{"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":"2026-09-30","version":"1.0.0","out_of_network":[{"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":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":42.00,"npi":[1891782470]}]}]}]},{"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":"Chest x-ray","billing_code_type":"CPT","billing_code_type_version":"2018","billing_code":"71045","description":"x-ray exam chest 1 view","allowed_amounts":[{"tin":{"Type":"ein","value":"591226176"},"service_code":["21","23"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":9.69,"billing_code_modifier":["26"],"providers":[{"billed_charge":176.00,"npi":[1972577856]}]}]}]},{"name":"CT scan of abdomen and pelvis","billing_code_type":"CPT","billing_code_type_version":"2011","billing_code":"74177","description":"ct abd & pelvis w/contrast","allowed_amounts":[{"tin":{"Type":"ein","value":"591226176"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":96.23,"billing_code_modifier":["26"],"providers":[{"billed_charge":1692.00,"npi":[1972577856]}]}]}]},{"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":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":345.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":232.88,"providers":[{"billed_charge":345.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":241.50,"providers":[{"billed_charge":345.00,"npi":[1891782470]}]}]},{"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]}]}]},{"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]}]}]}]},{"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":0.00,"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":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":"Immune suppressant monitoring","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"80197","description":"assay of tacrolimus","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":214.20,"providers":[{"billed_charge":306.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":229.50,"providers":[{"billed_charge":306.00,"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]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":41.30,"providers":[{"billed_charge":59.00,"npi":[1285621631]}]}]}]},{"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]}]}]},{"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]}]}]}]},{"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":"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":"Test for tissue damage","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"83615","description":"lactate (ld) (ldh) enzyme","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":52.50,"providers":[{"billed_charge":75.00,"npi":[1285621631]}]}]},{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":56.25,"providers":[{"billed_charge":75.00,"npi":[1285621631]}]}]}]},{"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":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":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":"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,"providers":[{"billed_charge":103.00,"npi":[1841351566]}]}]}]},{"name":"Urine test for bacteria","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87086","description":"urine culture/colony count","allowed_amounts":[{"tin":{"Type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":6.14,"providers":[{"billed_charge":69.50,"npi":[1891731626]}]}]}]},{"name":"Cytomegalovirus (CMV) test","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"87497","description":"cytomeg dna quant","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["81"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":548.80,"providers":[{"billed_charge":784.00,"npi":[1285621631]}]}]}]},{"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":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":13.29,"billing_code_modifier":["26"],"providers":[{"billed_charge":192.00,"npi":[1154309680,1184782500]}]}]}]},{"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":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":105.22,"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":"Pathology exam of body tissue","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"88307","description":"tissue exam by pathologist","allowed_amounts":[{"tin":{"Type":"ein","value":"800564919"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":94.58,"billing_code_modifier":["26"],"providers":[{"billed_charge":468.00,"npi":[1154309680,1184782500]}]}]}]},{"name":"Prep for tissue study","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"88311","description":"decalcify tissue","allowed_amounts":[{"tin":{"Type":"ein","value":"800564919"},"service_code":["22"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":14.48,"billing_code_modifier":["26"],"providers":[{"billed_charge":88.00,"npi":[1154309680,1184782500]}]}]}]},{"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]}]}]},{"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":"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]}]}]}]},{"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 (ECG)","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"93000","description":"electrocardiogram complete","allowed_amounts":[{"tin":{"Type":"ein","value":"593337028"},"service_code":["11"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":81.14,"billing_code_modifier":["59"],"providers":[{"billed_charge":120.00,"npi":[1174596324]}]}]}]},{"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":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":8.29,"providers":[{"billed_charge":65.00,"npi":[1033744610,1124789805,1467932152]}]}]},{"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":[1013189224,1306824693,1508917105,1629174917,1710379920,1740922061,1982021846]}]}]}]},{"name":"Ultrasound of heart","billing_code_type":"CPT","billing_code_type_version":"2008","billing_code":"93306","description":"tte w/doppler complete","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2079.75,"providers":[{"billed_charge":2773.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":2773.00,"providers":[{"billed_charge":2773.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":4486.00,"providers":[{"billed_charge":2773.00,"npi":[1891782470]}]}]}]},{"name":"Doctor service heart rehab","billing_code_type":"CPT","billing_code_type_version":"2005","billing_code":"93798","description":"phys/qhp op car rhab w/ecg","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":274.40,"providers":[{"billed_charge":392.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":294.00,"providers":[{"billed_charge":392.00,"npi":[1891782470]}]}]}]},{"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]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":426.14,"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":69.64,"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":[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":66.61,"providers":[{"billed_charge":378.00,"npi":[1164764445,1184859530,1730251943,1972570885]}]}]}]},{"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":[1164764445,1184859530,1316236045,1972570885]}]}]}]},{"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,"providers":[{"billed_charge":488.00,"npi":[1164764445]}]}]},{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":179.31,"providers":[{"billed_charge":694.00,"npi":[1508604216,1518385913]}]}]},{"tin":{"Type":"ein","value":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":210.95,"providers":[{"billed_charge":694.00,"npi":[1033615208,1235459355,1518385913,1659936177,1689459307,1700445533,1992190631]}]}]},{"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":"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,"providers":[{"billed_charge":195.00,"npi":[1356931067]}]}]},{"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":[1023670833,1033615208,1033791942,1063552396,1073174314,1083766687,1285383372,1467734681,1548902307,1578021689,1700517893,1750802930,1902922727,1922705524,1932773793,1932841806]}]}]},{"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]}]}]}]},{"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":"812660368"},"service_code":["21"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":143.23,"providers":[{"billed_charge":359.00,"npi":[1023670833,1033615208,1033791942,1063552396,1073174314,1285383372,1750802930,1801458435]}]}]},{"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]}]}]}]},{"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":[1508509092,1548902307,1699171538,1750802930,1932773793,1932841806]}]}]}]},{"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":[1033791942,1063552396,1285383372,1578021689]}]}]}]},{"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":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":74.36,"billing_code_modifier":["25"],"providers":[{"billed_charge":594.00,"npi":[1467932152,1700241023]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":87.49,"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":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":127.20,"billing_code_modifier":["25"],"providers":[{"billed_charge":994.00,"npi":[1023605912,1033744610,1063998235,1124789805,1164032330,1295019925,1467932152,1649806175,1700241023,1740022086,1821593252,1942385901,1972802510]}]}]},{"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":[1013189224,1174086110,1194068247,1306824693,1437252657,1508492158,1508917105,1568925527,1588124333,1629174917,1639676059,1649477993,1679525463,1710379920,1740922061,1780640599,1891012845,1912274481,1932197076,1932563145,1972025310,1982021846]}]}]}]},{"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,"providers":[{"billed_charge":1451.00,"npi":[1023605912,1033744610,1063998235,1124789805,1467932152,1558032045,1609408939,1649806175,1700241023,1740022086,1972802510]}]}]},{"tin":{"Type":"ein","value":"810584939"},"service_code":["23"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":217.26,"providers":[{"billed_charge":1451.00,"npi":[1013189224,1174086110,1194068247,1265474019,1306824693,1437252657,1508917105,1568925527,1588124333,1629174917,1639676059,1649477993,1659588762,1679525463,1710379920,1740922061,1891012845,1912274481,1932197076,1932563145,1972025310,1982021846]}]}]}]},{"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":"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]}]}]}]},{"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":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":75.85,"providers":[{"billed_charge":105.00,"npi":[1558248120]}]}]}]},{"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":"550893915"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":160.00,"npi":[1255956934]}]}]},{"tin":{"Type":"ein","value":"843784979"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":138.00,"npi":[1508667379,1558248120]}]}]},{"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]}]}]},{"tin":{"Type":"ein","value":"920548864"},"service_code":["31"],"billing_class":"professional","setting":"inpatient","payments":[{"allowed_amount":110.34,"providers":[{"billed_charge":124.00,"npi":[1184951436,1609623032]}]}]}]},{"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":["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":["RH","SH"],"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","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":["RH"],"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":["PH","RH"],"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":"Emergency medical services","billing_code_type":"CPT","billing_code_type_version":"2006","billing_code":"A0998","description":"Ambulance response/treatment","allowed_amounts":[{"tin":{"Type":"ein","value":"596031875"},"service_code":["41"],"billing_class":"professional","setting":"outpatient","payments":[{"allowed_amount":100.00,"billing_code_modifier":["RR","SS"],"providers":[{"billed_charge":100.00,"npi":[1952448383]}]}]}]},{"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,"providers":[{"billed_charge":10.08,"npi":[1891782470]}]},{"allowed_amount":0.00,"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,"providers":[{"billed_charge":9.10,"npi":[1891782470]}]}]}]},{"name":"Hydromorphone injection","billing_code_type":"CPT","billing_code_type_version":"2024","billing_code":"J1171","description":"Inj hydromorphone 0.1 mg","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":15.56,"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":19.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.58,"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":36.35,"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":9.20,"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":0.47,"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":2.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"billing_code_modifier":["JW"],"providers":[{"billed_charge":3.16,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.07,"billing_code_modifier":["JW"],"providers":[{"billed_charge":0.47,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"outpatient","payments":[{"allowed_amount":0.47,"providers":[{"billed_charge":3.16,"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":"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":3612.00,"npi":[1891782470]}]}]},{"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":5063.00,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":6341.38,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":17032.94,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":24814.07,"providers":[{"billed_charge":3172.00,"npi":[1891782470]}]}]}]},{"name":"Psychiatric","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0124","description":"PSYCH/SEMI-PVT","allowed_amounts":[{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":984.51,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":993.35,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1079.96,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1110.55,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1177.18,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1214.73,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1239.03,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1275.47,"providers":[{"billed_charge":3854.80,"npi":[1912396326]}]}]}]},{"name":"General Classification","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0250","description":"PHARMACY","allowed_amounts":[{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":10.86,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":17.93,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":20.83,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":35.40,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":47.14,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.22,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":72.10,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":79.20,"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":9.21,"providers":[{"billed_charge":13.15,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":10.63,"providers":[{"billed_charge":72.10,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":38.74,"providers":[{"billed_charge":55.35,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":39.36,"providers":[{"billed_charge":79.20,"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":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":11.69,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":5.56,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.85,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.88,"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":324.68,"providers":[{"billed_charge":4.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"596001321"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":14.88,"npi":[1538108725]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":37.00,"npi":[1538108725]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":33.01,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":41.09,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":41.26,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":41.77,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":43.92,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":46.93,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":70.41,"npi":[1912396326]}]}]}]},{"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":1.29,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.55,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1.66,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":2.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":13.83,"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":31.94,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":32.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":32.39,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":33.00,"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":3.80,"providers":[{"billed_charge":31.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.10,"providers":[{"billed_charge":32.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":946.58,"providers":[{"billed_charge":32.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1252.84,"providers":[{"billed_charge":32.00,"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":294.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":408.13,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":433.50,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":463.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":530.67,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":881.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":980.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":147.32,"providers":[{"billed_charge":294.00,"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,"billing_code_modifier":["XE"],"providers":[{"billed_charge":463.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":441.47,"providers":[{"billed_charge":881.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":491.08,"billing_code_modifier":["XE"],"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":590.15,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":610.80,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":643.47,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":854.34,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":86.97,"providers":[{"billed_charge":590.15,"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":111.75,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":353.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":42.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":117.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":169.38,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":261.28,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":358.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":53.12,"providers":[{"billed_charge":106.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":167.87,"providers":[{"billed_charge":335.00,"npi":[1780653618]}]}]}]},{"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":147.63,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":168.56,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":229.47,"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":192.76,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":202.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":207.26,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":209.18,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":329.47,"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":13.03,"providers":[{"billed_charge":26.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":32.07,"providers":[{"billed_charge":64.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":53.62,"providers":[{"billed_charge":107.00,"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":101.22,"providers":[{"billed_charge":202.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":109.24,"providers":[{"billed_charge":218.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":132.79,"providers":[{"billed_charge":265.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":202.95,"providers":[{"billed_charge":405.00,"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":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":1039.12,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1171.65,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":1482.66,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":722.68,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":898.92,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":967.98,"npi":[1912396326]}]}]}]},{"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":123.12,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":136.50,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":211.13,"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":108.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":118.58,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":85.19,"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":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":294.13,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":302.45,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":304.67,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":89.00,"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]}]}]},{"tin":{"Type":"ein","value":"621091430"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":119.86,"npi":[1912396326]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":81.00,"npi":[1912396326]}]}]}]},{"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":195.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":262.29,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":628.11,"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":369.31,"providers":[{"billed_charge":737.00,"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":416.33,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":304.50,"providers":[{"billed_charge":453.80,"npi":[1891782470]}]}]}]},{"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":262.00,"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]}]}]}]},{"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":"Body Scan","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0352","description":"CT SCAN/BODY","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":7879.00,"npi":[1780653618]}]}]}]},{"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":3970.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":6431.00,"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":607.16,"providers":[{"billed_charge":4120.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.01,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.01,"providers":[{"billed_charge":0.01,"npi":[1780653618]}]}]}]},{"name":"Ultrasound","billing_code_type":"REV","billing_code_type_version":"2005","billing_code":"0402","description":"ULTRASOUND","allowed_amounts":[{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":2708.75,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1630.08,"providers":[{"billed_charge":3253.00,"npi":[1780653618]}]}]}]},{"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":172.62,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":178.11,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":211.33,"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":178.29,"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,"billing_code_modifier":["25"],"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":1.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":10.57,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":12.25,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":15.55,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":7.00,"npi":[1780653618]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":9.36,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.02,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.04,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.17,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.19,"providers":[{"billed_charge":3.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.23,"providers":[{"billed_charge":1.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":0.25,"providers":[{"billed_charge":0.50,"npi":[1780653618]}]}]},{"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":0.76,"providers":[{"billed_charge":81.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.01,"providers":[{"billed_charge":18.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":1.60,"providers":[{"billed_charge":6.00,"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":2.31,"providers":[{"billed_charge":14.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":3.80,"providers":[{"billed_charge":10.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":4.18,"providers":[{"billed_charge":19.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":14.03,"providers":[{"billed_charge":28.00,"npi":[1780653618]}]}]},{"tin":{"Type":"ein","value":"593238634"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":71.51,"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":222.00,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":267.76,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":294.89,"npi":[1891782470]}]},{"allowed_amount":0.00,"providers":[{"billed_charge":387.25,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":32.72,"providers":[{"billed_charge":222.00,"npi":[1891782470]}]}]},{"tin":{"Type":"ein","value":"590714831"},"billing_class":"institutional","setting":"inpatient","payments":[{"allowed_amount":351.83,"providers":[{"billed_charge":524.33,"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]}]}]}]}]}