500]}]}]}]},{"name":"Pathology exam of body tissue","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"88305","description":"tissue exam by pathologist","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":714.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"800564919"},"service_code":["21","22"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":43.08,"billing_code_modifier":["26"],"providers":[{"billed_charge":260.00,"npi":[1154309680,1184782500]}]}]}]},{"name":"Typing of diseased cells","billing_code_type":"CPT","billing_code_type_version":"2015","billing_code":"88341","description":"imhchem/imcytchm ea add antb","allowed_amounts":[{"tin":{"Type":"ein","value":"621687140"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":61.45,"billing_code_modifier":["TC"],"providers":[{"billed_charge":61.45,"npi":[1487657573]}]}]}]},{"name":"Typing of diseased cells","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"88342","description":"imhchem/imcytchm 1st antb","allowed_amounts":[{"tin":{"Type":"ein","value":"621687140"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":89.91,"billing_code_modifier":["TC"],"providers":[{"billed_charge":117.00,"npi":[1487657573]}]}]},{"tin":{"Type":"ein","value":"621687140"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":89.92,"billing_code_modifier":["TC"],"providers":[{"billed_charge":117.00,"npi":[1487657573]}]}]}]},{"name":"Coronavirus vaccination","billing_code_type":"CPT","billing_code_type_version":"2023","billing_code":"90480","description":"admn sarscov2 vac 1/only cmp","allowed_amounts":[{"tin":{"Type":"ein","value":"411939629"},"service_code":["17"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":56.19,"providers":[{"billed_charge":105.05,"npi":[1134191836]}]}]}]},{"name":"Mental health eval w/services","billing_code_type":"CPT","billing_code_type_version":"2013","billing_code":"90792","description":"psych diag eval w/med srvcs","allowed_amounts":[{"tin":{"Type":"ein","value":"475240597"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":174.94,"providers":[{"billed_charge":341.41,"npi":[1295445914]}]}]}]},{"name":"Psychotherapy session 60 mins","billing_code_type":"CPT","billing_code_type_version":"2013","billing_code":"90837","description":"psytx w pt 60 minutes","allowed_amounts":[{"tin":{"Type":"ein","value":"842706066"},"service_code":["02"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":75.00,"billing_code_modifier":["AJ","GT"],"providers":[{"billed_charge":150.00,"npi":[1437534237]}]}]},{"tin":{"Type":"ein","value":"842706066"},"service_code":["02"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":94.43,"billing_code_modifier":["AJ","GT"],"providers":[{"billed_charge":150.00,"npi":[1437534237]}]}]}]},{"name":"Group therapy","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"90853","description":"group psychotherapy","allowed_amounts":[{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":92.85,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":116.06,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]},{"allowed_amount":116.06,"providers":[{"billed_charge":412.60,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":116.07,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":116.08,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":116.16,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":116.63,"providers":[{"billed_charge":382.05,"npi":[1912396326]}]}]}]},{"name":"Coronavirus vaccination","billing_code_type":"CPT","billing_code_type_version":"2023","billing_code":"91322","description":"sarscov2 vac 50 mcg/0.5ml im","allowed_amounts":[{"tin":{"Type":"ein","value":"411939629"},"service_code":["17"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":202.06,"providers":[{"billed_charge":366.84,"npi":[1134191836]}]}]}]},{"name":"Heart test review and report","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"93010","description":"electrocardiogram report","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":37.39,"billing_code_modifier":["76"],"providers":[{"billed_charge":118.00,"npi":[1174596324]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":82.60,"billing_code_modifier":["76"],"providers":[{"billed_charge":118.00,"npi":[1174596324]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":8.29,"billing_code_modifier":["76"],"providers":[{"billed_charge":65.00,"npi":[1033744610,1124789805,1467932152,1700241023]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":9.75,"billing_code_modifier":["76"],"providers":[{"billed_charge":65.00,"npi":[1013189224,1306824693,1508917105,1588124333,1629174917,1679525463,1710379920,1740922061,1972025310,1972711810,1982021846]}]}]}]},{"name":"Group intervention 30 mins","billing_code_type":"CPT","billing_code_type_version":"2020","billing_code":"96164","description":"hlth bhv ivntj grp 1st 30","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":134.54,"billing_code_modifier":["59"],"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":134.55,"billing_code_modifier":["59"],"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":426.14,"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1139.33,"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":11880.25,"providers":[{"billed_charge":252.00,"npi":[1891782470]}]}]}]},{"name":"Group intervention 15 mins","billing_code_type":"CPT","billing_code_type_version":"2020","billing_code":"96165","description":"hlth bhv ivntj grp ea addl","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":130.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":69.41,"billing_code_modifier":["59"],"providers":[{"billed_charge":130.00,"npi":[1891782470]}]}]}]},{"name":"Group physical therapy","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"97150","description":"group therapeutic procedures","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["59","GO","GP"],"providers":[{"billed_charge":182.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":97.17,"billing_code_modifier":["59","GO","GP"],"providers":[{"billed_charge":182.00,"npi":[1891782470]}]}]}]},{"name":"Assessment of behavior 15 min","billing_code_type":"CPT","billing_code_type_version":"2018","billing_code":"97151","description":"bhv id assmt by phys/qhp","allowed_amounts":[{"tin":{"Type":"ein","value":"994055213"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":17.50,"providers":[{"billed_charge":17.50,"npi":[1376980532]}]}]}]},{"name":"Behavior therapy 15 mins","billing_code_type":"CPT","billing_code_type_version":"2018","billing_code":"97153","description":"adaptive behavior tx by tech","allowed_amounts":[{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.13,"providers":[{"billed_charge":6.13,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.05,"providers":[{"billed_charge":12.05,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.26,"providers":[{"billed_charge":12.26,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.41,"providers":[{"billed_charge":12.41,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.50,"providers":[{"billed_charge":12.50,"npi":[1376980532,1801325741]}]},{"allowed_amount":12.50,"providers":[{"billed_charge":13.54,"npi":[1376980532]}]},{"allowed_amount":12.50,"providers":[{"billed_charge":14.20,"npi":[1801325741]}]},{"allowed_amount":12.50,"providers":[{"billed_charge":20.83,"npi":[1376980532]}]},{"allowed_amount":12.50,"providers":[{"billed_charge":25.00,"npi":[1376980532]}]}]}]},{"name":"Behavior therapy 15 mins","billing_code_type":"CPT","billing_code_type_version":"2018","billing_code":"97155","description":"adapt behavior tx phys/qhp","allowed_amounts":[{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":17.31,"providers":[{"billed_charge":17.31,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":21.43,"providers":[{"billed_charge":21.43,"npi":[1376980532]}]}]},{"tin":{"Type":"ein","value":"994055213"},"service_code":["03","12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":25.00,"providers":[{"billed_charge":25.00,"npi":[1376980532,1801325741]}]},{"allowed_amount":25.00,"providers":[{"billed_charge":39.29,"npi":[1376980532]}]}]}]},{"name":"New doctor visit 45+ minutes","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99204","description":"office o/p new mod 45 min","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":215.66,"providers":[{"billed_charge":553.00,"npi":[1164764445,1184859530,1316236045,1972570885]}]}]}]},{"name":"Doctor's office visit","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99213","description":"office o/p est low 20 min","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":56.62,"providers":[{"billed_charge":378.00,"npi":[1184910192]}]}]},{"tin":{"Type":"ein","value":"591286000"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":66.61,"billing_code_modifier":["24"],"providers":[{"billed_charge":378.00,"npi":[1164764445,1730251943,1972570885]}]}]}]},{"name":"Doctor's office visit long","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99214","description":"office o/p est mod 30 min","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":77.63,"billing_code_modifier":["24","25","57"],"providers":[{"billed_charge":553.00,"npi":[1164764445,1184859530,1316236045,1730251943,1972570885]}]}]}]},{"name":"Admission day doctor service","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99223","description":"1st hosp ip/obs high 75","allowed_amounts":[{"tin":{"Type":"ein","value":"591286000"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":301.91,"billing_code_modifier":["24","AI"],"providers":[{"billed_charge":488.00,"npi":[1164764445,1972570885]}]}]},{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":210.95,"billing_code_modifier":["25","AI","FS"],"providers":[{"billed_charge":694.00,"npi":[1134172588,1467853929,1659045318,1659936177,1992190631]}]}]},{"tin":{"Type":"ein","value":"814723941"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":210.95,"providers":[{"billed_charge":310.00,"npi":[1225327380]}]}]},{"tin":{"Type":"ein","value":"823032998"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":210.95,"billing_code_modifier":["AI"],"providers":[{"billed_charge":311.00,"npi":[1811302771]}]}]}]},{"name":"Doctor care in hospital","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99231","description":"sbsq hosp ip/obs sf/low 25","allowed_amounts":[{"tin":{"Type":"ein","value":"582236140"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":59.63,"providers":[{"billed_charge":93.38,"npi":[1285605063]}]}]}]},{"name":"Doctor care in hospital","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99232","description":"sbsq hosp ip/obs moderate 35","allowed_amounts":[{"tin":{"Type":"ein","value":"582236140"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":150.94,"npi":[1285605063]}]}]},{"tin":{"Type":"ein","value":"591286000"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":67.95,"billing_code_modifier":["24","57"],"providers":[{"billed_charge":195.00,"npi":[1356931067,1578903886]}]},{"allowed_amount":67.95,"billing_code_modifier":["24","57"],"providers":[{"billed_charge":488.00,"npi":[1356931067]}]}]},{"tin":{"Type":"ein","value":"591286000"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":79.94,"billing_code_modifier":["24","57"],"providers":[{"billed_charge":195.00,"npi":[1164764445]}]}]},{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":250.00,"npi":[1003548116,1023670833,1033615208,1033791942,1063552396,1073174314,1083766687,1306073028,1376958561,1467734681,1508509092,1548902307,1578021689,1659936177,1699171538,1700517893,1750802930,1801458435,1851330807,1902922727,1922705524,1932841806]}]}]},{"tin":{"Type":"ein","value":"814723941"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":111.00,"npi":[1225327380]}]}]},{"tin":{"Type":"ein","value":"823032998"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":111.00,"npi":[1811302771]}]}]},{"tin":{"Type":"ein","value":"851622874"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":87.49,"billing_code_modifier":["95"],"providers":[{"billed_charge":200.00,"npi":[1235140419]}]}]},{"tin":{"Type":"ein","value":"851622874"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"billing_code_modifier":["95"],"providers":[{"billed_charge":200.00,"npi":[1235140419]}]}]}]},{"name":"Doctor care in hospital","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99233","description":"sbsq hosp ip/obs high 50","allowed_amounts":[{"tin":{"Type":"ein","value":"462964946"},"service_code":["02"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":143.23,"billing_code_modifier":["95"],"providers":[{"billed_charge":250.00,"npi":[1750743621,1871722520]}]}]},{"tin":{"Type":"ein","value":"582236140"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":224.36,"npi":[1285605063]}]}]},{"tin":{"Type":"ein","value":"651020460"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":300.00,"npi":[1831256809]}]}]},{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"billing_code_modifier":["25"],"providers":[{"billed_charge":359.00,"npi":[1023670833,1033615208,1033791942,1063552396,1073174314,1376958561,1750802930,1801458435,1902922727]}]}]},{"tin":{"Type":"ein","value":"814723941"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":160.00,"npi":[1225327380]}]}]},{"tin":{"Type":"ein","value":"823032998"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":159.00,"npi":[1811302771]}]}]}]},{"name":"Physician hospital discharge","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99238","description":"hosp ip/obs dschrg mgmt 30/<","allowed_amounts":[{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":98.18,"providers":[{"billed_charge":252.00,"npi":[1699171538,1750802930]}]}]}]},{"name":"Physician hospital discharge","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99239","description":"hosp ip/obs dschrg mgmt >30","allowed_amounts":[{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":138.61,"billing_code_modifier":["25"],"providers":[{"billed_charge":368.00,"npi":[1023670833,1033615208,1033791942,1063552396,1376958561,1578021689,1659936177,1801458435,1902922727]}]}]}]},{"name":"ER visit doctor services","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99283","description":"emergency dept visit low mdm","allowed_amounts":[{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":372.09,"billing_code_modifier":["25"],"providers":[{"billed_charge":679.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":968.00,"billing_code_modifier":["25"],"providers":[{"billed_charge":679.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":74.36,"billing_code_modifier":["25"],"providers":[{"billed_charge":594.00,"npi":[1700241023]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":87.49,"billing_code_modifier":["25"],"providers":[{"billed_charge":594.00,"npi":[1437252657]}]}]}]},{"name":"Doctor visit ER","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99284","description":"emergency dept visit mod mdm","allowed_amounts":[{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":572.21,"billing_code_modifier":["25"],"providers":[{"billed_charge":1431.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3558.05,"billing_code_modifier":["25"],"providers":[{"billed_charge":1431.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":127.20,"billing_code_modifier":["25","57"],"providers":[{"billed_charge":994.00,"npi":[1023605912,1033744610,1063998235,1124789805,1164032330,1295019925,1467932152,1588255434,1649806175,1700241023,1740022086,1942385901]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":149.65,"billing_code_modifier":["25"],"providers":[{"billed_charge":994.00,"npi":[1013189224,1063153021,1174086110,1194068247,1306824693,1437252657,1508492158,1568925527,1588124333,1629174917,1639676059,1659588762,1679525463,1710379920,1740922061,1780640599,1902884109,1932197076,1932563145,1972025310,1982021846]}]}]}]},{"name":"Doctor visit ER","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99285","description":"emergency dept visit hi mdm","allowed_amounts":[{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":184.67,"billing_code_modifier":["25","57"],"providers":[{"billed_charge":1451.00,"npi":[1023605912,1033744610,1063998235,1124789805,1295019925,1467932152,1700241023,1740022086]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":217.26,"billing_code_modifier":["25","57"],"providers":[{"billed_charge":1451.00,"npi":[1013189224,1063153021,1194068247,1265474019,1306824693,1437252657,1508492158,1508917105,1568925527,1588124333,1629174917,1639676059,1649477993,1659588762,1679525463,1710379920,1740922061,1932197076,1932563145,1972025310,1972711810,1982021846]}]}]}]},{"name":"Critical care doctor services","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99291","description":"critical care first hour","allowed_amounts":[{"tin":{"Type":"ein","value":"202252101"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":262.01,"providers":[{"billed_charge":1217.00,"npi":[1265452791,1730539990]}]}]}]},{"name":"Doctor care nursing home","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"99305","description":"1st nf care moderate mdm 35","allowed_amounts":[{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":160.36,"providers":[{"billed_charge":251.56,"npi":[1114928603]}]}]}]},{"name":"Doctor care nursing home","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"99306","description":"1st nf care high mdm 50","allowed_amounts":[{"tin":{"Type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":163.95,"providers":[{"billed_charge":566.00,"npi":[1790257756]}]}]},{"tin":{"Type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":186.30,"providers":[{"billed_charge":566.00,"npi":[1790257756]}]}]},{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":219.18,"billing_code_modifier":["25"],"providers":[{"billed_charge":255.00,"npi":[1225463649]}]}]},{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":219.18,"providers":[{"billed_charge":343.66,"npi":[1114928603]}]}]}]},{"name":"Doctor care nursing home","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"99308","description":"sbsq nf care low mdm 20","allowed_amounts":[{"tin":{"Type":"ein","value":"371703159"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":75.85,"providers":[{"billed_charge":150.00,"npi":[1992471874]}]}]},{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":89.24,"providers":[{"billed_charge":140.16,"npi":[1114928603]}]}]}]},{"name":"Doctor care nursing home","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"99309","description":"sbsq nf care moderate mdm 30","allowed_amounts":[{"tin":{"Type":"ein","value":"475240597"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":153.94,"npi":[1295445914]}]}]},{"tin":{"Type":"ein","value":"814723941"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":141.00,"npi":[1235128869]}]}]},{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":138.00,"npi":[1295019925,1508335290,1508667379]}]}]},{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":129.81,"providers":[{"billed_charge":138.00,"npi":[1225463649]}]}]},{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":129.81,"providers":[{"billed_charge":203.84,"npi":[1114928603]}]}]}]},{"name":"Doctor care nursing home","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"99310","description":"sbsq nf care high mdm 45","allowed_amounts":[{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":157.69,"billing_code_modifier":["25"],"providers":[{"billed_charge":204.00,"npi":[1508335290,1508667379]}]}]}]},{"name":"Discharge care nursing home","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99315","description":"nf dschrg mgmt 30 min/less","allowed_amounts":[{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":98.13,"billing_code_modifier":["FS"],"providers":[{"billed_charge":154.00,"npi":[1114928603]}]}]}]},{"name":"Discharge care nursing home","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"99316","description":"nf dschrg mgmt 30 min+","allowed_amounts":[{"tin":{"Type":"ein","value":"883526640"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":157.33,"billing_code_modifier":["FS"],"providers":[{"billed_charge":246.70,"npi":[1114928603]}]}]}]},{"name":"Managing medical care","billing_code_type":"CPT","billing_code_type_version":"2013","billing_code":"99487","description":"cplx chrnc care 1st 60 min","allowed_amounts":[{"tin":{"Type":"ein","value":"814723941"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":109.40,"providers":[{"billed_charge":206.00,"npi":[1225327380]}]}]}]},{"name":"Ambulance mileage","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"A0425","description":"Ground mileage","allowed_amounts":[{"tin":{"Type":"ein","value":"596000616"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":13.07,"billing_code_modifier":["EH","HH","PH","RH","SH"],"providers":[{"billed_charge":13.07,"npi":[1700856754]}]}]},{"tin":{"Type":"ein","value":"596000690"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":22.50,"billing_code_modifier":["PH","RH","SH"],"providers":[{"billed_charge":22.50,"npi":[1396880654]}]}]},{"tin":{"Type":"ein","value":"596017778"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":11.21,"billing_code_modifier":["RH","SH"],"providers":[{"billed_charge":12.50,"npi":[1205982774]}]}]},{"tin":{"Type":"ein","value":"596017778"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":11.44,"billing_code_modifier":["RH","SH"],"providers":[{"billed_charge":12.50,"npi":[1205982774]}]}]},{"tin":{"Type":"ein","value":"596031875"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.50,"billing_code_modifier":["EH","RH","SH"],"providers":[{"billed_charge":12.50,"npi":[1952448383]}]}]}]},{"name":"Ambulance transport","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"A0427","description":"ALS1-emergency","allowed_amounts":[{"tin":{"Type":"ein","value":"596000616"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":739.50,"billing_code_modifier":["EH","HH","PH","RH","SH"],"providers":[{"billed_charge":739.50,"npi":[1700856754]}]}]},{"tin":{"Type":"ein","value":"596000690"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":1169.52,"billing_code_modifier":["PH","RH","SH"],"providers":[{"billed_charge":1169.52,"npi":[1396880654]}]}]},{"tin":{"Type":"ein","value":"596031875"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":821.00,"billing_code_modifier":["EH","RH","SH"],"providers":[{"billed_charge":821.00,"npi":[1952448383]}]}]}]},{"name":"Ambulance transport","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"A0429","description":"BLS-emergency","allowed_amounts":[{"tin":{"Type":"ein","value":"596000616"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":622.74,"billing_code_modifier":["QL","RH","SH"],"providers":[{"billed_charge":622.74,"npi":[1700856754]}]}]},{"tin":{"Type":"ein","value":"596031875"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":684.00,"billing_code_modifier":["RH","SH"],"providers":[{"billed_charge":684.00,"npi":[1952448383]}]}]}]},{"name":"Spinal bone growth stimulator","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"E0748","description":"Elec osteogen stim spinal","allowed_amounts":[{"tin":{"Type":"ein","value":"752608036"},"service_code":["12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":5995.00,"billing_code_modifier":["KF","NU"],"providers":[{"billed_charge":5995.00,"npi":[1235136060]}]}]}]},{"name":"Vacuum pump for wound therapy","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"E2402","description":"Neg press wound therapy pump","allowed_amounts":[{"tin":{"Type":"ein","value":"742152396"},"service_code":["12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":160.60,"billing_code_modifier":["RR"],"providers":[{"billed_charge":160.60,"npi":[1649267857]}]}]}]},{"name":"Nursing home care extra time","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"G0317","description":"Prolong nursin fac eval 15m","allowed_amounts":[{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":36.54,"providers":[{"billed_charge":47.00,"npi":[1225463649]}]}]}]},{"name":"Bupivacaine injection","billing_code_type":"CPT","billing_code_type_version":"2023","billing_code":"J0665","description":"Inj bupivacaine nos 0.5mg","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.18,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.19,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.42,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.65,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.95,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.53,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.20,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.20,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.25,"providers":[{"billed_charge":0.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1.92,"providers":[{"billed_charge":1.95,"npi":[1891782470]}]}]}]},{"name":"Cefazolin sodium shot/infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J0690","description":"Cefazolin sodium injection","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":10.08,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":13.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":37.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":5.57,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":5.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":7.15,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.87,"providers":[{"billed_charge":10.08,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3.83,"providers":[{"billed_charge":13.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":4.38,"providers":[{"billed_charge":13.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.36,"providers":[{"billed_charge":7.15,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":7.22,"providers":[{"billed_charge":13.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":10.09,"providers":[{"billed_charge":13.45,"npi":[1891782470]}]}]}]},{"name":"Dexamethasone shot or infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J1100","description":"Dexamethasone sodium phos","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":11.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":3.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":3.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.73,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":9.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":9.28,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1.40,"providers":[{"billed_charge":4.90,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.97,"providers":[{"billed_charge":9.10,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":4.64,"providers":[{"billed_charge":6.18,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":4.88,"providers":[{"billed_charge":9.10,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.62,"providers":[{"billed_charge":9.28,"npi":[1891782470]}]}]}]},{"name":"Heparin sodium shot or infusio","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J1644","description":"Inj heparin sodium per 1000u","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":25.97,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.82,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.84,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.58,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.50,"providers":[{"billed_charge":7.66,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":4.11,"providers":[{"billed_charge":7.66,"npi":[1891782470]}]}]}]},{"name":"Midazolam shot or infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J2250","description":"Inj midazolam hydrochloride","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":18.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":36.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":36.35,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":36.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":70.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":70.70,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":71.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":71.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":71.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":10.38,"providers":[{"billed_charge":36.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":11.39,"providers":[{"billed_charge":36.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":11.84,"providers":[{"billed_charge":36.35,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":27.26,"providers":[{"billed_charge":36.35,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":52.95,"providers":[{"billed_charge":70.60,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":53.55,"providers":[{"billed_charge":71.40,"npi":[1891782470]}]}]}]},{"name":"Ondansetron shot or infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J2405","description":"Ondansetron hcl injection","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":5.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.68,"providers":[{"billed_charge":9.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.93,"providers":[{"billed_charge":9.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":9.20,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3.24,"providers":[{"billed_charge":4.63,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.05,"providers":[{"billed_charge":9.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.70,"providers":[{"billed_charge":9.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":6.90,"providers":[{"billed_charge":9.20,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":7.05,"providers":[{"billed_charge":9.40,"npi":[1891782470]}]}]}]},{"name":"Propofol infusion or injection","billing_code_type":"CPT","billing_code_type_version":"2015","billing_code":"J2704","description":"Inj propofol 10 MG","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.42,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.43,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.44,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.46,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.47,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.48,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.53,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.55,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.57,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.69,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.72,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.78,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.81,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.04,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.27,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.46,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.54,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.64,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.68,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.77,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.88,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.92,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.93,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.97,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.37,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.47,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.53,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.62,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.68,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.81,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":3.02,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":3.97,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":5.47,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":6.32,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":7.48,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.13,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.44,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.14,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.44,"npi":[1891782470]}]},{"allowed_amount":0.14,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.48,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.23,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.43,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.24,"providers":[{"billed_charge":0.83,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.32,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.43,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.34,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.46,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.36,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.48,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.42,"providers":[{"billed_charge":0.77,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.47,"providers":[{"billed_charge":1.44,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.53,"providers":[{"billed_charge":1.87,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.61,"providers":[{"billed_charge":0.81,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.72,"providers":[{"billed_charge":2.22,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1.19,"providers":[{"billed_charge":2.22,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1.40,"providers":[{"billed_charge":1.87,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2.81,"providers":[{"billed_charge":3.75,"npi":[1891782470]}]}]}]},{"name":"Ropivacaine shot or infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J2795","description":"Ropivacaine HCl injection","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.14,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.16,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.23,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.32,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.35,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.44,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.46,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.51,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.69,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.74,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.19,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.04,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.16,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.11,"providers":[{"billed_charge":0.38,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.21,"providers":[{"billed_charge":0.74,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.52,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.68,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.68,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.68,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3.82,"providers":[{"billed_charge":5.06,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.06,"providers":[{"billed_charge":5.06,"npi":[1891782470]}]}]}]},{"name":"Magnesium sulfate infusion","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"J3475","description":"Inj magnesium sulfate","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.28,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.87,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":3.14,"providers":[{"billed_charge":9.63,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":15.09,"providers":[{"billed_charge":21.55,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":16.16,"providers":[{"billed_charge":21.55,"npi":[1891782470]}]}]}]},{"name":"Vest with heart pacer","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"K0606","description":"AED garment w elec analysis","allowed_amounts":[{"tin":{"Type":"ein","value":"201121194"},"service_code":["12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":2638.90,"billing_code_modifier":["KF","KJ","KX","RR"],"providers":[{"billed_charge":4960.00,"npi":[1164535274]}]}]},{"tin":{"Type":"ein","value":"201121194"},"service_code":["12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":3534.00,"billing_code_modifier":["KF","KJ","KX","RR"],"providers":[{"billed_charge":4960.00,"npi":[1164535274]}]}]},{"tin":{"Type":"ein","value":"201121194"},"service_code":["12"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":4712.00,"billing_code_modifier":["KF","KI","KX","RR"],"providers":[{"billed_charge":4960.00,"npi":[1164535274]}]}]}]},{"name":"Contrast material for scan","billing_code_type":"CPT","billing_code_type_version":"2008","billing_code":"Q9967","description":"LOCM 300-399mg/ml iodine1ml","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.70,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.79,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.84,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.94,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":1.37,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":10.81,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.19,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":2.26,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":48.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":1.86,"providers":[{"billed_charge":48.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":5.97,"billing_code_modifier":["JW"],"providers":[{"billed_charge":10.81,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":6.34,"billing_code_modifier":["JW"],"providers":[{"billed_charge":11.49,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":10.81,"billing_code_modifier":["JW"],"providers":[{"billed_charge":10.81,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":15.04,"providers":[{"billed_charge":27.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":26.50,"providers":[{"billed_charge":48.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":30.50,"providers":[{"billed_charge":30.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":41.87,"billing_code_modifier":["JW"],"providers":[{"billed_charge":10.81,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":48.00,"providers":[{"billed_charge":48.00,"npi":[1891782470]}]}]}]},{"name":"In-home immune therapy","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"S9338","description":"HIT immunotherapy diem","allowed_amounts":[{"tin":{"Type":"ein","value":"204881413"},"service_code":["12"],"billing_class":"universalc","setting":"outpatient","payments":[{"allowed_amount":50.00,"providers":[{"billed_charge":400.00,"npi":[1700975802]}]}]},{"tin":{"Type":"ein","value":"204881413"},"service_code":["12"],"billing_class":"universalc","setting":"outpatient","payments":[{"allowed_amount":400.00,"providers":[{"billed_charge":400.00,"npi":[1700975802]}]}]}]},{"name":"Medical/Surgical/Gyn","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0111","description":"MED-SUR-GY/PVT","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3860.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.12,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":542.00,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":608.12,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":709.47,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":900.67,"providers":[{"billed_charge":3860.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2423.65,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2528.40,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2983.13,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5814.80,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6484.35,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6648.27,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":7270.96,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":8096.21,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":8145.92,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":11968.33,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":12180.58,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":12563.20,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":13186.97,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":14048.70,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":14419.62,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":16726.59,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":16756.99,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":16965.56,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":21332.01,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24852.10,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":25525.87,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":35492.27,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":37603.58,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":64998.97,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":70816.69,"providers":[{"billed_charge":3612.00,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0250","description":"PHARMACY","allowed_amounts":[{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.08,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.40,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.16,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":11.11,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":15.00,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":19.20,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":19.50,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.10,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.68,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.15,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.68,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.97,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":93.65,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.08,"providers":[{"billed_charge":0.30,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.11,"providers":[{"billed_charge":0.40,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.07,"providers":[{"billed_charge":7.68,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.83,"providers":[{"billed_charge":10.47,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5.76,"providers":[{"billed_charge":21.33,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":18.09,"providers":[{"billed_charge":67.02,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1.14,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.65,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.84,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":10.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":11.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":11.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":111.84,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":12.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":123.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":14.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":14.86,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":144.87,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":152.39,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":159.04,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":16.81,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":18.28,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":18.34,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":18.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":18.98,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.24,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.34,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.71,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.35,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.36,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.63,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":22.61,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":28.47,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":28.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":28.74,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":29.11,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":31.44,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":32.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":35.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":36.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":36.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":38.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4.14,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":40.42,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":41.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":426.59,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":43.68,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":44.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":45.95,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":47.54,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":48.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":48.07,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":49.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":49.27,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.48,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":50.82,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":51.61,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":52.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":56.53,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":56.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":57.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":57.57,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.56,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.71,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":60.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":61.27,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":63.70,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":69.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.37,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.97,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":70.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":72.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":72.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":73.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":75.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":75.93,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.01,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.02,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.98,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":80.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":81.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":82.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.79,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":94.87,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":96.94,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.03,"providers":[{"billed_charge":0.89,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.89,"providers":[{"billed_charge":0.89,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.79,"providers":[{"billed_charge":3.17,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.66,"providers":[{"billed_charge":8.19,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.91,"providers":[{"billed_charge":17.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6.08,"providers":[{"billed_charge":8.11,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":20.82,"providers":[{"billed_charge":27.76,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":26.87,"providers":[{"billed_charge":35.60,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":28.70,"providers":[{"billed_charge":41.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":29.26,"providers":[{"billed_charge":54.53,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":32.60,"providers":[{"billed_charge":80.10,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":46.52,"providers":[{"billed_charge":62.03,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":49.58,"providers":[{"billed_charge":72.64,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":57.40,"providers":[{"billed_charge":82.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":61.50,"providers":[{"billed_charge":82.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":64.13,"providers":[{"billed_charge":85.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":64.89,"providers":[{"billed_charge":92.70,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":73.40,"providers":[{"billed_charge":116.31,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":74.09,"providers":[{"billed_charge":82.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":74.37,"providers":[{"billed_charge":122.77,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":79.80,"providers":[{"billed_charge":79.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":96.97,"providers":[{"billed_charge":138.53,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":116.76,"providers":[{"billed_charge":166.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":136.55,"providers":[{"billed_charge":195.07,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":176.12,"providers":[{"billed_charge":251.60,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":194.78,"providers":[{"billed_charge":6.24,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":241.91,"providers":[{"billed_charge":362.31,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":347.44,"providers":[{"billed_charge":37.68,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":781.75,"providers":[{"billed_charge":37.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1631.25,"providers":[{"billed_charge":34.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":10.04,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1783.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":24.33,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.34,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":87.48,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.25,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.50,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.50,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.80,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.01,"providers":[{"billed_charge":4.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.51,"providers":[{"billed_charge":5.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3.51,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.02,"providers":[{"billed_charge":18.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.02,"providers":[{"billed_charge":20.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":18.04,"providers":[{"billed_charge":36.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24.55,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":99.22,"providers":[{"billed_charge":198.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":326.22,"providers":[{"billed_charge":651.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.55,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":10.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":11.50,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":12.25,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":33.05,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":34.77,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":38.67,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":43.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":48.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":48.50,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":49.75,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":76.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.00,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":8.75,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":83.41,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.04,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.10,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.20,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.25,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.50,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.90,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.10,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.40,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.70,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":18.87,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.14,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3.70,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":30.35,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":42.50,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":54.14,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.20,"npi":[1720078041]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":62.50,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.01,"providers":[{"billed_charge":0.04,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.03,"providers":[{"billed_charge":0.10,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.05,"providers":[{"billed_charge":0.20,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.06,"providers":[{"billed_charge":0.25,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.13,"providers":[{"billed_charge":0.50,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.28,"providers":[{"billed_charge":1.10,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.34,"providers":[{"billed_charge":1.10,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.36,"providers":[{"billed_charge":1.17,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":7.60,"providers":[{"billed_charge":30.35,"npi":[1720078041]}]}]},{"tin":{"Type":"ein","value":"900799724"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2095.00,"providers":[{"billed_charge":7.98,"npi":[1720078041]}]}]}]},{"name":"Drugs Incident to Radiology","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0255","description":"DRUGS/INCIDENT RAD","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.94,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":0.96,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.09,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.53,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.26,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.32,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3.05,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.23,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":5.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.51,"providers":[{"billed_charge":5.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.51,"providers":[{"billed_charge":9.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5.40,"providers":[{"billed_charge":9.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":17.04,"providers":[{"billed_charge":34.00,"npi":[1780653618]}]}]}]},{"name":"IV Solutions","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0258","description":"IV SOLUTIONS","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":26.43,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":29.20,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":37.33,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":48.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.38,"providers":[{"billed_charge":31.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.79,"providers":[{"billed_charge":32.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.02,"providers":[{"billed_charge":18.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.52,"providers":[{"billed_charge":19.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":18.60,"providers":[{"billed_charge":31.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":19.20,"providers":[{"billed_charge":32.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24.05,"providers":[{"billed_charge":48.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0260","description":"IV THERAPY","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":458.75,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":103.80,"billing_code_modifier":["XE"],"providers":[{"billed_charge":173.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":159.35,"providers":[{"billed_charge":318.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":176.40,"providers":[{"billed_charge":294.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":277.80,"billing_code_modifier":["XE"],"providers":[{"billed_charge":463.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":558.23,"providers":[{"billed_charge":1114.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":588.00,"billing_code_modifier":["XE"],"providers":[{"billed_charge":980.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":668.40,"providers":[{"billed_charge":1114.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0270","description":"MED-SUR SUPPLIES","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":28.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":8.90,"providers":[{"billed_charge":28.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":19.60,"providers":[{"billed_charge":28.00,"npi":[1891782470]}]}]}]},{"name":"Sterile Supply","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0272","description":"STERILE SUPPLY","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1012.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1015.42,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1046.73,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1090.79,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1106.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1121.36,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1123.29,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1153.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1197.95,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1258.64,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1288.19,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1308.21,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1557.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1675.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":173.88,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1747.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2672.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":345.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":357.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4506.29,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":476.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":497.56,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":500.04,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":510.31,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":524.42,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":562.76,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":584.14,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":588.62,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":590.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":608.82,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":630.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":650.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":709.74,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":762.73,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":791.92,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":813.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":815.77,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":860.21,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":873.34,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":896.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":905.74,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":999.98,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":150.52,"providers":[{"billed_charge":528.49,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":164.83,"providers":[{"billed_charge":506.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":267.98,"providers":[{"billed_charge":357.30,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":360.51,"providers":[{"billed_charge":480.68,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":803.43,"providers":[{"billed_charge":1326.36,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":961.22,"providers":[{"billed_charge":1791.20,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2332.76,"providers":[{"billed_charge":4506.29,"npi":[1891782470]}]}]}]},{"name":"Other Implant","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0278","description":"SUPPLY/IMPLANTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":11400.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":127.44,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1781.05,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":260.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":29174.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3909.08,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":506.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":536.04,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":541.82,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":644.26,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":699.24,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":174.46,"providers":[{"billed_charge":260.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":207.80,"providers":[{"billed_charge":296.86,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0300","description":"LAB","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":227.12,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":42.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":455.79,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":697.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":949.38,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":158.77,"providers":[{"billed_charge":266.62,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":190.90,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":255.29,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":335.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":53.50,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24.54,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24.55,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24.56,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":28.21,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":40.09,"providers":[{"billed_charge":80.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":68.15,"providers":[{"billed_charge":136.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":76.17,"providers":[{"billed_charge":152.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":84.69,"providers":[{"billed_charge":169.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":87.19,"providers":[{"billed_charge":174.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":87.69,"providers":[{"billed_charge":175.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":138.80,"providers":[{"billed_charge":277.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":167.87,"providers":[{"billed_charge":335.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":205.44,"providers":[{"billed_charge":410.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":205.45,"providers":[{"billed_charge":410.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":215.97,"providers":[{"billed_charge":49.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":490.08,"providers":[{"billed_charge":978.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":538.68,"providers":[{"billed_charge":1075.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2104.20,"billing_code_modifier":["XE"],"providers":[{"billed_charge":3507.00,"npi":[1780653618]}]}]}]},{"name":"Chemistry","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0301","description":"CHEMISTRY TESTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":132.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":138.46,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":141.26,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":148.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":155.64,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":156.77,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":158.51,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":162.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":173.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":177.68,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":181.72,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":182.81,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":185.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":194.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":194.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":196.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":205.27,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":208.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":219.63,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":259.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":345.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":51.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":62.88,"providers":[{"billed_charge":135.52,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":76.13,"providers":[{"billed_charge":171.94,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":122.19,"providers":[{"billed_charge":182.10,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":171.41,"providers":[{"billed_charge":259.38,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":141.25,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":169.28,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":190.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":216.18,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":362.26,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":406.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":447.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":482.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":551.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":73.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":806.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5.01,"providers":[{"billed_charge":10.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":25.56,"providers":[{"billed_charge":51.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":28.56,"providers":[{"billed_charge":57.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":29.56,"providers":[{"billed_charge":59.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":63.14,"providers":[{"billed_charge":126.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":63.64,"providers":[{"billed_charge":127.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":71.16,"providers":[{"billed_charge":142.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":71.66,"providers":[{"billed_charge":143.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":82.68,"providers":[{"billed_charge":165.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":84.18,"providers":[{"billed_charge":168.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":85.20,"providers":[{"billed_charge":142.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":95.21,"providers":[{"billed_charge":190.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":101.22,"providers":[{"billed_charge":202.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":106.20,"providers":[{"billed_charge":177.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":108.60,"providers":[{"billed_charge":181.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":118.26,"providers":[{"billed_charge":236.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":121.20,"providers":[{"billed_charge":202.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":125.28,"providers":[{"billed_charge":250.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":203.45,"providers":[{"billed_charge":406.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":210.96,"providers":[{"billed_charge":421.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":216.98,"providers":[{"billed_charge":433.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":223.99,"providers":[{"billed_charge":447.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":227.40,"providers":[{"billed_charge":379.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":241.53,"providers":[{"billed_charge":482.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":256.06,"providers":[{"billed_charge":511.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":276.11,"providers":[{"billed_charge":551.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":283.12,"providers":[{"billed_charge":565.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":330.60,"providers":[{"billed_charge":551.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":403.89,"providers":[{"billed_charge":806.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":483.60,"providers":[{"billed_charge":806.00,"npi":[1780653618]}]}]}]},{"name":"Immunology","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0302","description":"IMMUNOLOGY TESTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":103.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":107.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":119.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":183.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":195.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":225.72,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":396.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":87.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":91.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":58.82,"providers":[{"billed_charge":87.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":61.40,"providers":[{"billed_charge":91.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":81.19,"providers":[{"billed_charge":121.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":328.42,"providers":[{"billed_charge":469.17,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":175.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":273.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":595.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":25.06,"providers":[{"billed_charge":50.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":27.06,"providers":[{"billed_charge":54.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":28.57,"providers":[{"billed_charge":57.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":40.09,"providers":[{"billed_charge":80.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":48.11,"providers":[{"billed_charge":96.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":72.16,"providers":[{"billed_charge":144.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":79.17,"providers":[{"billed_charge":158.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":87.69,"providers":[{"billed_charge":175.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":87.70,"providers":[{"billed_charge":175.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":103.23,"providers":[{"billed_charge":206.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":113.25,"providers":[{"billed_charge":226.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":115.25,"providers":[{"billed_charge":230.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":133.30,"providers":[{"billed_charge":266.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":165.36,"providers":[{"billed_charge":330.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":182.40,"providers":[{"billed_charge":364.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":248.55,"providers":[{"billed_charge":496.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":298.15,"providers":[{"billed_charge":595.00,"npi":[1780653618]}]}]}]},{"name":"Hematology","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0305","description":"HEMATOLOGY TESTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":105.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":105.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":108.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":111.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":39.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":46.95,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":52.39,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":78.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":81.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":82.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":83.63,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":87.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":87.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":90.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":91.59,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":92.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":92.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":99.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":99.02,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":33.97,"providers":[{"billed_charge":70.48,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":61.86,"providers":[{"billed_charge":119.35,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":65.46,"providers":[{"billed_charge":97.56,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":136.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":22.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":286.83,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":389.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":51.67,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":14.53,"providers":[{"billed_charge":29.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":16.70,"providers":[{"billed_charge":29.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":17.40,"providers":[{"billed_charge":29.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":31.57,"providers":[{"billed_charge":63.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":36.27,"providers":[{"billed_charge":63.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":37.80,"providers":[{"billed_charge":63.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":71.16,"providers":[{"billed_charge":142.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":194.93,"providers":[{"billed_charge":389.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":205.95,"providers":[{"billed_charge":411.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":233.40,"providers":[{"billed_charge":389.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":556.72,"providers":[{"billed_charge":1111.00,"npi":[1780653618]}]}]}]},{"name":"Bacteriology & Microbiology","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0306","description":"BACT & MICRO TESTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":101.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":108.44,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":147.89,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":217.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":222.88,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":225.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":226.57,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":231.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":245.17,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":291.59,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":473.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":563.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":70.68,"providers":[{"billed_charge":180.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":163.10,"providers":[{"billed_charge":261.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":453.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":737.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.00,"providers":[{"billed_charge":15.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":22.05,"providers":[{"billed_charge":44.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":113.25,"providers":[{"billed_charge":226.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":116.76,"providers":[{"billed_charge":233.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":238.20,"billing_code_modifier":["XE"],"providers":[{"billed_charge":397.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":570.00,"providers":[{"billed_charge":950.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0310","description":"PATHOLOGY LAB","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["XE"],"providers":[{"billed_charge":730.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":136.80,"providers":[{"billed_charge":273.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":165.36,"providers":[{"billed_charge":330.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":191.92,"providers":[{"billed_charge":383.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":266.08,"providers":[{"billed_charge":531.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":267.59,"providers":[{"billed_charge":534.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":305.67,"providers":[{"billed_charge":610.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":365.80,"billing_code_modifier":["XE"],"providers":[{"billed_charge":730.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":525.15,"billing_code_modifier":["XE"],"providers":[{"billed_charge":1048.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":543.69,"billing_code_modifier":["XE"],"providers":[{"billed_charge":1085.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":806.77,"providers":[{"billed_charge":1610.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":832.33,"providers":[{"billed_charge":1661.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1405.80,"providers":[{"billed_charge":2343.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4819.58,"providers":[{"billed_charge":9618.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6648.59,"providers":[{"billed_charge":9618.00,"npi":[1780653618]}]}]}]},{"name":"Histology","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0312","description":"HISTOLOGY TESTS","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":198.34,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":213.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":225.01,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":225.62,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":259.96,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":260.51,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":299.95,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":304.76,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":340.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":357.01,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":375.71,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":405.34,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":531.01,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":850.28,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":142.92,"providers":[{"billed_charge":213.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":490.62,"providers":[{"billed_charge":731.18,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1010.40,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1066.93,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1525.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":644.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":67.65,"providers":[{"billed_charge":135.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":223.49,"providers":[{"billed_charge":446.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":281.12,"providers":[{"billed_charge":561.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":322.71,"providers":[{"billed_charge":644.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":370.75,"providers":[{"billed_charge":644.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":418.42,"providers":[{"billed_charge":835.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":515.13,"billing_code_modifier":["XU"],"providers":[{"billed_charge":1028.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":709.06,"providers":[{"billed_charge":1415.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":764.18,"providers":[{"billed_charge":1525.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1016.73,"providers":[{"billed_charge":2029.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1168.10,"providers":[{"billed_charge":2029.00,"npi":[1780653618]}]}]}]},{"name":"Chest X-Ray","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0324","description":"DX X-RAY/CHEST","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":217.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":228.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":48.54,"providers":[{"billed_charge":217.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":167.65,"providers":[{"billed_charge":239.50,"npi":[1891782470]}]}]}]},{"name":"Radiation Therapy","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0333","description":"RAD-RADIATION","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1173.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1243.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1623.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2295.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2963.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":587.79,"providers":[{"billed_charge":1173.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":622.87,"providers":[{"billed_charge":1243.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":645.92,"providers":[{"billed_charge":1289.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":788.23,"providers":[{"billed_charge":1573.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":813.29,"providers":[{"billed_charge":1623.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1150.02,"providers":[{"billed_charge":2295.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1161.55,"providers":[{"billed_charge":2318.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1484.76,"providers":[{"billed_charge":2963.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2142.20,"providers":[{"billed_charge":4275.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2923.92,"providers":[{"billed_charge":5835.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3091.29,"providers":[{"billed_charge":6169.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4404.67,"providers":[{"billed_charge":8790.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5835.00,"providers":[{"billed_charge":5835.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6404.56,"providers":[{"billed_charge":12781.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9723.34,"providers":[{"billed_charge":8790.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0350","description":"CT SCAN","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":4975.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2019.43,"providers":[{"billed_charge":4030.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2492.97,"providers":[{"billed_charge":4975.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2985.00,"providers":[{"billed_charge":4975.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4006.80,"providers":[{"billed_charge":7996.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4797.60,"providers":[{"billed_charge":7996.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":15356.00,"providers":[{"billed_charge":7996.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0360","description":"OR SERVICES","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":11081.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":1961.74,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2209.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2243.07,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2326.92,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2451.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2519.69,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2560.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2653.70,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2730.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2771.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2782.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2857.48,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["LT"],"providers":[{"billed_charge":2942.83,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1519.19,"providers":[{"billed_charge":2264.07,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1988.42,"providers":[{"billed_charge":2840.60,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0370","description":"ANESTHESIA","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":11405.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":288.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":330.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3970.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":412.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4167.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4197.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4224.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4243.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4447.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5275.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5819.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6431.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6922.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7414.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7786.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":309.38,"providers":[{"billed_charge":412.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1208.44,"providers":[{"billed_charge":4243.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1342.10,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2252.25,"providers":[{"billed_charge":4197.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2306.42,"providers":[{"billed_charge":4224.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2495.65,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3090.00,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3168.00,"providers":[{"billed_charge":4224.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3539.86,"providers":[{"billed_charge":5275.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5189.80,"providers":[{"billed_charge":7414.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":362.17,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":384.85,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":458.75,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.01,"providers":[{"billed_charge":0.01,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":189.76,"providers":[{"billed_charge":378.69,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":203.13,"providers":[{"billed_charge":405.38,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":212.05,"providers":[{"billed_charge":423.17,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":229.88,"providers":[{"billed_charge":458.75,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":247.71,"providers":[{"billed_charge":494.33,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":390.36,"providers":[{"billed_charge":779.00,"npi":[1780653618]}]}]}]},{"name":"Ultrasound","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0402","description":"ULTRASOUND","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":514.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":796.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":355.13,"providers":[{"billed_charge":678.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":549.22,"providers":[{"billed_charge":818.50,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0420","description":"PHYSICAL THERP","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":166.52,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":173.85,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":174.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":175.08,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":178.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":190.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":195.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":219.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":249.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":257.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":258.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":172.79,"providers":[{"billed_charge":257.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":180.25,"providers":[{"billed_charge":257.50,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0430","description":"OCCUPATIONAL THER","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":169.93,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":171.41,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":175.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":176.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":194.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":198.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":209.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":226.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":251.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":259.00,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0510","description":"CLINIC","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":309.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":154.84,"billing_code_modifier":["25"],"providers":[{"billed_charge":309.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":177.89,"billing_code_modifier":["25"],"providers":[{"billed_charge":309.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":185.40,"billing_code_modifier":["25"],"providers":[{"billed_charge":309.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2659.13,"billing_code_modifier":["25"],"providers":[{"billed_charge":309.00,"npi":[1780653618]}]}]}]},{"name":"Drugs Requiring Detailed Coding","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0636","description":"DRUGS/DETAIL CODE","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":16.56,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":17.45,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.16,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":210.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":29.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":35.01,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":65.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.02,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]},{"allowed_amount":0.02,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.06,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.09,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]},{"allowed_amount":0.09,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.11,"providers":[{"billed_charge":12.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.16,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.17,"providers":[{"billed_charge":6.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.19,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]},{"allowed_amount":0.19,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.25,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]},{"allowed_amount":0.25,"providers":[{"billed_charge":6.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.32,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.34,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.44,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]},{"allowed_amount":0.44,"providers":[{"billed_charge":81.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.46,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.50,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.60,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.84,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.90,"providers":[{"billed_charge":6.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.96,"providers":[{"billed_charge":14.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.50,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.51,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.68,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.77,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.02,"providers":[{"billed_charge":14.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.31,"providers":[{"billed_charge":14.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3.01,"providers":[{"billed_charge":6.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3.51,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.20,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5.29,"providers":[{"billed_charge":10.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":5.71,"providers":[{"billed_charge":66.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6.98,"providers":[{"billed_charge":210.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":7.02,"providers":[{"billed_charge":14.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.52,"providers":[{"billed_charge":19.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":9.53,"providers":[{"billed_charge":10.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.02,"providers":[{"billed_charge":20.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.06,"providers":[{"billed_charge":81.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.80,"providers":[{"billed_charge":18.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.92,"providers":[{"billed_charge":287.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":12.12,"billing_code_modifier":["JW"],"providers":[{"billed_charge":92.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":14.66,"providers":[{"billed_charge":210.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":21.55,"providers":[{"billed_charge":43.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":28.06,"providers":[{"billed_charge":56.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":29.24,"providers":[{"billed_charge":124.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":33.07,"providers":[{"billed_charge":66.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":61.40,"providers":[{"billed_charge":124.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":64.14,"providers":[{"billed_charge":128.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":208.46,"providers":[{"billed_charge":416.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":243.82,"providers":[{"billed_charge":1013.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":304.25,"providers":[{"billed_charge":985.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":337.74,"providers":[{"billed_charge":674.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":512.02,"providers":[{"billed_charge":1013.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":553.80,"providers":[{"billed_charge":923.00,"npi":[1780653618]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0710","description":"RECOVERY ROOM","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":217.56,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":256.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":269.90,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":287.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":294.89,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":299.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":316.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":324.78,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":327.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":331.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":337.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":345.11,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":353.29,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":354.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":374.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":387.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":404.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":438.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":442.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":449.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":490.25,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":553.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":577.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":674.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":78.29,"providers":[{"billed_charge":274.89,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":102.94,"providers":[{"billed_charge":316.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":168.93,"providers":[{"billed_charge":314.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":237.00,"providers":[{"billed_charge":316.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":241.58,"providers":[{"billed_charge":345.11,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":268.14,"providers":[{"billed_charge":442.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":301.62,"providers":[{"billed_charge":449.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":367.69,"providers":[{"billed_charge":490.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":765.25,"providers":[{"billed_charge":387.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1396.04,"providers":[{"billed_charge":281.45,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1577.00,"providers":[{"billed_charge":354.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3795.86,"providers":[{"billed_charge":281.45,"npi":[1891782470]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0730","description":"EKG/ECG","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":307.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":103.00,"providers":[{"billed_charge":307.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":206.00,"providers":[{"billed_charge":307.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":214.90,"providers":[{"billed_charge":307.00,"npi":[1891782470]}]}]}]},{"name":"Residential Treatment - Psychiatric","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"1001","description":"BH R&B RES/PSYCH","allowed_amounts":[{"tin":{"Type":"ein","value":"581791069"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":670.00,"providers":[{"billed_charge":1400.00,"npi":[1811964737]}]}]}]}]}
