28516 lines (28515 with data), 1.2 MB
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"line": ["13359 Fawn Ct"],
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"given": ["Priscilla Anton"]
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"value": 329.72,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_alowd_chrg_amt",
"display": "Line Allowed Charge Amount"
}
]
},
"amount": {
"value": 329.72,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_bene_ptb_ddctbl_amt",
"display": "Line Beneficiary Part B Deductible Amount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "https://bluebutton.cms.gov/resources/codesystem/adjudication",
"code": "https://bluebutton.cms.gov/resources/variables/line_prcsg_ind_cd",
"display": "Line Processing Indicator Code"
}
]
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted",
"display": "Submitted Amount"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 115.63,
"currency": "USD"
}
}
],
"payment": {
"amount": {
"value": 364.42400000000004,
"currency": "USD"
}
}
},
"request": {
"method": "POST",
"url": "ExplanationOfBenefit"
}
}
]
}