{"reporting_entity_name": "Molina-Healthcare-of-Florida", "reporting_entity_type": "health insurance issuer", "last_updated_on": "2026-07-18", "version": "2.0.0", "out_of_network": [{"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "043775926"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1952351983]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1952351983]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000773"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 668.11, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 1024.0, "npi": [1033215348]}]}, {"allowed_amount": 668.11, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 1024.0, "npi": [1033215348]}]}, {"allowed_amount": 668.11, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 1024.0, "npi": [1033215348]}]}]}]}, {"name": "Laboratory - Immunology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0302", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 166.0, "npi": [1578620449]}, {"billed_charge": 218.0, "npi": [1578620449]}, {"billed_charge": 107.5, "npi": [1578620449]}, {"billed_charge": 91.7143, "npi": [1578620449]}, {"billed_charge": 48.488, "npi": [1578620449]}, {"billed_charge": 154.3333, "npi": [1578620449]}, {"billed_charge": 125.4, "npi": [1578620449]}, {"billed_charge": 43.5, "npi": [1578620449]}, {"billed_charge": 72.0, "npi": [1578620449]}, {"billed_charge": 199.3333, "npi": [1578620449]}]}, {"allowed_amount": 29.79, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.0, "npi": [1578620449]}]}]}]}, {"name": "THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96372", "description": "THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 136.025, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1578547865]}]}, {"allowed_amount": 138.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1578547865]}]}, {"allowed_amount": 136.02, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1578547865]}]}]}]}, {"name": "Physical Therapy - Evaluation or Reevaluation", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0424", "description": "Physical Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1042.0, "npi": [1306938071]}, {"billed_charge": 1414.0, "npi": [1306938071]}, {"billed_charge": 1143.0, "npi": [1306938071]}, {"billed_charge": 1321.0, "npi": [1306938071]}, {"billed_charge": 927.0, "npi": [1306938071]}]}, {"allowed_amount": 166.43, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 1042.0, "npi": [1306938071]}, {"billed_charge": 927.0, "npi": [1306938071]}]}, {"allowed_amount": 216.0, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 1042.0, "npi": [1306938071]}, {"billed_charge": 927.0, "npi": [1306938071]}]}, {"allowed_amount": 215.55, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 927.0, "npi": [1306938071]}]}]}]}, {"name": "OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99202", "description": "OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 176.72, "billing_code_modifier": [""], "providers": [{"billed_charge": 561.0, "npi": [1528042884]}]}, {"allowed_amount": 219.91, "billing_code_modifier": [""], "providers": [{"billed_charge": 561.0, "npi": [1528042884]}]}, {"allowed_amount": 176.72, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 561.0, "npi": [1528042884]}]}, {"allowed_amount": 219.91, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 561.0, "npi": [1528042884]}]}]}]}, {"name": "RADIOLOGIC EXAM CHEST 2 VIEWS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71046", "description": "RADIOLOGIC EXAM CHEST 2 VIEWS", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 185.81, "billing_code_modifier": [""], "providers": [{"billed_charge": 474.0, "npi": [1528042884]}]}, {"allowed_amount": 306.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 765.0, "npi": [1528042884]}]}, {"allowed_amount": 149.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 474.0, "npi": [1528042884]}]}, {"allowed_amount": 299.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 765.0, "npi": [1528042884]}]}]}]}, {"name": "Other Imaging Services - Ultrasound", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0402", "description": "Other Imaging Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1897.0, "npi": [1578620449]}, {"billed_charge": 1869.0, "npi": [1578620449]}, {"billed_charge": 1629.0, "npi": [1578620449]}, {"billed_charge": 2185.5, "npi": [1578620449]}, {"billed_charge": 1817.0, "npi": [1578620449]}, {"billed_charge": 1245.5, "npi": [1578620449]}, {"billed_charge": 1086.0, "npi": [1578620449]}, {"billed_charge": 2035.0, "npi": [1578620449]}, {"billed_charge": 771.0, "npi": [1578620449]}]}, {"allowed_amount": 244.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 1800.0, "npi": [1578620449]}, {"billed_charge": 2198.0, "npi": [1578620449]}, {"billed_charge": 1817.0, "npi": [1578620449]}]}, {"allowed_amount": 244.44, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 2198.0, "npi": [1578620449]}]}]}]}, {"name": "Treatment or Observation Room - Observation Hours", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0762", "description": "Specialty Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 736.3333, "npi": [1306938071]}, {"billed_charge": 441.4615, "npi": [1306938071]}, {"billed_charge": 457.5455, "npi": [1306938071]}, {"billed_charge": 544.6667, "npi": [1306938071]}, {"billed_charge": 517.2857, "npi": [1306938071]}, {"billed_charge": 427.1935, "npi": [1306938071]}, {"billed_charge": 432.3103, "npi": [1306938071]}, {"billed_charge": 413.5263, "npi": [1306938071]}, {"billed_charge": 435.1429, "npi": [1306938071]}, {"billed_charge": 439.25, "npi": [1306938071]}, {"billed_charge": 424.875, "npi": [1306938071]}, {"billed_charge": 433.2326, "npi": [1306938071]}, {"billed_charge": 1503.0, "npi": [1306938071]}, {"billed_charge": 468.0, "npi": [1306938071]}, {"billed_charge": 462.5238, "npi": [1306938071]}, {"billed_charge": 488.2941, "npi": [1306938071]}, {"billed_charge": 426.4043, "npi": [1306938071]}, {"billed_charge": 448.8333, "npi": [1306938071]}, {"billed_charge": 453.0, "npi": [1306938071]}, {"billed_charge": 562.0909, "npi": [1306938071]}, {"billed_charge": 420.6471, "npi": [1306938071]}, {"billed_charge": 474.0526, "npi": [1306938071]}, {"billed_charge": 928.0, "npi": [1306938071]}]}]}]}, {"name": "EKG/ECG (Electrocardiogram) - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0730", "description": "EKG/ECG (Electrocardiogram)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 878.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 878.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 878.0, "npi": [1306938071]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "650524728"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 96.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 228.0, "npi": [1942267190]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99285", "description": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1141.5, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2912.0, "npi": [1578547865]}]}, {"allowed_amount": 1164.8, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2912.0, "npi": [1578547865]}]}, {"allowed_amount": 1141.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 2912.0, "npi": [1578547865]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 977.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1528042884]}]}, {"allowed_amount": 958.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1528042884]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000573"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 709.13, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 880.0, "npi": [1588768279]}, {"billed_charge": 800.0, "npi": [1588768279]}, {"billed_charge": 905.0, "npi": [1588768279]}, {"billed_charge": 850.0, "npi": [1588768279]}]}, {"allowed_amount": 709.13, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 825.0, "npi": [1588768279]}, {"billed_charge": 880.0, "npi": [1588768279]}, {"billed_charge": 800.0, "npi": [1588768279]}, {"billed_charge": 855.0, "npi": [1588768279]}, {"billed_charge": 850.0, "npi": [1588768279]}]}, {"allowed_amount": 709.13, "billing_code_modifier": ["SH76"], "providers": [{"billed_charge": 800.0, "npi": [1588768279]}]}, {"allowed_amount": 709.13, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 825.0, "npi": [1588768279]}, {"billed_charge": 880.0, "npi": [1588768279]}, {"billed_charge": 800.0, "npi": [1588768279]}, {"billed_charge": 830.0, "npi": [1588768279]}, {"billed_charge": 855.0, "npi": [1588768279]}, {"billed_charge": 850.0, "npi": [1588768279]}]}]}]}, {"name": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 17.82, "billing_code_modifier": [""], "providers": [{"billed_charge": 32.4, "npi": [1285662239]}]}, {"allowed_amount": 8.6625, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.75, "npi": [1285662239]}]}, {"allowed_amount": 13.545, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 24.625, "npi": [1285662239]}]}, {"allowed_amount": 8.665, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 15.75, "npi": [1285662239]}]}, {"allowed_amount": 4.3325, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.75, "npi": [1285662239]}]}, {"allowed_amount": 4.335, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.75, "npi": [1285662239]}]}, {"allowed_amount": 8.665, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.75, "npi": [1285662239]}]}, {"allowed_amount": 17.82, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 32.4, "npi": [1285662239]}]}]}]}, {"name": "IV Therapy -General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0260", "description": "IV Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "824372339"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 106.515, "billing_code_modifier": [""], "providers": [{"billed_charge": 503.6, "npi": [1740772268]}]}, {"allowed_amount": 106.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.46, "npi": [1740772268]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1369.68, "npi": [1740772268]}, {"billed_charge": 400.66, "npi": [1740772268]}, {"billed_charge": 503.6, "npi": [1740772268]}, {"billed_charge": 250.84, "npi": [1740772268]}, {"billed_charge": 250.46, "npi": [1740772268]}, {"billed_charge": 279.93, "npi": [1740772268]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 1369.68, "npi": [1740772268]}, {"billed_charge": 279.93, "npi": [1740772268]}]}, {"allowed_amount": 508.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 503.25, "npi": [1740772268]}]}, {"allowed_amount": 486.43, "billing_code_modifier": [""], "providers": [{"billed_charge": 503.25, "npi": [1740772268]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1578547865]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1578547865]}]}]}]}, {"name": "GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82962", "description": "GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}, {"allowed_amount": 30.03, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}, {"allowed_amount": 21.02, "billing_code_modifier": [""], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}, {"allowed_amount": 21.022, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}, {"allowed_amount": 30.03, "billing_code_modifier": [""], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}, {"allowed_amount": 30.03, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 54.6, "npi": [1285662239]}]}]}]}, {"name": "Medical/Surgical Supplies and Devices - Sterile Supply", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0272", "description": "Med/Surg Supplies &Devices (also see 062x, extension of 027x", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 255.472, "billing_code_modifier": [""], "providers": [{"billed_charge": 464.495, "npi": [1285662239]}]}, {"allowed_amount": 21.84, "billing_code_modifier": [""], "providers": [{"billed_charge": 39.71, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 130.7856, "npi": [1285662239]}, {"billed_charge": 364.6814, "npi": [1285662239]}, {"billed_charge": 116.1681, "npi": [1285662239]}]}, {"allowed_amount": 71.9322, "billing_code_modifier": [""], "providers": [{"billed_charge": 130.7856, "npi": [1285662239]}]}, {"allowed_amount": 120.2433, "billing_code_modifier": [""], "providers": [{"billed_charge": 218.6267, "npi": [1285662239]}]}, {"allowed_amount": 252.0165, "billing_code_modifier": [""], "providers": [{"billed_charge": 458.2118, "npi": [1285662239]}]}, {"allowed_amount": 131.1967, "billing_code_modifier": [""], "providers": [{"billed_charge": 238.54, "npi": [1285662239]}]}, {"allowed_amount": 409.695, "billing_code_modifier": [""], "providers": [{"billed_charge": 744.9, "npi": [1285662239]}]}, {"allowed_amount": 131.13, "billing_code_modifier": [""], "providers": [{"billed_charge": 238.42, "npi": [1285662239]}]}, {"allowed_amount": 143.5476, "billing_code_modifier": [""], "providers": [{"billed_charge": 260.9953, "npi": [1285662239]}]}, {"allowed_amount": 107.6606, "billing_code_modifier": [""], "providers": [{"billed_charge": 260.9953, "npi": [1285662239]}]}, {"allowed_amount": 171.215, "billing_code_modifier": [""], "providers": [{"billed_charge": 311.3, "npi": [1285662239]}]}, {"allowed_amount": 82.6533, "billing_code_modifier": [""], "providers": [{"billed_charge": 150.2767, "npi": [1285662239]}]}, {"allowed_amount": 257.2921, "billing_code_modifier": [""], "providers": [{"billed_charge": 467.8037, "npi": [1285662239]}]}, {"allowed_amount": 216.7633, "billing_code_modifier": [""], "providers": [{"billed_charge": 394.1152, "npi": [1285662239]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "591113901"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 638.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 2004.0, "npi": [1053321919]}, {"billed_charge": 3108.0, "npi": [1053321919]}]}, {"allowed_amount": 359.01, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2004.0, "npi": [1053321919]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 4094.095, "npi": [1053321919]}, {"billed_charge": 5859.0, "npi": [1053321919]}, {"billed_charge": 3108.0, "npi": [1053321919]}]}, {"allowed_amount": 6115.34, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5859.0, "npi": [1053321919]}]}, {"allowed_amount": 1392.41, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5859.0, "npi": [1053321919]}]}, {"allowed_amount": 357.66, "billing_code_modifier": [""], "providers": [{"billed_charge": 954.0, "npi": [1053321919]}]}, {"allowed_amount": 975.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 5859.0, "npi": [1053321919]}, {"billed_charge": 3108.0, "npi": [1053321919]}]}, {"allowed_amount": 359.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 954.0, "npi": [1053321919]}]}, {"allowed_amount": 950.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 1275.01, "npi": [1053321919]}]}, {"allowed_amount": 961.72, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3108.0, "npi": [1053321919]}]}]}]}, {"name": "Pharmacy - Drugs Incident to Radiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0255", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 44.0682, "npi": [1306938071]}, {"billed_charge": 1.3885, "npi": [1306938071]}, {"billed_charge": 1.25, "npi": [1306938071]}, {"billed_charge": 4.7987, "npi": [1306938071]}, {"billed_charge": 1.5155, "npi": [1306938071]}, {"billed_charge": 1.2048, "npi": [1306938071]}, {"billed_charge": 42.415, "npi": [1306938071]}, {"billed_charge": 2.5672, "npi": [1306938071]}, {"billed_charge": 1.4459, "npi": [1306938071]}, {"billed_charge": 43.445, "npi": [1306938071]}, {"billed_charge": 2.3675, "npi": [1306938071]}, {"billed_charge": 13.8722, "npi": [1306938071]}, {"billed_charge": 1.4458, "npi": [1306938071]}, {"billed_charge": 510.925, "npi": [1306938071]}, {"billed_charge": 44.299, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 1.4459, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "841793121"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 0.9365, "npi": [1801457510]}, {"billed_charge": 61.944, "npi": [1801457510]}, {"billed_charge": 0.2784, "npi": [1801457510]}, {"billed_charge": 131.94, "npi": [1801457510]}, {"billed_charge": 99.9525, "npi": [1801457510]}, {"billed_charge": 12.1365, "npi": [1801457510]}, {"billed_charge": 199.33, "npi": [1801457510]}, {"billed_charge": 338.55, "npi": [1801457510]}, {"billed_charge": 27.45, "npi": [1801457510]}, {"billed_charge": 21.1504, "npi": [1801457510]}, {"billed_charge": 548.35, "npi": [1801457510]}, {"billed_charge": 279.69, "npi": [1801457510]}, {"billed_charge": 16.5012, "npi": [1801457510]}, {"billed_charge": 1.7735, "npi": [1801457510]}, {"billed_charge": 316.33, "npi": [1801457510]}, {"billed_charge": 19.3525, "npi": [1801457510]}, {"billed_charge": 126.7267, "npi": [1801457510]}, {"billed_charge": 279.64, "npi": [1801457510]}, {"billed_charge": 18.7989, "npi": [1801457510]}, {"billed_charge": 38.6875, "npi": [1801457510]}, {"billed_charge": 53.9434, "npi": [1801457510]}, {"billed_charge": 266.72, "npi": [1801457510]}, {"billed_charge": 1.2876, "npi": [1801457510]}, {"billed_charge": 3.2239, "npi": [1801457510]}, {"billed_charge": 8.6938, "npi": [1801457510]}, {"billed_charge": 191.34, "npi": [1801457510]}, {"billed_charge": 491.05, "npi": [1801457510]}, {"billed_charge": 25.9875, "npi": [1801457510]}, {"billed_charge": 56.12, "npi": [1801457510]}, {"billed_charge": 56.865, "npi": [1801457510]}]}, {"allowed_amount": 0.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 159.93, "npi": [1801457510]}]}, {"allowed_amount": 0.77, "billing_code_modifier": [""], "providers": [{"billed_charge": 64.105, "npi": [1801457510]}]}, {"allowed_amount": 0.76, "billing_code_modifier": [""], "providers": [{"billed_charge": 124.27, "npi": [1801457510]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "592447554"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417952748]}]}, {"allowed_amount": 4.558, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.6276, "npi": [1417952748]}]}, {"allowed_amount": 1.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1417952748]}]}, {"allowed_amount": 6.006, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.3215, "npi": [1417952748]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417952748]}]}, {"allowed_amount": 18.9109, "billing_code_modifier": [""], "providers": [{"billed_charge": 48.2424, "npi": [1417952748]}]}, {"allowed_amount": 318.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 796.0, "npi": [1417952748]}]}, {"allowed_amount": 14.7, "billing_code_modifier": [""], "providers": [{"billed_charge": 36.75, "npi": [1417952748]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417952748]}]}, {"allowed_amount": 3.341, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.5229, "npi": [1417952748]}]}, {"allowed_amount": 7.3185, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.2961, "npi": [1417952748]}]}, {"allowed_amount": 31.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 78.0, "npi": [1417952748]}]}, {"allowed_amount": 19.297, "billing_code_modifier": [""], "providers": [{"billed_charge": 48.2424, "npi": [1417952748]}]}, {"allowed_amount": 72.52, "billing_code_modifier": [""], "providers": [{"billed_charge": 185.0, "npi": [1417952748]}]}]}]}, {"name": "Radiology - Diagnostic - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0320", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 766.63, "npi": [1821186313]}, {"billed_charge": 751.8, "npi": [1821186313]}, {"billed_charge": 913.31, "npi": [1821186313]}, {"billed_charge": 995.28, "npi": [1821186313]}, {"billed_charge": 842.138, "npi": [1821186313]}, {"billed_charge": 775.0267, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 891.98, "npi": [1821186313]}, {"billed_charge": 1059.23, "npi": [1821186313]}, {"billed_charge": 887.07, "npi": [1821186313]}, {"billed_charge": 878.86, "npi": [1821186313]}, {"billed_charge": 849.37, "npi": [1821186313]}, {"billed_charge": 995.28, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 983.81, "npi": [1821186313]}, {"billed_charge": 891.98, "npi": [1821186313]}, {"billed_charge": 1059.23, "npi": [1821186313]}, {"billed_charge": 778.85, "npi": [1821186313]}, {"billed_charge": 977.26, "npi": [1821186313]}, {"billed_charge": 819.84, "npi": [1821186313]}]}]}]}, {"name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "ASSAY OF MAGNESIUM", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 325.24, "npi": [1376571323]}]}, {"allowed_amount": 178.88, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 325.24, "npi": [1285662239]}]}, {"allowed_amount": 178.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 325.24, "npi": [1376571323]}, {"billed_charge": 325.24, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 325.24, "npi": [1285662239]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "043775926"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 264.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1952351983]}]}, {"allowed_amount": 270.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1952351983]}]}]}]}, {"name": "Laboratory - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0300", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "426004813"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 329.0, "npi": [1376544320]}, {"billed_charge": 126.0, "npi": [1376544320]}, {"billed_charge": 84.0, "npi": [1376544320]}, {"billed_charge": 217.0, "npi": [1376544320]}, {"billed_charge": 453.0, "npi": [1376544320]}, {"billed_charge": 162.0, "npi": [1376544320]}, {"billed_charge": 218.0, "npi": [1376544320]}, {"billed_charge": 86.0, "npi": [1376544320]}, {"billed_charge": 152.0, "npi": [1376544320]}, {"billed_charge": 95.0, "npi": [1376544320]}, {"billed_charge": 87.0, "npi": [1376544320]}, {"billed_charge": 223.0, "npi": [1376544320]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 118.0, "npi": [1376544320]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Self Administrable Drugs", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0637", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.15, "npi": [1578620449]}, {"billed_charge": 2.75, "npi": [1578620449]}, {"billed_charge": 427.05, "npi": [1578620449]}, {"billed_charge": 145.6, "npi": [1578620449]}, {"billed_charge": 12.575, "npi": [1578620449]}, {"billed_charge": 12.2, "npi": [1578620449]}, {"billed_charge": 1.85, "npi": [1578620449]}, {"billed_charge": 12.9, "npi": [1578620449]}, {"billed_charge": 21.15, "npi": [1578620449]}, {"billed_charge": 3.4, "npi": [1578620449]}, {"billed_charge": 23.05, "npi": [1578620449]}, {"billed_charge": 18.45, "npi": [1578620449]}, {"billed_charge": 47.8, "npi": [1578620449]}, {"billed_charge": 8.95, "npi": [1578620449]}, {"billed_charge": 15.925, "npi": [1578620449]}, {"billed_charge": 4.1, "npi": [1578620449]}, {"billed_charge": 114.5, "npi": [1578620449]}, {"billed_charge": 71.9, "npi": [1578620449]}, {"billed_charge": 2.8875, "npi": [1578620449]}, {"billed_charge": 2.7, "npi": [1578620449]}, {"billed_charge": 6.0, "npi": [1578620449]}, {"billed_charge": 2.55, "npi": [1578620449]}, {"billed_charge": 22.8, "npi": [1578620449]}, {"billed_charge": 0.1, "npi": [1578620449]}, {"billed_charge": 77.5, "npi": [1578620449]}, {"billed_charge": 103.65, "npi": [1578620449]}, {"billed_charge": 0.6, "npi": [1578620449]}, {"billed_charge": 7.65, "npi": [1578620449]}, {"billed_charge": 4.25, "npi": [1578620449]}, {"billed_charge": 0.4, "npi": [1578620449]}, {"billed_charge": 3.65, "npi": [1578620449]}, {"billed_charge": 1.4, "npi": [1578620449]}, {"billed_charge": 5.7, "npi": [1578620449]}, {"billed_charge": 7.55, "npi": [1578620449]}, {"billed_charge": 6.9, "npi": [1578620449]}, {"billed_charge": 2.0, "npi": [1578620449]}, {"billed_charge": 4.2, "npi": [1578620449]}, {"billed_charge": 2.05, "npi": [1578620449]}, {"billed_charge": 35.8, "npi": [1578620449]}, {"billed_charge": 1.75, "npi": [1578620449]}, {"billed_charge": 9.1, "npi": [1578620449]}, {"billed_charge": 7.85, "npi": [1578620449]}, {"billed_charge": 10.45, "npi": [1578620449]}, {"billed_charge": 0.55, "npi": [1578620449]}, {"billed_charge": 1.2, "npi": [1578620449]}, {"billed_charge": 1.35, "npi": [1578620449]}, {"billed_charge": 3.2, "npi": [1578620449]}, {"billed_charge": 8.85, "npi": [1578620449]}, {"billed_charge": 2.35, "npi": [1578620449]}, {"billed_charge": 3.0, "npi": [1578620449]}, {"billed_charge": 3.275, "npi": [1578620449]}, {"billed_charge": 1.7, "npi": [1578620449]}, {"billed_charge": 3.75, "npi": [1578620449]}, {"billed_charge": 104.95, "npi": [1578620449]}, {"billed_charge": 1.1125, "npi": [1578620449]}, {"billed_charge": 1.3, "npi": [1578620449]}, {"billed_charge": 4.2875, "npi": [1578620449]}, {"billed_charge": 3.95, "npi": [1578620449]}, {"billed_charge": 56.4, "npi": [1578620449]}, {"billed_charge": 0.05, "npi": [1578620449]}, {"billed_charge": 2.925, "npi": [1578620449]}, {"billed_charge": 0.95, "npi": [1578620449]}, {"billed_charge": 3.075, "npi": [1578620449]}, {"billed_charge": 8.0, "npi": [1578620449]}]}]}]}, {"name": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000319"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 585.79, "billing_code_modifier": ["NH"], "providers": [{"billed_charge": 950.0, "npi": [1649281924]}]}, {"allowed_amount": 585.79, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 950.0, "npi": [1649281924]}]}, {"allowed_amount": 585.79, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 950.0, "npi": [1649281924]}]}, {"allowed_amount": 585.79, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 950.0, "npi": [1649281924]}]}]}]}, {"name": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 8.0, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 20.0, "npi": [1528042884]}]}, {"allowed_amount": 19.21, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 49.0, "npi": [1528042884]}]}, {"allowed_amount": 7.84, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 20.0, "npi": [1528042884]}]}, {"allowed_amount": 2.0475, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 6.5, "npi": [1528042884]}]}, {"allowed_amount": 19.6, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 49.0, "npi": [1528042884]}]}, {"allowed_amount": 2.05, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 6.5, "npi": [1528042884]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000411"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 695.61, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 1327.66, "npi": [1891790424]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 1327.66, "npi": [1891790424]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 1327.66, "npi": [1891790424]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 1327.66, "npi": [1891790424]}, {"billed_charge": 1394.05, "npi": [1891790424]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 29.4, "npi": [1376571323]}, {"billed_charge": 29.4, "npi": [1285662239]}]}, {"allowed_amount": 16.17, "billing_code_modifier": [""], "providers": [{"billed_charge": 29.4, "npi": [1174551147]}, {"billed_charge": 29.4, "npi": [1265460232]}, {"billed_charge": 29.4, "npi": [1376571323]}, {"billed_charge": 29.4, "npi": [1285662239]}]}, {"allowed_amount": 16.17, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 29.4, "npi": [1265460232]}]}, {"allowed_amount": 11.32, "billing_code_modifier": [""], "providers": [{"billed_charge": 29.4, "npi": [1285662239]}]}, {"allowed_amount": 12.13, "billing_code_modifier": [""], "providers": [{"billed_charge": 29.4, "npi": [1285662239]}]}, {"allowed_amount": 32.34, "billing_code_modifier": [""], "providers": [{"billed_charge": 58.8, "npi": [1174551147]}, {"billed_charge": 58.8, "npi": [1265460232]}, {"billed_charge": 58.8, "npi": [1376571323]}, {"billed_charge": 58.8, "npi": [1285662239]}]}, {"allowed_amount": 16.17, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 29.4, "npi": [1376571323]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "841793121"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 65.23, "npi": [1801457510]}, {"billed_charge": 63.0, "npi": [1801457510]}, {"billed_charge": 865.21, "npi": [1801457510]}, {"billed_charge": 276.91, "npi": [1801457510]}, {"billed_charge": 396.25, "npi": [1801457510]}, {"billed_charge": 731.37, "npi": [1801457510]}, {"billed_charge": 162.52, "npi": [1801457510]}, {"billed_charge": 444.1304, "npi": [1801457510]}, {"billed_charge": 372.67, "npi": [1801457510]}, {"billed_charge": 454.44, "npi": [1801457510]}, {"billed_charge": 569.11, "npi": [1801457510]}, {"billed_charge": 622.44, "npi": [1801457510]}, {"billed_charge": 354.05, "npi": [1801457510]}, {"billed_charge": 221.99, "npi": [1801457510]}, {"billed_charge": 577.83, "npi": [1801457510]}, {"billed_charge": 630.1, "npi": [1801457510]}, {"billed_charge": 207.25, "npi": [1801457510]}, {"billed_charge": 148.7, "npi": [1801457510]}, {"billed_charge": 286.95, "npi": [1801457510]}, {"billed_charge": 669.35, "npi": [1801457510]}, {"billed_charge": 57.92, "npi": [1801457510]}, {"billed_charge": 360.84, "npi": [1801457510]}, {"billed_charge": 548.97, "npi": [1801457510]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 454.44, "npi": [1801457510]}, {"billed_charge": 630.1, "npi": [1801457510]}]}, {"allowed_amount": 9.04, "billing_code_modifier": [""], "providers": [{"billed_charge": 330.83, "npi": [1801457510]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "591943502"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 508.39, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 789.0, "npi": [1699874248]}, {"billed_charge": 809.0, "npi": [1699874248]}]}, {"allowed_amount": 106.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 343.0, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 2675.5, "npi": [1699874248]}, {"billed_charge": 1183.0, "npi": [1699874248]}]}, {"allowed_amount": 486.43, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 789.0, "npi": [1699874248]}]}, {"allowed_amount": 111.92, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 343.0, "npi": [1699874248]}, {"billed_charge": 165.0, "npi": [1699874248]}]}, {"allowed_amount": 106.5133, "billing_code_modifier": [""], "providers": [{"billed_charge": 343.0, "npi": [1699874248]}]}, {"allowed_amount": 1423.36, "billing_code_modifier": ["2527"], "providers": [{"billed_charge": 4542.0, "npi": [1699874248]}]}, {"allowed_amount": 106.5133, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 343.0, "npi": [1699874248]}]}, {"allowed_amount": 508.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 809.0, "npi": [1699874248]}]}, {"allowed_amount": 997.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3837.0, "npi": [1699874248]}, {"billed_charge": 4542.0, "npi": [1699874248]}]}, {"allowed_amount": 6251.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 3837.0, "npi": [1699874248]}]}, {"allowed_amount": 983.09, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3837.0, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 317.0, "npi": [1699874248]}]}, {"allowed_amount": 111.9167, "billing_code_modifier": [""], "providers": [{"billed_charge": 343.0, "npi": [1699874248]}]}, {"allowed_amount": 486.43, "billing_code_modifier": [""], "providers": [{"billed_charge": 809.0, "npi": [1699874248]}]}, {"allowed_amount": 652.42, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3033.0, "npi": [1699874248]}]}, {"allowed_amount": 1415.47, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4542.0, "npi": [1699874248]}]}, {"allowed_amount": 1423.36, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4542.0, "npi": [1699874248]}]}, {"allowed_amount": 106.51, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 272.0, "npi": [1699874248]}, {"billed_charge": 343.0, "npi": [1699874248]}]}]}]}, {"name": "THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96372", "description": "THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 136.025, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1528042884]}]}, {"allowed_amount": 34.965, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.0, "npi": [1528042884]}]}, {"allowed_amount": 43.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.0, "npi": [1528042884]}]}, {"allowed_amount": 34.97, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.0, "npi": [1528042884]}]}, {"allowed_amount": 138.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1528042884]}]}, {"allowed_amount": 136.02, "billing_code_modifier": [""], "providers": [{"billed_charge": 347.0, "npi": [1528042884]}]}]}]}, {"name": "Laboratory - Hematology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0305", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "841793121"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 350.06, "npi": [1801457510]}, {"billed_charge": 317.8138, "npi": [1801457510]}, {"billed_charge": 162.39, "npi": [1801457510]}, {"billed_charge": 267.19, "npi": [1801457510]}, {"billed_charge": 321.1, "npi": [1801457510]}, {"billed_charge": 461.89, "npi": [1801457510]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 321.1, "npi": [1801457510]}, {"billed_charge": 66.16, "npi": [1801457510]}, {"billed_charge": 86.09, "npi": [1801457510]}]}]}]}, {"name": "THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96375", "description": "THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 93.688, "billing_code_modifier": [""], "providers": [{"billed_charge": 239.0, "npi": [1578547865]}]}, {"allowed_amount": 95.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 239.0, "npi": [1578547865]}]}, {"allowed_amount": 93.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 239.0, "npi": [1578547865]}]}, {"allowed_amount": 93.69, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 239.0, "npi": [1578547865]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 264.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1578547865]}]}, {"allowed_amount": 270.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1578547865]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.0, "npi": [1306938071]}, {"billed_charge": 40.43, "npi": [1306938071]}, {"billed_charge": 56.3, "npi": [1306938071]}]}, {"allowed_amount": 0.7475, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.645, "npi": [1306938071]}, {"billed_charge": 29.16, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 32.145, "npi": [1306938071]}, {"billed_charge": 197.71, "npi": [1306938071]}, {"billed_charge": 19.385, "npi": [1306938071]}, {"billed_charge": 0.3784, "npi": [1306938071]}, {"billed_charge": 16.945, "npi": [1306938071]}, {"billed_charge": 33.005, "npi": [1306938071]}, {"billed_charge": 8.5433, "npi": [1306938071]}, {"billed_charge": 112.83, "npi": [1306938071]}, {"billed_charge": 120.96, "npi": [1306938071]}, {"billed_charge": 83.52, "npi": [1306938071]}, {"billed_charge": 208.08, "npi": [1306938071]}, {"billed_charge": 133.38, "npi": [1306938071]}, {"billed_charge": 19.38, "npi": [1306938071]}, {"billed_charge": 9.9658, "npi": [1306938071]}, {"billed_charge": 5.6465, "npi": [1306938071]}, {"billed_charge": 110.7, "npi": [1306938071]}, {"billed_charge": 46.33, "npi": [1306938071]}, {"billed_charge": 127.96, "npi": [1306938071]}, {"billed_charge": 0.7283, "npi": [1306938071]}, {"billed_charge": 1.748, "npi": [1306938071]}, {"billed_charge": 3.1022, "npi": [1306938071]}, {"billed_charge": 0.9177, "npi": [1306938071]}, {"billed_charge": 19.31, "npi": [1306938071]}, {"billed_charge": 94.12, "npi": [1306938071]}, {"billed_charge": 139.405, "npi": [1306938071]}, {"billed_charge": 27.486, "npi": [1306938071]}, {"billed_charge": 13.584, "npi": [1306938071]}, {"billed_charge": 17.792, "npi": [1306938071]}, {"billed_charge": 4.5086, "npi": [1306938071]}, {"billed_charge": 14.29, "npi": [1306938071]}, {"billed_charge": 2.4195, "npi": [1306938071]}, {"billed_charge": 17.4806, "npi": [1306938071]}, {"billed_charge": 6.7963, "npi": [1306938071]}, {"billed_charge": 109.11, "npi": [1306938071]}, {"billed_charge": 5.4872, "npi": [1306938071]}, {"billed_charge": 40.15, "npi": [1306938071]}, {"billed_charge": 43.84, "npi": [1306938071]}, {"billed_charge": 5.1851, "npi": [1306938071]}, {"billed_charge": 1.2504, "npi": [1306938071]}, {"billed_charge": 112.32, "npi": [1306938071]}, {"billed_charge": 1.3108, "npi": [1306938071]}, {"billed_charge": 1.0925, "npi": [1306938071]}, {"billed_charge": 65.02, "npi": [1306938071]}, {"billed_charge": 16.9581, "npi": [1306938071]}, {"billed_charge": 0.3773, "npi": [1306938071]}, {"billed_charge": 5.2611, "npi": [1306938071]}, {"billed_charge": 73.84, "npi": [1306938071]}, {"billed_charge": 117.18, "npi": [1306938071]}, {"billed_charge": 205.965, "npi": [1306938071]}, {"billed_charge": 46.3467, "npi": [1306938071]}, {"billed_charge": 20.7487, "npi": [1306938071]}, {"billed_charge": 10.892, "npi": [1306938071]}, {"billed_charge": 151.495, "npi": [1306938071]}, {"billed_charge": 8.6025, "npi": [1306938071]}, {"billed_charge": 14.775, "npi": [1306938071]}, {"billed_charge": 214.55, "npi": [1306938071]}, {"billed_charge": 21.798, "npi": [1306938071]}, {"billed_charge": 123.2, "npi": [1306938071]}, {"billed_charge": 92.1, "npi": [1306938071]}, {"billed_charge": 41.04, "npi": [1306938071]}, {"billed_charge": 42.66, "npi": [1306938071]}, {"billed_charge": 8.9363, "npi": [1306938071]}, {"billed_charge": 15.3177, "npi": [1306938071]}, {"billed_charge": 7.2318, "npi": [1306938071]}, {"billed_charge": 17.9413, "npi": [1306938071]}, {"billed_charge": 1.7334, "npi": [1306938071]}, {"billed_charge": 115.56, "npi": [1306938071]}, {"billed_charge": 63.4722, "npi": [1306938071]}, {"billed_charge": 17.94, "npi": [1306938071]}, {"billed_charge": 0.6, "npi": [1306938071]}, {"billed_charge": 2.4754, "npi": [1306938071]}, {"billed_charge": 2.6454, "npi": [1306938071]}, {"billed_charge": 10.3698, "npi": [1306938071]}, {"billed_charge": 5.6131, "npi": [1306938071]}, {"billed_charge": 122.58, "npi": [1306938071]}, {"billed_charge": 2.7672, "npi": [1306938071]}, {"billed_charge": 16.1156, "npi": [1306938071]}, {"billed_charge": 26.121, "npi": [1306938071]}, {"billed_charge": 6.8471, "npi": [1306938071]}, {"billed_charge": 0.5538, "npi": [1306938071]}, {"billed_charge": 3.4398, "npi": [1306938071]}, {"billed_charge": 74.72, "npi": [1306938071]}, {"billed_charge": 14.088, "npi": [1306938071]}, {"billed_charge": 49.84, "npi": [1306938071]}, {"billed_charge": 77.955, "npi": [1306938071]}, {"billed_charge": 34.6223, "npi": [1306938071]}, {"billed_charge": 2.9307, "npi": [1306938071]}, {"billed_charge": 21.2906, "npi": [1306938071]}, {"billed_charge": 8.6408, "npi": [1306938071]}, {"billed_charge": 12.4812, "npi": [1306938071]}, {"billed_charge": 6.3877, "npi": [1306938071]}, {"billed_charge": 40.4903, "npi": [1306938071]}, {"billed_charge": 136.84, "npi": [1306938071]}, {"billed_charge": 0.9994, "npi": [1306938071]}, {"billed_charge": 4.5253, "npi": [1306938071]}, {"billed_charge": 8.9691, "npi": [1306938071]}, {"billed_charge": 1.0153, "npi": [1306938071]}, {"billed_charge": 23.3908, "npi": [1306938071]}, {"billed_charge": 20.2286, "npi": [1306938071]}, {"billed_charge": 122.8, "npi": [1306938071]}, {"billed_charge": 1500.74, "npi": [1306938071]}, {"billed_charge": 13.24, "npi": [1306938071]}, {"billed_charge": 285.95, "npi": [1306938071]}, {"billed_charge": 15.336, "npi": [1306938071]}, {"billed_charge": 13.068, "npi": [1306938071]}, {"billed_charge": 509.84, "npi": [1306938071]}, {"billed_charge": 9.415, "npi": [1306938071]}, {"billed_charge": 125.09, "npi": [1306938071]}, {"billed_charge": 0.9494, "npi": [1306938071]}, {"billed_charge": 272.15, "npi": [1306938071]}, {"billed_charge": 123.57, "npi": [1306938071]}, {"billed_charge": 15.5885, "npi": [1306938071]}, {"billed_charge": 44.61, "npi": [1306938071]}, {"billed_charge": 1.5448, "npi": [1306938071]}, {"billed_charge": 734.15, "npi": [1306938071]}, {"billed_charge": 7.845, "npi": [1306938071]}, {"billed_charge": 10.017, "npi": [1306938071]}, {"billed_charge": 137.16, "npi": [1306938071]}, {"billed_charge": 15.2932, "npi": [1306938071]}, {"billed_charge": 1.3329, "npi": [1306938071]}, {"billed_charge": 50.1484, "npi": [1306938071]}, {"billed_charge": 168.73, "npi": [1306938071]}, {"billed_charge": 20.4315, "npi": [1306938071]}, {"billed_charge": 274.59, "npi": [1306938071]}, {"billed_charge": 13.3665, "npi": [1306938071]}, {"billed_charge": 27.325, "npi": [1306938071]}, {"billed_charge": 9.057, "npi": [1306938071]}, {"billed_charge": 53.1533, "npi": [1306938071]}, {"billed_charge": 6.9532, "npi": [1306938071]}, {"billed_charge": 5.7743, "npi": [1306938071]}, {"billed_charge": 47.06, "npi": [1306938071]}, {"billed_charge": 43.7, "npi": [1306938071]}, {"billed_charge": 150.66, "npi": [1306938071]}, {"billed_charge": 12.4566, "npi": [1306938071]}, {"billed_charge": 22.5025, "npi": [1306938071]}, {"billed_charge": 31.4925, "npi": [1306938071]}, {"billed_charge": 113.4, "npi": [1306938071]}, {"billed_charge": 56.0625, "npi": [1306938071]}, {"billed_charge": 91.49, "npi": [1306938071]}, {"billed_charge": 0.863, "npi": [1306938071]}, {"billed_charge": 16.6125, "npi": [1306938071]}, {"billed_charge": 128.15, "npi": [1306938071]}, {"billed_charge": 10.152, "npi": [1306938071]}, {"billed_charge": 20.8482, "npi": [1306938071]}, {"billed_charge": 35.09, "npi": [1306938071]}, {"billed_charge": 11.666, "npi": [1306938071]}, {"billed_charge": 0.729, "npi": [1306938071]}, {"billed_charge": 3.231, "npi": [1306938071]}, {"billed_charge": 796.27, "npi": [1306938071]}, {"billed_charge": 34.6825, "npi": [1306938071]}, {"billed_charge": 0.325, "npi": [1306938071]}, {"billed_charge": 3.9409, "npi": [1306938071]}, {"billed_charge": 3.4374, "npi": [1306938071]}, {"billed_charge": 217.24, "npi": [1306938071]}, {"billed_charge": 125.87, "npi": [1306938071]}]}, {"allowed_amount": 0.755, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.77, "npi": [1306938071]}, {"billed_charge": 29.075, "npi": [1306938071]}, {"billed_charge": 21.09, "npi": [1306938071]}, {"billed_charge": 41.445, "npi": [1306938071]}]}, {"allowed_amount": 0.68, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.0, "npi": [1306938071]}]}, {"allowed_amount": 2.979, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.2812, "npi": [1306938071]}]}, {"allowed_amount": 0.4724, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.6408, "npi": [1306938071]}, {"billed_charge": 15.2932, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["EC"], "providers": [{"billed_charge": 186.324, "npi": [1306938071]}]}, {"allowed_amount": 0.685, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.77, "npi": [1306938071]}, {"billed_charge": 21.09, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "043775926"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1952351983]}]}, {"allowed_amount": 1.1767, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1952351983]}]}, {"allowed_amount": 6.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.0, "npi": [1952351983]}]}, {"allowed_amount": 4.6952, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.738, "npi": [1952351983]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1952351983]}]}, {"allowed_amount": 3.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.0, "npi": [1952351983]}]}, {"allowed_amount": 9.4164, "billing_code_modifier": [""], "providers": [{"billed_charge": 23.541, "npi": [1952351983]}]}, {"allowed_amount": 2.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.0, "npi": [1952351983]}]}, {"allowed_amount": 2.8649, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.3083, "npi": [1952351983]}]}, {"allowed_amount": 5.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 13.0, "npi": [1952351983]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1952351983]}]}, {"allowed_amount": 4.4341, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.3115, "npi": [1952351983]}]}, {"allowed_amount": 1.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1952351983]}]}, {"allowed_amount": 19.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 48.0, "npi": [1952351983]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000344"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 10.0, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 10.0, "npi": [1356341531]}]}, {"allowed_amount": 10.0, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 10.0, "npi": [1356341531]}]}, {"allowed_amount": 10.0, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 10.0, "npi": [1356341531]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 264.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1528042884]}]}, {"allowed_amount": 270.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1528042884]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.8617, "npi": [1578620449]}, {"billed_charge": 10.8782, "npi": [1578620449]}, {"billed_charge": 10.2045, "npi": [1578620449]}, {"billed_charge": 1.25, "npi": [1578620449]}, {"billed_charge": 3.4695, "npi": [1578620449]}, {"billed_charge": 2.5187, "npi": [1578620449]}, {"billed_charge": 2.5231, "npi": [1578620449]}, {"billed_charge": 0.1, "npi": [1578620449]}, {"billed_charge": 5.1403, "npi": [1578620449]}, {"billed_charge": 30.5833, "npi": [1578620449]}, {"billed_charge": 307.1333, "npi": [1578620449]}, {"billed_charge": 1.05, "npi": [1578620449]}, {"billed_charge": 1.247, "npi": [1578620449]}, {"billed_charge": 183.1688, "npi": [1578620449]}, {"billed_charge": 2.5294, "npi": [1578620449]}, {"billed_charge": 6.6143, "npi": [1578620449]}, {"billed_charge": 19.8875, "npi": [1578620449]}, {"billed_charge": 6.6375, "npi": [1578620449]}, {"billed_charge": 7.5124, "npi": [1578620449]}, {"billed_charge": 30.75, "npi": [1578620449]}, {"billed_charge": 10.0095, "npi": [1578620449]}, {"billed_charge": 9.8051, "npi": [1578620449]}, {"billed_charge": 18.85, "npi": [1578620449]}, {"billed_charge": 310.6375, "npi": [1578620449]}, {"billed_charge": 2.7002, "npi": [1578620449]}, {"billed_charge": 15.9854, "npi": [1578620449]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "823180067"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 12.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.26, "npi": [1932725322]}]}, {"allowed_amount": 0.0013, "billing_code_modifier": ["XP"], "providers": [{"billed_charge": 0.0013, "npi": [1932725322]}]}]}]}, {"name": "Hepatic Function Panel", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "Hepatic Function Panel", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 236.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1417279936]}]}, {"allowed_amount": 231.28, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1417279936]}]}]}]}, {"name": "IAAD IA SARSCOV  and  INFLUENZA VIRUS TYPES A and B", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87428", "description": "IAAD IA SARSCOV  and  INFLUENZA VIRUS TYPES A and B", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 140.34, "billing_code_modifier": ["QW"], "providers": [{"billed_charge": 358.0, "npi": [1528042884]}]}, {"allowed_amount": 112.77, "billing_code_modifier": ["QW"], "providers": [{"billed_charge": 358.0, "npi": [1528042884]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.3378, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.8878, "npi": [1376571323]}]}, {"allowed_amount": 1.46, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.65, "npi": [1174551147]}, {"billed_charge": 2.65, "npi": [1376571323]}, {"billed_charge": 2.65, "npi": [1285662239]}]}, {"allowed_amount": 3.4635, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.2973, "npi": [1376571323]}]}, {"allowed_amount": 2.5057, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.5557, "npi": [1285662239]}]}, {"allowed_amount": 26.238, "billing_code_modifier": [""], "providers": [{"billed_charge": 47.704, "npi": [1174551147]}]}, {"allowed_amount": 3.936, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.156, "npi": [1376571323]}]}, {"allowed_amount": 3.179, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.78, "npi": [1285662239]}]}, {"allowed_amount": 19.8008, "billing_code_modifier": [""], "providers": [{"billed_charge": 36.0013, "npi": [1174551147]}]}, {"allowed_amount": 3.9805, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.2374, "npi": [1285662239]}]}, {"allowed_amount": 45.6833, "billing_code_modifier": [""], "providers": [{"billed_charge": 83.06, "npi": [1376571323]}]}, {"allowed_amount": 12.7186, "billing_code_modifier": [""], "providers": [{"billed_charge": 23.1257, "npi": [1285662239]}]}, {"allowed_amount": 3.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.34, "npi": [1285662239]}]}, {"allowed_amount": 10.25, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.635, "npi": [1174551147]}]}, {"allowed_amount": 3.0075, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.4675, "npi": [1174551147]}]}, {"allowed_amount": 15.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 27.5459, "npi": [1174551147]}]}, {"allowed_amount": 90.7431, "billing_code_modifier": [""], "providers": [{"billed_charge": 164.9875, "npi": [1285662239]}]}, {"allowed_amount": 9.079, "billing_code_modifier": [""], "providers": [{"billed_charge": 16.507, "npi": [1376571323]}]}, {"allowed_amount": 4.1138, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.4788, "npi": [1285662239]}]}, {"allowed_amount": 0.9733, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.7667, "npi": [1376571323]}, {"billed_charge": 1.7667, "npi": [1265460232]}, {"billed_charge": 1.7667, "npi": [1285662239]}]}, {"allowed_amount": 10.2192, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.5804, "npi": [1285662239]}]}, {"allowed_amount": 8.7467, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.9, "npi": [1376571323]}, {"billed_charge": 15.9, "npi": [1285662239]}]}, {"allowed_amount": 14.1754, "billing_code_modifier": [""], "providers": [{"billed_charge": 25.7731, "npi": [1285662239]}]}, {"allowed_amount": 21.6775, "billing_code_modifier": [""], "providers": [{"billed_charge": 39.4125, "npi": [1285662239]}]}, {"allowed_amount": 4.995, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.0825, "npi": [1265460232]}]}, {"allowed_amount": 36.3577, "billing_code_modifier": [""], "providers": [{"billed_charge": 66.1048, "npi": [1376571323]}]}, {"allowed_amount": 4.66, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.4725, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 22.4097, "npi": [1376571323]}, {"billed_charge": 29.67, "npi": [1376571323]}, {"billed_charge": 52.6563, "npi": [1285662239]}, {"billed_charge": 36.0107, "npi": [1285662239]}, {"billed_charge": 8.774, "npi": [1285662239]}, {"billed_charge": 39.4125, "npi": [1285662239]}, {"billed_charge": 46.9542, "npi": [1285662239]}, {"billed_charge": 2.65, "npi": [1285662239]}, {"billed_charge": 24.7513, "npi": [1285662239]}, {"billed_charge": 5.3, "npi": [1285662239]}, {"billed_charge": 15.9, "npi": [1285662239]}, {"billed_charge": 40.3855, "npi": [1285662239]}]}, {"allowed_amount": 3.48, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.325, "npi": [1285662239]}]}, {"allowed_amount": 48.03, "billing_code_modifier": [""], "providers": [{"billed_charge": 87.32, "npi": [1285662239]}]}, {"allowed_amount": 3.365, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.12, "npi": [1376571323]}]}, {"allowed_amount": 3.8233, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.9533, "npi": [1285662239]}]}, {"allowed_amount": 9.5386, "billing_code_modifier": [""], "providers": [{"billed_charge": 23.1257, "npi": [1285662239]}]}, {"allowed_amount": 26.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 47.745, "npi": [1285662239]}]}, {"allowed_amount": 8.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.98, "npi": [1285662239]}]}, {"allowed_amount": 5.1742, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.4075, "npi": [1376571323]}]}, {"allowed_amount": 4.5562, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0446, "npi": [1285662239]}]}, {"allowed_amount": 16.32, "billing_code_modifier": [""], "providers": [{"billed_charge": 29.67, "npi": [1376571323]}, {"billed_charge": 29.67, "npi": [1174551147]}]}, {"allowed_amount": 8.4442, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.3531, "npi": [1376571323]}]}, {"allowed_amount": 19.48, "billing_code_modifier": [""], "providers": [{"billed_charge": 35.42, "npi": [1265460232]}]}, {"allowed_amount": 4.155, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.5533, "npi": [1376571323]}]}, {"allowed_amount": 21.612, "billing_code_modifier": [""], "providers": [{"billed_charge": 39.296, "npi": [1285662239]}]}, {"allowed_amount": 24.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 44.9825, "npi": [1285662239]}]}, {"allowed_amount": 2.5575, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.65, "npi": [1174551147]}]}, {"allowed_amount": 11.9, "billing_code_modifier": [""], "providers": [{"billed_charge": 21.64, "npi": [1174551147]}]}, {"allowed_amount": 3.6685, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.67, "npi": [1285662239]}]}, {"allowed_amount": 12.0653, "billing_code_modifier": [""], "providers": [{"billed_charge": 21.937, "npi": [1285662239]}]}, {"allowed_amount": 1.9433, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.5333, "npi": [1285662239]}]}, {"allowed_amount": 5.9333, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.4133, "npi": [1285662239]}]}, {"allowed_amount": 18.0522, "billing_code_modifier": [""], "providers": [{"billed_charge": 32.8221, "npi": [1376571323]}]}, {"allowed_amount": 13.565, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.665, "npi": [1285662239]}]}, {"allowed_amount": 4.826, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.774, "npi": [1285662239]}]}, {"allowed_amount": 6.308, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.47, "npi": [1265460232]}]}, {"allowed_amount": 20.376, "billing_code_modifier": [""], "providers": [{"billed_charge": 37.048, "npi": [1285662239]}]}, {"allowed_amount": 1.97, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.5825, "npi": [1376571323]}, {"billed_charge": 3.5825, "npi": [1285662239]}]}, {"allowed_amount": 5.46, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.92, "npi": [1285662239]}]}, {"allowed_amount": 7.4286, "billing_code_modifier": [""], "providers": [{"billed_charge": 13.5065, "npi": [1285662239]}]}, {"allowed_amount": 24.21, "billing_code_modifier": [""], "providers": [{"billed_charge": 44.015, "npi": [1285662239]}]}, {"allowed_amount": 54.6167, "billing_code_modifier": [""], "providers": [{"billed_charge": 99.3017, "npi": [1285662239]}]}, {"allowed_amount": 2.0333, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.6967, "npi": [1285662239]}]}, {"allowed_amount": 4.816, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.758, "npi": [1174551147]}]}, {"allowed_amount": 5.9867, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.8867, "npi": [1285662239]}]}, {"allowed_amount": 1.4575, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.65, "npi": [1376571323]}]}, {"allowed_amount": 2.7067, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.9217, "npi": [1285662239]}]}, {"allowed_amount": 4.185, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.61, "npi": [1285662239]}]}, {"allowed_amount": 6.7707, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.31, "npi": [1285662239]}]}, {"allowed_amount": 5.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.65, "npi": [1376571323]}]}, {"allowed_amount": 9.3, "billing_code_modifier": [""], "providers": [{"billed_charge": 16.9, "npi": [1174551147]}]}, {"allowed_amount": 14.055, "billing_code_modifier": [""], "providers": [{"billed_charge": 25.5525, "npi": [1285662239]}]}, {"allowed_amount": 61.4311, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.6929, "npi": [1285662239]}]}, {"allowed_amount": 142.8769, "billing_code_modifier": [""], "providers": [{"billed_charge": 259.7763, "npi": [1376571323]}]}, {"allowed_amount": 5.22, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.49, "npi": [1285662239]}]}, {"allowed_amount": 0.73, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.325, "npi": [1174551147]}]}, {"allowed_amount": 4.9391, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.9809, "npi": [1285662239]}]}, {"allowed_amount": 17.65, "billing_code_modifier": [""], "providers": [{"billed_charge": 32.0913, "npi": [1265460232]}]}, {"allowed_amount": 29.5229, "billing_code_modifier": [""], "providers": [{"billed_charge": 53.6786, "npi": [1285662239]}]}, {"allowed_amount": 510.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 927.55, "npi": [1174551147]}]}, {"allowed_amount": 11.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 20.475, "npi": [1285662239]}]}, {"allowed_amount": 4.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.31, "npi": [1376571323]}]}, {"allowed_amount": 42.97, "billing_code_modifier": [""], "providers": [{"billed_charge": 78.12, "npi": [1285662239]}]}, {"allowed_amount": 13.8628, "billing_code_modifier": [""], "providers": [{"billed_charge": 25.2052, "npi": [1265460232]}]}, {"allowed_amount": 10.02, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.22, "npi": [1285662239]}]}, {"allowed_amount": 78.419, "billing_code_modifier": [""], "providers": [{"billed_charge": 142.5797, "npi": [1376571323]}]}, {"allowed_amount": 29.77, "billing_code_modifier": [""], "providers": [{"billed_charge": 54.125, "npi": [1285662239]}]}, {"allowed_amount": 25.825, "billing_code_modifier": [""], "providers": [{"billed_charge": 46.9542, "npi": [1285662239]}]}, {"allowed_amount": 32.99, "billing_code_modifier": [""], "providers": [{"billed_charge": 59.98, "npi": [1285662239]}]}, {"allowed_amount": 5.7675, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.98, "npi": [1285662239]}]}, {"allowed_amount": 7.8821, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.3312, "npi": [1285662239]}]}, {"allowed_amount": 53.7183, "billing_code_modifier": [""], "providers": [{"billed_charge": 97.67, "npi": [1265460232]}]}, {"allowed_amount": 6.7275, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.2325, "npi": [1265460232]}]}, {"allowed_amount": 2.7739, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0433, "npi": [1376571323]}]}, {"allowed_amount": 8.75, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.9, "npi": [1174551147]}]}, {"allowed_amount": 17.734, "billing_code_modifier": [""], "providers": [{"billed_charge": 32.2438, "npi": [1285662239]}]}, {"allowed_amount": 104.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1376571323]}]}, {"allowed_amount": 10.2638, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.8813, "npi": [1285662239]}]}, {"allowed_amount": 9.0052, "billing_code_modifier": [""], "providers": [{"billed_charge": 16.3732, "npi": [1265460232]}]}, {"allowed_amount": 19.8057, "billing_code_modifier": [""], "providers": [{"billed_charge": 36.0107, "npi": [1285662239]}]}, {"allowed_amount": 5.0863, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.2478, "npi": [1376571323]}]}, {"allowed_amount": 6.77, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.31, "npi": [1265460232]}]}, {"allowed_amount": 3.8578, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.0133, "npi": [1265460232]}]}, {"allowed_amount": 17.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 31.762, "npi": [1265460232]}]}, {"allowed_amount": 4.48, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.14, "npi": [1285662239]}]}, {"allowed_amount": 3.908, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.106, "npi": [1376571323]}]}, {"allowed_amount": 19.61, "billing_code_modifier": [""], "providers": [{"billed_charge": 35.65, "npi": [1265460232]}]}, {"allowed_amount": 36.3576, "billing_code_modifier": [""], "providers": [{"billed_charge": 66.105, "npi": [1285662239]}]}, {"allowed_amount": 4.8691, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.8536, "npi": [1174551147]}]}, {"allowed_amount": 3.5133, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.3883, "npi": [1265460232]}]}, {"allowed_amount": 3.5533, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.46, "npi": [1285662239]}]}, {"allowed_amount": 9.5314, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.33, "npi": [1174551147]}]}, {"allowed_amount": 13.685, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.8813, "npi": [1285662239]}]}, {"allowed_amount": 5.9529, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.8243, "npi": [1376571323]}]}, {"allowed_amount": 2.1167, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.8489, "npi": [1285662239]}]}, {"allowed_amount": 5.245, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.535, "npi": [1285662239]}]}, {"allowed_amount": 21.0718, "billing_code_modifier": [""], "providers": [{"billed_charge": 38.3124, "npi": [1285662239]}]}, {"allowed_amount": 7.8953, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.3553, "npi": [1265460232]}]}, {"allowed_amount": 3.7467, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.8133, "npi": [1285662239]}]}, {"allowed_amount": 2.915, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.3, "npi": [1285662239]}, {"billed_charge": 5.3, "npi": [1265460232]}]}, {"allowed_amount": 28.9613, "billing_code_modifier": [""], "providers": [{"billed_charge": 52.6563, "npi": [1285662239]}]}, {"allowed_amount": 16.9, "billing_code_modifier": [""], "providers": [{"billed_charge": 30.725, "npi": [1174551147]}]}, {"allowed_amount": 27.5825, "billing_code_modifier": [""], "providers": [{"billed_charge": 50.15, "npi": [1376571323]}, {"billed_charge": 50.15, "npi": [1285662239]}]}, {"allowed_amount": 3.9588, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.1988, "npi": [1174551147]}]}, {"allowed_amount": 2.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.3, "npi": [1174551147]}, {"billed_charge": 5.3, "npi": [1376571323]}, {"billed_charge": 5.3, "npi": [1285662239]}, {"billed_charge": 5.3, "npi": [1265460232]}]}, {"allowed_amount": 5.7056, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.3744, "npi": [1174551147]}]}, {"allowed_amount": 9.6542, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.5532, "npi": [1376571323]}]}, {"allowed_amount": 4.84, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.8, "npi": [1285662239]}]}, {"allowed_amount": 129.725, "billing_code_modifier": [""], "providers": [{"billed_charge": 235.8625, "npi": [1174551147]}]}, {"allowed_amount": 2.456, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.466, "npi": [1265460232]}]}, {"allowed_amount": 171.0233, "billing_code_modifier": [""], "providers": [{"billed_charge": 310.95, "npi": [1285662239]}]}, {"allowed_amount": 6.0746, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0446, "npi": [1285662239]}]}, {"allowed_amount": 7.52, "billing_code_modifier": [""], "providers": [{"billed_charge": 13.68, "npi": [1285662239]}]}, {"allowed_amount": 4.19, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.8867, "npi": [1285662239]}]}, {"allowed_amount": 3.615, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.575, "npi": [1285662239]}]}, {"allowed_amount": 4.1738, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.5885, "npi": [1285662239]}]}, {"allowed_amount": 3.2933, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.9867, "npi": [1265460232]}]}, {"allowed_amount": 46.652, "billing_code_modifier": [""], "providers": [{"billed_charge": 84.82, "npi": [1376571323]}]}, {"allowed_amount": 44.135, "billing_code_modifier": [""], "providers": [{"billed_charge": 80.245, "npi": [1285662239]}]}, {"allowed_amount": 55.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 100.32, "npi": [1376571323]}]}, {"allowed_amount": 15.5483, "billing_code_modifier": [""], "providers": [{"billed_charge": 28.27, "npi": [1376571323]}]}, {"allowed_amount": 48.3699, "billing_code_modifier": [""], "providers": [{"billed_charge": 87.9453, "npi": [1285662239]}]}, {"allowed_amount": 8.4767, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.4133, "npi": [1285662239]}]}, {"allowed_amount": 74.9614, "billing_code_modifier": [""], "providers": [{"billed_charge": 136.2929, "npi": [1376571323]}]}, {"allowed_amount": 14.1925, "billing_code_modifier": [""], "providers": [{"billed_charge": 25.805, "npi": [1174551147]}]}, {"allowed_amount": 4.7733, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.68, "npi": [1285662239]}]}, {"allowed_amount": 2.265, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.1175, "npi": [1174551147]}]}, {"allowed_amount": 2.485, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.515, "npi": [1376571323]}, {"billed_charge": 4.515, "npi": [1285662239]}]}, {"allowed_amount": 36.5783, "billing_code_modifier": [""], "providers": [{"billed_charge": 66.5067, "npi": [1285662239]}]}, {"allowed_amount": 2.5375, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.6125, "npi": [1285662239]}]}, {"allowed_amount": 34.8415, "billing_code_modifier": [""], "providers": [{"billed_charge": 63.3482, "npi": [1376571323]}]}, {"allowed_amount": 4.3271, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.8671, "npi": [1376571323]}]}, {"allowed_amount": 16.9944, "billing_code_modifier": [""], "providers": [{"billed_charge": 30.8989, "npi": [1285662239]}]}, {"allowed_amount": 5.12, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.31, "npi": [1265460232]}]}, {"allowed_amount": 5.5624, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.1134, "npi": [1376571323]}]}, {"allowed_amount": 7.85, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.272, "npi": [1376571323]}]}, {"allowed_amount": 13.3017, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.1833, "npi": [1285662239]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "992902671"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 146.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1700826807]}]}, {"allowed_amount": 140.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1700826807]}]}, {"allowed_amount": 140.01, "billing_code_modifier": ["FS"], "providers": [{"billed_charge": 250.0, "npi": [1700826807]}]}]}]}, {"name": "CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99292", "description": "CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "823699891"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 113.3033, "billing_code_modifier": [""], "providers": [{"billed_charge": 380.0, "npi": [1952272932]}]}, {"allowed_amount": 113.3, "billing_code_modifier": [""], "providers": [{"billed_charge": 380.0, "npi": [1952272932]}]}, {"allowed_amount": 113.305, "billing_code_modifier": [""], "providers": [{"billed_charge": 380.0, "npi": [1952272932]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "592447554"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 733.2, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1417952748]}]}, {"allowed_amount": 977.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 2444.0, "npi": [1417952748]}]}, {"allowed_amount": 977.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1417952748]}]}, {"allowed_amount": 958.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1417952748]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "650793259"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 92.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1851343578]}]}, {"allowed_amount": 92.36, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 250.0, "npi": [1851343578]}]}]}]}, {"name": "INJECTION ONDANSETRON HCL PER 1 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J2405", "description": "INJECTION ONDANSETRON HCL PER 1 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.3317, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.875, "npi": [1285662239]}]}, {"allowed_amount": 4.3325, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.875, "npi": [1285662239]}]}, {"allowed_amount": 4.3313, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.875, "npi": [1285662239]}]}, {"allowed_amount": 2.1675, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.875, "npi": [1285662239]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.65, "npi": [1578620449]}, {"billed_charge": 20.95, "npi": [1578620449]}]}, {"allowed_amount": 0.7475, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.45, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 53.05, "npi": [1578620449]}, {"billed_charge": 0.187, "npi": [1578620449]}, {"billed_charge": 137.3, "npi": [1578620449]}, {"billed_charge": 1.582, "npi": [1578620449]}, {"billed_charge": 1.9, "npi": [1578620449]}, {"billed_charge": 0.0867, "npi": [1578620449]}, {"billed_charge": 4.025, "npi": [1578620449]}, {"billed_charge": 2.0938, "npi": [1578620449]}, {"billed_charge": 22.6125, "npi": [1578620449]}, {"billed_charge": 0.0625, "npi": [1578620449]}, {"billed_charge": 29.6, "npi": [1578620449]}, {"billed_charge": 16.8, "npi": [1578620449]}, {"billed_charge": 0.19, "npi": [1578620449]}, {"billed_charge": 0.3531, "npi": [1578620449]}, {"billed_charge": 17.9125, "npi": [1578620449]}, {"billed_charge": 87.05, "npi": [1578620449]}, {"billed_charge": 0.3688, "npi": [1578620449]}, {"billed_charge": 0.0563, "npi": [1578620449]}, {"billed_charge": 1.0833, "npi": [1578620449]}, {"billed_charge": 1.675, "npi": [1578620449]}, {"billed_charge": 0.09, "npi": [1578620449]}, {"billed_charge": 19.45, "npi": [1578620449]}, {"billed_charge": 11.9, "npi": [1578620449]}, {"billed_charge": 9.075, "npi": [1578620449]}, {"billed_charge": 18.6, "npi": [1578620449]}, {"billed_charge": 6.975, "npi": [1578620449]}, {"billed_charge": 0.85, "npi": [1578620449]}, {"billed_charge": 1.205, "npi": [1578620449]}, {"billed_charge": 0.0325, "npi": [1578620449]}, {"billed_charge": 0.5625, "npi": [1578620449]}, {"billed_charge": 0.0838, "npi": [1578620449]}, {"billed_charge": 13.55, "npi": [1578620449]}, {"billed_charge": 0.8375, "npi": [1578620449]}, {"billed_charge": 16.05, "npi": [1578620449]}, {"billed_charge": 1.1075, "npi": [1578620449]}, {"billed_charge": 68.675, "npi": [1578620449]}, {"billed_charge": 10.9375, "npi": [1578620449]}, {"billed_charge": 1.674, "npi": [1578620449]}, {"billed_charge": 0.975, "npi": [1578620449]}, {"billed_charge": 16.75, "npi": [1578620449]}, {"billed_charge": 13.95, "npi": [1578620449]}, {"billed_charge": 0.819, "npi": [1578620449]}, {"billed_charge": 3.4375, "npi": [1578620449]}, {"billed_charge": 14.025, "npi": [1578620449]}, {"billed_charge": 1.4375, "npi": [1578620449]}, {"billed_charge": 1.3375, "npi": [1578620449]}, {"billed_charge": 269.95, "npi": [1578620449]}, {"billed_charge": 6.55, "npi": [1578620449]}, {"billed_charge": 0.335, "npi": [1578620449]}, {"billed_charge": 0.28, "npi": [1578620449]}, {"billed_charge": 10.65, "npi": [1578620449]}, {"billed_charge": 15.7, "npi": [1578620449]}, {"billed_charge": 51.15, "npi": [1578620449]}, {"billed_charge": 166.55, "npi": [1578620449]}, {"billed_charge": 1.455, "npi": [1578620449]}, {"billed_charge": 0.265, "npi": [1578620449]}, {"billed_charge": 2.4438, "npi": [1578620449]}, {"billed_charge": 3.85, "npi": [1578620449]}, {"billed_charge": 1.35, "npi": [1578620449]}, {"billed_charge": 1.24, "npi": [1578620449]}, {"billed_charge": 2.1375, "npi": [1578620449]}, {"billed_charge": 9.35, "npi": [1578620449]}, {"billed_charge": 1.825, "npi": [1578620449]}, {"billed_charge": 12.5085, "npi": [1578620449]}, {"billed_charge": 0.0613, "npi": [1578620449]}, {"billed_charge": 0.252, "npi": [1578620449]}, {"billed_charge": 93.925, "npi": [1578620449]}, {"billed_charge": 80.45, "npi": [1578620449]}, {"billed_charge": 46.925, "npi": [1578620449]}, {"billed_charge": 2.775, "npi": [1578620449]}, {"billed_charge": 0.8976, "npi": [1578620449]}, {"billed_charge": 1.3, "npi": [1578620449]}, {"billed_charge": 2.33, "npi": [1578620449]}, {"billed_charge": 2.925, "npi": [1578620449]}, {"billed_charge": 2.28, "npi": [1578620449]}, {"billed_charge": 16.6, "npi": [1578620449]}, {"billed_charge": 0.3516, "npi": [1578620449]}, {"billed_charge": 35.35, "npi": [1578620449]}]}, {"allowed_amount": 0.4724, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 1.698, "npi": [1578620449]}]}, {"allowed_amount": 0.755, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.9, "npi": [1578620449]}, {"billed_charge": 13.925, "npi": [1578620449]}, {"billed_charge": 5.65, "npi": [1578620449]}, {"billed_charge": 15.925, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 2.326, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["JW"], "providers": [{"billed_charge": 53.0167, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["TB"], "providers": [{"billed_charge": 24.2667, "npi": [1578620449]}]}, {"allowed_amount": 0.685, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.9, "npi": [1578620449]}, {"billed_charge": 13.925, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["TBJZ"], "providers": [{"billed_charge": 2.326, "npi": [1578620449]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "651002016"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6625, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 11.663, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 10.851, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 10.851, "npi": [1891840401]}]}, {"allowed_amount": 10.8502, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8502, "npi": [1891840401]}]}, {"allowed_amount": 10.8503, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8503, "npi": [1891840401]}]}, {"allowed_amount": 11.6622, "billing_code_modifier": ["HN"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 10.8506, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8506, "npi": [1891840401]}]}, {"allowed_amount": 11.6632, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 10.8508, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8508, "npi": [1891840401]}]}, {"allowed_amount": 10.85, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.85, "npi": [1891840401]}]}, {"allowed_amount": 10.8514, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 10.8514, "npi": [1891840401]}]}, {"allowed_amount": 10.8505, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8505, "npi": [1891840401]}]}, {"allowed_amount": 10.8504, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.8504, "npi": [1891840401]}]}, {"allowed_amount": 11.6624, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}, {"allowed_amount": 11.6627, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 14.2, "npi": [1891840401]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 83.1585, "npi": [1306938071]}, {"billed_charge": 56.57, "npi": [1306938071]}, {"billed_charge": 105.2638, "npi": [1306938071]}, {"billed_charge": 75.9131, "npi": [1306938071]}, {"billed_charge": 54.8167, "npi": [1306938071]}, {"billed_charge": 50.84, "npi": [1306938071]}, {"billed_charge": 50.795, "npi": [1306938071]}, {"billed_charge": 86.475, "npi": [1306938071]}, {"billed_charge": 125.0123, "npi": [1306938071]}, {"billed_charge": 2.49, "npi": [1306938071]}, {"billed_charge": 65.935, "npi": [1306938071]}, {"billed_charge": 65.492, "npi": [1306938071]}, {"billed_charge": 15.25, "npi": [1306938071]}, {"billed_charge": 354.18, "npi": [1306938071]}, {"billed_charge": 55.0092, "npi": [1306938071]}, {"billed_charge": 80.005, "npi": [1306938071]}, {"billed_charge": 199.535, "npi": [1306938071]}, {"billed_charge": 47.22, "npi": [1306938071]}, {"billed_charge": 139.38, "npi": [1306938071]}, {"billed_charge": 65.0875, "npi": [1306938071]}, {"billed_charge": 133.5, "npi": [1306938071]}, {"billed_charge": 48.1957, "npi": [1306938071]}, {"billed_charge": 94.12, "npi": [1306938071]}, {"billed_charge": 82.355, "npi": [1306938071]}, {"billed_charge": 72.94, "npi": [1306938071]}, {"billed_charge": 70.59, "npi": [1306938071]}, {"billed_charge": 33.0333, "npi": [1306938071]}, {"billed_charge": 11.62, "npi": [1306938071]}, {"billed_charge": 74.1675, "npi": [1306938071]}, {"billed_charge": 64.2074, "npi": [1306938071]}, {"billed_charge": 65.02, "npi": [1306938071]}, {"billed_charge": 72.54, "npi": [1306938071]}, {"billed_charge": 53.92, "npi": [1306938071]}, {"billed_charge": 5.5333, "npi": [1306938071]}, {"billed_charge": 86.51, "npi": [1306938071]}, {"billed_charge": 72.95, "npi": [1306938071]}, {"billed_charge": 16.395, "npi": [1306938071]}, {"billed_charge": 212.68, "npi": [1306938071]}, {"billed_charge": 24.95, "npi": [1306938071]}, {"billed_charge": 6.89, "npi": [1306938071]}, {"billed_charge": 119.2417, "npi": [1306938071]}, {"billed_charge": 37.84, "npi": [1306938071]}, {"billed_charge": 17.41, "npi": [1306938071]}, {"billed_charge": 80.946, "npi": [1306938071]}, {"billed_charge": 81.5733, "npi": [1306938071]}, {"billed_charge": 111.5218, "npi": [1306938071]}, {"billed_charge": 13.668, "npi": [1306938071]}, {"billed_charge": 88.24, "npi": [1306938071]}, {"billed_charge": 82.36, "npi": [1306938071]}, {"billed_charge": 133.17, "npi": [1306938071]}, {"billed_charge": 54.685, "npi": [1306938071]}, {"billed_charge": 44.875, "npi": [1306938071]}, {"billed_charge": 75.3, "npi": [1306938071]}, {"billed_charge": 76.4967, "npi": [1306938071]}, {"billed_charge": 97.53, "npi": [1306938071]}, {"billed_charge": 71.7408, "npi": [1306938071]}, {"billed_charge": 62.4217, "npi": [1306938071]}, {"billed_charge": 66.0538, "npi": [1306938071]}, {"billed_charge": 87.8467, "npi": [1306938071]}, {"billed_charge": 70.3114, "npi": [1306938071]}, {"billed_charge": 9.95, "npi": [1306938071]}, {"billed_charge": 44.862, "npi": [1306938071]}, {"billed_charge": 58.2148, "npi": [1306938071]}, {"billed_charge": 97.354, "npi": [1306938071]}, {"billed_charge": 37.495, "npi": [1306938071]}, {"billed_charge": 31.38, "npi": [1306938071]}, {"billed_charge": 11.58, "npi": [1306938071]}, {"billed_charge": 95.825, "npi": [1306938071]}, {"billed_charge": 56.87, "npi": [1306938071]}, {"billed_charge": 9.442, "npi": [1306938071]}, {"billed_charge": 49.53, "npi": [1306938071]}, {"billed_charge": 84.71, "npi": [1306938071]}, {"billed_charge": 138.5207, "npi": [1306938071]}, {"billed_charge": 62.8133, "npi": [1306938071]}, {"billed_charge": 44.0833, "npi": [1306938071]}, {"billed_charge": 132.7575, "npi": [1306938071]}, {"billed_charge": 36.4433, "npi": [1306938071]}, {"billed_charge": 5.5129, "npi": [1306938071]}, {"billed_charge": 165.3167, "npi": [1306938071]}, {"billed_charge": 178.584, "npi": [1306938071]}, {"billed_charge": 65.98, "npi": [1306938071]}, {"billed_charge": 12.45, "npi": [1306938071]}, {"billed_charge": 75.345, "npi": [1306938071]}, {"billed_charge": 162.55, "npi": [1306938071]}, {"billed_charge": 110.0511, "npi": [1306938071]}, {"billed_charge": 51.91, "npi": [1306938071]}, {"billed_charge": 33.2, "npi": [1306938071]}, {"billed_charge": 26.3803, "npi": [1306938071]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "590872594"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1982688230]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1982688230]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "453710878"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 92.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 150.0, "npi": [1689630527]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "823180067"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 12.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.26, "npi": [1932725322]}]}, {"allowed_amount": 0.0013, "billing_code_modifier": ["XP"], "providers": [{"billed_charge": 0.0013, "npi": [1932725322]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "394362698"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 92.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 130.0, "npi": [1447887773]}, {"billed_charge": 120.0, "npi": [1447887773]}]}]}]}, {"name": "ASSAY OF LIPASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83690", "description": "ASSAY OF LIPASE", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 55.27, "billing_code_modifier": [""], "providers": [{"billed_charge": 141.0, "npi": [1417279936]}]}, {"allowed_amount": 56.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 141.0, "npi": [1417279936]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 441.0, "npi": [1306938071]}, {"billed_charge": 308.9697, "npi": [1306938071]}, {"billed_charge": 463.6667, "npi": [1306938071]}, {"billed_charge": 117.0, "npi": [1306938071]}, {"billed_charge": 135.0, "npi": [1306938071]}, {"billed_charge": 279.1923, "npi": [1306938071]}, {"billed_charge": 122.0, "npi": [1306938071]}, {"billed_charge": 349.6552, "npi": [1306938071]}, {"billed_charge": 576.6, "npi": [1306938071]}, {"billed_charge": 191.92, "npi": [1306938071]}, {"billed_charge": 333.0, "npi": [1306938071]}, {"billed_charge": 127.0, "npi": [1306938071]}, {"billed_charge": 554.0, "npi": [1306938071]}, {"billed_charge": 326.0, "npi": [1306938071]}, {"billed_charge": 461.75, "npi": [1306938071]}, {"billed_charge": 375.75, "npi": [1306938071]}, {"billed_charge": 361.0, "npi": [1306938071]}, {"billed_charge": 1001.0, "npi": [1306938071]}, {"billed_charge": 349.0, "npi": [1306938071]}, {"billed_charge": 419.0, "npi": [1306938071]}, {"billed_charge": 394.0, "npi": [1306938071]}, {"billed_charge": 157.0, "npi": [1306938071]}, {"billed_charge": 183.6, "npi": [1306938071]}, {"billed_charge": 304.0, "npi": [1306938071]}, {"billed_charge": 513.6364, "npi": [1306938071]}, {"billed_charge": 116.0, "npi": [1306938071]}, {"billed_charge": 546.7333, "npi": [1306938071]}, {"billed_charge": 302.0, "npi": [1306938071]}, {"billed_charge": 129.0, "npi": [1306938071]}, {"billed_charge": 198.2821, "npi": [1306938071]}, {"billed_charge": 475.0, "npi": [1306938071]}, {"billed_charge": 283.0, "npi": [1306938071]}, {"billed_charge": 321.6429, "npi": [1306938071]}, {"billed_charge": 691.0, "npi": [1306938071]}, {"billed_charge": 181.6818, "npi": [1306938071]}, {"billed_charge": 133.0, "npi": [1306938071]}, {"billed_charge": 282.7778, "npi": [1306938071]}, {"billed_charge": 161.76, "npi": [1306938071]}, {"billed_charge": 136.0, "npi": [1306938071]}, {"billed_charge": 548.0, "npi": [1306938071]}, {"billed_charge": 756.0, "npi": [1306938071]}, {"billed_charge": 258.0488, "npi": [1306938071]}, {"billed_charge": 585.0, "npi": [1306938071]}, {"billed_charge": 848.0, "npi": [1306938071]}, {"billed_charge": 318.3107, "npi": [1306938071]}, {"billed_charge": 174.1905, "npi": [1306938071]}, {"billed_charge": 592.0, "npi": [1306938071]}, {"billed_charge": 329.2416, "npi": [1306938071]}, {"billed_charge": 458.0, "npi": [1306938071]}, {"billed_charge": 388.0, "npi": [1306938071]}, {"billed_charge": 297.0, "npi": [1306938071]}, {"billed_charge": 315.9333, "npi": [1306938071]}, {"billed_charge": 418.1111, "npi": [1306938071]}, {"billed_charge": 441.2, "npi": [1306938071]}, {"billed_charge": 490.0, "npi": [1306938071]}, {"billed_charge": 531.0, "npi": [1306938071]}, {"billed_charge": 123.0, "npi": [1306938071]}, {"billed_charge": 523.0, "npi": [1306938071]}, {"billed_charge": 612.0, "npi": [1306938071]}, {"billed_charge": 277.3095, "npi": [1306938071]}, {"billed_charge": 180.7593, "npi": [1306938071]}, {"billed_charge": 291.0, "npi": [1306938071]}, {"billed_charge": 296.1818, "npi": [1306938071]}, {"billed_charge": 614.0, "npi": [1306938071]}, {"billed_charge": 386.0, "npi": [1306938071]}, {"billed_charge": 138.0, "npi": [1306938071]}, {"billed_charge": 353.0, "npi": [1306938071]}, {"billed_charge": 621.0, "npi": [1306938071]}, {"billed_charge": 535.0, "npi": [1306938071]}, {"billed_charge": 289.2958, "npi": [1306938071]}, {"billed_charge": 170.3333, "npi": [1306938071]}, {"billed_charge": 461.0, "npi": [1306938071]}, {"billed_charge": 419.6842, "npi": [1306938071]}, {"billed_charge": 565.0, "npi": [1306938071]}, {"billed_charge": 448.0, "npi": [1306938071]}, {"billed_charge": 444.0, "npi": [1306938071]}, {"billed_charge": 180.913, "npi": [1306938071]}, {"billed_charge": 355.0, "npi": [1306938071]}, {"billed_charge": 426.0, "npi": [1306938071]}, {"billed_charge": 427.0857, "npi": [1306938071]}, {"billed_charge": 483.0, "npi": [1306938071]}, {"billed_charge": 642.0, "npi": [1306938071]}, {"billed_charge": 431.4118, "npi": [1306938071]}, {"billed_charge": 256.7059, "npi": [1306938071]}, {"billed_charge": 623.25, "npi": [1306938071]}, {"billed_charge": 463.0, "npi": [1306938071]}, {"billed_charge": 507.0, "npi": [1306938071]}, {"billed_charge": 1420.0, "npi": [1306938071]}, {"billed_charge": 231.0545, "npi": [1306938071]}, {"billed_charge": 271.0, "npi": [1306938071]}, {"billed_charge": 131.0, "npi": [1306938071]}, {"billed_charge": 372.1005, "npi": [1306938071]}, {"billed_charge": 306.6535, "npi": [1306938071]}, {"billed_charge": 1402.0, "npi": [1306938071]}, {"billed_charge": 618.25, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 135.0, "npi": [1306938071]}, {"billed_charge": 127.0, "npi": [1306938071]}, {"billed_charge": 756.0, "npi": [1306938071]}, {"billed_charge": 483.0, "npi": [1306938071]}]}, {"allowed_amount": 8.8433, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 89.0, "npi": [1306938071]}]}, {"allowed_amount": 8.84, "billing_code_modifier": [""], "providers": [{"billed_charge": 135.0, "npi": [1306938071]}, {"billed_charge": 89.0, "npi": [1306938071]}]}, {"allowed_amount": 8.845, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 89.0, "npi": [1306938071]}]}, {"allowed_amount": 8.8425, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 89.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 441.0, "npi": [1306938071]}, {"billed_charge": 135.0, "npi": [1306938071]}, {"billed_charge": 554.0, "npi": [1306938071]}, {"billed_charge": 369.0, "npi": [1306938071]}, {"billed_charge": 136.0, "npi": [1306938071]}, {"billed_charge": 756.0, "npi": [1306938071]}, {"billed_charge": 386.0, "npi": [1306938071]}, {"billed_charge": 621.0, "npi": [1306938071]}, {"billed_charge": 461.0, "npi": [1306938071]}, {"billed_charge": 1420.0, "npi": [1306938071]}]}, {"allowed_amount": 8.842, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 89.0, "npi": [1306938071]}]}, {"allowed_amount": 30.13, "billing_code_modifier": [""], "providers": [{"billed_charge": 553.0, "npi": [1306938071]}]}, {"allowed_amount": 8.84, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 89.0, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417279936]}]}, {"allowed_amount": 6.9333, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.3333, "npi": [1417279936]}]}, {"allowed_amount": 31.75, "billing_code_modifier": [""], "providers": [{"billed_charge": 81.0, "npi": [1417279936]}]}, {"allowed_amount": 1.1767, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417279936]}]}, {"allowed_amount": 15.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 38.0, "npi": [1417279936]}]}, {"allowed_amount": 7.3489, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.7472, "npi": [1417279936]}]}, {"allowed_amount": 1.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1417279936]}]}, {"allowed_amount": 6.665, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.0, "npi": [1417279936]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417279936]}]}, {"allowed_amount": 18.82, "billing_code_modifier": [""], "providers": [{"billed_charge": 48.0, "npi": [1417279936]}]}, {"allowed_amount": 20.6584, "billing_code_modifier": [""], "providers": [{"billed_charge": 52.7, "npi": [1417279936]}]}, {"allowed_amount": 4.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.0, "npi": [1417279936]}]}, {"allowed_amount": 6.7039, "billing_code_modifier": [""], "providers": [{"billed_charge": 16.7598, "npi": [1417279936]}]}, {"allowed_amount": 1.96, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1417279936]}]}, {"allowed_amount": 5.4673, "billing_code_modifier": [""], "providers": [{"billed_charge": 13.6682, "npi": [1417279936]}]}, {"allowed_amount": 71.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 183.0, "npi": [1417279936]}]}, {"allowed_amount": 2.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1417279936]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1417279936]}]}, {"allowed_amount": 3.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.0, "npi": [1417279936]}]}, {"allowed_amount": 7.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.0, "npi": [1417279936]}]}, {"allowed_amount": 11.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 28.0, "npi": [1417279936]}]}, {"allowed_amount": 1.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1417279936]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "590872594"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1982688230]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1982688230]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1417279936]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1417279936]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000375"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 15.0, "npi": [1821109612]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 1.1767, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 5.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.0, "npi": [1528042884]}]}, {"allowed_amount": 74.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 185.0, "npi": [1528042884]}]}, {"allowed_amount": 210.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 526.0, "npi": [1528042884]}]}, {"allowed_amount": 15.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 38.0, "npi": [1528042884]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.0409, "npi": [1528042884]}]}, {"allowed_amount": 2.5954, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.4885, "npi": [1528042884]}]}, {"allowed_amount": 2.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.0, "npi": [1528042884]}]}, {"allowed_amount": 0.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.0, "npi": [1528042884]}]}, {"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1528042884]}]}, {"allowed_amount": 1.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1528042884]}]}, {"allowed_amount": 1.9636, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.9089, "npi": [1528042884]}]}, {"allowed_amount": 100.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1528042884]}]}, {"allowed_amount": 9.6229, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.0571, "npi": [1528042884]}]}, {"allowed_amount": 0.945, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 21.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 53.0, "npi": [1528042884]}]}, {"allowed_amount": 1.254, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.2, "npi": [1528042884]}]}, {"allowed_amount": 3.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 9.0, "npi": [1528042884]}]}, {"allowed_amount": 40.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 101.0, "npi": [1528042884]}]}, {"allowed_amount": 2.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.0, "npi": [1528042884]}]}, {"allowed_amount": 0.9467, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 10.4571, "billing_code_modifier": [""], "providers": [{"billed_charge": 26.1429, "npi": [1528042884]}]}, {"allowed_amount": 2.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1528042884]}]}, {"allowed_amount": 0.32, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.0, "npi": [1528042884]}]}, {"allowed_amount": 1.568, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1528042884]}]}, {"allowed_amount": 20.48, "billing_code_modifier": [""], "providers": [{"billed_charge": 65.0, "npi": [1528042884]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 0.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.0, "npi": [1528042884]}]}, {"allowed_amount": 0.95, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1528042884]}]}, {"allowed_amount": 31.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 78.0, "npi": [1528042884]}]}, {"allowed_amount": 7.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.0, "npi": [1528042884]}]}, {"allowed_amount": 2.8686, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.3179, "npi": [1528042884]}]}, {"allowed_amount": 98.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1528042884]}]}, {"allowed_amount": 1.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1528042884]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "650130324"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 96.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 114.15, "npi": [1033151113]}]}]}]}, {"name": "CT Scan - Body Scan", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0352", "description": "CT Scan", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1004.45, "billing_code_modifier": [""], "providers": [{"billed_charge": 9950.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 21087.0, "npi": [1306938071]}, {"billed_charge": 13704.0, "npi": [1306938071]}, {"billed_charge": 10687.0, "npi": [1306938071]}, {"billed_charge": 13371.3333, "npi": [1306938071]}, {"billed_charge": 12603.5, "npi": [1306938071]}, {"billed_charge": 18084.5, "npi": [1306938071]}, {"billed_charge": 5580.0, "npi": [1306938071]}, {"billed_charge": 10424.0, "npi": [1306938071]}, {"billed_charge": 15767.0, "npi": [1306938071]}, {"billed_charge": 16624.3333, "npi": [1306938071]}, {"billed_charge": 7686.4, "npi": [1306938071]}, {"billed_charge": 8358.0, "npi": [1306938071]}, {"billed_charge": 15082.0, "npi": [1306938071]}, {"billed_charge": 9950.0, "npi": [1306938071]}, {"billed_charge": 14393.0, "npi": [1306938071]}, {"billed_charge": 6908.0, "npi": [1306938071]}, {"billed_charge": 4006.0, "npi": [1306938071]}, {"billed_charge": 12065.6667, "npi": [1306938071]}, {"billed_charge": 14657.0, "npi": [1306938071]}, {"billed_charge": 6898.0, "npi": [1306938071]}, {"billed_charge": 6286.0, "npi": [1306938071]}, {"billed_charge": 10770.0, "npi": [1306938071]}, {"billed_charge": 6292.0, "npi": [1306938071]}]}, {"allowed_amount": 410.11, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 10560.0, "npi": [1306938071]}]}, {"allowed_amount": 815.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 15082.0, "npi": [1306938071]}, {"billed_charge": 14657.0, "npi": [1306938071]}]}, {"allowed_amount": 815.69, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 5428.0, "npi": [1306938071]}]}, {"allowed_amount": 982.71, "billing_code_modifier": [""], "providers": [{"billed_charge": 9950.0, "npi": [1306938071]}]}, {"allowed_amount": 1004.45, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 13704.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 4006.0, "npi": [1306938071]}]}, {"allowed_amount": 557.89, "billing_code_modifier": [""], "providers": [{"billed_charge": 10424.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 6908.0, "npi": [1306938071]}, {"billed_charge": 6898.0, "npi": [1306938071]}, {"billed_charge": 6292.0, "npi": [1306938071]}]}, {"allowed_amount": 806.58, "billing_code_modifier": [""], "providers": [{"billed_charge": 15082.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 5580.0, "npi": [1306938071]}, {"billed_charge": 4006.0, "npi": [1306938071]}]}, {"allowed_amount": 410.11, "billing_code_modifier": [""], "providers": [{"billed_charge": 13704.0, "npi": [1306938071]}, {"billed_charge": 9950.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 4006.0, "npi": [1306938071]}]}, {"allowed_amount": 806.58, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 5428.0, "npi": [1306938071]}]}, {"allowed_amount": 517.37, "billing_code_modifier": [""], "providers": [{"billed_charge": 6898.0, "npi": [1306938071]}]}, {"allowed_amount": 507.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 6898.0, "npi": [1306938071]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "043775926"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1952351983]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1952351983]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1578547865]}]}, {"allowed_amount": 4.06, "billing_code_modifier": [""], "providers": [{"billed_charge": 10.15, "npi": [1578547865]}]}, {"allowed_amount": 1.1767, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1578547865]}]}, {"allowed_amount": 74.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 185.0, "npi": [1578547865]}]}, {"allowed_amount": 6.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 17.0, "npi": [1578547865]}]}, {"allowed_amount": 14.9, "billing_code_modifier": [""], "providers": [{"billed_charge": 38.0, "npi": [1578547865]}]}, {"allowed_amount": 15.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 38.0, "npi": [1578547865]}]}, {"allowed_amount": 22.2431, "billing_code_modifier": [""], "providers": [{"billed_charge": 55.6078, "npi": [1578547865]}]}, {"allowed_amount": 2.8481, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.1203, "npi": [1578547865]}]}, {"allowed_amount": 5.488, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.0, "npi": [1578547865]}]}, {"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1578547865]}]}, {"allowed_amount": 1.5667, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1578547865]}]}, {"allowed_amount": 32.7206, "billing_code_modifier": [""], "providers": [{"billed_charge": 83.4706, "npi": [1578547865]}]}, {"allowed_amount": 10.53, "billing_code_modifier": [""], "providers": [{"billed_charge": 26.325, "npi": [1578547865]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1578547865]}]}, {"allowed_amount": 18.82, "billing_code_modifier": [""], "providers": [{"billed_charge": 48.0, "npi": [1578547865]}]}, {"allowed_amount": 5.9568, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.892, "npi": [1578547865]}]}, {"allowed_amount": 0.8501, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.1686, "npi": [1578547865]}]}, {"allowed_amount": 1.8639, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.7548, "npi": [1578547865]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1578547865]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1578547865]}]}, {"allowed_amount": 7.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 18.0, "npi": [1578547865]}]}, {"allowed_amount": 72.52, "billing_code_modifier": [""], "providers": [{"billed_charge": 185.0, "npi": [1578547865]}]}, {"allowed_amount": 1.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.5, "npi": [1578547865]}]}, {"allowed_amount": 1.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1578547865]}]}, {"allowed_amount": 52.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 130.0, "npi": [1578547865]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "824372339"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 57.845, "npi": [1740772268]}, {"billed_charge": 25.91, "npi": [1740772268]}, {"billed_charge": 12.905, "npi": [1740772268]}, {"billed_charge": 94.28, "npi": [1740772268]}, {"billed_charge": 29.7925, "npi": [1740772268]}, {"billed_charge": 35.36, "npi": [1740772268]}, {"billed_charge": 43.9489, "npi": [1740772268]}, {"billed_charge": 49.43, "npi": [1740772268]}, {"billed_charge": 193.77, "npi": [1740772268]}, {"billed_charge": 370.56, "npi": [1740772268]}, {"billed_charge": 0.6942, "npi": [1740772268]}, {"billed_charge": 178.57, "npi": [1740772268]}, {"billed_charge": 2.1498, "npi": [1740772268]}, {"billed_charge": 54.885, "npi": [1740772268]}, {"billed_charge": 232.08, "npi": [1740772268]}, {"billed_charge": 128.67, "npi": [1740772268]}, {"billed_charge": 28.017, "npi": [1740772268]}, {"billed_charge": 54.8825, "npi": [1740772268]}, {"billed_charge": 12.9025, "npi": [1740772268]}, {"billed_charge": 351.63, "npi": [1740772268]}, {"billed_charge": 128.94, "npi": [1740772268]}, {"billed_charge": 68.67, "npi": [1740772268]}, {"billed_charge": 18.996, "npi": [1740772268]}]}, {"allowed_amount": 0.4832, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.2924, "npi": [1740772268]}]}, {"allowed_amount": 0.76, "billing_code_modifier": [""], "providers": [{"billed_charge": 151.61, "npi": [1740772268]}, {"billed_charge": 56.94, "npi": [1740772268]}]}]}]}, {"name": "INJECTION ONDANSETRON HCL PER 1 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J2405", "description": "INJECTION ONDANSETRON HCL PER 1 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.7838, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.0, "npi": [1528042884]}]}, {"allowed_amount": 0.63, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.0, "npi": [1528042884]}]}, {"allowed_amount": 1.96, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1528042884]}]}, {"allowed_amount": 2.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1528042884]}]}]}]}, {"name": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J7030", "description": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 130.14, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1578547865]}]}, {"allowed_amount": 132.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1578547865]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99285", "description": "EMERGENCY DEPARTMENT VISIT HIGH MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1666.07, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3029.21, "npi": [1285662239]}]}, {"allowed_amount": 1666.07, "billing_code_modifier": [""], "providers": [{"billed_charge": 3029.21, "npi": [1285662239]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000534"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 695.61, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 1000.0, "npi": [1437262565]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 850.0, "npi": [1437262565]}, {"billed_charge": 750.0, "npi": [1437262565]}, {"billed_charge": 805.0, "npi": [1437262565]}, {"billed_charge": 1489.81, "npi": [1437262565]}, {"billed_charge": 1000.0, "npi": [1437262565]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 1035.0, "npi": [1437262565]}, {"billed_charge": 850.0, "npi": [1437262565]}, {"billed_charge": 1489.81, "npi": [1437262565]}, {"billed_charge": 1000.0, "npi": [1437262565]}, {"billed_charge": 780.0, "npi": [1437262565]}]}]}]}, {"name": "Radiology - Diagnostic - Chest X-Ray", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0324", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 820.0, "npi": [1306938071]}]}, {"allowed_amount": 203.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 820.0, "npi": [1306938071]}]}, {"allowed_amount": 198.86, "billing_code_modifier": [""], "providers": [{"billed_charge": 820.0, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - IV Solutions", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0258", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 178.8235, "npi": [1285662239]}, {"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 73.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 78.375, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 104.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 97.5333, "billing_code_modifier": [""], "providers": [{"billed_charge": 177.3333, "npi": [1285662239]}]}, {"allowed_amount": 104.2325, "billing_code_modifier": [""], "providers": [{"billed_charge": 189.514, "npi": [1285662239]}]}, {"allowed_amount": 84.0543, "billing_code_modifier": [""], "providers": [{"billed_charge": 152.8261, "npi": [1285662239]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "922847892"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 248.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 186.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 247.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}]}]}, {"name": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [{"tin": {"type": "ein", "value": "591226176"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 10.54, "billing_code_modifier": ["2676"], "providers": [{"billed_charge": 202.0, "npi": [1972550416]}]}, {"allowed_amount": 10.54, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 202.0, "npi": [1972550416]}]}, {"allowed_amount": 10.54, "billing_code_modifier": ["2677"], "providers": [{"billed_charge": 202.0, "npi": [1972550416]}]}]}]}, {"name": "Pharmacy - Other Pharmacy", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0259", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 26.84, "npi": [1306938071]}, {"billed_charge": 15.1111, "npi": [1306938071]}, {"billed_charge": 22.455, "npi": [1306938071]}, {"billed_charge": 6.14, "npi": [1306938071]}, {"billed_charge": 29.37, "npi": [1306938071]}, {"billed_charge": 16.15, "npi": [1306938071]}, {"billed_charge": 42.82, "npi": [1306938071]}, {"billed_charge": 14.4275, "npi": [1306938071]}, {"billed_charge": 2.49, "npi": [1306938071]}, {"billed_charge": 187.32, "npi": [1306938071]}, {"billed_charge": 28.79, "npi": [1306938071]}, {"billed_charge": 10.1433, "npi": [1306938071]}, {"billed_charge": 7.876, "npi": [1306938071]}, {"billed_charge": 15.25, "npi": [1306938071]}, {"billed_charge": 264.8856, "npi": [1306938071]}, {"billed_charge": 16.294, "npi": [1306938071]}, {"billed_charge": 8.3, "npi": [1306938071]}, {"billed_charge": 30.8521, "npi": [1306938071]}, {"billed_charge": 39.8271, "npi": [1306938071]}, {"billed_charge": 30.4863, "npi": [1306938071]}, {"billed_charge": 29.0817, "npi": [1306938071]}, {"billed_charge": 44.1653, "npi": [1306938071]}, {"billed_charge": 17.99, "npi": [1306938071]}, {"billed_charge": 25.9033, "npi": [1306938071]}, {"billed_charge": 27.4183, "npi": [1306938071]}, {"billed_charge": 12.77, "npi": [1306938071]}, {"billed_charge": 21.6175, "npi": [1306938071]}, {"billed_charge": 14.194, "npi": [1306938071]}, {"billed_charge": 16.2071, "npi": [1306938071]}, {"billed_charge": 133.5, "npi": [1306938071]}, {"billed_charge": 7.2567, "npi": [1306938071]}, {"billed_charge": 6.325, "npi": [1306938071]}, {"billed_charge": 14.81, "npi": [1306938071]}, {"billed_charge": 80.476, "npi": [1306938071]}, {"billed_charge": 23.0433, "npi": [1306938071]}, {"billed_charge": 13.13, "npi": [1306938071]}, {"billed_charge": 8.145, "npi": [1306938071]}, {"billed_charge": 4.01, "npi": [1306938071]}, {"billed_charge": 11.62, "npi": [1306938071]}, {"billed_charge": 15.325, "npi": [1306938071]}, {"billed_charge": 122.955, "npi": [1306938071]}, {"billed_charge": 15.46, "npi": [1306938071]}, {"billed_charge": 5.805, "npi": [1306938071]}, {"billed_charge": 11.61, "npi": [1306938071]}, {"billed_charge": 5.165, "npi": [1306938071]}, {"billed_charge": 11.8954, "npi": [1306938071]}, {"billed_charge": 8.765, "npi": [1306938071]}, {"billed_charge": 2.74, "npi": [1306938071]}, {"billed_charge": 10.091, "npi": [1306938071]}, {"billed_charge": 24.815, "npi": [1306938071]}, {"billed_charge": 25.8523, "npi": [1306938071]}, {"billed_charge": 13.69, "npi": [1306938071]}, {"billed_charge": 30.5464, "npi": [1306938071]}, {"billed_charge": 8.675, "npi": [1306938071]}, {"billed_charge": 50.644, "npi": [1306938071]}, {"billed_charge": 18.28, "npi": [1306938071]}, {"billed_charge": 22.31, "npi": [1306938071]}, {"billed_charge": 5.458, "npi": [1306938071]}, {"billed_charge": 14.53, "npi": [1306938071]}, {"billed_charge": 66.355, "npi": [1306938071]}, {"billed_charge": 22.05, "npi": [1306938071]}, {"billed_charge": 22.9443, "npi": [1306938071]}, {"billed_charge": 2.35, "npi": [1306938071]}, {"billed_charge": 22.7, "npi": [1306938071]}, {"billed_charge": 24.95, "npi": [1306938071]}, {"billed_charge": 11.762, "npi": [1306938071]}, {"billed_charge": 6.89, "npi": [1306938071]}, {"billed_charge": 16.54, "npi": [1306938071]}, {"billed_charge": 13.925, "npi": [1306938071]}, {"billed_charge": 12.8241, "npi": [1306938071]}, {"billed_charge": 8.2858, "npi": [1306938071]}, {"billed_charge": 25.055, "npi": [1306938071]}, {"billed_charge": 8.9, "npi": [1306938071]}, {"billed_charge": 24.97, "npi": [1306938071]}, {"billed_charge": 17.41, "npi": [1306938071]}, {"billed_charge": 9.9809, "npi": [1306938071]}, {"billed_charge": 15.7361, "npi": [1306938071]}, {"billed_charge": 62.8157, "npi": [1306938071]}, {"billed_charge": 20.902, "npi": [1306938071]}, {"billed_charge": 89.895, "npi": [1306938071]}, {"billed_charge": 34.3659, "npi": [1306938071]}, {"billed_charge": 4.6343, "npi": [1306938071]}, {"billed_charge": 16.1167, "npi": [1306938071]}, {"billed_charge": 22.25, "npi": [1306938071]}, {"billed_charge": 13.668, "npi": [1306938071]}, {"billed_charge": 10.062, "npi": [1306938071]}, {"billed_charge": 33.8031, "npi": [1306938071]}, {"billed_charge": 17.12, "npi": [1306938071]}, {"billed_charge": 13.82, "npi": [1306938071]}, {"billed_charge": 25.2306, "npi": [1306938071]}, {"billed_charge": 15.77, "npi": [1306938071]}, {"billed_charge": 15.4398, "npi": [1306938071]}, {"billed_charge": 9.1908, "npi": [1306938071]}, {"billed_charge": 22.9385, "npi": [1306938071]}, {"billed_charge": 150.3764, "npi": [1306938071]}, {"billed_charge": 14.7883, "npi": [1306938071]}, {"billed_charge": 10.935, "npi": [1306938071]}, {"billed_charge": 30.6282, "npi": [1306938071]}, {"billed_charge": 3.93, "npi": [1306938071]}, {"billed_charge": 17.2857, "npi": [1306938071]}, {"billed_charge": 7.37, "npi": [1306938071]}, {"billed_charge": 41.911, "npi": [1306938071]}, {"billed_charge": 75.455, "npi": [1306938071]}, {"billed_charge": 5.1075, "npi": [1306938071]}, {"billed_charge": 18.57, "npi": [1306938071]}, {"billed_charge": 22.5167, "npi": [1306938071]}, {"billed_charge": 16.1925, "npi": [1306938071]}, {"billed_charge": 13.98, "npi": [1306938071]}, {"billed_charge": 18.2734, "npi": [1306938071]}, {"billed_charge": 7.64, "npi": [1306938071]}, {"billed_charge": 43.0364, "npi": [1306938071]}, {"billed_charge": 8.15, "npi": [1306938071]}, {"billed_charge": 28.5647, "npi": [1306938071]}, {"billed_charge": 37.7033, "npi": [1306938071]}, {"billed_charge": 157.625, "npi": [1306938071]}, {"billed_charge": 9.09, "npi": [1306938071]}, {"billed_charge": 7.3, "npi": [1306938071]}, {"billed_charge": 15.97, "npi": [1306938071]}, {"billed_charge": 9.8767, "npi": [1306938071]}, {"billed_charge": 9.95, "npi": [1306938071]}, {"billed_charge": 10.7847, "npi": [1306938071]}, {"billed_charge": 3.52, "npi": [1306938071]}, {"billed_charge": 42.0035, "npi": [1306938071]}, {"billed_charge": 44.2833, "npi": [1306938071]}, {"billed_charge": 11.18, "npi": [1306938071]}, {"billed_charge": 94.11, "npi": [1306938071]}, {"billed_charge": 114.825, "npi": [1306938071]}, {"billed_charge": 9.96, "npi": [1306938071]}, {"billed_charge": 58.59, "npi": [1306938071]}, {"billed_charge": 7.2529, "npi": [1306938071]}, {"billed_charge": 8.0733, "npi": [1306938071]}, {"billed_charge": 19.74, "npi": [1306938071]}, {"billed_charge": 61.135, "npi": [1306938071]}, {"billed_charge": 11.0033, "npi": [1306938071]}, {"billed_charge": 161.4889, "npi": [1306938071]}, {"billed_charge": 251.08, "npi": [1306938071]}, {"billed_charge": 14.08, "npi": [1306938071]}, {"billed_charge": 11.9129, "npi": [1306938071]}, {"billed_charge": 12.05, "npi": [1306938071]}, {"billed_charge": 49.7033, "npi": [1306938071]}, {"billed_charge": 3.3, "npi": [1306938071]}, {"billed_charge": 16.53, "npi": [1306938071]}, {"billed_charge": 8.2543, "npi": [1306938071]}, {"billed_charge": 10.0633, "npi": [1306938071]}, {"billed_charge": 20.5786, "npi": [1306938071]}, {"billed_charge": 13.3525, "npi": [1306938071]}, {"billed_charge": 9.2453, "npi": [1306938071]}, {"billed_charge": 17.89, "npi": [1306938071]}, {"billed_charge": 15.465, "npi": [1306938071]}, {"billed_charge": 10.79, "npi": [1306938071]}, {"billed_charge": 16.47, "npi": [1306938071]}, {"billed_charge": 12.389, "npi": [1306938071]}, {"billed_charge": 14.0678, "npi": [1306938071]}, {"billed_charge": 12.0267, "npi": [1306938071]}, {"billed_charge": 237.4633, "npi": [1306938071]}, {"billed_charge": 39.339, "npi": [1306938071]}, {"billed_charge": 126.51, "npi": [1306938071]}, {"billed_charge": 13.4888, "npi": [1306938071]}, {"billed_charge": 5.2567, "npi": [1306938071]}, {"billed_charge": 34.885, "npi": [1306938071]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT LOW MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT LOW MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1335.825, "billing_code_modifier": ["27"], "providers": [{"billed_charge": 2428.77, "npi": [1285662239]}]}, {"allowed_amount": 1335.82, "billing_code_modifier": [""], "providers": [{"billed_charge": 2428.77, "npi": [1285662239]}]}, {"allowed_amount": 1335.82, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2428.77, "npi": [1285662239]}]}, {"allowed_amount": 1335.82, "billing_code_modifier": ["27"], "providers": [{"billed_charge": 2428.77, "npi": [1285662239]}]}, {"allowed_amount": 1335.82, "billing_code_modifier": ["2527"], "providers": [{"billed_charge": 2428.77, "npi": [1285662239]}]}]}]}, {"name": "CT Scan - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0350", "description": "CT Scan", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1004.45, "billing_code_modifier": [""], "providers": [{"billed_charge": 3199.0, "npi": [1578620449]}, {"billed_charge": 6806.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 3762.0, "npi": [1578620449]}, {"billed_charge": 3385.5, "npi": [1578620449]}, {"billed_charge": 3199.0, "npi": [1578620449]}, {"billed_charge": 1818.0, "npi": [1578620449]}, {"billed_charge": 2052.0, "npi": [1578620449]}, {"billed_charge": 2009.0, "npi": [1578620449]}, {"billed_charge": 6806.0, "npi": [1578620449]}, {"billed_charge": 4325.0, "npi": [1578620449]}]}, {"allowed_amount": 815.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 6806.0, "npi": [1578620449]}, {"billed_charge": 4325.0, "npi": [1578620449]}]}, {"allowed_amount": 557.89, "billing_code_modifier": [""], "providers": [{"billed_charge": 3094.0, "npi": [1578620449]}]}, {"allowed_amount": 244.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 1908.0, "npi": [1578620449]}]}, {"allowed_amount": 240.17, "billing_code_modifier": [""], "providers": [{"billed_charge": 2052.0, "npi": [1578620449]}]}, {"allowed_amount": 410.11, "billing_code_modifier": [""], "providers": [{"billed_charge": 3199.0, "npi": [1578620449]}, {"billed_charge": 2589.0, "npi": [1578620449]}]}, {"allowed_amount": 517.37, "billing_code_modifier": [""], "providers": [{"billed_charge": 1895.0, "npi": [1578620449]}]}]}]}, {"name": "Behavioral Health Accommodations - Residential -Chemical Dep", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "1002", "description": "Behavioral Health Accommodations", "allowed_amounts": [{"tin": {"type": "ein", "value": "273164934"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 650.0, "npi": [1053728790]}]}]}]}, {"name": "Ambulance - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0540", "description": "Ambulance", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 632.95, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 2532.0, "npi": [1306938071]}]}, {"allowed_amount": 20.9922, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 759.53, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 2910.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 2910.0, "npi": [1306938071]}, {"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 1202.6, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 3384.0, "npi": [1306938071]}]}, {"allowed_amount": 20.9927, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 1202.6, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 3384.0, "npi": [1306938071]}]}, {"allowed_amount": 20.9925, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 20.9925, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 20.9927, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 36.0, "npi": [1306938071]}]}, {"allowed_amount": 759.53, "billing_code_modifier": ["HHQN"], "providers": [{"billed_charge": 2910.0, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "208488713"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 171.21, "npi": [1073893020]}, {"billed_charge": 22.835, "npi": [1073893020]}, {"billed_charge": 23.0363, "npi": [1073893020]}, {"billed_charge": 3.1566, "npi": [1073893020]}, {"billed_charge": 10.3275, "npi": [1073893020]}, {"billed_charge": 11.3428, "npi": [1073893020]}, {"billed_charge": 44.94, "npi": [1073893020]}, {"billed_charge": 104.51, "npi": [1073893020]}, {"billed_charge": 2.7112, "npi": [1073893020]}, {"billed_charge": 2.7768, "npi": [1073893020]}, {"billed_charge": 130.92, "npi": [1073893020]}, {"billed_charge": 85.27, "npi": [1073893020]}, {"billed_charge": 82.23, "npi": [1073893020]}]}, {"allowed_amount": 0.755, "billing_code_modifier": [""], "providers": [{"billed_charge": 43.96, "npi": [1073893020]}, {"billed_charge": 34.13, "npi": [1073893020]}]}]}]}, {"name": "Laboratory - Immunology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0302", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 514.5, "npi": [1306938071]}, {"billed_charge": 433.0, "npi": [1306938071]}, {"billed_charge": 395.5217, "npi": [1306938071]}, {"billed_charge": 462.75, "npi": [1306938071]}, {"billed_charge": 304.0, "npi": [1306938071]}, {"billed_charge": 547.0, "npi": [1306938071]}, {"billed_charge": 498.0, "npi": [1306938071]}, {"billed_charge": 84.0, "npi": [1306938071]}, {"billed_charge": 344.5, "npi": [1306938071]}, {"billed_charge": 656.0, "npi": [1306938071]}, {"billed_charge": 389.2, "npi": [1306938071]}, {"billed_charge": 282.4, "npi": [1306938071]}, {"billed_charge": 692.0, "npi": [1306938071]}, {"billed_charge": 357.0, "npi": [1306938071]}, {"billed_charge": 558.0, "npi": [1306938071]}]}, {"allowed_amount": 9.61, "billing_code_modifier": [""], "providers": [{"billed_charge": 309.0, "npi": [1306938071]}]}]}]}, {"name": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96374", "description": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 196.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 490.0, "npi": [1417279936]}]}, {"allowed_amount": 192.08, "billing_code_modifier": [""], "providers": [{"billed_charge": 490.0, "npi": [1417279936]}]}]}]}, {"name": "Laboratory - Urology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0307", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 151.11, "npi": [1821186313]}, {"billed_charge": 65.29, "npi": [1821186313]}]}]}]}, {"name": "THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96375", "description": "THERAPEUTIC INJECTION IV PUSH EACH NEW DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 95.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 239.0, "npi": [1528042884]}]}, {"allowed_amount": 93.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 239.0, "npi": [1528042884]}]}, {"allowed_amount": 43.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.0, "npi": [1528042884]}]}, {"allowed_amount": 34.97, "billing_code_modifier": [""], "providers": [{"billed_charge": 111.0, "npi": [1528042884]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 144.38, "billing_code_modifier": [""], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}, {"allowed_amount": 108.29, "billing_code_modifier": [""], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}, {"allowed_amount": 148.42, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 269.85, "npi": [1376571323]}]}, {"allowed_amount": 101.07, "billing_code_modifier": [""], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}, {"allowed_amount": 88.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 160.65, "npi": [1265460232]}]}, {"allowed_amount": 146.69, "billing_code_modifier": [""], "providers": [{"billed_charge": 266.7, "npi": [1174551147]}]}, {"allowed_amount": 148.42, "billing_code_modifier": [""], "providers": [{"billed_charge": 269.85, "npi": [1376571323]}]}, {"allowed_amount": 144.38, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}, {"allowed_amount": 144.375, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 262.5, "npi": [1285662239]}]}]}]}, {"name": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "831850558"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 108.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 236.0, "npi": [1114505161]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "823782639"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 92.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 125.0, "npi": [1275589764]}]}]}]}, {"name": "Radiology - Diagnostic - Chest X-Ray", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0324", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 298.0, "npi": [1578620449]}, {"billed_charge": 825.0, "npi": [1578620449]}, {"billed_charge": 341.9167, "npi": [1578620449]}]}, {"allowed_amount": 203.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 298.0, "npi": [1578620449]}, {"billed_charge": 825.0, "npi": [1578620449]}]}, {"allowed_amount": 198.86, "billing_code_modifier": [""], "providers": [{"billed_charge": 298.0, "npi": [1578620449]}]}]}]}, {"name": "CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99291", "description": "CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "823699891"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 225.16, "billing_code_modifier": ["FS"], "providers": [{"billed_charge": 753.0, "npi": [1952272932]}]}]}]}, {"name": "CT HEAD/BRAIN W/O CONTRAST MATERIAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "70450", "description": "CT HEAD/BRAIN W/O CONTRAST MATERIAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1879.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4699.0, "npi": [1578547865]}]}, {"allowed_amount": 1842.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 4699.0, "npi": [1578547865]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "843235850"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 140.01, "billing_code_modifier": ["Q6"], "providers": [{"billed_charge": 300.0, "npi": [1083677322]}]}, {"allowed_amount": 140.01, "billing_code_modifier": ["AIQ6"], "providers": [{"billed_charge": 300.0, "npi": [1083677322]}]}, {"allowed_amount": 140.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 300.0, "npi": [1083677322]}]}, {"allowed_amount": 140.01, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 300.0, "npi": [1083677322]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 14.0254, "npi": [1821186313]}, {"billed_charge": 46.47, "npi": [1821186313]}, {"billed_charge": 7.5808, "npi": [1821186313]}, {"billed_charge": 33.97, "npi": [1821186313]}, {"billed_charge": 2.5856, "npi": [1821186313]}, {"billed_charge": 19.5554, "npi": [1821186313]}, {"billed_charge": 5.112, "npi": [1821186313]}, {"billed_charge": 89.94, "npi": [1821186313]}, {"billed_charge": 2.9577, "npi": [1821186313]}, {"billed_charge": 2.9411, "npi": [1821186313]}, {"billed_charge": 3.7589, "npi": [1821186313]}, {"billed_charge": 7.3989, "npi": [1821186313]}, {"billed_charge": 32.0485, "npi": [1821186313]}, {"billed_charge": 8.845, "npi": [1821186313]}, {"billed_charge": 9.4, "npi": [1821186313]}, {"billed_charge": 19.393, "npi": [1821186313]}, {"billed_charge": 4.3392, "npi": [1821186313]}, {"billed_charge": 13.77, "npi": [1821186313]}, {"billed_charge": 3.7039, "npi": [1821186313]}, {"billed_charge": 17.049, "npi": [1821186313]}]}]}]}, {"name": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION KETOROLAC TROMETHAMINE PER 15 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 8.0, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 20.0, "npi": [1578547865]}]}, {"allowed_amount": 19.21, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 49.0, "npi": [1578547865]}]}, {"allowed_amount": 3.5275, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 9.0, "npi": [1578547865]}]}, {"allowed_amount": 7.84, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 20.0, "npi": [1578547865]}]}, {"allowed_amount": 3.6, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 9.0, "npi": [1578547865]}]}, {"allowed_amount": 19.6, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 49.0, "npi": [1578547865]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "992646504"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.1667, "npi": [1366281750]}, {"billed_charge": 8.375, "npi": [1366281750]}, {"billed_charge": 8.4, "npi": [1366281750]}, {"billed_charge": 0.553, "npi": [1366281750]}, {"billed_charge": 209.3, "npi": [1366281750]}, {"billed_charge": 42.7, "npi": [1366281750]}, {"billed_charge": 33.5, "npi": [1366281750]}, {"billed_charge": 49.0, "npi": [1366281750]}, {"billed_charge": 1.675, "npi": [1366281750]}, {"billed_charge": 213.15, "npi": [1366281750]}, {"billed_charge": 1.386, "npi": [1366281750]}, {"billed_charge": 2.9715, "npi": [1366281750]}, {"billed_charge": 0.4188, "npi": [1366281750]}, {"billed_charge": 1.204, "npi": [1366281750]}, {"billed_charge": 14.0484, "npi": [1366281750]}, {"billed_charge": 404.95, "npi": [1366281750]}, {"billed_charge": 6.7, "npi": [1366281750]}, {"billed_charge": 3.35, "npi": [1366281750]}, {"billed_charge": 27.3289, "npi": [1366281750]}, {"billed_charge": 0.5671, "npi": [1366281750]}, {"billed_charge": 13.56, "npi": [1366281750]}, {"billed_charge": 23.85, "npi": [1366281750]}, {"billed_charge": 9.7708, "npi": [1366281750]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "591943502"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 9.04, "billing_code_modifier": ["QW91"], "providers": [{"billed_charge": 29.0, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 207.0, "npi": [1699874248]}, {"billed_charge": 2061.0, "npi": [1699874248]}, {"billed_charge": 244.0, "npi": [1699874248]}, {"billed_charge": 76.0, "npi": [1699874248]}, {"billed_charge": 34.0, "npi": [1699874248]}, {"billed_charge": 108.0, "npi": [1699874248]}, {"billed_charge": 50.0, "npi": [1699874248]}, {"billed_charge": 31.0, "npi": [1699874248]}, {"billed_charge": 64.0, "npi": [1699874248]}, {"billed_charge": 59.5357, "npi": [1699874248]}, {"billed_charge": 59.0, "npi": [1699874248]}, {"billed_charge": 48.0, "npi": [1699874248]}, {"billed_charge": 88.0, "npi": [1699874248]}, {"billed_charge": 174.0, "npi": [1699874248]}, {"billed_charge": 65.0, "npi": [1699874248]}, {"billed_charge": 151.0, "npi": [1699874248]}, {"billed_charge": 69.6618, "npi": [1699874248]}]}, {"allowed_amount": 10.07, "billing_code_modifier": [""], "providers": [{"billed_charge": 27.0, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 88.0, "npi": [1699874248]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "364730709"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 146.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 896.0, "npi": [1063866242]}]}, {"allowed_amount": 146.15, "billing_code_modifier": ["24"], "providers": [{"billed_charge": 896.0, "npi": [1063866242]}]}]}]}, {"name": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 288.12, "billing_code_modifier": [""], "providers": [{"billed_charge": 735.0, "npi": [1528042884]}]}, {"allowed_amount": 231.53, "billing_code_modifier": [""], "providers": [{"billed_charge": 735.0, "npi": [1528042884]}]}, {"allowed_amount": 231.53, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 735.0, "npi": [1528042884]}]}, {"allowed_amount": 288.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 735.0, "npi": [1528042884]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 366.99, "billing_code_modifier": [""], "providers": [{"billed_charge": 1846.95, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1994.42, "npi": [1821186313]}, {"billed_charge": 8373.36, "npi": [1821186313]}, {"billed_charge": 788.27, "npi": [1821186313]}, {"billed_charge": 3350.58, "npi": [1821186313]}, {"billed_charge": 5324.34, "npi": [1821186313]}]}, {"allowed_amount": 983.09, "billing_code_modifier": [""], "providers": [{"billed_charge": 3350.58, "npi": [1821186313]}]}, {"allowed_amount": 1100.46, "billing_code_modifier": ["50"], "providers": [{"billed_charge": 809.62, "npi": [1821186313]}]}, {"allowed_amount": 997.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3350.58, "npi": [1821186313]}]}, {"allowed_amount": 652.42, "billing_code_modifier": [""], "providers": [{"billed_charge": 1994.42, "npi": [1821186313]}, {"billed_charge": 3350.58, "npi": [1821186313]}]}, {"allowed_amount": 483.21, "billing_code_modifier": [""], "providers": [{"billed_charge": 900.36, "npi": [1821186313]}]}, {"allowed_amount": 6251.24, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 8373.36, "npi": [1821186313]}]}, {"allowed_amount": 983.09, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3350.58, "npi": [1821186313]}]}, {"allowed_amount": 639.26, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1994.42, "npi": [1821186313]}]}, {"allowed_amount": 652.42, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1994.42, "npi": [1821186313]}, {"billed_charge": 3350.58, "npi": [1821186313]}]}, {"allowed_amount": 639.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 1994.42, "npi": [1821186313]}]}, {"allowed_amount": 366.99, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1846.95, "npi": [1821186313]}]}, {"allowed_amount": 1423.36, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 8373.36, "npi": [1821186313]}]}, {"allowed_amount": 464.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 900.36, "npi": [1821186313]}]}, {"allowed_amount": 997.28, "billing_code_modifier": [""], "providers": [{"billed_charge": 8373.36, "npi": [1821186313]}, {"billed_charge": 3350.58, "npi": [1821186313]}]}]}]}, {"name": "IV Therapy -General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0260", "description": "IV Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 773.0, "npi": [1578620449]}, {"billed_charge": 360.8333, "npi": [1578620449]}, {"billed_charge": 261.0, "npi": [1578620449]}, {"billed_charge": 494.5, "npi": [1578620449]}, {"billed_charge": 305.0, "npi": [1578620449]}, {"billed_charge": 461.0, "npi": [1578620449]}, {"billed_charge": 298.0, "npi": [1578620449]}, {"billed_charge": 380.8, "npi": [1578620449]}, {"billed_charge": 422.0, "npi": [1578620449]}, {"billed_charge": 624.0, "npi": [1578620449]}, {"billed_charge": 416.0, "npi": [1578620449]}, {"billed_charge": 1241.0, "npi": [1578620449]}, {"billed_charge": 372.0, "npi": [1578620449]}, {"billed_charge": 728.0, "npi": [1578620449]}, {"billed_charge": 516.5, "npi": [1578620449]}]}, {"allowed_amount": 497.34, "billing_code_modifier": [""], "providers": [{"billed_charge": 624.0, "npi": [1578620449]}, {"billed_charge": 1241.0, "npi": [1578620449]}, {"billed_charge": 728.0, "npi": [1578620449]}]}, {"allowed_amount": 109.486, "billing_code_modifier": [""], "providers": [{"billed_charge": 416.0, "npi": [1578620449]}]}, {"allowed_amount": 497.34, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 624.0, "npi": [1578620449]}, {"billed_charge": 1241.0, "npi": [1578620449]}, {"billed_charge": 728.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 305.0, "npi": [1578620449]}, {"billed_charge": 298.0, "npi": [1578620449]}, {"billed_charge": 624.0, "npi": [1578620449]}, {"billed_charge": 728.0, "npi": [1578620449]}]}, {"allowed_amount": 109.4867, "billing_code_modifier": [""], "providers": [{"billed_charge": 305.0, "npi": [1578620449]}]}, {"allowed_amount": 109.485, "billing_code_modifier": [""], "providers": [{"billed_charge": 305.0, "npi": [1578620449]}]}, {"allowed_amount": 475.85, "billing_code_modifier": [""], "providers": [{"billed_charge": 624.0, "npi": [1578620449]}, {"billed_charge": 1241.0, "npi": [1578620449]}, {"billed_charge": 728.0, "npi": [1578620449]}]}, {"allowed_amount": 109.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 261.0, "npi": [1578620449]}, {"billed_charge": 305.0, "npi": [1578620449]}, {"billed_charge": 416.0, "npi": [1578620449]}]}, {"allowed_amount": 104.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 261.0, "npi": [1578620449]}, {"billed_charge": 305.0, "npi": [1578620449]}]}, {"allowed_amount": 109.49, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 261.0, "npi": [1578620449]}, {"billed_charge": 305.0, "npi": [1578620449]}]}, {"allowed_amount": 109.485, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 305.0, "npi": [1578620449]}]}]}]}, {"name": "Laboratory - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0300", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 40.0, "npi": [1578620449]}, {"billed_charge": 29.0, "npi": [1578620449]}, {"billed_charge": 543.0, "npi": [1578620449]}, {"billed_charge": 1542.0, "npi": [1578620449]}, {"billed_charge": 78.15, "npi": [1578620449]}]}]}]}, {"name": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 98.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 251.0, "npi": [1528042884]}]}, {"allowed_amount": 22.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 58.0, "npi": [1528042884]}]}, {"allowed_amount": 100.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 251.0, "npi": [1528042884]}]}, {"allowed_amount": 18.27, "billing_code_modifier": [""], "providers": [{"billed_charge": 58.0, "npi": [1528042884]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "272582397"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 140.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 600.0, "npi": [1306000211]}]}]}]}, {"name": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93005", "description": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 251.6, "billing_code_modifier": ["77"], "providers": [{"billed_charge": 629.0, "npi": [1578547865]}]}, {"allowed_amount": 251.6, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 629.0, "npi": [1578547865]}]}, {"allowed_amount": 246.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1578547865]}]}, {"allowed_amount": 251.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1578547865]}]}]}]}, {"name": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96374", "description": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 196.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 490.0, "npi": [1578547865]}]}, {"allowed_amount": 192.08, "billing_code_modifier": [""], "providers": [{"billed_charge": 490.0, "npi": [1578547865]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "590737717"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 10.85, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 10.85, "npi": [1306896790]}]}, {"allowed_amount": 10.85, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 10.85, "npi": [1306896790]}]}, {"allowed_amount": 10.85, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 10.85, "npi": [1306896790]}]}, {"allowed_amount": 10.85, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 10.85, "npi": [1306896790]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "591113901"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 66.07, "npi": [1053321919]}, {"billed_charge": 38.85, "npi": [1053321919]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 22.3075, "npi": [1053321919]}, {"billed_charge": 1.2498, "npi": [1053321919]}, {"billed_charge": 0.5533, "npi": [1053321919]}, {"billed_charge": 3.1022, "npi": [1053321919]}, {"billed_charge": 5.9286, "npi": [1053321919]}, {"billed_charge": 5.0732, "npi": [1053321919]}, {"billed_charge": 1.6692, "npi": [1053321919]}, {"billed_charge": 6.925, "npi": [1053321919]}, {"billed_charge": 10.0368, "npi": [1053321919]}, {"billed_charge": 7.7045, "npi": [1053321919]}, {"billed_charge": 77.41, "npi": [1053321919]}, {"billed_charge": 29.2565, "npi": [1053321919]}, {"billed_charge": 87.09, "npi": [1053321919]}, {"billed_charge": 8.46, "npi": [1053321919]}, {"billed_charge": 6.658, "npi": [1053321919]}, {"billed_charge": 20.3083, "npi": [1053321919]}]}, {"allowed_amount": 0.4724, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.3284, "npi": [1053321919]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1548.99, "billing_code_modifier": [""], "providers": [{"billed_charge": 2816.34, "npi": [1376571323]}]}, {"allowed_amount": 1487.56, "billing_code_modifier": ["2527"], "providers": [{"billed_charge": 2704.65, "npi": [1285662239]}]}, {"allowed_amount": 1487.56, "billing_code_modifier": [""], "providers": [{"billed_charge": 2704.65, "npi": [1285662239]}]}, {"allowed_amount": 1548.99, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2816.34, "npi": [1376571323]}]}, {"allowed_amount": 1487.56, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2704.65, "npi": [1285662239]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 977.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 2444.0, "npi": [1578547865]}]}, {"allowed_amount": 977.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1578547865]}]}, {"allowed_amount": 958.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1578547865]}]}]}]}, {"name": "Occupational Therapy - Evaluation or Reevaluation", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0434", "description": "Occupational Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 975.0, "npi": [1306938071]}, {"billed_charge": 873.0, "npi": [1306938071]}, {"billed_charge": 1344.0, "npi": [1306938071]}]}, {"allowed_amount": 221.76, "billing_code_modifier": ["GO"], "providers": [{"billed_charge": 975.0, "npi": [1306938071]}, {"billed_charge": 873.0, "npi": [1306938071]}]}, {"allowed_amount": 221.02, "billing_code_modifier": ["GO"], "providers": [{"billed_charge": 873.0, "npi": [1306938071]}]}]}]}, {"name": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 184.94, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 336.26, "npi": [1285662239]}]}, {"allowed_amount": 184.94, "billing_code_modifier": [""], "providers": [{"billed_charge": 336.26, "npi": [1285662239]}]}, {"allowed_amount": 184.94, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 336.26, "npi": [1285662239]}]}]}]}, {"name": "IV Therapy -General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0260", "description": "IV Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "841793121"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 508.39, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 1563.84, "npi": [1801457510]}]}, {"allowed_amount": 106.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 567.96, "npi": [1801457510]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 556.66, "npi": [1801457510]}, {"billed_charge": 731.1817, "npi": [1801457510]}]}, {"allowed_amount": 111.918, "billing_code_modifier": [""], "providers": [{"billed_charge": 567.96, "npi": [1801457510]}]}, {"allowed_amount": 508.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 1941.09, "npi": [1801457510]}, {"billed_charge": 1563.84, "npi": [1801457510]}]}, {"allowed_amount": 111.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 567.96, "npi": [1801457510]}, {"billed_charge": 921.17, "npi": [1801457510]}, {"billed_charge": 1023.52, "npi": [1801457510]}]}, {"allowed_amount": 111.9167, "billing_code_modifier": [""], "providers": [{"billed_charge": 567.96, "npi": [1801457510]}, {"billed_charge": 921.17, "npi": [1801457510]}]}, {"allowed_amount": 486.43, "billing_code_modifier": [""], "providers": [{"billed_charge": 1941.09, "npi": [1801457510]}]}]}]}, {"name": "EKG/ECG (Electrocardiogram) - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0730", "description": "EKG/ECG (Electrocardiogram)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 715.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 715.0, "npi": [1578620449]}]}]}]}, {"name": "Respiratory Services - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0410", "description": "Respiratory Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 3488.1429, "npi": [1306938071]}, {"billed_charge": 1536.1852, "npi": [1306938071]}, {"billed_charge": 3488.3333, "npi": [1306938071]}, {"billed_charge": 388.0, "npi": [1306938071]}, {"billed_charge": 3327.1429, "npi": [1306938071]}, {"billed_charge": 737.0, "npi": [1306938071]}, {"billed_charge": 776.0, "npi": [1306938071]}, {"billed_charge": 863.625, "npi": [1306938071]}, {"billed_charge": 1374.5, "npi": [1306938071]}]}]}]}, {"name": "Respiratory Services - Inhalation Services", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0412", "description": "Respiratory Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 714.0, "npi": [1578620449]}, {"billed_charge": 771.0238, "npi": [1578620449]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "591634257"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 89.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 250.0, "npi": [1912153057]}]}]}]}, {"name": "Hepatic Function Panel", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "Hepatic Function Panel", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 236.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1578547865]}]}, {"allowed_amount": 231.28, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1578547865]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1528042884]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1528042884]}]}]}]}, {"name": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J7030", "description": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 52.25, "billing_code_modifier": [""], "providers": [{"billed_charge": 95.0, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}, {"billed_charge": 95.0, "npi": [1285662239]}]}, {"allowed_amount": 73.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 104.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 78.3767, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}]}]}, {"name": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93005", "description": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 251.6, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 629.0, "npi": [1528042884]}]}, {"allowed_amount": 246.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1528042884]}]}, {"allowed_amount": 128.84, "billing_code_modifier": [""], "providers": [{"billed_charge": 409.0, "npi": [1528042884]}]}, {"allowed_amount": 251.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1528042884]}]}, {"allowed_amount": 160.33, "billing_code_modifier": [""], "providers": [{"billed_charge": 409.0, "npi": [1528042884]}]}]}]}, {"name": "ASSAY OF TROPONIN QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84484", "description": "ASSAY OF TROPONIN QUANTITATIVE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 421.16, "npi": [1285662239]}]}, {"allowed_amount": 58.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 421.16, "npi": [1285662239]}]}, {"allowed_amount": 231.64, "billing_code_modifier": [""], "providers": [{"billed_charge": 421.16, "npi": [1285662239]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "591943502"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.77, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 6.3, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.24, "npi": [1699874248]}, {"billed_charge": 8.61, "npi": [1699874248]}, {"billed_charge": 2.43, "npi": [1699874248]}, {"billed_charge": 0.1374, "npi": [1699874248]}, {"billed_charge": 290.23, "npi": [1699874248]}, {"billed_charge": 0.972, "npi": [1699874248]}, {"billed_charge": 7.266, "npi": [1699874248]}, {"billed_charge": 0.081, "npi": [1699874248]}, {"billed_charge": 8.64, "npi": [1699874248]}, {"billed_charge": 100.98, "npi": [1699874248]}, {"billed_charge": 17.23, "npi": [1699874248]}, {"billed_charge": 7.272, "npi": [1699874248]}, {"billed_charge": 4.25, "npi": [1699874248]}]}, {"allowed_amount": 0.4832, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 2.5, "npi": [1699874248]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 0.825, "npi": [1699874248]}, {"billed_charge": 2.5, "npi": [1699874248]}, {"billed_charge": 4.2, "npi": [1699874248]}, {"billed_charge": 2.73, "npi": [1699874248]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99284", "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 977.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 2444.0, "npi": [1417279936]}]}, {"allowed_amount": 977.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1417279936]}]}, {"allowed_amount": 958.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2444.0, "npi": [1417279936]}]}]}]}, {"name": "Physical Therapy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0420", "description": "Physical Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 241.2, "npi": [1306938071]}, {"billed_charge": 241.0, "npi": [1306938071]}, {"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 240.6, "npi": [1306938071]}, {"billed_charge": 239.4, "npi": [1306938071]}, {"billed_charge": 239.0, "npi": [1306938071]}, {"billed_charge": 240.5, "npi": [1306938071]}, {"billed_charge": 241.3636, "npi": [1306938071]}, {"billed_charge": 242.0, "npi": [1306938071]}, {"billed_charge": 240.0, "npi": [1306938071]}, {"billed_charge": 238.5, "npi": [1306938071]}, {"billed_charge": 240.05, "npi": [1306938071]}, {"billed_charge": 254.1014, "npi": [1306938071]}, {"billed_charge": 239.1429, "npi": [1306938071]}]}, {"allowed_amount": 49.68, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 240.0, "npi": [1306938071]}]}, {"allowed_amount": 55.755, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 237.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 249.0, "npi": [1306938071]}, {"billed_charge": 240.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GPU5"], "providers": [{"billed_charge": 240.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GPU5XU"], "providers": [{"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 240.0, "npi": [1306938071]}]}, {"allowed_amount": 55.6, "billing_code_modifier": ["GP"], "providers": [{"billed_charge": 240.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GPXU"], "providers": [{"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 240.0, "npi": [1306938071]}]}]}]}, {"name": "Prothrombin time", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85610", "description": "Prothrombin time", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 63.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 229.95, "npi": [1285662239]}]}, {"allowed_amount": 59.52, "billing_code_modifier": [""], "providers": [{"billed_charge": 229.95, "npi": [1285662239]}]}, {"allowed_amount": 126.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 229.95, "npi": [1285662239]}]}]}]}, {"name": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93005", "description": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 251.6, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 629.0, "npi": [1417279936]}]}, {"allowed_amount": 246.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1417279936]}]}, {"allowed_amount": 251.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 629.0, "npi": [1417279936]}]}, {"allowed_amount": 246.57, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 629.0, "npi": [1417279936]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99232", "description": "SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "201021229"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 85.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 85.0, "npi": [1346700507]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "262255271"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 146.15, "billing_code_modifier": [""], "providers": [{"billed_charge": 219.0, "npi": [1790836997]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000411"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.9102, "npi": [1891790424]}, {"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 19.91, "npi": [1891790424]}]}]}]}, {"name": "Pharmacy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0250", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590872594"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.175, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1982688230]}]}, {"allowed_amount": 4.8895, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.4737, "npi": [1982688230]}]}, {"allowed_amount": 1.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1982688230]}]}, {"allowed_amount": 6.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 15.0, "npi": [1982688230]}]}, {"allowed_amount": 0.945, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1982688230]}]}, {"allowed_amount": 1.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1982688230]}]}, {"allowed_amount": 8.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 20.0, "npi": [1982688230]}]}, {"allowed_amount": 2.52, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.0, "npi": [1982688230]}]}, {"allowed_amount": 6.27, "billing_code_modifier": [""], "providers": [{"billed_charge": 16.0, "npi": [1982688230]}]}, {"allowed_amount": 2.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1982688230]}]}, {"allowed_amount": 3.0081, "billing_code_modifier": [""], "providers": [{"billed_charge": 7.5203, "npi": [1982688230]}]}, {"allowed_amount": 0.32, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.0, "npi": [1982688230]}]}, {"allowed_amount": 1.18, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1982688230]}]}, {"allowed_amount": 0.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 1.0, "npi": [1982688230]}]}, {"allowed_amount": 0.95, "billing_code_modifier": [""], "providers": [{"billed_charge": 3.0, "npi": [1982688230]}]}, {"allowed_amount": 9.604, "billing_code_modifier": [""], "providers": [{"billed_charge": 24.5, "npi": [1982688230]}]}, {"allowed_amount": 1.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4.0, "npi": [1982688230]}]}]}]}, {"name": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "allowed_amounts": [{"tin": {"type": "ein", "value": "590737717"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 597.16, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 600.0, "npi": [1306896790]}]}, {"allowed_amount": 597.16, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 600.0, "npi": [1306896790]}]}, {"allowed_amount": 597.16, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 600.0, "npi": [1306896790]}]}, {"allowed_amount": 597.16, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 600.0, "npi": [1306896790]}]}]}]}, {"name": "Radiology - Diagnostic - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0320", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1578620449]}, {"billed_charge": 762.0, "npi": [1578620449]}, {"billed_charge": 743.0, "npi": [1578620449]}, {"billed_charge": 1677.0, "npi": [1578620449]}, {"billed_charge": 1027.5, "npi": [1578620449]}, {"billed_charge": 1215.0, "npi": [1578620449]}, {"billed_charge": 1006.0, "npi": [1578620449]}, {"billed_charge": 840.6667, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 429.0, "npi": [1578620449]}, {"billed_charge": 904.0, "npi": [1578620449]}, {"billed_charge": 993.0, "npi": [1578620449]}, {"billed_charge": 870.0, "npi": [1578620449]}, {"billed_charge": 991.0, "npi": [1578620449]}, {"billed_charge": 1023.0, "npi": [1578620449]}, {"billed_charge": 972.0, "npi": [1578620449]}, {"billed_charge": 758.0, "npi": [1578620449]}, {"billed_charge": 1185.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 765.0, "npi": [1578620449]}, {"billed_charge": 972.0, "npi": [1578620449]}, {"billed_charge": 1104.0, "npi": [1578620449]}, {"billed_charge": 1081.0, "npi": [1578620449]}, {"billed_charge": 1012.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XUFY"], "providers": [{"billed_charge": 1927.0, "npi": [1578620449]}]}]}]}, {"name": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96374", "description": "THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 163.73, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 396.9, "npi": [1285662239]}]}, {"allowed_amount": 218.3, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 396.9, "npi": [1285662239]}]}, {"allowed_amount": 218.3, "billing_code_modifier": [""], "providers": [{"billed_charge": 396.9, "npi": [1285662239]}]}, {"allowed_amount": 218.3, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 396.9, "npi": [1285662239]}]}, {"allowed_amount": 229.21, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 416.75, "npi": [1376571323]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 416.75, "npi": [1376571323]}]}, {"allowed_amount": 229.21, "billing_code_modifier": [""], "providers": [{"billed_charge": 416.75, "npi": [1376571323]}]}]}]}, {"name": "Laboratory - Hematology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0305", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 432.6667, "npi": [1306938071]}, {"billed_charge": 483.8333, "npi": [1306938071]}, {"billed_charge": 443.6, "npi": [1306938071]}, {"billed_charge": 525.5714, "npi": [1306938071]}, {"billed_charge": 326.0, "npi": [1306938071]}, {"billed_charge": 463.4, "npi": [1306938071]}, {"billed_charge": 350.0, "npi": [1306938071]}, {"billed_charge": 473.2, "npi": [1306938071]}, {"billed_charge": 456.0, "npi": [1306938071]}, {"billed_charge": 370.6667, "npi": [1306938071]}, {"billed_charge": 444.25, "npi": [1306938071]}, {"billed_charge": 368.5294, "npi": [1306938071]}, {"billed_charge": 418.5455, "npi": [1306938071]}, {"billed_charge": 485.4, "npi": [1306938071]}, {"billed_charge": 391.8667, "npi": [1306938071]}, {"billed_charge": 301.0, "npi": [1306938071]}, {"billed_charge": 405.7778, "npi": [1306938071]}, {"billed_charge": 709.0, "npi": [1306938071]}, {"billed_charge": 465.6, "npi": [1306938071]}, {"billed_charge": 434.6875, "npi": [1306938071]}, {"billed_charge": 330.75, "npi": [1306938071]}, {"billed_charge": 563.0, "npi": [1306938071]}, {"billed_charge": 430.84, "npi": [1306938071]}, {"billed_charge": 656.0, "npi": [1306938071]}, {"billed_charge": 397.0, "npi": [1306938071]}, {"billed_charge": 259.0, "npi": [1306938071]}, {"billed_charge": 409.4545, "npi": [1306938071]}, {"billed_charge": 366.2545, "npi": [1306938071]}, {"billed_charge": 480.0, "npi": [1306938071]}, {"billed_charge": 428.5556, "npi": [1306938071]}, {"billed_charge": 520.75, "npi": [1306938071]}, {"billed_charge": 398.2571, "npi": [1306938071]}, {"billed_charge": 452.3333, "npi": [1306938071]}, {"billed_charge": 507.6667, "npi": [1306938071]}, {"billed_charge": 503.25, "npi": [1306938071]}, {"billed_charge": 453.1667, "npi": [1306938071]}, {"billed_charge": 89.0, "npi": [1306938071]}, {"billed_charge": 522.875, "npi": [1306938071]}, {"billed_charge": 594.0, "npi": [1306938071]}, {"billed_charge": 578.5, "npi": [1306938071]}, {"billed_charge": 367.6846, "npi": [1306938071]}, {"billed_charge": 420.3333, "npi": [1306938071]}, {"billed_charge": 502.2, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 326.0, "npi": [1306938071]}, {"billed_charge": 277.0, "npi": [1306938071]}, {"billed_charge": 563.0, "npi": [1306938071]}, {"billed_charge": 397.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 326.0, "npi": [1306938071]}, {"billed_charge": 277.0, "npi": [1306938071]}, {"billed_charge": 563.0, "npi": [1306938071]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 264.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1417279936]}]}, {"allowed_amount": 270.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1417279936]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "650844880"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 107.0, "npi": [1083644033]}, {"billed_charge": 154.0, "npi": [1083644033]}, {"billed_charge": 178.0, "npi": [1083644033]}, {"billed_charge": 306.0, "npi": [1083644033]}, {"billed_charge": 215.0, "npi": [1083644033]}, {"billed_charge": 147.0, "npi": [1083644033]}, {"billed_charge": 35.0, "npi": [1083644033]}, {"billed_charge": 80.0, "npi": [1083644033]}, {"billed_charge": 98.0, "npi": [1083644033]}, {"billed_charge": 349.0, "npi": [1083644033]}, {"billed_charge": 173.0, "npi": [1083644033]}, {"billed_charge": 156.0, "npi": [1083644033]}, {"billed_charge": 75.0, "npi": [1083644033]}, {"billed_charge": 144.0, "npi": [1083644033]}, {"billed_charge": 129.0, "npi": [1083644033]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 178.0, "npi": [1083644033]}]}]}]}, {"name": "IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87651", "description": "IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 88.59, "billing_code_modifier": ["QW"], "providers": [{"billed_charge": 226.0, "npi": [1528042884]}]}, {"allowed_amount": 71.19, "billing_code_modifier": ["QW"], "providers": [{"billed_charge": 226.0, "npi": [1528042884]}]}, {"allowed_amount": 90.4, "billing_code_modifier": ["QW"], "providers": [{"billed_charge": 226.0, "npi": [1528042884]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 108.0, "npi": [1578620449]}, {"billed_charge": 370.0, "npi": [1578620449]}, {"billed_charge": 279.0, "npi": [1578620449]}, {"billed_charge": 389.0, "npi": [1578620449]}, {"billed_charge": 375.0, "npi": [1578620449]}, {"billed_charge": 308.0, "npi": [1578620449]}, {"billed_charge": 48.0, "npi": [1578620449]}, {"billed_charge": 7.0, "npi": [1578620449]}, {"billed_charge": 290.0, "npi": [1578620449]}, {"billed_charge": 69.0, "npi": [1578620449]}, {"billed_charge": 47.0, "npi": [1578620449]}, {"billed_charge": 187.0, "npi": [1578620449]}, {"billed_charge": 36.0, "npi": [1578620449]}, {"billed_charge": 190.6667, "npi": [1578620449]}, {"billed_charge": 86.0, "npi": [1578620449]}, {"billed_charge": 149.0, "npi": [1578620449]}, {"billed_charge": 365.0, "npi": [1578620449]}, {"billed_charge": 191.6667, "npi": [1578620449]}, {"billed_charge": 190.0, "npi": [1578620449]}, {"billed_charge": 206.05, "npi": [1578620449]}, {"billed_charge": 90.0, "npi": [1578620449]}, {"billed_charge": 63.0, "npi": [1578620449]}, {"billed_charge": 15.0, "npi": [1578620449]}, {"billed_charge": 197.68, "npi": [1578620449]}, {"billed_charge": 84.0, "npi": [1578620449]}, {"billed_charge": 260.0, "npi": [1578620449]}, {"billed_charge": 181.3871, "npi": [1578620449]}, {"billed_charge": 187.7273, "npi": [1578620449]}, {"billed_charge": 74.0, "npi": [1578620449]}, {"billed_charge": 441.0, "npi": [1578620449]}, {"billed_charge": 46.0, "npi": [1578620449]}, {"billed_charge": 303.0, "npi": [1578620449]}, {"billed_charge": 99.0, "npi": [1578620449]}, {"billed_charge": 291.5, "npi": [1578620449]}, {"billed_charge": 372.0, "npi": [1578620449]}, {"billed_charge": 114.0, "npi": [1578620449]}, {"billed_charge": 65.0, "npi": [1578620449]}, {"billed_charge": 142.0, "npi": [1578620449]}, {"billed_charge": 400.0, "npi": [1578620449]}, {"billed_charge": 141.0, "npi": [1578620449]}, {"billed_charge": 268.0, "npi": [1578620449]}, {"billed_charge": 234.5, "npi": [1578620449]}, {"billed_charge": 194.25, "npi": [1578620449]}, {"billed_charge": 184.0, "npi": [1578620449]}, {"billed_charge": 215.1429, "npi": [1578620449]}, {"billed_charge": 61.0, "npi": [1578620449]}, {"billed_charge": 155.0, "npi": [1578620449]}, {"billed_charge": 169.2857, "npi": [1578620449]}, {"billed_charge": 168.0, "npi": [1578620449]}, {"billed_charge": 206.3675, "npi": [1578620449]}, {"billed_charge": 198.6, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 30.0, "npi": [1578620449]}, {"billed_charge": 24.0, "npi": [1578620449]}, {"billed_charge": 776.0, "npi": [1578620449]}, {"billed_charge": 35.0, "npi": [1578620449]}, {"billed_charge": 278.0, "npi": [1578620449]}, {"billed_charge": 168.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 30.0, "npi": [1578620449]}, {"billed_charge": 308.0, "npi": [1578620449]}, {"billed_charge": 187.0, "npi": [1578620449]}, {"billed_charge": 15.0, "npi": [1578620449]}, {"billed_charge": 168.0, "npi": [1578620449]}]}, {"allowed_amount": 30.13, "billing_code_modifier": [""], "providers": [{"billed_charge": 393.0, "npi": [1578620449]}]}]}]}, {"name": "CREATINE KINASE TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82550", "description": "CREATINE KINASE TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 371.54, "npi": [1285662239]}]}, {"allowed_amount": 204.345, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 371.54, "npi": [1285662239]}]}, {"allowed_amount": 204.35, "billing_code_modifier": [""], "providers": [{"billed_charge": 371.54, "npi": [1285662239]}]}]}]}, {"name": "COMPREHENSIVE METABOLIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 416.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 1081.55, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 589.84, "npi": [1376571323]}, {"billed_charge": 1081.55, "npi": [1285662239]}]}, {"allowed_amount": 324.41, "billing_code_modifier": [""], "providers": [{"billed_charge": 589.84, "npi": [1376571323]}]}, {"allowed_amount": 460.85, "billing_code_modifier": [""], "providers": [{"billed_charge": 837.9, "npi": [1174551147]}]}, {"allowed_amount": 594.85, "billing_code_modifier": [""], "providers": [{"billed_charge": 1081.55, "npi": [1285662239]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1417279936]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1417279936]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "332257010"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 290.51, "npi": [1760299093]}, {"billed_charge": 84.94, "npi": [1760299093]}, {"billed_charge": 83.48, "npi": [1760299093]}, {"billed_charge": 124.33, "npi": [1760299093]}, {"billed_charge": 352.06, "npi": [1760299093]}, {"billed_charge": 415.15, "npi": [1760299093]}, {"billed_charge": 77.55, "npi": [1760299093]}, {"billed_charge": 62.78, "npi": [1760299093]}, {"billed_charge": 50.47, "npi": [1760299093]}, {"billed_charge": 92.33, "npi": [1760299093]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 92.33, "npi": [1760299093]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "821977573"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0013, "billing_code_modifier": ["XP"], "providers": [{"billed_charge": 0.0013, "npi": [1194488536]}]}, {"allowed_amount": 12.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.26, "npi": [1194488536]}]}, {"allowed_amount": 73.56, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.26, "npi": [1194488536]}]}]}]}, {"name": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 252.45, "billing_code_modifier": [""], "providers": [{"billed_charge": 644.0, "npi": [1578547865]}]}, {"allowed_amount": 257.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 644.0, "npi": [1578547865]}]}]}]}, {"name": "EKG/ECG (Electrocardiogram) - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0730", "description": "EKG/ECG (Electrocardiogram)", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 526.7, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["76"], "providers": [{"billed_charge": 526.7, "npi": [1821186313]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "370960170"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 91.0, "npi": [1497859649]}, {"billed_charge": 113.0, "npi": [1497859649]}, {"billed_charge": 326.0, "npi": [1497859649]}, {"billed_charge": 98.0, "npi": [1497859649]}, {"billed_charge": 238.0, "npi": [1497859649]}, {"billed_charge": 244.0, "npi": [1497859649]}, {"billed_charge": 314.0, "npi": [1497859649]}, {"billed_charge": 206.0, "npi": [1497859649]}]}, {"allowed_amount": 7.31, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 63.0, "npi": [1497859649]}]}]}]}, {"name": "Laboratory - Bacteriology & Microbiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0306", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 715.0, "npi": [1578620449]}, {"billed_charge": 85.0, "npi": [1578620449]}, {"billed_charge": 172.0, "npi": [1578620449]}, {"billed_charge": 553.0, "npi": [1578620449]}, {"billed_charge": 40.0, "npi": [1578620449]}, {"billed_charge": 80.0, "npi": [1578620449]}, {"billed_charge": 689.0, "npi": [1578620449]}, {"billed_charge": 355.3333, "npi": [1578620449]}, {"billed_charge": 170.0, "npi": [1578620449]}, {"billed_charge": 219.125, "npi": [1578620449]}, {"billed_charge": 242.8571, "npi": [1578620449]}, {"billed_charge": 295.095, "npi": [1578620449]}, {"billed_charge": 376.0, "npi": [1578620449]}, {"billed_charge": 394.8, "npi": [1578620449]}, {"billed_charge": 287.3333, "npi": [1578620449]}, {"billed_charge": 372.3333, "npi": [1578620449]}, {"billed_charge": 95.0, "npi": [1578620449]}, {"billed_charge": 303.0, "npi": [1578620449]}, {"billed_charge": 511.0, "npi": [1578620449]}, {"billed_charge": 65.0, "npi": [1578620449]}, {"billed_charge": 40.95, "npi": [1578620449]}, {"billed_charge": 177.3333, "npi": [1578620449]}, {"billed_charge": 250.0, "npi": [1578620449]}, {"billed_charge": 147.0, "npi": [1578620449]}, {"billed_charge": 197.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XS"], "providers": [{"billed_charge": 511.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 436.0, "npi": [1578620449]}, {"billed_charge": 350.0, "npi": [1578620449]}, {"billed_charge": 116.0, "npi": [1578620449]}, {"billed_charge": 124.0, "npi": [1578620449]}, {"billed_charge": 197.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91XU"], "providers": [{"billed_charge": 147.0, "npi": [1578620449]}]}, {"allowed_amount": 320.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 502.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 511.0, "npi": [1578620449]}, {"billed_charge": 147.0, "npi": [1578620449]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000319"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.66, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6613, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6621, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6636, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6622, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["NH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6618, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.6635, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["NH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}, {"allowed_amount": 11.663, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 13.0, "npi": [1649281924]}]}]}]}, {"name": "THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85730", "description": "THROMBOPLASTIN TIME PARTIAL PLASMA/WHOLE BLOOD", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 155.93, "billing_code_modifier": [""], "providers": [{"billed_charge": 283.5, "npi": [1285662239]}]}, {"allowed_amount": 77.97, "billing_code_modifier": [""], "providers": [{"billed_charge": 283.5, "npi": [1285662239]}]}, {"allowed_amount": 155.93, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 283.5, "npi": [1285662239]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 638.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}, {"billed_charge": 7445.0, "npi": [1578620449]}, {"billed_charge": 4710.0, "npi": [1578620449]}, {"billed_charge": 3819.5, "npi": [1578620449]}, {"billed_charge": 4660.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 625.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}]}, {"allowed_amount": 6115.34, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}]}, {"allowed_amount": 1392.41, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}]}, {"allowed_amount": 1392.41, "billing_code_modifier": [""], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["27"], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}]}, {"allowed_amount": 469.13, "billing_code_modifier": [""], "providers": [{"billed_charge": 2082.0, "npi": [1578620449]}]}, {"allowed_amount": 1931.33, "billing_code_modifier": [""], "providers": [{"billed_charge": 7445.0, "npi": [1578620449]}]}, {"allowed_amount": 356.38, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 1207.0, "npi": [1578620449]}]}, {"allowed_amount": 357.66, "billing_code_modifier": [""], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}, {"billed_charge": 1595.0, "npi": [1578620449]}]}, {"allowed_amount": 975.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 625.37, "billing_code_modifier": [""], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}]}, {"allowed_amount": 638.24, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}]}, {"allowed_amount": 6115.34, "billing_code_modifier": [""], "providers": [{"billed_charge": 7445.0, "npi": [1578620449]}, {"billed_charge": 4710.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["52RT"], "providers": [{"billed_charge": 753.0, "npi": [1578620449]}]}, {"allowed_amount": 359.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 2630.0, "npi": [1578620449]}, {"billed_charge": 1595.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 472.7, "billing_code_modifier": [""], "providers": [{"billed_charge": 2903.0, "npi": [1578620449]}]}, {"allowed_amount": 1384.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}]}, {"allowed_amount": 975.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 961.72, "billing_code_modifier": [""], "providers": [{"billed_charge": 4610.0, "npi": [1578620449]}]}, {"allowed_amount": 950.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 2222.0, "npi": [1578620449]}]}, {"allowed_amount": 961.72, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 4710.0, "npi": [1578620449]}, {"billed_charge": 4610.0, "npi": [1578620449]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "590872594"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 264.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1982688230]}]}, {"allowed_amount": 270.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 675.0, "npi": [1982688230]}]}]}]}, {"name": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "93005", "description": "ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I and R", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 690.17, "npi": [1285662239]}]}, {"allowed_amount": 350.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 637.25, "npi": [1376571323]}]}, {"allowed_amount": 379.59, "billing_code_modifier": [""], "providers": [{"billed_charge": 690.17, "npi": [1285662239]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000785"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6627, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 11.6623, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}, {"allowed_amount": 15.0, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1962412072]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "825012837"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 140.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 195.0, "npi": [1730479387]}]}]}]}, {"name": "Laboratory - Bacteriology & Microbiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0306", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 328.05, "billing_code_modifier": [""], "providers": [{"billed_charge": 393.13, "npi": [1821186313]}, {"billed_charge": 557.54, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 229.29, "npi": [1821186313]}, {"billed_charge": 461.59, "npi": [1821186313]}, {"billed_charge": 435.96, "npi": [1821186313]}, {"billed_charge": 426.9044, "npi": [1821186313]}, {"billed_charge": 1780.26, "npi": [1821186313]}, {"billed_charge": 178.0, "npi": [1821186313]}, {"billed_charge": 241.36, "npi": [1821186313]}, {"billed_charge": 609.3025, "npi": [1821186313]}, {"billed_charge": 154.86, "npi": [1821186313]}, {"billed_charge": 121.45, "npi": [1821186313]}, {"billed_charge": 326.2382, "npi": [1821186313]}, {"billed_charge": 73.69, "npi": [1821186313]}, {"billed_charge": 113.9, "npi": [1821186313]}, {"billed_charge": 585.69, "npi": [1821186313]}, {"billed_charge": 496.29, "npi": [1821186313]}, {"billed_charge": 324.014, "npi": [1821186313]}, {"billed_charge": 347.695, "npi": [1821186313]}, {"billed_charge": 105.59, "npi": [1821186313]}, {"billed_charge": 257.95, "npi": [1821186313]}, {"billed_charge": 185.04, "npi": [1821186313]}, {"billed_charge": 346.58, "npi": [1821186313]}, {"billed_charge": 149.92, "npi": [1821186313]}, {"billed_charge": 279.98, "npi": [1821186313]}, {"billed_charge": 129.73, "npi": [1821186313]}, {"billed_charge": 187.66, "npi": [1821186313]}, {"billed_charge": 529.4425, "npi": [1821186313]}, {"billed_charge": 149.33, "npi": [1821186313]}, {"billed_charge": 233.8, "npi": [1821186313]}, {"billed_charge": 288.9, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 105.59, "npi": [1821186313]}, {"billed_charge": 129.73, "npi": [1821186313]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1578547865]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1578547865]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 13942.49, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 469.13, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 1201.0, "npi": [1306938071]}]}, {"allowed_amount": 638.24, "billing_code_modifier": [""], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 359.01, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 667.0, "npi": [1306938071]}]}, {"allowed_amount": 379.96, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 868.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 3392.0, "npi": [1306938071]}, {"billed_charge": 6054.0, "npi": [1306938071]}, {"billed_charge": 4363.0, "npi": [1306938071]}, {"billed_charge": 7214.0, "npi": [1306938071]}, {"billed_charge": 3611.5, "npi": [1306938071]}, {"billed_charge": 4941.5, "npi": [1306938071]}, {"billed_charge": 796.0, "npi": [1306938071]}]}, {"allowed_amount": 1903.05, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 5979.92, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}]}, {"allowed_amount": 625.37, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 6115.34, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}, {"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 1392.41, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}]}, {"allowed_amount": 1392.41, "billing_code_modifier": [""], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}]}, {"allowed_amount": 469.13, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 1201.0, "npi": [1306938071]}]}, {"allowed_amount": 197.17, "billing_code_modifier": [""], "providers": [{"billed_charge": 436.0, "npi": [1306938071]}, {"billed_charge": 490.0, "npi": [1306938071]}]}, {"allowed_amount": 1931.33, "billing_code_modifier": [""], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 357.66, "billing_code_modifier": [""], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 666.0, "npi": [1306938071]}]}, {"allowed_amount": 1931.33, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 975.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 625.37, "billing_code_modifier": [""], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 234.56, "billing_code_modifier": ["F8"], "providers": [{"billed_charge": 1048.0, "npi": [1306938071]}]}, {"allowed_amount": 17081.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 638.24, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}, {"billed_charge": 1201.0, "npi": [1306938071]}]}, {"allowed_amount": 6115.34, "billing_code_modifier": [""], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}, {"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 448.76, "billing_code_modifier": [""], "providers": [{"billed_charge": 867.0, "npi": [1306938071]}]}, {"allowed_amount": 18456.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 7214.0, "npi": [1306938071]}]}, {"allowed_amount": 198.86, "billing_code_modifier": [""], "providers": [{"billed_charge": 436.0, "npi": [1306938071]}]}, {"allowed_amount": 16389.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}]}, {"allowed_amount": 359.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 1535.0, "npi": [1306938071]}, {"billed_charge": 666.0, "npi": [1306938071]}, {"billed_charge": 667.0, "npi": [1306938071]}]}, {"allowed_amount": 357.66, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 666.0, "npi": [1306938071]}]}, {"allowed_amount": 472.7, "billing_code_modifier": [""], "providers": [{"billed_charge": 1029.0, "npi": [1306938071]}]}, {"allowed_amount": 1384.7, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}]}, {"allowed_amount": 576.74, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 820.0, "npi": [1306938071]}]}, {"allowed_amount": 961.72, "billing_code_modifier": [""], "providers": [{"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 975.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 3392.0, "npi": [1306938071]}]}, {"allowed_amount": 469.13, "billing_code_modifier": ["XURT"], "providers": [{"billed_charge": 1201.0, "npi": [1306938071]}]}, {"allowed_amount": 961.72, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 6054.0, "npi": [1306938071]}, {"billed_charge": 3392.0, "npi": [1306938071]}]}]}]}, {"name": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 247.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 449.82, "npi": [1285662239]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "884016086"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 12.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 12.26, "npi": [1467279901]}]}]}]}, {"name": "Laboratory - Hematology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0305", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 172.2222, "npi": [1578620449]}, {"billed_charge": 73.0, "npi": [1578620449]}, {"billed_charge": 130.0, "npi": [1578620449]}, {"billed_charge": 128.6, "npi": [1578620449]}, {"billed_charge": 118.0, "npi": [1578620449]}, {"billed_charge": 91.0, "npi": [1578620449]}, {"billed_charge": 105.2, "npi": [1578620449]}, {"billed_charge": 159.0, "npi": [1578620449]}, {"billed_charge": 121.0, "npi": [1578620449]}, {"billed_charge": 115.4643, "npi": [1578620449]}, {"billed_charge": 87.0, "npi": [1578620449]}, {"billed_charge": 130.8333, "npi": [1578620449]}, {"billed_charge": 96.0, "npi": [1578620449]}, {"billed_charge": 613.0, "npi": [1578620449]}, {"billed_charge": 142.0, "npi": [1578620449]}, {"billed_charge": 101.5, "npi": [1578620449]}, {"billed_charge": 132.6667, "npi": [1578620449]}, {"billed_charge": 61.0, "npi": [1578620449]}, {"billed_charge": 72.0, "npi": [1578620449]}, {"billed_charge": 115.48, "npi": [1578620449]}, {"billed_charge": 139.0, "npi": [1578620449]}, {"billed_charge": 100.2692, "npi": [1578620449]}, {"billed_charge": 78.2857, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 94.0, "npi": [1578620449]}, {"billed_charge": 151.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 159.0, "npi": [1578620449]}, {"billed_charge": 121.0, "npi": [1578620449]}]}]}]}, {"name": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99213", "description": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "590872594"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 288.12, "billing_code_modifier": [""], "providers": [{"billed_charge": 735.0, "npi": [1982688230]}]}, {"allowed_amount": 231.53, "billing_code_modifier": [""], "providers": [{"billed_charge": 735.0, "npi": [1982688230]}]}, {"allowed_amount": 231.53, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 735.0, "npi": [1982688230]}]}, {"allowed_amount": 288.12, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 735.0, "npi": [1982688230]}]}]}]}, {"name": "Room & Board - Semiprivate - 2 Beds - Medical/Surgical/GYN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0121", "description": "Room & Board - Semi-private (Two Beds)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 5525.5367, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 13619.25, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 4423.0445, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 14577.4367, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 12315.98, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 10429.58, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 17640.54, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 5534.4425, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 32542.74, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 4528.465, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 11068.885, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}, {"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 12469.07, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 7727.005, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 15046.19, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 9226.62, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 7611.47, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 10914.535, "billing_code_modifier": [""], "providers": [{"billed_charge": 5090.0, "npi": [1306938071]}]}, {"allowed_amount": 6709.625, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 9461.7367, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 5457.016, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 6359.5583, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 3626.3975, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 7379.2567, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}, {"allowed_amount": 30092.38, "billing_code_modifier": [""], "providers": [{"billed_charge": 5771.0, "npi": [1306938071]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000785"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 695.61, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 730.0, "npi": [1962412072]}]}, {"allowed_amount": 695.61, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 730.0, "npi": [1962412072]}]}, {"allowed_amount": 702.44, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 730.0, "npi": [1962412072]}]}]}]}, {"name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99233", "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES", "allowed_amounts": [{"tin": {"type": "ein", "value": "813080216"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 130.0, "billing_code_modifier": ["25FS"], "providers": [{"billed_charge": 130.0, "npi": [1407815525]}]}, {"allowed_amount": 110.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 110.0, "npi": [1407815525]}]}, {"allowed_amount": 130.0, "billing_code_modifier": ["FS"], "providers": [{"billed_charge": 130.0, "npi": [1407815525]}]}, {"allowed_amount": 110.0, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 110.0, "npi": [1407815525]}]}]}]}, {"name": "LOCM 300-399 MG/ML IODINE CONCENTRATION PER ML", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "Q9967", "description": "LOCM 300-399 MG/ML IODINE CONCENTRATION PER ML", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 3.2942, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.9895, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.508, "npi": [1285662239]}]}, {"allowed_amount": 1.3794, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.508, "npi": [1285662239]}]}, {"allowed_amount": 0.9953, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.585, "npi": [1285662239]}]}, {"allowed_amount": 3.8448, "billing_code_modifier": [""], "providers": [{"billed_charge": 6.9905, "npi": [1285662239]}]}, {"allowed_amount": 1.4218, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.585, "npi": [1285662239]}]}, {"allowed_amount": 1.1208, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.717, "npi": [1285662239]}]}, {"allowed_amount": 1.4944, "billing_code_modifier": [""], "providers": [{"billed_charge": 2.717, "npi": [1285662239]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "591113901"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 315.87, "npi": [1053321919]}, {"billed_charge": 384.84, "npi": [1053321919]}, {"billed_charge": 190.79, "npi": [1053321919]}, {"billed_charge": 164.8425, "npi": [1053321919]}, {"billed_charge": 294.7265, "npi": [1053321919]}, {"billed_charge": 430.59, "npi": [1053321919]}, {"billed_charge": 188.04, "npi": [1053321919]}, {"billed_charge": 871.59, "npi": [1053321919]}, {"billed_charge": 219.29, "npi": [1053321919]}, {"billed_charge": 321.39, "npi": [1053321919]}, {"billed_charge": 438.59, "npi": [1053321919]}, {"billed_charge": 349.24, "npi": [1053321919]}, {"billed_charge": 175.5988, "npi": [1053321919]}, {"billed_charge": 544.07, "npi": [1053321919]}, {"billed_charge": 164.0823, "npi": [1053321919]}, {"billed_charge": 179.8923, "npi": [1053321919]}, {"billed_charge": 570.28, "npi": [1053321919]}, {"billed_charge": 911.17, "npi": [1053321919]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 215.27, "npi": [1053321919]}, {"billed_charge": 71.62, "npi": [1053321919]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 430.59, "npi": [1053321919]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "592447554"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 116.7, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1417952748]}]}, {"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1417952748]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1417952748]}]}]}]}, {"name": "Radiology - Diagnostic - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0320", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 999.0, "npi": [1306938071]}, {"billed_charge": 748.0, "npi": [1306938071]}, {"billed_charge": 639.5, "npi": [1306938071]}, {"billed_charge": 936.0, "npi": [1306938071]}, {"billed_charge": 986.0, "npi": [1306938071]}, {"billed_charge": 2770.5, "npi": [1306938071]}, {"billed_charge": 1199.0, "npi": [1306938071]}, {"billed_charge": 1881.0, "npi": [1306938071]}, {"billed_charge": 1316.0, "npi": [1306938071]}, {"billed_charge": 1121.0, "npi": [1306938071]}, {"billed_charge": 1408.5, "npi": [1306938071]}, {"billed_charge": 1125.0, "npi": [1306938071]}, {"billed_charge": 787.0, "npi": [1306938071]}, {"billed_charge": 743.3333, "npi": [1306938071]}, {"billed_charge": 1073.0, "npi": [1306938071]}, {"billed_charge": 763.0, "npi": [1306938071]}, {"billed_charge": 751.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 811.0, "npi": [1306938071]}, {"billed_charge": 748.0, "npi": [1306938071]}, {"billed_charge": 986.0, "npi": [1306938071]}, {"billed_charge": 495.0, "npi": [1306938071]}, {"billed_charge": 793.0, "npi": [1306938071]}, {"billed_charge": 835.0, "npi": [1306938071]}, {"billed_charge": 792.0, "npi": [1306938071]}, {"billed_charge": 770.0, "npi": [1306938071]}, {"billed_charge": 998.0, "npi": [1306938071]}, {"billed_charge": 784.0, "npi": [1306938071]}, {"billed_charge": 763.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["50"], "providers": [{"billed_charge": 1622.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 811.0, "npi": [1306938071]}, {"billed_charge": 748.0, "npi": [1306938071]}, {"billed_charge": 986.0, "npi": [1306938071]}, {"billed_charge": 792.0, "npi": [1306938071]}, {"billed_charge": 835.0, "npi": [1306938071]}, {"billed_charge": 998.0, "npi": [1306938071]}, {"billed_charge": 784.0, "npi": [1306938071]}, {"billed_charge": 763.0, "npi": [1306938071]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "824372339"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 9.04, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 81.93, "npi": [1740772268]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1171.51, "npi": [1740772268]}, {"billed_charge": 543.9, "npi": [1740772268]}, {"billed_charge": 820.48, "npi": [1740772268]}, {"billed_charge": 376.57, "npi": [1740772268]}, {"billed_charge": 254.3, "npi": [1740772268]}, {"billed_charge": 1168.81, "npi": [1740772268]}, {"billed_charge": 289.79, "npi": [1740772268]}, {"billed_charge": 1022.19, "npi": [1740772268]}, {"billed_charge": 358.5237, "npi": [1740772268]}, {"billed_charge": 231.82, "npi": [1740772268]}, {"billed_charge": 446.75, "npi": [1740772268]}, {"billed_charge": 1020.83, "npi": [1740772268]}, {"billed_charge": 342.29, "npi": [1740772268]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 543.9, "npi": [1740772268]}]}]}]}, {"name": "INJECTION HYDROMORPHONE 0.1 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J1171", "description": "INJECTION HYDROMORPHONE 0.1 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 3.136, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.0, "npi": [1528042884]}]}, {"allowed_amount": 3.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 8.0, "npi": [1528042884]}]}]}]}, {"name": "Laboratory - Bacteriology & Microbiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0306", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 493.0, "npi": [1306938071]}, {"billed_charge": 732.5, "npi": [1306938071]}, {"billed_charge": 473.7436, "npi": [1306938071]}, {"billed_charge": 502.6364, "npi": [1306938071]}, {"billed_charge": 624.75, "npi": [1306938071]}, {"billed_charge": 316.9, "npi": [1306938071]}, {"billed_charge": 554.0, "npi": [1306938071]}, {"billed_charge": 726.1429, "npi": [1306938071]}, {"billed_charge": 438.0, "npi": [1306938071]}, {"billed_charge": 914.5, "npi": [1306938071]}, {"billed_charge": 687.25, "npi": [1306938071]}, {"billed_charge": 417.0, "npi": [1306938071]}, {"billed_charge": 430.5, "npi": [1306938071]}, {"billed_charge": 549.0, "npi": [1306938071]}, {"billed_charge": 927.6667, "npi": [1306938071]}, {"billed_charge": 886.4286, "npi": [1306938071]}, {"billed_charge": 218.0, "npi": [1306938071]}, {"billed_charge": 851.0, "npi": [1306938071]}, {"billed_charge": 864.2, "npi": [1306938071]}, {"billed_charge": 400.0, "npi": [1306938071]}, {"billed_charge": 393.0, "npi": [1306938071]}, {"billed_charge": 687.75, "npi": [1306938071]}, {"billed_charge": 585.0, "npi": [1306938071]}, {"billed_charge": 175.0, "npi": [1306938071]}, {"billed_charge": 401.0, "npi": [1306938071]}, {"billed_charge": 873.0, "npi": [1306938071]}, {"billed_charge": 296.0, "npi": [1306938071]}, {"billed_charge": 789.3182, "npi": [1306938071]}, {"billed_charge": 1390.0, "npi": [1306938071]}, {"billed_charge": 614.0, "npi": [1306938071]}, {"billed_charge": 539.0, "npi": [1306938071]}, {"billed_charge": 1391.0, "npi": [1306938071]}, {"billed_charge": 399.0, "npi": [1306938071]}, {"billed_charge": 692.0, "npi": [1306938071]}, {"billed_charge": 693.0, "npi": [1306938071]}, {"billed_charge": 453.5294, "npi": [1306938071]}, {"billed_charge": 1037.0, "npi": [1306938071]}, {"billed_charge": 347.3, "npi": [1306938071]}, {"billed_charge": 617.125, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 417.0, "npi": [1306938071]}, {"billed_charge": 851.0, "npi": [1306938071]}]}, {"allowed_amount": 320.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 493.0, "npi": [1306938071]}]}, {"allowed_amount": 320.92, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 493.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 851.0, "npi": [1306938071]}, {"billed_charge": 890.0, "npi": [1306938071]}, {"billed_charge": 1037.0, "npi": [1306938071]}]}]}]}, {"name": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71045", "description": "RADIOLOGIC EXAM CHEST SINGLE VIEW", "allowed_amounts": [{"tin": {"type": "ein", "value": "201025679"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 12.07, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 60.0, "npi": [1225069776]}]}, {"allowed_amount": 11.68, "billing_code_modifier": ["26"], "providers": [{"billed_charge": 60.0, "npi": [1225069776]}]}]}]}, {"name": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J7030", "description": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 130.14, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1417279936]}]}, {"allowed_amount": 132.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1417279936]}]}, {"allowed_amount": 130.145, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1417279936]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT LOW MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT LOW MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 711.09, "billing_code_modifier": [""], "providers": [{"billed_charge": 1814.0, "npi": [1578547865]}]}, {"allowed_amount": 711.09, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1814.0, "npi": [1578547865]}]}, {"allowed_amount": 725.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 1814.0, "npi": [1578547865]}]}, {"allowed_amount": 725.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1814.0, "npi": [1578547865]}]}]}]}, {"name": "IV Therapy -General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0260", "description": "IV Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 481.0, "npi": [1306938071]}, {"billed_charge": 973.0, "npi": [1306938071]}, {"billed_charge": 428.5, "npi": [1306938071]}, {"billed_charge": 407.0, "npi": [1306938071]}, {"billed_charge": 303.0, "npi": [1306938071]}, {"billed_charge": 428.3333, "npi": [1306938071]}, {"billed_charge": 427.5, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}, {"billed_charge": 609.6667, "npi": [1306938071]}, {"billed_charge": 417.5, "npi": [1306938071]}, {"billed_charge": 426.0, "npi": [1306938071]}, {"billed_charge": 700.5, "npi": [1306938071]}, {"billed_charge": 429.0, "npi": [1306938071]}, {"billed_charge": 295.0, "npi": [1306938071]}]}, {"allowed_amount": 497.34, "billing_code_modifier": [""], "providers": [{"billed_charge": 973.0, "npi": [1306938071]}, {"billed_charge": 429.0, "npi": [1306938071]}]}, {"allowed_amount": 109.486, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}]}, {"allowed_amount": 104.2, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}]}, {"allowed_amount": 497.34, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 973.0, "npi": [1306938071]}, {"billed_charge": 429.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 973.0, "npi": [1306938071]}, {"billed_charge": 426.0, "npi": [1306938071]}, {"billed_charge": 429.0, "npi": [1306938071]}, {"billed_charge": 295.0, "npi": [1306938071]}]}, {"allowed_amount": 109.4867, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}]}, {"allowed_amount": 109.485, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}]}, {"allowed_amount": 475.85, "billing_code_modifier": [""], "providers": [{"billed_charge": 973.0, "npi": [1306938071]}, {"billed_charge": 429.0, "npi": [1306938071]}]}, {"allowed_amount": 109.4867, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}]}, {"allowed_amount": 109.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}]}, {"allowed_amount": 104.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}]}, {"allowed_amount": 475.85, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 429.0, "npi": [1306938071]}]}, {"allowed_amount": 109.49, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}]}, {"allowed_amount": 109.485, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 428.0, "npi": [1306938071]}, {"billed_charge": 385.0, "npi": [1306938071]}]}]}]}, {"name": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000375"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 597.16, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 825.0, "npi": [1821109612]}, {"billed_charge": 800.0, "npi": [1821109612]}]}, {"allowed_amount": 597.16, "billing_code_modifier": ["HH"], "providers": [{"billed_charge": 800.0, "npi": [1821109612]}]}, {"allowed_amount": 597.16, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 800.0, "npi": [1821109612]}]}]}]}, {"name": "CT Scan - Head Scan", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0351", "description": "CT Scan", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1004.45, "billing_code_modifier": [""], "providers": [{"billed_charge": 5188.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5177.0, "npi": [1306938071]}, {"billed_charge": 10274.0, "npi": [1306938071]}, {"billed_charge": 13583.0, "npi": [1306938071]}, {"billed_charge": 18951.0, "npi": [1306938071]}, {"billed_charge": 9128.0, "npi": [1306938071]}, {"billed_charge": 15723.0, "npi": [1306938071]}, {"billed_charge": 7982.0, "npi": [1306938071]}, {"billed_charge": 5188.0, "npi": [1306938071]}, {"billed_charge": 29306.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 5188.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 5177.0, "npi": [1306938071]}, {"billed_charge": 5188.0, "npi": [1306938071]}]}, {"allowed_amount": 410.11, "billing_code_modifier": [""], "providers": [{"billed_charge": 13583.0, "npi": [1306938071]}, {"billed_charge": 8296.0, "npi": [1306938071]}, {"billed_charge": 15723.0, "npi": [1306938071]}, {"billed_charge": 7982.0, "npi": [1306938071]}]}, {"allowed_amount": 517.37, "billing_code_modifier": [""], "providers": [{"billed_charge": 5188.0, "npi": [1306938071]}]}]}]}, {"name": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J7030", "description": "INFUSION NORMAL SALINE SOLUTION 1000 CC", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 44.1, "billing_code_modifier": [""], "providers": [{"billed_charge": 140.0, "npi": [1528042884]}]}, {"allowed_amount": 54.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 140.0, "npi": [1528042884]}]}, {"allowed_amount": 130.14, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1528042884]}]}, {"allowed_amount": 132.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 332.0, "npi": [1528042884]}]}]}]}, {"name": "INJECTION MORPHINE SULFATE UP TO 10 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J2270", "description": "INJECTION MORPHINE SULFATE UP TO 10 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 26.66, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 68.0, "npi": [1417279936]}]}, {"allowed_amount": 27.2, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 68.0, "npi": [1417279936]}]}, {"allowed_amount": 26.6567, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 68.0, "npi": [1417279936]}]}, {"allowed_amount": 26.655, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 68.0, "npi": [1417279936]}]}]}]}, {"name": "HOSPITAL OBSERVATION SERVICE PER HOUR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "G0378", "description": "HOSPITAL OBSERVATION SERVICE PER HOUR", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 76.205, "billing_code_modifier": [""], "providers": [{"billed_charge": 138.5542, "npi": [1285662239]}, {"billed_charge": 138.555, "npi": [1285662239]}, {"billed_charge": 138.5545, "npi": [1285662239]}, {"billed_charge": 138.5544, "npi": [1285662239]}, {"billed_charge": 138.5543, "npi": [1285662239]}]}, {"allowed_amount": 76.2049, "billing_code_modifier": [""], "providers": [{"billed_charge": 138.5545, "npi": [1285662239]}, {"billed_charge": 138.5544, "npi": [1285662239]}, {"billed_charge": 138.5543, "npi": [1285662239]}]}, {"allowed_amount": 76.2048, "billing_code_modifier": [""], "providers": [{"billed_charge": 138.5544, "npi": [1285662239]}, {"billed_charge": 138.5543, "npi": [1285662239]}]}, {"allowed_amount": 53.3435, "billing_code_modifier": [""], "providers": [{"billed_charge": 138.5544, "npi": [1285662239]}]}, {"allowed_amount": 79.38, "billing_code_modifier": [""], "providers": [{"billed_charge": 144.3272, "npi": [1285662239]}]}, {"allowed_amount": 78.2103, "billing_code_modifier": [""], "providers": [{"billed_charge": 142.2003, "npi": [1285662239]}]}, {"allowed_amount": 76.2053, "billing_code_modifier": [""], "providers": [{"billed_charge": 138.5547, "npi": [1285662239]}]}]}]}, {"name": "Intensive Care - Intermediate  (ICU)", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0206", "description": "Intensive Care Unit", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 5958.63, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 16711.29, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 10350.2957, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 4033.7825, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 3059.4061, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 30401.03, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 7727.005, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 13830.48, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 15037.9925, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 2543.8233, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 5229.4967, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 12686.33, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}, {"allowed_amount": 30092.38, "billing_code_modifier": [""], "providers": [{"billed_charge": 7026.0, "npi": [1306938071]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000573"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6632, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6627, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["NH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6627, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6615, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6622, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH76"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["SH76"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1588768279]}]}]}]}, {"name": "Laboratory - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0300", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 154.9429, "npi": [1821186313]}, {"billed_charge": 30.56, "npi": [1821186313]}, {"billed_charge": 271.7, "npi": [1821186313]}, {"billed_charge": 26.64, "npi": [1821186313]}, {"billed_charge": 43.75, "npi": [1821186313]}, {"billed_charge": 84.0, "npi": [1821186313]}, {"billed_charge": 59.29, "npi": [1821186313]}, {"billed_charge": 60.0033, "npi": [1821186313]}, {"billed_charge": 90.38, "npi": [1821186313]}, {"billed_charge": 108.2742, "npi": [1821186313]}, {"billed_charge": 188.6367, "npi": [1821186313]}, {"billed_charge": 20.61, "npi": [1821186313]}, {"billed_charge": 49.524, "npi": [1821186313]}, {"billed_charge": 105.91, "npi": [1821186313]}]}]}]}, {"name": "Laboratory - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0300", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 275.0, "npi": [1306938071]}, {"billed_charge": 317.6667, "npi": [1306938071]}, {"billed_charge": 113.75, "npi": [1306938071]}, {"billed_charge": 84.7273, "npi": [1306938071]}, {"billed_charge": 236.15, "npi": [1306938071]}, {"billed_charge": 270.8, "npi": [1306938071]}, {"billed_charge": 30.0, "npi": [1306938071]}, {"billed_charge": 101.25, "npi": [1306938071]}, {"billed_charge": 991.5, "npi": [1306938071]}, {"billed_charge": 97.0, "npi": [1306938071]}, {"billed_charge": 236.3333, "npi": [1306938071]}, {"billed_charge": 290.4737, "npi": [1306938071]}, {"billed_charge": 369.1429, "npi": [1306938071]}, {"billed_charge": 297.0, "npi": [1306938071]}, {"billed_charge": 388.0, "npi": [1306938071]}, {"billed_charge": 182.0455, "npi": [1306938071]}, {"billed_charge": 229.0, "npi": [1306938071]}, {"billed_charge": 197.5, "npi": [1306938071]}, {"billed_charge": 134.1111, "npi": [1306938071]}, {"billed_charge": 278.2857, "npi": [1306938071]}, {"billed_charge": 253.3333, "npi": [1306938071]}, {"billed_charge": 147.125, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 223.0, "npi": [1306938071]}]}, {"allowed_amount": 320.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 791.0, "npi": [1306938071]}]}]}]}, {"name": "Laboratory - Chemistry", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0301", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 9.04, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 41.18, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 156.6529, "npi": [1821186313]}, {"billed_charge": 223.14, "npi": [1821186313]}, {"billed_charge": 164.3772, "npi": [1821186313]}, {"billed_charge": 233.87, "npi": [1821186313]}, {"billed_charge": 145.46, "npi": [1821186313]}, {"billed_charge": 136.2086, "npi": [1821186313]}, {"billed_charge": 160.4896, "npi": [1821186313]}, {"billed_charge": 168.8936, "npi": [1821186313]}, {"billed_charge": 80.54, "npi": [1821186313]}, {"billed_charge": 184.72, "npi": [1821186313]}, {"billed_charge": 168.05, "npi": [1821186313]}, {"billed_charge": 150.82, "npi": [1821186313]}, {"billed_charge": 141.97, "npi": [1821186313]}, {"billed_charge": 282.44, "npi": [1821186313]}, {"billed_charge": 66.37, "npi": [1821186313]}, {"billed_charge": 214.66, "npi": [1821186313]}, {"billed_charge": 104.51, "npi": [1821186313]}, {"billed_charge": 146.3914, "npi": [1821186313]}, {"billed_charge": 223.8843, "npi": [1821186313]}, {"billed_charge": 150.449, "npi": [1821186313]}, {"billed_charge": 552.47, "npi": [1821186313]}, {"billed_charge": 66.9, "npi": [1821186313]}, {"billed_charge": 203.34, "npi": [1821186313]}, {"billed_charge": 127.09, "npi": [1821186313]}, {"billed_charge": 111.0647, "npi": [1821186313]}, {"billed_charge": 477.59, "npi": [1821186313]}, {"billed_charge": 140.6307, "npi": [1821186313]}, {"billed_charge": 183.59, "npi": [1821186313]}, {"billed_charge": 211.84, "npi": [1821186313]}, {"billed_charge": 270.42, "npi": [1821186313]}, {"billed_charge": 193.47, "npi": [1821186313]}, {"billed_charge": 93.21, "npi": [1821186313]}, {"billed_charge": 76.26, "npi": [1821186313]}, {"billed_charge": 190.2925, "npi": [1821186313]}, {"billed_charge": 138.4159, "npi": [1821186313]}, {"billed_charge": 171.4088, "npi": [1821186313]}, {"billed_charge": 148.043, "npi": [1821186313]}, {"billed_charge": 159.8631, "npi": [1821186313]}, {"billed_charge": 201.67, "npi": [1821186313]}, {"billed_charge": 177.94, "npi": [1821186313]}]}, {"allowed_amount": 13.2, "billing_code_modifier": [""], "providers": [{"billed_charge": 83.32, "npi": [1821186313]}]}, {"allowed_amount": 30.8, "billing_code_modifier": [""], "providers": [{"billed_charge": 272.12, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 168.05, "npi": [1821186313]}, {"billed_charge": 67.02, "npi": [1821186313]}, {"billed_charge": 66.9, "npi": [1821186313]}, {"billed_charge": 56.61, "npi": [1821186313]}, {"billed_charge": 35.58, "npi": [1821186313]}]}]}]}, {"name": "Occupational Therapy - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0430", "description": "Occupational Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 257.5, "npi": [1306938071]}, {"billed_charge": 248.6667, "npi": [1306938071]}, {"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 255.25, "npi": [1306938071]}, {"billed_charge": 255.7, "npi": [1306938071]}, {"billed_charge": 257.0, "npi": [1306938071]}, {"billed_charge": 265.0, "npi": [1306938071]}, {"billed_charge": 254.5, "npi": [1306938071]}, {"billed_charge": 251.6, "npi": [1306938071]}, {"billed_charge": 251.0, "npi": [1306938071]}, {"billed_charge": 256.5, "npi": [1306938071]}, {"billed_charge": 260.3333, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GO"], "providers": [{"billed_charge": 237.0, "npi": [1306938071]}, {"billed_charge": 240.0, "npi": [1306938071]}, {"billed_charge": 272.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["GOU5"], "providers": [{"billed_charge": 272.0, "npi": [1306938071]}]}]}]}, {"name": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION VENOUS BLOOD VENIPUNCTURE", "allowed_amounts": [{"tin": {"type": "ein", "value": "592447554"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 3.3, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1417952748]}]}, {"allowed_amount": 4.4, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1417952748]}]}, {"allowed_amount": 4.31, "billing_code_modifier": [""], "providers": [{"billed_charge": 11.0, "npi": [1417952748]}]}]}]}, {"name": "Laboratory - Urology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0307", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 113.0, "npi": [1578620449]}, {"billed_charge": 280.0, "npi": [1578620449]}, {"billed_charge": 199.0, "npi": [1578620449]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 199.0, "npi": [1578620449]}]}]}]}, {"name": "Radiology - Diagnostic - Chest X-Ray", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0324", "description": "Radiology - Diagnostic", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 834.83, "npi": [1821186313]}, {"billed_charge": 710.27, "npi": [1821186313]}, {"billed_charge": 585.71, "npi": [1821186313]}]}, {"allowed_amount": 207.99, "billing_code_modifier": [""], "providers": [{"billed_charge": 834.83, "npi": [1821186313]}, {"billed_charge": 585.71, "npi": [1821186313]}]}, {"allowed_amount": 203.27, "billing_code_modifier": [""], "providers": [{"billed_charge": 834.83, "npi": [1821186313]}]}]}]}, {"name": "ASSAY OF TROPONIN QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84484", "description": "ASSAY OF TROPONIN QUANTITATIVE", "allowed_amounts": [{"tin": {"type": "ein", "value": "650232993"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 214.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 535.0, "npi": [1578547865]}]}, {"allowed_amount": 209.72, "billing_code_modifier": [""], "providers": [{"billed_charge": 535.0, "npi": [1578547865]}]}]}]}, {"name": "EMERGENCY DEPARTMENT VISIT LOW MDM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99283", "description": "EMERGENCY DEPARTMENT VISIT LOW MDM", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 711.09, "billing_code_modifier": [""], "providers": [{"billed_charge": 1814.0, "npi": [1417279936]}]}, {"allowed_amount": 711.09, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1814.0, "npi": [1417279936]}]}, {"allowed_amount": 725.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 1814.0, "npi": [1417279936]}]}, {"allowed_amount": 725.6, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1814.0, "npi": [1417279936]}]}]}]}, {"name": "Laboratory - Urology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0307", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 307.0, "npi": [1306938071]}, {"billed_charge": 304.0, "npi": [1306938071]}, {"billed_charge": 314.6667, "npi": [1306938071]}, {"billed_charge": 270.0, "npi": [1306938071]}, {"billed_charge": 337.0, "npi": [1306938071]}, {"billed_charge": 367.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 307.0, "npi": [1306938071]}, {"billed_charge": 367.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 307.0, "npi": [1306938071]}]}]}]}, {"name": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0429", "description": "AMBULANCE SERVICE BLS EMERGENCY TRANSPORT", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000344"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 550.0, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 550.0, "npi": [1356341531]}]}, {"allowed_amount": 550.0, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 550.0, "npi": [1356341531]}]}, {"allowed_amount": 550.0, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 550.0, "npi": [1356341531]}]}]}]}, {"name": "Pharmacy - Drugs Incident to Radiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0255", "description": "Pharmacy (also see 063x, an extension of 025x)", "allowed_amounts": [{"tin": {"type": "ein", "value": "590747311"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 0.01, "npi": [1578620449]}, {"billed_charge": 0.1, "npi": [1578620449]}, {"billed_charge": 0.005, "npi": [1578620449]}, {"billed_charge": 0.0103, "npi": [1578620449]}, {"billed_charge": 0.0114, "npi": [1578620449]}, {"billed_charge": 0.0154, "npi": [1578620449]}, {"billed_charge": 0.0105, "npi": [1578620449]}, {"billed_charge": 0.0233, "npi": [1578620449]}, {"billed_charge": 0.014, "npi": [1578620449]}]}]}]}, {"name": "INJECTION ONDANSETRON HCL PER 1 MG", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J2405", "description": "INJECTION ONDANSETRON HCL PER 1 MG", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 1.96, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1417279936]}]}, {"allowed_amount": 2.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5.0, "npi": [1417279936]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000534"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["NH"], "providers": [{"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1437262565]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.66, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 15.0, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 10.0, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 10.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 27.5, "npi": [1437262565]}, {"billed_charge": 15.0, "npi": [1437262565]}, {"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 12.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6617, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 15.0, "npi": [1437262565]}]}, {"allowed_amount": 10.0, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 10.0, "npi": [1437262565]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 15.0, "npi": [1437262565]}]}]}]}, {"name": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{"tin": {"type": "ein", "value": "922847892"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 248.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 186.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}, {"allowed_amount": 247.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 620.0, "npi": [1992351621]}]}]}]}, {"name": "Emergency Room - General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0450", "description": "Emergency Room", "allowed_amounts": [{"tin": {"type": "ein", "value": "841793121"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 3574.0, "npi": [1801457510]}, {"billed_charge": 1593.0, "npi": [1801457510]}, {"billed_charge": 7600.0, "npi": [1801457510]}, {"billed_charge": 6054.0, "npi": [1801457510]}]}, {"allowed_amount": 388.4, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 2516.12, "npi": [1801457510]}]}, {"allowed_amount": 201.55, "billing_code_modifier": [""], "providers": [{"billed_charge": 490.0, "npi": [1801457510]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 3294.43, "npi": [1801457510]}, {"billed_charge": 534.86, "npi": [1801457510]}]}, {"allowed_amount": 997.28, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3574.0, "npi": [1801457510]}, {"billed_charge": 2516.11, "npi": [1801457510]}, {"billed_charge": 3392.0, "npi": [1801457510]}, {"billed_charge": 1593.0, "npi": [1801457510]}, {"billed_charge": 6054.0, "npi": [1801457510]}]}, {"allowed_amount": 652.42, "billing_code_modifier": [""], "providers": [{"billed_charge": 1533.0, "npi": [1801457510]}]}, {"allowed_amount": 365.61, "billing_code_modifier": [""], "providers": [{"billed_charge": 665.0, "npi": [1801457510]}]}, {"allowed_amount": 566.08, "billing_code_modifier": [""], "providers": [{"billed_charge": 1013.59, "npi": [1801457510]}]}, {"allowed_amount": 1423.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 6054.0, "npi": [1801457510]}]}, {"allowed_amount": 639.26, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 1593.0, "npi": [1801457510]}]}, {"allowed_amount": 652.42, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3392.0, "npi": [1801457510]}]}, {"allowed_amount": 1415.47, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3574.0, "npi": [1801457510]}]}, {"allowed_amount": 639.26, "billing_code_modifier": [""], "providers": [{"billed_charge": 1533.0, "npi": [1801457510]}]}, {"allowed_amount": 1423.36, "billing_code_modifier": ["25"], "providers": [{"billed_charge": 3574.0, "npi": [1801457510]}, {"billed_charge": 3294.43, "npi": [1801457510]}, {"billed_charge": 6054.0, "npi": [1801457510]}]}, {"allowed_amount": 516.07, "billing_code_modifier": [""], "providers": [{"billed_charge": 1230.46, "npi": [1801457510]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000375"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 709.13, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 830.0, "npi": [1821109612]}, {"billed_charge": 860.0, "npi": [1821109612]}, {"billed_charge": 890.0, "npi": [1821109612]}, {"billed_charge": 800.0, "npi": [1821109612]}]}, {"allowed_amount": 709.13, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 830.0, "npi": [1821109612]}, {"billed_charge": 860.0, "npi": [1821109612]}, {"billed_charge": 890.0, "npi": [1821109612]}]}]}]}, {"name": "ASSAY OF TROPONIN QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84484", "description": "ASSAY OF TROPONIN QUANTITATIVE", "allowed_amounts": [{"tin": {"type": "ein", "value": "522438452"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 214.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 535.0, "npi": [1417279936]}]}, {"allowed_amount": 209.72, "billing_code_modifier": [""], "providers": [{"billed_charge": 535.0, "npi": [1417279936]}]}]}]}, {"name": "IV Therapy -General", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0260", "description": "IV Therapy", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 508.39, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 106.51, "billing_code_modifier": [""], "providers": [{"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 899.41, "npi": [1821186313]}, {"billed_charge": 561.6456, "npi": [1821186313]}, {"billed_charge": 798.245, "npi": [1821186313]}, {"billed_charge": 548.845, "npi": [1821186313]}, {"billed_charge": 556.985, "npi": [1821186313]}, {"billed_charge": 593.322, "npi": [1821186313]}, {"billed_charge": 262.41, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 111.92, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 336.515, "npi": [1821186313]}, {"billed_charge": 697.085, "npi": [1821186313]}]}, {"allowed_amount": 508.39, "billing_code_modifier": [""], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 486.43, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 111.92, "billing_code_modifier": [""], "providers": [{"billed_charge": 336.515, "npi": [1821186313]}, {"billed_charge": 336.51, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 262.405, "npi": [1821186313]}, {"billed_charge": 262.41, "npi": [1821186313]}]}, {"allowed_amount": 111.9167, "billing_code_modifier": [""], "providers": [{"billed_charge": 336.5133, "npi": [1821186313]}]}, {"allowed_amount": 486.43, "billing_code_modifier": [""], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 106.51, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 336.51, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 508.39, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 761.18, "npi": [1821186313]}, {"billed_charge": 899.41, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}, {"allowed_amount": 106.515, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 336.515, "npi": [1821186313]}]}, {"allowed_amount": 111.92, "billing_code_modifier": ["59"], "providers": [{"billed_charge": 336.515, "npi": [1821186313]}, {"billed_charge": 697.085, "npi": [1821186313]}, {"billed_charge": 336.51, "npi": [1821186313]}, {"billed_charge": 697.08, "npi": [1821186313]}]}]}]}, {"name": "Hepatic Function Panel", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "Hepatic Function Panel", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 236.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1528042884]}]}, {"allowed_amount": 231.28, "billing_code_modifier": [""], "providers": [{"billed_charge": 590.0, "npi": [1528042884]}]}]}]}, {"name": "Laboratory - Hematology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0305", "description": "Laboratory", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 177.106, "npi": [1821186313]}, {"billed_charge": 194.89, "npi": [1821186313]}, {"billed_charge": 191.5342, "npi": [1821186313]}, {"billed_charge": 194.33, "npi": [1821186313]}, {"billed_charge": 194.2857, "npi": [1821186313]}, {"billed_charge": 179.92, "npi": [1821186313]}, {"billed_charge": 189.8935, "npi": [1821186313]}, {"billed_charge": 190.71, "npi": [1821186313]}, {"billed_charge": 201.8343, "npi": [1821186313]}, {"billed_charge": 73.19, "npi": [1821186313]}, {"billed_charge": 198.5971, "npi": [1821186313]}, {"billed_charge": 211.84, "npi": [1821186313]}, {"billed_charge": 172.9553, "npi": [1821186313]}, {"billed_charge": 141.21, "npi": [1821186313]}, {"billed_charge": 188.54, "npi": [1821186313]}, {"billed_charge": 194.442, "npi": [1821186313]}]}]}]}, {"name": "Cardiology - Echocardiology", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0483", "description": "Cardiology", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 5276.0, "npi": [1306938071]}, {"billed_charge": 3217.25, "npi": [1306938071]}, {"billed_charge": 1252.6667, "npi": [1306938071]}, {"billed_charge": 3629.0, "npi": [1306938071]}, {"billed_charge": 2962.8, "npi": [1306938071]}, {"billed_charge": 3446.0, "npi": [1306938071]}]}, {"allowed_amount": 1277.57, "billing_code_modifier": [""], "providers": [{"billed_charge": 5276.0, "npi": [1306938071]}]}]}]}, {"name": "Other Diagnostic Services - Peripheral Vascular Lab", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0921", "description": "Other Diagnostic Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 2358.0, "npi": [1306938071]}, {"billed_charge": 1940.0, "npi": [1306938071]}, {"billed_charge": 1828.0, "npi": [1306938071]}, {"billed_charge": 2372.0, "npi": [1306938071]}, {"billed_charge": 2097.0, "npi": [1306938071]}, {"billed_charge": 1924.5714, "npi": [1306938071]}, {"billed_charge": 2185.6667, "npi": [1306938071]}, {"billed_charge": 2177.0, "npi": [1306938071]}, {"billed_charge": 1710.0, "npi": [1306938071]}]}, {"allowed_amount": 240.17, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 2097.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": ["LT"], "providers": [{"billed_charge": 2097.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 2097.0, "npi": [1306938071]}]}, {"allowed_amount": 557.89, "billing_code_modifier": [""], "providers": [{"billed_charge": 2372.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["RT"], "providers": [{"billed_charge": 2097.0, "npi": [1306938071]}]}]}]}, {"name": "Pharmacy - Extension of 25X - Drug Requiring Detailed Coding", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0636", "description": "Pharmacy - Extension of 25x", "allowed_amounts": [{"tin": {"type": "ein", "value": "592142859"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.77, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 24.235, "npi": [1821186313]}, {"billed_charge": 7.27, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 0.486, "npi": [1821186313]}, {"billed_charge": 0.081, "npi": [1821186313]}, {"billed_charge": 290.23, "npi": [1821186313]}, {"billed_charge": 12.24, "npi": [1821186313]}, {"billed_charge": 34.34, "npi": [1821186313]}, {"billed_charge": 25.2, "npi": [1821186313]}, {"billed_charge": 11.75, "npi": [1821186313]}, {"billed_charge": 0.1224, "npi": [1821186313]}, {"billed_charge": 0.1993, "npi": [1821186313]}, {"billed_charge": 7.266, "npi": [1821186313]}, {"billed_charge": 2.34, "npi": [1821186313]}, {"billed_charge": 0.5563, "npi": [1821186313]}, {"billed_charge": 308.88, "npi": [1821186313]}, {"billed_charge": 17.17, "npi": [1821186313]}, {"billed_charge": 24.13, "npi": [1821186313]}, {"billed_charge": 36.0, "npi": [1821186313]}, {"billed_charge": 18.6, "npi": [1821186313]}, {"billed_charge": 72.0, "npi": [1821186313]}, {"billed_charge": 0.4519, "npi": [1821186313]}, {"billed_charge": 12.82, "npi": [1821186313]}]}, {"allowed_amount": 0.69, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 7.27, "npi": [1821186313]}, {"billed_charge": 24.3, "npi": [1821186313]}]}, {"allowed_amount": 0.76, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 24.24, "npi": [1821186313]}, {"billed_charge": 7.27, "npi": [1821186313]}, {"billed_charge": 24.3, "npi": [1821186313]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["JZ"], "providers": [{"billed_charge": 4.2, "npi": [1821186313]}, {"billed_charge": 7.595, "npi": [1821186313]}, {"billed_charge": 1.08, "npi": [1821186313]}, {"billed_charge": 5.76, "npi": [1821186313]}, {"billed_charge": 3.8965, "npi": [1821186313]}, {"billed_charge": 1.71, "npi": [1821186313]}, {"billed_charge": 4.375, "npi": [1821186313]}, {"billed_charge": 0.825, "npi": [1821186313]}, {"billed_charge": 0.3744, "npi": [1821186313]}, {"billed_charge": 2.16, "npi": [1821186313]}]}]}]}, {"name": "RINGERS LACTATE INFUSION UP TO 1000 CC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "J7120", "description": "RINGERS LACTATE INFUSION UP TO 1000 CC", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 52.25, "billing_code_modifier": [""], "providers": [{"billed_charge": 95.0, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 78.38, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 79.01, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}, {"allowed_amount": 104.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 190.0, "npi": [1285662239]}]}]}]}, {"name": "Medical/Surgical Supplies and Devices - Nonsterile Supply", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0271", "description": "Med/Surg Supplies &Devices (also see 062x, extension of 027x", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 518.0, "npi": [1285662239]}]}, {"allowed_amount": 284.9, "billing_code_modifier": [""], "providers": [{"billed_charge": 518.0, "npi": [1285662239]}]}, {"allowed_amount": 124.12, "billing_code_modifier": [""], "providers": [{"billed_charge": 225.68, "npi": [1285662239]}]}, {"allowed_amount": 86.88, "billing_code_modifier": [""], "providers": [{"billed_charge": 225.68, "npi": [1285662239]}]}, {"allowed_amount": 213.68, "billing_code_modifier": [""], "providers": [{"billed_charge": 518.0, "npi": [1285662239]}]}, {"allowed_amount": 285.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 519.28, "npi": [1285662239]}]}, {"allowed_amount": 449.5788, "billing_code_modifier": [""], "providers": [{"billed_charge": 817.415, "npi": [1285662239]}]}, {"allowed_amount": 47.43, "billing_code_modifier": [""], "providers": [{"billed_charge": 86.23, "npi": [1285662239]}]}]}]}, {"name": "GROUND MILEAGE PER STATUTE MILE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0425", "description": "GROUND MILEAGE PER STATUTE MILE", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000773"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 11.6633, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["EH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.662, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6625, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6629, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.665, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}, {"allowed_amount": 11.6633, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 17.0, "npi": [1033215348]}]}]}]}, {"name": "Other Imaging Services - Ultrasound", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "0402", "description": "Other Imaging Services", "allowed_amounts": [{"tin": {"type": "ein", "value": "590724459"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 1060.0, "npi": [1306938071]}, {"billed_charge": 1750.0, "npi": [1306938071]}, {"billed_charge": 1288.5, "npi": [1306938071]}, {"billed_charge": 1162.0, "npi": [1306938071]}, {"billed_charge": 630.0, "npi": [1306938071]}, {"billed_charge": 1009.0, "npi": [1306938071]}, {"billed_charge": 1517.0, "npi": [1306938071]}, {"billed_charge": 1380.0, "npi": [1306938071]}, {"billed_charge": 1265.0, "npi": [1306938071]}, {"billed_charge": 1568.0, "npi": [1306938071]}, {"billed_charge": 460.0, "npi": [1306938071]}]}, {"allowed_amount": 240.17, "billing_code_modifier": ["XURT"], "providers": [{"billed_charge": 2303.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": ["XURT"], "providers": [{"billed_charge": 2303.0, "npi": [1306938071]}]}, {"allowed_amount": 0.0, "billing_code_modifier": ["XU"], "providers": [{"billed_charge": 1162.0, "npi": [1306938071]}]}, {"allowed_amount": 244.44, "billing_code_modifier": [""], "providers": [{"billed_charge": 1750.0, "npi": [1306938071]}, {"billed_charge": 1623.0, "npi": [1306938071]}, {"billed_charge": 1860.0, "npi": [1306938071]}, {"billed_charge": 1983.0, "npi": [1306938071]}]}, {"allowed_amount": 240.17, "billing_code_modifier": [""], "providers": [{"billed_charge": 1750.0, "npi": [1306938071]}, {"billed_charge": 1623.0, "npi": [1306938071]}]}]}]}, {"name": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT COMPLETE AUTO AND AUTO DIFRNTL WBC", "allowed_amounts": [{"tin": {"type": "ein", "value": "590910342"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 152.49, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1528042884]}]}, {"allowed_amount": 85.06, "billing_code_modifier": [""], "providers": [{"billed_charge": 217.0, "npi": [1528042884]}]}, {"allowed_amount": 155.6, "billing_code_modifier": [""], "providers": [{"billed_charge": 389.0, "npi": [1528042884]}]}, {"allowed_amount": 68.36, "billing_code_modifier": [""], "providers": [{"billed_charge": 217.0, "npi": [1528042884]}]}]}]}, {"name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "A0427", "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1", "allowed_amounts": [{"tin": {"type": "ein", "value": "596000344"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 635.0, "billing_code_modifier": ["PH"], "providers": [{"billed_charge": 635.0, "npi": [1356341531]}]}, {"allowed_amount": 635.0, "billing_code_modifier": ["RH"], "providers": [{"billed_charge": 635.0, "npi": [1356341531]}]}, {"allowed_amount": 635.0, "billing_code_modifier": ["SH"], "providers": [{"billed_charge": 635.0, "npi": [1356341531]}]}]}]}, {"name": "BASIC METABOLIC PANEL CALCIUM TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL CALCIUM TOTAL", "allowed_amounts": [{"tin": {"type": "ein", "value": "596012065"}, "service_code": [""], "billing_class": "institutional", "payments": [{"allowed_amount": 258.5, "billing_code_modifier": [""], "providers": [{"billed_charge": 671.42, "npi": [1285662239]}]}, {"allowed_amount": 0.0, "billing_code_modifier": [""], "providers": [{"billed_charge": 671.42, "npi": [1285662239]}]}, {"allowed_amount": 369.28, "billing_code_modifier": [""], "providers": [{"billed_charge": 671.42, "npi": [1285662239]}]}, {"allowed_amount": 218.9, "billing_code_modifier": [""], "providers": [{"billed_charge": 398.0, "npi": [1376571323]}]}, {"allowed_amount": 276.96, "billing_code_modifier": [""], "providers": [{"billed_charge": 671.42, "npi": [1285662239]}]}, {"allowed_amount": 369.28, "billing_code_modifier": ["91"], "providers": [{"billed_charge": 671.42, "npi": [1285662239]}]}]}]}]}