{"reporting_entity_name":"Capital Health Plan Inc.","reporting_entity_type":"health insurance issuer","plan_name":"Individual-Market","plan_id_type":"ein","plan_id":"59-1830622","plan_market_type":"individual","last_updated_on":"2026-07-31","version":"1.0.0","out_of_network":[{"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":["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","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":241.50,"providers":[{"billed_charge":345.00,"npi":[1285621631]}]}]}]},{"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":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,"providers":[{"billed_charge":59.00,"npi":[1841351566]}]}]}]},{"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]}]}]}]},{"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]}]}]}]},{"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":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":54.09,"providers":[{"billed_charge":362.00,"npi":[1841351566]}]}]},{"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":10.15,"billing_code_modifier":["90","91"],"providers":[{"billed_charge":101.00,"npi":[1841351566]}]}]}]},{"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,"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":18.25,"billing_code_modifier":["90"],"providers":[{"billed_charge":137.00,"npi":[1841351566]}]}]}]},{"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":"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":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]}]}]}]},{"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":7.19,"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":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":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]}]}]}]},{"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":72.90,"providers":[{"billed_charge":108.00,"npi":[1891782470]}]}]}]},{"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]}]}]}]},{"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,"billing_code_modifier":["91"],"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 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":[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":["22"],"billing_class":"professional","setting":"outpatient","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]}]}]}]},{"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":53.85,"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":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]}]},{"allowed_amount":116.07,"providers":[{"billed_charge":412.60,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":382.05,"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,"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,"providers":[{"billed_charge":118.00,"npi":[1174596324]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":88.50,"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,"providers":[{"billed_charge":65.00,"npi":[1033744610,1124789805,1700241023]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":9.75,"providers":[{"billed_charge":65.00,"npi":[1306824693,1508917105,1629174917,1679525463,1710379920,1740922061,1972711810,1982021846]}]}]}]},{"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":135.00,"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":69.64,"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":97.50,"billing_code_modifier":["59","GO","GP"],"providers":[{"billed_charge":182.00,"npi":[1891782470]}]}]}]},{"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"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.50,"providers":[{"billed_charge":12.50,"npi":[1376980532,1801325741]}]}]}]},{"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"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":25.00,"providers":[{"billed_charge":25.00,"npi":[1801325741]}]}]}]},{"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,"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"],"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"],"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":["AI"],"providers":[{"billed_charge":694.00,"npi":[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]}]}]}]},{"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":"474464147"},"service_code":["61"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":65.81,"providers":[{"billed_charge":151.00,"npi":[1588910343]}]}]},{"tin":{"Type":"ein","value":"474464147"},"service_code":["61"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":151.00,"npi":[1588910343]}]}]},{"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"],"providers":[{"billed_charge":195.00,"npi":[1356931067,1578903886]}]}]},{"tin":{"Type":"ein","value":"591286000"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":79.94,"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":[1023670833,1033615208,1033791942,1063552396,1073174314,1083766687,1467734681,1548902307,1578021689,1659936177,1699171538,1700517893,1750802930,1851330807,1902922727,1922705524,1932841806]}]}]},{"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":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":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":359.00,"npi":[1023670833,1033615208,1063552396,1073174314,1750802930,1902922727]}]}]},{"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]}]}]}]},{"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,"providers":[{"billed_charge":368.00,"npi":[1023670833,1033615208,1033791942,1063552396,1578021689,1659936177,1801458435,1902922727]}]}]}]},{"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]}]}]}]},{"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":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":127.20,"billing_code_modifier":["25"],"providers":[{"billed_charge":994.00,"npi":[1023605912,1033744610,1063998235,1124789805,1164032330,1295019925,1467932152,1649806175,1700241023,1740022086]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":149.65,"billing_code_modifier":["25","57"],"providers":[{"billed_charge":994.00,"npi":[1013189224,1063153021,1174086110,1194068247,1306824693,1437252657,1508492158,1568925527,1588124333,1629174917,1639676059,1659588762,1679525463,1710379920,1780640599,1902884109,1932197076,1932563145,1972025310,1982021846]}]}]}]},{"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"],"providers":[{"billed_charge":1451.00,"npi":[1023605912,1033744610,1063998235,1124789805,1467932152,1700241023,1740022086]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":217.26,"providers":[{"billed_charge":1451.00,"npi":[1013189224,1063153021,1194068247,1265474019,1306824693,1437252657,1508492158,1508917105,1568925527,1588124333,1629174917,1659588762,1679525463,1710379920,1740922061,1932563145,1972025310,1972711810,1982021846]}]}]}]},{"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":[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":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":35.07,"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":[1457078867]}]}]}]},{"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":"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":"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":["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":["RH"],"providers":[{"billed_charge":22.50,"npi":[1396880654]}]}]},{"tin":{"Type":"ein","value":"596031875"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":12.50,"billing_code_modifier":["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":["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":["RH"],"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":["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":["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"],"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":"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,"providers":[{"billed_charge":4.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"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":26.33,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3.75,"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":9.00,"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":6.08,"providers":[{"billed_charge":9.00,"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":0.43,"npi":[1891782470]}]},{"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":3.97,"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":0.69,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":4.19,"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":4712.00,"billing_code_modifier":["KF","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,"providers":[{"billed_charge":1.20,"npi":[1891782470]}]}]}]},{"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":2128.41,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2220.40,"providers":[{"billed_charge":3172.00,"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":2702.00,"providers":[{"billed_charge":3860.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":61764.35,"providers":[{"billed_charge":3860.00,"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":11.11,"npi":[1083941678]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.68,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"300577249"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.97,"providers":[{"billed_charge":11.11,"npi":[1083941678]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":11.06,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.70,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":24.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":31.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":35.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6.49,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":66.86,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.82,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":79.20,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":80.60,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":82.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.01,"providers":[{"billed_charge":5.95,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.09,"providers":[{"billed_charge":6.48,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":55.35,"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":4611.52,"providers":[{"billed_charge":79.20,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":11.83,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":13.04,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":756.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.85,"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":378.83,"providers":[{"billed_charge":756.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":37.00,"npi":[1538108725]}]}]}]},{"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":0.97,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.55,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":13.83,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.51,"providers":[{"billed_charge":9.00,"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":161.06,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":31.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":32.80,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":80.70,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":2.90,"providers":[{"billed_charge":31.00,"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,"billing_code_modifier":["XS"],"providers":[{"billed_charge":318.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"billing_code_modifier":["XS"],"providers":[{"billed_charge":433.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"billing_code_modifier":["XS"],"providers":[{"billed_charge":463.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"billing_code_modifier":["XS"],"providers":[{"billed_charge":980.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":159.35,"billing_code_modifier":["XS"],"providers":[{"billed_charge":318.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":232.01,"providers":[{"billed_charge":463.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":491.08,"providers":[{"billed_charge":980.00,"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":18.79,"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":1024.03,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":395.51,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":573.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":590.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":609.07,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":610.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":725.79,"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":42455.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":426.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":790.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":236.66,"providers":[{"billed_charge":897.47,"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":1024.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2500.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":42.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":422.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1638.26,"providers":[{"billed_charge":2345.63,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":146.67,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":171.63,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":261.28,"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":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":87.19,"providers":[{"billed_charge":174.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":205.45,"providers":[{"billed_charge":410.00,"npi":[1780653618]}]}]}]},{"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":171.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":174.45,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":179.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":183.70,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":60.99,"providers":[{"billed_charge":195.46,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":231.50,"providers":[{"billed_charge":345.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1265.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":128.20,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":200.01,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":209.18,"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":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":101.22,"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":276.11,"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":633.89,"providers":[{"billed_charge":1265.00,"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":196.57,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":400.30,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":463.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":87.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":139.14,"providers":[{"billed_charge":198.78,"npi":[1891782470]}]}]}]},{"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":111.13,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":74.52,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":83.26,"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":48.31,"providers":[{"billed_charge":97.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":56.91,"providers":[{"billed_charge":84.22,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":172.14,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":302.45,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":319.00,"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":31.57,"providers":[{"billed_charge":63.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":194.93,"providers":[{"billed_charge":389.00,"npi":[1780653618]}]}]}]},{"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":122.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":225.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":244.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":370.30,"providers":[{"billed_charge":695.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":677.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":752.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":17.54,"providers":[{"billed_charge":35.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":19.54,"providers":[{"billed_charge":39.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":19.55,"providers":[{"billed_charge":39.00,"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":350.91,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":265.77,"providers":[{"billed_charge":379.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":304.50,"providers":[{"billed_charge":453.80,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":293.14,"billing_code_modifier":["XE"],"providers":[{"billed_charge":585.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":323.21,"providers":[{"billed_charge":645.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":418.42,"providers":[{"billed_charge":835.00,"npi":[1780653618]}]}]}]},{"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":221.09,"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":2198.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":3805.40,"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":583.50,"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,"providers":[{"billed_charge":1111.38,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2801.42,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1400.60,"providers":[{"billed_charge":2087.33,"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":3970.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6431.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":660.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7414.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":497.48,"providers":[{"billed_charge":939.40,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1389.50,"providers":[{"billed_charge":2315.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":405.38,"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":682.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":747.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":285.95,"providers":[{"billed_charge":665.50,"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":154.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":161.07,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":257.50,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":122.69,"providers":[{"billed_charge":175.28,"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":155.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":164.67,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":369.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":127.20,"providers":[{"billed_charge":181.71,"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]}]}]}]},{"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":0.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":12.25,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.71,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":458.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.09,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.00,"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":7.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":76.99,"providers":[{"billed_charge":458.00,"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":274.89,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":442.67,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":351.83,"providers":[{"billed_charge":524.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":387.45,"providers":[{"billed_charge":553.50,"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":214.90,"providers":[{"billed_charge":307.00,"npi":[1891782470]}]}]}]}]}
