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"providers": [ { "billed_charge": 26.75, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 5.68, "providers": [ { "billed_charge": 26.75, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 10.00, "providers": [ { "billed_charge": 26.75, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 10.15, "providers": [ { "billed_charge": 26.75, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BCR/ABL1 MAJOR BREAKPNT QUALITATIVE/QUANTITATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81206", "description": "BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 49.19, "providers": [ { "billed_charge": 481.48, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLD GLU TEST/REAGT STRIPS HOME BLD GLU MON-50", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4253", "description": "Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1467488148" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.24, "providers": [ { "billed_charge": 37.44, "npi": [ 1467488148 ] }, { "billed_charge": 49.92, "npi": [ 1467488148 ] }, { "billed_charge": 62.40, "npi": [ 1467488148 ] }, { "billed_charge": 124.80, "npi": [ 1467488148 ] } ] }, { "allowed_amount": 37.44, "providers": [ { "billed_charge": 37.44, "npi": [ 1467488148 ] } ] } ] } ] }, { "name": "BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1033716147" }, "service_code": [], "billing_class": "institutional", "payments": [ { "allowed_amount": 68.51, "providers": [ { "billed_charge": 155.00, "npi": [ 1033716147 ] } ] } ] }, { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.54, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 0.78, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 1.96, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 2.75, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 2.79, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 4.58, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 6.20, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 9.32, "providers": [ { "billed_charge": 30.00, "npi": [ 1043256886 ] }, { "billed_charge": 45.50, "npi": [ 1043256886 ] } ] } ] }, { "tin": { "type": "npi", "value": "1538118989" }, "service_code": [], "billing_class": "institutional", "payments": [ { "allowed_amount": 178.19, "providers": [ { "billed_charge": 333.76, "npi": [ 1538118989 ] } ] } ] } ] }, { "name": "BLOOD COUNT COMPLETE AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85027", "description": "Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.34, "providers": [ { "billed_charge": 22.20, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 6.76, "providers": [ { "billed_charge": 22.20, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 7.76, "providers": [ { "billed_charge": 15.94, "npi": [ 1043256886 ] }, { "billed_charge": 22.20, "npi": [ 1043256886 ] }, { "billed_charge": 30.00, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLOOD COUNT HEMATOCRIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85014", "description": "Blood count; hematocrit (Hct)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.84, "providers": [ { "billed_charge": 5.10, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLOOD COUNT HEMOGLOBIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85018", "description": "Blood count; hemoglobin (Hgb)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.84, "providers": [ { "billed_charge": 5.10, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLOOD COUNT SMEAR MCRSCP W/MNL DIFRNTL WBC COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85007", "description": "Blood count; blood smear, microscopic examination with manual differential WBC count", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 2.24, "providers": [ { "billed_charge": 8.47, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLOOD OCCULT FECAL HGB DETER IA QUAL FECES 1-3", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82274", "description": "Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 66.87, "npi": [ 1043256886 ] }, { "billed_charge": 116.99, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BLOOD SMEAR PERIPHERAL INTERP PHYS W/WRIT REPORT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85060", "description": "Blood smear, peripheral, interpretation by physician with written report", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1285019612" }, "service_code": [ "21" ], "billing_class": "professional", "payments": [ { "allowed_amount": 29.82, "providers": [ { "billed_charge": 81.00, "npi": [ 1285019612 ] } ] } ] }, { "tin": { "type": "npi", "value": "1396810057" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 54.00, "npi": [ 1396810057 ] } ] } ] } ] }, { "name": "BLOOD TYPING SEROLOGIC ABO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86900", "description": "Blood typing, serologic; ABO", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.68, "providers": [ { "billed_charge": 27.87, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "BOTULINUM TOXIN TYPE A PER UNIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0585", "description": "Injection, onabotulinumtoxinA, 1 unit", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1467488148" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.00, "providers": [ { "billed_charge": 746.40, "npi": [ 1467488148 ] }, { "billed_charge": 1492.80, "npi": [ 1467488148 ] }, { "billed_charge": 2985.60, "npi": [ 1467488148 ] }, { "billed_charge": 5224.80, "npi": [ 1467488148 ] } ] } ] } ] }, { "name": "BRAIN IMAGING PET METABOLIC EVALUATION", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "78608", "description": "Brain imaging, positron emission tomography (PET); metabolic evaluation", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1891795274" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 950.00, "providers": [ { "billed_charge": 2541.00, "npi": [ 1891795274 ] } ] } ] } ] }, { "name": "BREAST PUMP ELECTRIC ANY TYPE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0603", "description": "Breast pump, electric (AC and/or DC), any type", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1467488148" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 120.00, "providers": [ { "billed_charge": 120.00, "npi": [ 1467488148 ] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-reactive protein;", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 1.34, "providers": [ { "billed_charge": 53.50, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 2.19, "providers": [ { "billed_charge": 53.50, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 6.22, "providers": [ { "billed_charge": 53.50, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "CALCIUM IONIZED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82330", "description": "Calcium; ionized", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 55.73, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "CALCIUM URINE QUANTITATIVE TIMED SPECIMEN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82340", "description": "Calcium; urine quantitative, timed specimen", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 7.24, "providers": [ { "billed_charge": 28.69, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "CANNULA NASAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A4615", "description": "Cannula, nasal", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1831371848" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.62, "providers": [ { "billed_charge": 1.20, "npi": [ 1831371848 ] } ] } ] } ] }, { "name": "CARCINOEMBRYONIC ANTIGEN CEA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82378", "description": "Carcinoembryonic antigen (CEA)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.68, "providers": [ { "billed_charge": 93.62, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 2.75, "providers": [ { "billed_charge": 93.62, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 10.00, "providers": [ { "billed_charge": 93.62, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "CARDIOLIPIN ANTIBODY EACH IG CLASS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86147", "description": "Cardiolipin (phospholipid) antibody, each Ig class", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.23, "providers": [ { "billed_charge": 97.75, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 3.33, "providers": [ { "billed_charge": 97.75, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "CERVICAL FLEXIBLE NONADJUSTABLE PREFAB OFF SHELF", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "L0120", "description": "Cervical, flexible, nonadjustable, prefabricated, off-the-shelf (foam collar)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1659342475" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 24.86, "providers": [ { "billed_charge": 41.44, "npi": [ 1659342475 ] } ] } ] } ] }, { "name": "CHOLESTEROL SERUM/WHOLE BLOOD TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82465", "description": "Cholesterol, serum or whole blood, total", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.22, "providers": [ { "billed_charge": 39.00, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "45378", "description": "Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1801073648" }, "service_code": [ "24" ], "billing_class": "professional", "payments": [ { "allowed_amount": 446.62, "providers": [ { "billed_charge": 1600.00, "npi": [ 1801073648 ] } ] } ] } ] }, { "name": "COMPLEMENT ANTIGEN EACH COMPONENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86160", "description": "Complement; antigen, each component", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 171.30, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "COMPREHENSIVE METABOLIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80053", "description": "Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1033716147" }, "service_code": [], "billing_class": "institutional", "payments": [ { "allowed_amount": 297.47, "providers": [ { "billed_charge": 673.00, "npi": [ 1033716147 ] } ] } ] }, { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 0.68, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 1.73, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 1.96, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 2.24, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 3.78, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 5.68, "providers": [ { "billed_charge": 23.41, "npi": [ 1043256886 ] }, { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 6.20, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 7.24, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 10.00, "providers": [ { "billed_charge": 33.42, "npi": [ 1043256886 ] } ] } ] }, { "tin": { "type": "npi", "value": "1538105366" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 0.14, "npi": [ 1538105366 ] } ] } ] }, { "tin": { "type": "npi", "value": "1538118989" }, "service_code": [], "billing_class": "institutional", "payments": [ { "allowed_amount": 412.22, "providers": [ { "billed_charge": 772.10, "npi": [ 1538118989 ] } ] } ] } ] }, { "name": "CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0601", "description": "Continuous positive airway pressure (CPAP) device", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1063452829" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 175.00, "providers": [ { "billed_charge": 175.00, "npi": [ 1063452829 ] } ] } ] }, { "tin": { "type": "npi", "value": "1518025550" }, "service_code": [ "12" ], "billing_class": "professional", "payments": [ { "allowed_amount": 46.24, "providers": [ { "billed_charge": 175.00, "npi": [ 1518025550 ] } ] }, { "allowed_amount": 49.11, "providers": [ { "billed_charge": 175.00, "npi": [ 1518025550 ] } ] } ] } ] }, { "name": "CREATINE KINASE TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", 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"npi": [ 1700836137 ] } ] } ] } ] }, { "name": "OBSTETRIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80081", "description": "Obstetric panel (includes HIV testing)", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1043256886" }, "service_code": [ "81" ], "billing_class": "professional", "payments": [ { "allowed_amount": 6.20, "providers": [ { "billed_charge": 364.18, "npi": [ 1043256886 ] } ] }, { "allowed_amount": 10.00, "providers": [ { "billed_charge": 364.18, "npi": [ 1043256886 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99211", "description": "Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1063995447" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1063995447 ] } ] } ] }, { "tin": { "type": "npi", "value": "1134191836" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1134191836 ] } ] } ] }, { "tin": { "type": "npi", "value": "1205444510" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1205444510 ] } ] } ] }, { "tin": { "type": "npi", "value": "1356917074" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1356917074 ] } ] } ] }, { "tin": { "type": "npi", "value": "1508479593" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1508479593 ] } ] } ] }, { "tin": { "type": "npi", "value": "1629571161" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1629571161 ] } ] } ] }, { "tin": { "type": "npi", "value": "1730266537" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 17.28, "providers": [ { "billed_charge": 39.00, "npi": [ 1730266537 ] } ] }, { "allowed_amount": 39.00, "providers": [ { "billed_charge": 39.00, "npi": [ 1730266537 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99213", "description": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1013527845" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 110.00, "providers": [ { "billed_charge": 144.00, "npi": [ 1013527845 ] } ] } ] }, { "tin": { "type": "npi", "value": "1053872119" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 148.00, "providers": [ { "billed_charge": 333.00, "npi": [ 1053872119 ] } ] } ] }, { "tin": { "type": "npi", "value": "1063055481" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 281.00, "npi": [ 1063055481 ] } ] } ] }, { "tin": { "type": "npi", "value": "1104449461" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 32.42, "providers": [ { "billed_charge": 335.79, "npi": [ 1104449461 ] } ] } ] }, { "tin": { "type": "npi", "value": "1184197972" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 148.00, "providers": [ { "billed_charge": 333.00, "npi": [ 1184197972 ] } ] } ] }, { "tin": { "type": "npi", "value": "1194272880" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 54.41, "providers": [ { "billed_charge": 125.00, "npi": [ 1194272880 ] } ] } ] }, { "tin": { "type": "npi", "value": "1245707090" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 281.00, "npi": [ 1245707090 ] } ] } ] }, { "tin": { "type": "npi", "value": "1316548431" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1316548431 ] } ] } ] }, { "tin": { "type": "npi", "value": "1376010082" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 281.00, "npi": [ 1376010082 ] } ] } ] }, { "tin": { "type": "npi", "value": "1376041145" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 20.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1376041145 ] } ] }, { "allowed_amount": 30.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1376041145 ] } ] } ] }, { "tin": { "type": "npi", "value": "1396364055" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 32.42, "providers": [ { "billed_charge": 264.00, "npi": [ 1396364055 ] } ] } ] }, { "tin": { "type": "npi", "value": "1417424243" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1417424243 ] } ] } ] }, { "tin": { "type": "npi", "value": "1558329839" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1558329839 ] } ] } ] }, { "tin": { "type": "npi", "value": "1558723486" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 296.01, "npi": [ 1558723486 ] } ] } ] }, { "tin": { "type": "npi", "value": "1659796274" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1659796274 ] }, { "billed_charge": 281.00, "npi": [ 1659796274 ] } ] } ] }, { "tin": { "type": "npi", "value": "1710411400" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 222.00, "npi": [ 1710411400 ] } ] } ] }, { "tin": { "type": "npi", "value": "1740771252" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 222.00, "npi": [ 1740771252 ] } ] } ] }, { "tin": { "type": "npi", "value": "1811357627" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 111.36, "npi": [ 1811357627 ] }, { "billed_charge": 280.00, "npi": [ 1811357627 ] } ] } ] }, { "tin": { "type": "npi", "value": "1831709740" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 148.00, "providers": [ { "billed_charge": 333.00, "npi": [ 1831709740 ] } ] } ] }, { "tin": { "type": "npi", "value": "1861077398" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 32.42, "providers": [ { "billed_charge": 882.00, "npi": [ 1861077398 ] } ] } ] }, { "tin": { "type": "npi", "value": "1871095612" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1871095612 ] } ] } ] }, { "tin": { "type": "npi", "value": "1881166361" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 100.14, "providers": [ { "billed_charge": 116.00, "npi": [ 1881166361 ] } ] } ] }, { "tin": { "type": "npi", "value": "1881744886" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 50.00, "providers": [ { "billed_charge": 104.00, "npi": [ 1881744886 ] } ] } ] }, { "tin": { "type": "npi", "value": "1902448855" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 230.00, "npi": [ 1902448855 ] } ] } ] }, { "tin": { "type": "npi", "value": "1932106853" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 34.04, "providers": [ { "billed_charge": 177.00, "npi": [ 1932106853 ] } ] } ] }, { "tin": { "type": "npi", "value": "1942843719" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.00, "providers": [ { "billed_charge": 233.26, "npi": [ 1942843719 ] } ] } ] }, { "tin": { "type": "npi", "value": "1972690592" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 280.00, "npi": [ 1972690592 ] } ] } ] }, { "tin": { "type": "npi", "value": "1982149613" }, "service_code": [ "02" ], "billing_class": "professional", "payments": [ { "allowed_amount": 32.42, "providers": [ { "billed_charge": 220.00, "npi": [ 1982149613 ] } ] } ] }, { "tin": { "type": "npi", "value": "1992232334" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 26.31, "providers": [ { "billed_charge": 193.66, "npi": [ 1992232334 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99214", "description": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1053872119" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 410.00, "npi": [ 1053872119 ] } ] } ] }, { "tin": { "type": "npi", "value": "1225652191" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 65.00, "providers": [ { "billed_charge": 200.00, "npi": [ 1225652191 ] } ] } ] }, { "tin": { "type": "npi", "value": "1235771197" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 395.00, "npi": [ 1235771197 ] } ] } ] }, { "tin": { "type": "npi", "value": "1376041145" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 164.06, "npi": [ 1376041145 ] }, { "billed_charge": 395.00, "npi": [ 1376041145 ] } ] } ] }, { "tin": { "type": "npi", "value": "1457481517" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 158.00, "providers": [ { "billed_charge": 334.00, "npi": [ 1457481517 ] } ] } ] }, { "tin": { "type": "npi", "value": "1467018309" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 55.33, "providers": [ { "billed_charge": 440.00, "npi": [ 1467018309 ] } ] } ] }, { "tin": { "type": "npi", "value": "1558329839" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 164.06, "npi": [ 1558329839 ] }, { "billed_charge": 395.00, "npi": [ 1558329839 ] } ] } ] }, { "tin": { "type": "npi", "value": "1558723486" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 296.01, "npi": [ 1558723486 ] } ] } ] }, { "tin": { "type": "npi", "value": "1699382465" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 395.00, "npi": [ 1699382465 ] } ] } ] }, { "tin": { "type": "npi", "value": "1740771252" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 10.00, "providers": [ { "billed_charge": 222.00, "npi": [ 1740771252 ] } ] } ] }, { "tin": { "type": "npi", "value": "1902448855" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 395.00, "npi": [ 1902448855 ] } ] } ] }, { "tin": { "type": "npi", "value": "1942843719" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 25.00, "providers": [ { "billed_charge": 349.78, "npi": [ 1942843719 ] } ] } ] }, { "tin": { "type": "npi", "value": "1992832927" }, "service_code": [ "22" ], "billing_class": "professional", "payments": [ { "allowed_amount": 81.18, "providers": [ { "billed_charge": 237.41, "npi": [ 1992832927 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99212", "description": "Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1013329515" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 158.00, "providers": [ { "billed_charge": 140.00, "npi": [ 1013329515 ] } ] } ] }, { "tin": { "type": "npi", "value": "1013527845" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 110.00, "providers": [ { "billed_charge": 87.00, "npi": [ 1013527845 ] } ] } ] }, { "tin": { "type": "npi", "value": "1417424243" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 5.00, "providers": [ { "billed_charge": 176.00, "npi": [ 1417424243 ] } ] } ] }, { "tin": { "type": "npi", "value": "1538118989" }, "service_code": [], "billing_class": "institutional", "payments": [ { "allowed_amount": 75.00, "providers": [ { "billed_charge": 377.88, "npi": [ 1538118989 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99203", "description": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1013527845" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 110.00, "providers": [ { "billed_charge": 211.00, "npi": [ 1013527845 ] } ] } ] }, { "tin": { "type": "npi", "value": "1497282503" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 64.26, "providers": [ { "billed_charge": 147.00, "npi": [ 1497282503 ] } ] } ] }, { "tin": { "type": "npi", "value": "1659796274" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 30.00, "providers": [ { "billed_charge": 165.36, "npi": [ 1659796274 ] } ] } ] }, { "tin": { "type": "npi", "value": "1801130455" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 55.48, "providers": [ { "billed_charge": 173.80, "npi": [ 1801130455 ] } ] } ] }, { "tin": { "type": "npi", "value": "1821592445" }, "service_code": [ "20" ], "billing_class": "professional", "payments": [ { "allowed_amount": 148.00, "providers": [ { "billed_charge": 425.00, "npi": [ 1821592445 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99204", "description": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.", "allowed_amounts": [ { "tin": { "type": "npi", "value": "1568605806" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 74.80, "providers": [ { "billed_charge": 776.00, "npi": [ 1568605806 ] } ] } ] }, { "tin": { "type": "npi", "value": "1942843719" }, "service_code": [ "11" ], "billing_class": "professional", "payments": [ { "allowed_amount": 3.00, "providers": [ { "billed_charge": 415.00, "npi": [ 1942843719 ] } ] }, { "allowed_amount": 25.00, "providers": [ { "billed_charge": 415.00, "npi": [ 1942843719 ] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99202", "description": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. 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