{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator", "version": "2.0.0","last_updated_on":"2026-03-04","out_of_network":[{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":378770.27,"providers":[{"billed_charge":306368.14,"npi":[1831116441]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"382947657"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":83.27,"providers":[{"billed_charge":199.00,"npi":[1326043316]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":143806.12,"providers":[{"billed_charge":223165.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":294819.80,"providers":[{"billed_charge":207765.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":296218.62,"providers":[{"billed_charge":151335.00,"npi":[1053356352]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1852174.04,"providers":[{"billed_charge":1015336.00,"npi":[1619289998]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"382409580"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":435960.07,"providers":[{"billed_charge":486000.00,"npi":[1053342220]}]}]},{"tin":{"type":"ein","value":"872121325"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":318348.12,"providers":[{"billed_charge":426000.00,"npi":[1073359717]}]}]},{"tin":{"type":"ein","value":"43232990"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":391262.06,"providers":[{"billed_charge":764100.00,"npi":[1144381245]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":75748.65,"providers":[{"billed_charge":175268.00,"npi":[1619289998]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2.84,"providers":[{"billed_charge":15569.84,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":51.49,"providers":[{"billed_charge":2610.60,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4.43,"providers":[{"billed_charge":3637.02,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":499.06,"providers":[{"billed_charge":67319.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.20,"providers":[{"billed_charge":1732.80,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.03,"providers":[{"billed_charge":5797.55,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2.61,"providers":[{"billed_charge":402.65,"npi":[1992761985]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5651.46,"providers":[{"billed_charge":17800.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15280.96,"providers":[{"billed_charge":63693.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1190.01,"providers":[{"billed_charge":27186.55,"npi":[1831116441]}]},{"allowed_amount":210.88,"providers":[{"billed_charge":545.48,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27562.71,"providers":[{"billed_charge":90234.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52350.21,"providers":[{"billed_charge":216379.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8256.94,"providers":[{"billed_charge":17124.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5393.03,"providers":[{"billed_charge":17000.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6686.21,"providers":[{"billed_charge":10305.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4887.78,"providers":[{"billed_charge":41246.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2574.44,"providers":[{"billed_charge":17354.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1539.31,"providers":[{"billed_charge":5190.80,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":681.29,"providers":[{"billed_charge":2778.12,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9365.07,"providers":[{"billed_charge":39007.96,"npi":[1083644579]}]},{"allowed_amount":826.86,"providers":[{"billed_charge":2302.61,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6820.90,"providers":[{"billed_charge":14854.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32494.87,"providers":[{"billed_charge":116396.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8227.07,"providers":[{"billed_charge":30056.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1096.98,"providers":[{"billed_charge":4083.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":522.90,"providers":[{"billed_charge":2169.68,"npi":[1346275856]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19.24,"providers":[{"billed_charge":176.40,"npi":[1083644579]}]},{"allowed_amount":1270.20,"providers":[{"billed_charge":6364.89,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":173.17,"providers":[{"billed_charge":354.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40.18,"providers":[{"billed_charge":43195.96,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":56.80,"providers":[{"billed_charge":297.12,"npi":[1831116441]}]},{"allowed_amount":784.02,"providers":[{"billed_charge":5696.53,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"410695604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":775.63,"providers":[{"billed_charge":1000.00,"npi":[1457393035]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1622.96,"providers":[{"billed_charge":95310.00,"npi":[1619289998]}]},{"allowed_amount":74.50,"providers":[{"billed_charge":60.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":153.36,"providers":[{"billed_charge":7330.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":133.17,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1200.67,"providers":[{"billed_charge":17015.00,"npi":[1811097223]}]},{"allowed_amount":9.09,"providers":[{"billed_charge":21.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":47.17,"providers":[{"billed_charge":2219.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15.12,"providers":[{"billed_charge":62.44,"npi":[1962508259]}]},{"allowed_amount":162.06,"providers":[{"billed_charge":668.86,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":41.06,"npi":[1306227764]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49.59,"providers":[{"billed_charge":4689.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":167.96,"providers":[{"billed_charge":1030.00,"npi":[1790706901]}]},{"allowed_amount":717.60,"providers":[{"billed_charge":53402.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":301.06,"providers":[{"billed_charge":1767.13,"npi":[1831116441]}]},{"allowed_amount":351.01,"providers":[{"billed_charge":36848.95,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":14.88,"providers":[{"billed_charge":435.00,"npi":[1780658443]}]},{"allowed_amount":967.90,"providers":[{"billed_charge":54783.15,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1036.38,"providers":[{"billed_charge":83591.59,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1945.93,"providers":[{"billed_charge":4161.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":197.38,"providers":[{"billed_charge":1492.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":26.78,"providers":[{"billed_charge":15376.00,"npi":[1811097223]}]},{"allowed_amount":5.12,"providers":[{"billed_charge":31.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.66,"providers":[{"billed_charge":15526.51,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":88.39,"providers":[{"billed_charge":423.00,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":22.86,"providers":[{"billed_charge":605.50,"npi":[1306227764]}]},{"allowed_amount":68.86,"providers":[{"billed_charge":34262.99,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":468.86,"providers":[{"billed_charge":1925.58,"npi":[1962508259]}]},{"allowed_amount":1955.41,"providers":[{"billed_charge":7814.30,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":88.41,"providers":[{"billed_charge":357.02,"npi":[1083644579]}]},{"allowed_amount":100.45,"providers":[{"billed_charge":24686.59,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":188.14,"providers":[{"billed_charge":373.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":44.14,"providers":[{"billed_charge":1555.00,"npi":[1619289998]}]},{"allowed_amount":3278.06,"providers":[{"billed_charge":189338.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":731.65,"providers":[{"billed_charge":16470.59,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23.58,"providers":[{"billed_charge":5751.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"314394942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2096.39,"providers":[{"billed_charge":3553.00,"npi":[1255377149]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21.22,"providers":[{"billed_charge":83.86,"npi":[1346275856]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":126.29,"providers":[{"billed_charge":22.27,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":61.06,"providers":[{"billed_charge":177.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":68.87,"providers":[{"billed_charge":635.95,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19.86,"providers":[{"billed_charge":12976.00,"npi":[1619289998]}]},{"allowed_amount":76.40,"providers":[{"billed_charge":585.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":163.80,"providers":[{"billed_charge":1339.00,"npi":[1053356352]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11.63,"providers":[{"billed_charge":88.00,"npi":[1790706901]}]},{"allowed_amount":137.28,"providers":[{"billed_charge":10465.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":30.76,"providers":[{"billed_charge":362.83,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":308.21,"providers":[{"billed_charge":21564.00,"npi":[1619289998]}]},{"allowed_amount":9.34,"providers":[{"billed_charge":95.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":162.88,"providers":[{"billed_charge":12067.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":214.75,"providers":[{"billed_charge":22041.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":113.51,"providers":[{"billed_charge":3960.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":41.65,"providers":[{"billed_charge":400.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7.77,"providers":[{"billed_charge":72.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":37.87,"providers":[{"billed_charge":156.14,"npi":[1962508259]}]},{"allowed_amount":381.82,"providers":[{"billed_charge":1474.97,"npi":[1962508259]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":106.00,"providers":[{"billed_charge":1283.00,"npi":[1871672618]}]},{"allowed_amount":70.66,"providers":[{"billed_charge":1135.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2278.00,"providers":[{"billed_charge":6927.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5562.70,"providers":[{"billed_charge":18645.17,"npi":[1831116441]}]},{"allowed_amount":192.04,"providers":[{"billed_charge":447.18,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4509.91,"providers":[{"billed_charge":17042.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10223.72,"providers":[{"billed_charge":42356.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1069.75,"providers":[{"billed_charge":2912.00,"npi":[1831132133]}]},{"allowed_amount":175.45,"providers":[{"billed_charge":743.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":427.90,"providers":[{"billed_charge":1639.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2709.97,"providers":[{"billed_charge":17620.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.95,"providers":[{"billed_charge":805.29,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19.49,"providers":[{"billed_charge":80.58,"npi":[1962508259]}]},{"allowed_amount":676.89,"providers":[{"billed_charge":2743.01,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":778.95,"providers":[{"billed_charge":8826.12,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4920.85,"providers":[{"billed_charge":11358.81,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.70,"providers":[{"billed_charge":213.00,"npi":[1619289998]}]},{"allowed_amount":64.87,"providers":[{"billed_charge":9860.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":427.90,"providers":[{"billed_charge":1620.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":998.41,"providers":[{"billed_charge":3043.40,"npi":[1346275856]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11.47,"providers":[{"billed_charge":1524.03,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":37.89,"providers":[{"billed_charge":2175.00,"npi":[1619289998]}]},{"allowed_amount":2.70,"providers":[{"billed_charge":34.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":44.42,"providers":[{"billed_charge":4330.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":110.18,"providers":[{"billed_charge":387.07,"npi":[1962508259]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":881.38,"providers":[{"billed_charge":1232.00,"npi":[1053356352]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":86.51,"providers":[{"billed_charge":357.38,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":138.59,"providers":[{"billed_charge":668.00,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":840.27,"providers":[{"billed_charge":3478.06,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":187.94,"providers":[{"billed_charge":2784.00,"npi":[1619289998]}]},{"allowed_amount":1274.42,"providers":[{"billed_charge":78204.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":159.63,"providers":[{"billed_charge":18142.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2418.12,"providers":[{"billed_charge":13130.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":410.07,"providers":[{"billed_charge":1681.53,"npi":[1962508259]}]},{"allowed_amount":88.91,"providers":[{"billed_charge":367.57,"npi":[1962508259]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4917.58,"providers":[{"billed_charge":12083.99,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1193.04,"providers":[{"billed_charge":1881.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1581.55,"providers":[{"billed_charge":6062.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10180.25,"providers":[{"billed_charge":25162.22,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13010.02,"providers":[{"billed_charge":52348.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3806.66,"providers":[{"billed_charge":10570.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5961.50,"providers":[{"billed_charge":19274.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":277.18,"providers":[{"billed_charge":402.00,"npi":[1831132133]}]},{"allowed_amount":85.64,"providers":[{"billed_charge":244.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":258.81,"providers":[{"billed_charge":883.72,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":364.30,"providers":[{"billed_charge":1485.68,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":388.23,"providers":[{"billed_charge":1193.36,"npi":[1306227764]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1540.59,"providers":[{"billed_charge":5228.42,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2150.64,"providers":[{"billed_charge":19054.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2367.16,"providers":[{"billed_charge":17815.92,"npi":[1831116441]}]},{"allowed_amount":278.61,"providers":[{"billed_charge":3582.09,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9127.18,"providers":[{"billed_charge":178946.00,"npi":[1619289998]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1910.36,"providers":[{"billed_charge":25871.62,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2048.30,"providers":[{"billed_charge":53346.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4770.85,"providers":[{"billed_charge":41057.78,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5532.72,"providers":[{"billed_charge":183538.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4463.01,"providers":[{"billed_charge":55703.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3744.34,"providers":[{"billed_charge":67179.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":442.59,"providers":[{"billed_charge":1513.00,"npi":[1811097223]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9408.66,"providers":[{"billed_charge":89764.45,"npi":[1083644579]}]},{"allowed_amount":104.48,"providers":[{"billed_charge":1215.19,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5306.34,"providers":[{"billed_charge":124407.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1124.61,"providers":[{"billed_charge":12873.88,"npi":[1831116441]}]},{"allowed_amount":9432.33,"providers":[{"billed_charge":100483.32,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10697.58,"providers":[{"billed_charge":216960.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10843.83,"providers":[{"billed_charge":219793.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4040.28,"providers":[{"billed_charge":62488.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":363.26,"providers":[{"billed_charge":4360.00,"npi":[1811097223]}]},{"allowed_amount":4731.23,"providers":[{"billed_charge":86672.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1404.99,"providers":[{"billed_charge":20873.35,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1288.73,"providers":[{"billed_charge":5327.56,"npi":[1962508259]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":38301.57,"providers":[{"billed_charge":37854.39,"npi":[1831116441]}]},{"allowed_amount":6113.58,"providers":[{"billed_charge":9416.55,"npi":[1831116441]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":81.81,"providers":[{"billed_charge":90.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":70.00,"providers":[{"billed_charge":70.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":41.43,"providers":[{"billed_charge":334.88,"npi":[1881630614]}]}]},{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.16,"providers":[{"billed_charge":90.00,"npi":[1144990938]}]},{"allowed_amount":7.72,"providers":[{"billed_charge":30.00,"npi":[1770200552]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":4.55,"providers":[{"billed_charge":10.00,"npi":[1053314146]}]},{"allowed_amount":3999.34,"providers":[{"billed_charge":8783.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":15.00,"npi":[1629459904]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":231.90,"providers":[{"billed_charge":300.00,"npi":[1457065930]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":468.87,"providers":[{"billed_charge":2226.82,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":469.05,"providers":[{"billed_charge":3773.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":106.44,"providers":[{"billed_charge":1163.98,"npi":[1831116441]}]},{"allowed_amount":312.58,"providers":[{"billed_charge":8805.49,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":859.59,"providers":[{"billed_charge":18208.00,"npi":[1619289998]}]},{"allowed_amount":137.21,"providers":[{"billed_charge":1431.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1427.43,"providers":[{"billed_charge":22555.00,"npi":[1053356352]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":320.14,"providers":[{"billed_charge":16164.00,"npi":[1619289998]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":249.32,"providers":[{"billed_charge":3532.00,"npi":[1619289998]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19650.48,"providers":[{"billed_charge":31408.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"380833014"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4343.39,"providers":[{"billed_charge":8970.34,"npi":[1902841414]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":124210.76,"providers":[{"billed_charge":292376.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":372162.65,"providers":[{"billed_charge":678305.00,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":143620.76,"providers":[{"billed_charge":347174.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":310731.91,"providers":[{"billed_charge":611227.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27871.76,"providers":[{"billed_charge":53278.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10519.36,"providers":[{"billed_charge":22422.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41046.11,"providers":[{"billed_charge":87832.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":77633.39,"providers":[{"billed_charge":213695.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26140.68,"providers":[{"billed_charge":45586.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39763.65,"providers":[{"billed_charge":160235.25,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":61687.72,"providers":[{"billed_charge":162490.12,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":216843.77,"providers":[{"billed_charge":372626.88,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":80421.54,"providers":[{"billed_charge":157080.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18767.74,"providers":[{"billed_charge":39538.00,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":473539.41,"providers":[{"billed_charge":2814400.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"380997730"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3850.30,"providers":[{"billed_charge":8948.50,"npi":[1871507509]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43350.65,"providers":[{"billed_charge":92229.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7823.11,"providers":[{"billed_charge":28547.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":35824.08,"providers":[{"billed_charge":108986.13,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"314394942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":287.81,"providers":[{"billed_charge":349.00,"npi":[1255377149]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":762.64,"providers":[{"billed_charge":1697.30,"npi":[1871672618]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":355.25,"providers":[{"billed_charge":22359.00,"npi":[1053356352]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":524.01,"providers":[{"billed_charge":2007.00,"npi":[1619289998]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":1.38,"providers":[{"billed_charge":9645.41,"npi":[1871672618]}]},{"allowed_amount":10.41,"providers":[{"billed_charge":4791.41,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":159.41,"providers":[{"billed_charge":8768.80,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2684.52,"providers":[{"billed_charge":28071.44,"npi":[1831116441]}]},{"allowed_amount":7865.65,"providers":[{"billed_charge":51865.11,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":53.20,"providers":[{"billed_charge":6554.60,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":179.73,"providers":[{"billed_charge":309.95,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":346.02,"providers":[{"billed_charge":14625.30,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16.09,"providers":[{"billed_charge":3031.10,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.22,"providers":[{"billed_charge":1219.50,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5.68,"providers":[{"billed_charge":855.30,"npi":[1093748642]}]},{"allowed_amount":0.75,"providers":[{"billed_charge":225.10,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":64.03,"providers":[{"billed_charge":3370.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.43,"providers":[{"billed_charge":3477.85,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1636.74,"providers":[{"billed_charge":6591.68,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49.94,"providers":[{"billed_charge":15299.08,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4681.85,"providers":[{"billed_charge":23579.89,"npi":[1083644579]}]},{"allowed_amount":116.81,"providers":[{"billed_charge":20479.27,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382007629"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":359.28,"providers":[{"billed_charge":1113.09,"npi":[1942254529]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.42,"providers":[{"billed_charge":1072.50,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.43,"providers":[{"billed_charge":976.20,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":842.86,"providers":[{"billed_charge":555989.70,"npi":[1619289998]}]},{"allowed_amount":5555.59,"providers":[{"billed_charge":106855.92,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"380997730"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.90,"providers":[{"billed_charge":2.60,"npi":[1871507509]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.19,"providers":[{"billed_charge":1587.80,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.61,"providers":[{"billed_charge":547.64,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.47,"providers":[{"billed_charge":4526.37,"npi":[1346275856]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"341788398"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":1716.00,"providers":[{"billed_charge":1716.00,"npi":[1013617794]}]},{"allowed_amount":7479.15,"providers":[{"billed_charge":7488.00,"npi":[1932809613]}]}]},{"tin":{"type":"ein","value":"411458213"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":6864.00,"providers":[{"billed_charge":6864.00,"npi":[1467152140]}]}]},{"tin":{"type":"ein","value":"451270698"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":2400.00,"providers":[{"billed_charge":2400.00,"npi":[1740816479]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"381859770"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":371.03,"providers":[{"billed_charge":1265.00,"npi":[1104260603]}]},{"allowed_amount":101.19,"providers":[{"billed_charge":345.00,"npi":[1104260603]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"381850302"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":34.52,"providers":[{"billed_charge":132.00,"npi":[1396769378]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":8.26,"providers":[{"billed_charge":21.00,"npi":[1518157478]}]},{"allowed_amount":24.78,"providers":[{"billed_charge":63.00,"npi":[1518157478]}]},{"allowed_amount":41.30,"providers":[{"billed_charge":105.00,"npi":[1659687408]}]},{"allowed_amount":16.52,"providers":[{"billed_charge":42.00,"npi":[1659687408]}]},{"allowed_amount":57.74,"providers":[{"billed_charge":147.00,"npi":[1659687408]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"381357020"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":41.46,"providers":[{"billed_charge":120.00,"npi":[1871090415]}]}]}]},{"name":"CT THORAX LUNG CANCER SCR C-","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71271","description":"COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-","allowed_amounts":[{"tin":{"type":"ein","value":"382608391"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":540.50,"providers":[{"billed_charge":2690.00,"npi":[1093468183]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":85.76,"providers":[{"billed_charge":15006.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":217.40,"providers":[{"billed_charge":21783.50,"npi":[1831116441]}]},{"allowed_amount":59.45,"providers":[{"billed_charge":221.75,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":611.94,"providers":[{"billed_charge":33334.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.80,"providers":[{"billed_charge":15498.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":245.13,"providers":[{"billed_charge":21402.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":636.70,"providers":[{"billed_charge":2617.50,"npi":[1962508259]}]}]}]},{"name":"CT ANGIO HRT W/3D IMAGE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"75574","description":"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CO","allowed_amounts":[{"tin":{"type":"ein","value":"884063316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5693.10,"providers":[{"billed_charge":32970.00,"npi":[1821063496]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":435.82,"providers":[{"billed_charge":945.50,"npi":[1083644579]}]},{"allowed_amount":341.28,"providers":[{"billed_charge":4501.83,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":615.09,"providers":[{"billed_charge":1900.88,"npi":[1831116441]}]},{"allowed_amount":812.67,"providers":[{"billed_charge":21971.70,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10657.66,"providers":[{"billed_charge":39327.00,"npi":[1811097223]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":359.94,"providers":[{"billed_charge":26175.00,"npi":[1619289998]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1500.60,"providers":[{"billed_charge":102968.00,"npi":[1053356352]}]}]}]},{"name":"OB US FOLLOW-UP PER FETUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76816","description":"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FET","allowed_amounts":[{"tin":{"type":"ein","value":"451674932"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":943.47,"providers":[{"billed_charge":2691.00,"npi":[1285685503]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"383488574"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":313.53,"providers":[{"billed_charge":938.00,"npi":[1790300390]}]}]},{"tin":{"type":"ein","value":"383545312"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1517.04,"providers":[{"billed_charge":5964.00,"npi":[1467912477]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"386005550"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":216.66,"providers":[{"billed_charge":432.00,"npi":[1972554764]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":337.80,"providers":[{"billed_charge":420.00,"npi":[1396769378]}]},{"allowed_amount":422.25,"providers":[{"billed_charge":525.00,"npi":[1598887457]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":422.30,"providers":[{"billed_charge":930.00,"npi":[1982774469]}]}]},{"tin":{"type":"ein","value":"822768899"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":292.80,"providers":[{"billed_charge":960.00,"npi":[1912293036]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"386005550"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":274.91,"providers":[{"billed_charge":552.00,"npi":[1972554764]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":537.15,"providers":[{"billed_charge":1875.00,"npi":[1598887457]}]},{"allowed_amount":402.86,"providers":[{"billed_charge":1500.00,"npi":[1396769378]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":537.20,"providers":[{"billed_charge":1050.00,"npi":[1982774469]}]}]},{"tin":{"type":"ein","value":"822768899"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":698.25,"providers":[{"billed_charge":4290.00,"npi":[1912293036]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"272844942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":50.58,"providers":[{"billed_charge":2082.00,"npi":[1619289998]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":368.01,"providers":[{"billed_charge":1971.92,"npi":[1053314146]}]}]}]},{"name":"COMPREHEN 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, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.84,"providers":[{"billed_charge":307.29,"npi":[1881630614]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7930.56,"providers":[{"billed_charge":45248.74,"npi":[1053314146]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"364257926"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.10,"providers":[{"billed_charge":525.23,"npi":[1881630614]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9266.10,"providers":[{"billed_charge":49763.09,"npi":[1053314146]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2143.80,"providers":[{"billed_charge":11730.00,"npi":[1053314146]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":69.53,"providers":[{"billed_charge":476.00,"npi":[1053314146]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":279.63,"providers":[{"billed_charge":900.00,"npi":[1144606542]}]},{"allowed_amount":10532.73,"providers":[{"billed_charge":33900.00,"npi":[1144606542]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9463.92,"providers":[{"billed_charge":30400.00,"npi":[1053314146]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":516.75,"providers":[{"billed_charge":4862.62,"npi":[1053314146]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.92,"providers":[{"billed_charge":44.00,"npi":[1558354159]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2.37,"providers":[{"billed_charge":34.00,"npi":[1952016941]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":47.75,"providers":[{"billed_charge":250.00,"npi":[1457065930]}]}]}]},{"name":"ASSAY OF SERUM ALBUMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82040","description":"ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":178.56,"providers":[{"billed_charge":1008.00,"npi":[1053314146]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":913.24,"providers":[{"billed_charge":5688.00,"npi":[1053314146]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"42516906"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":2178.27,"providers":[{"billed_charge":26496.00,"npi":[1144335985]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.32,"providers":[{"billed_charge":324.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82247","description":"BILIRUBIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":180.72,"providers":[{"billed_charge":1008.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":115.46,"providers":[{"billed_charge":644.00,"npi":[1053314146]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12432.00,"providers":[{"billed_charge":67144.51,"npi":[1053314146]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":105.95,"providers":[{"billed_charge":598.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":94.54,"providers":[{"billed_charge":551.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":484.33,"providers":[{"billed_charge":1215.50,"npi":[1053314146]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4516.46,"providers":[{"billed_charge":26955.00,"npi":[1053314146]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":422.56,"providers":[{"billed_charge":2394.00,"npi":[1053314146]}]}]}]},{"name":"VIT D 1 25-DIHYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82652","description":"VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":57.75,"providers":[{"billed_charge":288.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1145.54,"providers":[{"billed_charge":6396.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1432.20,"providers":[{"billed_charge":7980.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":977.55,"providers":[{"billed_charge":5586.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":102.30,"providers":[{"billed_charge":660.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":53.19,"providers":[{"billed_charge":297.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.20,"providers":[{"billed_charge":340.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":882.55,"providers":[{"billed_charge":4940.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":805.62,"providers":[{"billed_charge":4524.00,"npi":[1053314146]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6104.16,"providers":[{"billed_charge":40168.04,"npi":[1053314146]}]}]}]},{"name":"IMMUNOASSAY NONANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83516","description":"IMMUNOASSAY FOR ANALYTE OTH THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE ","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.42,"providers":[{"billed_charge":704.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1053.00,"providers":[{"billed_charge":7800.00,"npi":[1053314146]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":865.26,"providers":[{"billed_charge":4752.00,"npi":[1053314146]}]}]}]},{"name":"LACTATE (LD) (LDH) ENZYME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83615","description":"LACTATE DEHYDROGENASE (LD), (LDH);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":84.56,"providers":[{"billed_charge":476.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":117.30,"providers":[{"billed_charge":714.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":840.85,"providers":[{"billed_charge":5020.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":165.12,"providers":[{"billed_charge":928.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY ALKALINE PHOSPHATASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84075","description":"PHOSPHATASE, ALKALINE;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":191.66,"providers":[{"billed_charge":1036.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":229.89,"providers":[{"billed_charge":1164.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":260.75,"providers":[{"billed_charge":1500.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":620.16,"providers":[{"billed_charge":3922.04,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2235.60,"providers":[{"billed_charge":9720.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84154","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":119.60,"providers":[{"billed_charge":650.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84155","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":145.36,"providers":[{"billed_charge":869.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":90.16,"providers":[{"billed_charge":588.00,"npi":[1053314146]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.96,"providers":[{"billed_charge":520.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1054.39,"providers":[{"billed_charge":4850.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2272.16,"providers":[{"billed_charge":12672.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3405.05,"providers":[{"billed_charge":30167.47,"npi":[1053314146]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10466.40,"providers":[{"billed_charge":59773.91,"npi":[1053314146]}]}]}]},{"name":"TRANSFERASE (AST) (SGOT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84450","description":"TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":305.62,"providers":[{"billed_charge":1652.00,"npi":[1053314146]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84460","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":320.65,"providers":[{"billed_charge":1694.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":850.80,"providers":[{"billed_charge":4800.00,"npi":[1053314146]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":974.05,"providers":[{"billed_charge":5486.03,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":709.64,"providers":[{"billed_charge":4386.52,"npi":[1053314146]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":715.35,"providers":[{"billed_charge":2362.47,"npi":[1053314146]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF 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 DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4850.83,"providers":[{"billed_charge":31139.20,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"451674932"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":116.55,"providers":[{"billed_charge":165.00,"npi":[1235120551]}]}]}]},{"name":"COMPLETE CBC, 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":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":392.04,"providers":[{"billed_charge":1573.00,"npi":[1053314146]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.00,"providers":[{"billed_charge":153.00,"npi":[1053314146]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":43.00,"providers":[{"billed_charge":320.00,"npi":[1053314146]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":148.50,"providers":[{"billed_charge":1210.00,"npi":[1053314146]}]}]}]},{"name":"THROMBOPLASTIN TIME, PARTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85730","description":"THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":24.08,"providers":[{"billed_charge":176.00,"npi":[1053314146]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":320.65,"providers":[{"billed_charge":2385.00,"npi":[1053314146]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":129.50,"providers":[{"billed_charge":750.00,"npi":[1053314146]}]}]}]},{"name":"C-REACTIVE PROTEIN, HS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86141","description":"C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.92,"providers":[{"billed_charge":148.00,"npi":[1053314146]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.92,"providers":[{"billed_charge":200.00,"npi":[1053314146]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.83,"providers":[{"billed_charge":306.00,"npi":[1053314146]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":358.62,"providers":[{"billed_charge":1680.00,"npi":[1053314146]}]}]}]},{"name":"IMMUNOFIX E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86334","description":"IMMUNOFIXATION ELECTROPHORESIS; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.17,"providers":[{"billed_charge":100.00,"npi":[1053314146]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":101.92,"providers":[{"billed_charge":560.00,"npi":[1053314146]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":105.08,"providers":[{"billed_charge":592.00,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":356.40,"providers":[{"billed_charge":1998.00,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":532.40,"providers":[{"billed_charge":3025.00,"npi":[1053314146]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":217.08,"providers":[{"billed_charge":1440.00,"npi":[1053314146]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":322.20,"providers":[{"billed_charge":2400.00,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":210.80,"providers":[{"billed_charge":1156.00,"npi":[1053314146]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":50.40,"providers":[{"billed_charge":280.00,"npi":[1053314146]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1098.92,"providers":[{"billed_charge":4980.00,"npi":[1053314146]}]}]}]},{"name":"VARICELLA-ZOSTER ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86787","description":"ANTIBODY; VARICELLA-ZOSTER","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.52,"providers":[{"billed_charge":304.00,"npi":[1053314146]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":95.52,"providers":[{"billed_charge":600.00,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1356.60,"providers":[{"billed_charge":7584.00,"npi":[1053314146]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":83.13,"providers":[{"billed_charge":510.00,"npi":[1053314146]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.50,"providers":[{"billed_charge":50.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":56.03,"providers":[{"billed_charge":390.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":311.08,"providers":[{"billed_charge":2310.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.96,"providers":[{"billed_charge":42.00,"npi":[1053314146]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1054.44,"providers":[{"billed_charge":7830.00,"npi":[1053314146]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":562.95,"providers":[{"billed_charge":4170.00,"npi":[1053314146]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":298.77,"providers":[{"billed_charge":2070.00,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":289.52,"providers":[{"billed_charge":1668.00,"npi":[1053314146]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2299.64,"providers":[{"billed_charge":9911.20,"npi":[1053314146]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.72,"providers":[{"billed_charge":130.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5158.70,"providers":[{"billed_charge":14700.00,"npi":[1053314146]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":359.74,"providers":[{"billed_charge":3790.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3036.15,"providers":[{"billed_charge":17300.00,"npi":[1053314146]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":81.43,"providers":[{"billed_charge":139.00,"npi":[1851094940]}]}]}]},{"name":"HIV-1 QUANT&REVRSE TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87536","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION, INCLUDES REVERSE TRA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":468.05,"providers":[{"billed_charge":1925.00,"npi":[1053314146]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":320.51,"providers":[{"billed_charge":3440.00,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":355.67,"providers":[{"billed_charge":3845.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3001.05,"providers":[{"billed_charge":17100.00,"npi":[1053314146]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3439.80,"providers":[{"billed_charge":9800.00,"npi":[1053314146]}]}]}]},{"name":"SARS-COV-2 COVID-19 AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87635","description":"Infectious agent detection by nucleic acid (DNA or RNA); (SARS-CoV-2) [COVID-19], amplified probe te","allowed_amounts":[{"tin":{"type":"ein","value":"813787598"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":87.22,"providers":[{"billed_charge":130.00,"npi":[1528886157]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":87.22,"providers":[{"billed_charge":150.00,"npi":[1851094940]}]}]}]},{"name":"SARSCOV2&INF A&B&RSV AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87637","description":"IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2638.84,"providers":[{"billed_charge":9250.00,"npi":[1144606542]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2983.50,"providers":[{"billed_charge":17000.00,"npi":[1053314146]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":339.88,"providers":[{"billed_charge":3770.00,"npi":[1234567893]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":172.29,"providers":[{"billed_charge":2383.35,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5686.20,"providers":[{"billed_charge":27400.00,"npi":[1053314146]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":74.20,"providers":[{"billed_charge":610.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2488.97,"providers":[{"billed_charge":13838.00,"npi":[1053314146]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"381357020"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":445.64,"providers":[{"billed_charge":1572.00,"npi":[1295221034]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":326.28,"providers":[{"billed_charge":1520.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"381857764"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":51.11,"providers":[{"billed_charge":150.00,"npi":[1336366293]}]},{"allowed_amount":715.49,"providers":[{"billed_charge":2100.00,"npi":[1336366293]}]}]},{"tin":{"type":"ein","value":"382147744"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":34.07,"providers":[{"billed_charge":195.00,"npi":[1609929629]}]},{"allowed_amount":716.03,"providers":[{"billed_charge":4095.00,"npi":[1104276997]}]},{"allowed_amount":477.12,"providers":[{"billed_charge":2730.00,"npi":[1609929629]}]},{"allowed_amount":579.19,"providers":[{"billed_charge":3315.00,"npi":[1205042207]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":40.20,"providers":[{"billed_charge":91.00,"npi":[1275055626]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":450.00,"providers":[{"billed_charge":8316.00,"npi":[1912670068]}]}]}]},{"name":"PSYTX COMPLEX INTERACTIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90785","description":"INTERACTIVE COMPLEXITY (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)","allowed_amounts":[{"tin":{"type":"ein","value":"883690599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.98,"providers":[{"billed_charge":120.00,"npi":[1326699182]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"815220142"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":50.65,"providers":[{"billed_charge":224.00,"npi":[1003168592]}]},{"allowed_amount":59.84,"providers":[{"billed_charge":224.00,"npi":[1003168592]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":335.52,"providers":[{"billed_charge":900.00,"npi":[1043507833]}]},{"allowed_amount":784.06,"providers":[{"billed_charge":2100.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1907.91,"providers":[{"billed_charge":4350.00,"npi":[1447323829]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"383206926"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":429.94,"providers":[{"billed_charge":840.00,"npi":[1780993493]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1831338441]}]}]}]},{"name":"PSYTX W PT W E/M 45 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90836","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4026.60,"providers":[{"billed_charge":5600.00,"npi":[1255372058]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":410.13,"providers":[{"billed_charge":420.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"273067006"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":117.02,"providers":[{"billed_charge":200.00,"npi":[1154095123]}]},{"allowed_amount":102.43,"providers":[{"billed_charge":200.00,"npi":[1154095123]}]}]},{"tin":{"type":"ein","value":"453823257"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":306.44,"providers":[{"billed_charge":645.00,"npi":[1871040311]}]}]},{"tin":{"type":"ein","value":"883690599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":815.82,"providers":[{"billed_charge":1260.00,"npi":[1326699182]}]}]},{"tin":{"type":"ein","value":"474144586"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2949.84,"providers":[{"billed_charge":7200.00,"npi":[1588826556]}]}]},{"tin":{"type":"ein","value":"863656058"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":91.01,"providers":[{"billed_charge":200.00,"npi":[1427423359]}]}]},{"tin":{"type":"ein","value":"472970145"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":409.71,"providers":[{"billed_charge":750.00,"npi":[1396913497]}]},{"allowed_amount":1092.14,"providers":[{"billed_charge":1750.00,"npi":[1396913497]}]}]},{"tin":{"type":"ein","value":"845134076"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":234.04,"providers":[{"billed_charge":450.00,"npi":[1952730624]}]},{"allowed_amount":1024.30,"providers":[{"billed_charge":2250.00,"npi":[1952730624]}]}]},{"tin":{"type":"ein","value":"853424902"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":955.65,"providers":[{"billed_charge":1350.00,"npi":[1487997797]}]}]},{"tin":{"type":"ein","value":"386122756"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1077.00,"providers":[{"billed_charge":1925.00,"npi":[1336339787]}]}]},{"tin":{"type":"ein","value":"383579022"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1229.16,"providers":[{"billed_charge":3000.00,"npi":[1215502265]}]},{"allowed_amount":124.55,"providers":[{"billed_charge":250.00,"npi":[1215502265]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":462.87,"providers":[{"billed_charge":1053.00,"npi":[1497889927]}]},{"allowed_amount":1234.32,"providers":[{"billed_charge":2808.00,"npi":[1417605833]}]},{"allowed_amount":925.74,"providers":[{"billed_charge":2106.00,"npi":[1427525757]}]},{"allowed_amount":617.16,"providers":[{"billed_charge":1404.00,"npi":[1669538211]}]},{"allowed_amount":1542.90,"providers":[{"billed_charge":3510.00,"npi":[1669538211]}]}]},{"tin":{"type":"ein","value":"824929588"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":133.71,"providers":[{"billed_charge":300.00,"npi":[1265995500]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"386122756"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1098.88,"providers":[{"billed_charge":2480.00,"npi":[1336339787]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"384149930"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1086.80,"providers":[{"billed_charge":10000.00,"npi":[1508449521]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"461281853"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3465.00,"providers":[{"billed_charge":43945.00,"npi":[1457232589]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"382027689"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":31.45,"providers":[{"billed_charge":108.00,"npi":[1073019956]}]},{"allowed_amount":102.14,"providers":[{"billed_charge":351.00,"npi":[1073019956]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":27.00,"npi":[1548210487]}]},{"allowed_amount":31.80,"providers":[{"billed_charge":108.00,"npi":[1073019956]}]}]},{"tin":{"type":"ein","value":"270391924"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":63.84,"providers":[{"billed_charge":90.00,"npi":[1831267376]}]}]},{"tin":{"type":"ein","value":"383322109"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":68.18,"providers":[{"billed_charge":413.00,"npi":[1811150881]}]},{"allowed_amount":39.08,"providers":[{"billed_charge":236.00,"npi":[1811150881]}]},{"allowed_amount":9.98,"providers":[{"billed_charge":59.00,"npi":[1619310885]}]}]},{"tin":{"type":"ein","value":"383316559"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":23.94,"providers":[{"billed_charge":84.00,"npi":[1073924189]}]},{"allowed_amount":39.90,"providers":[{"billed_charge":140.00,"npi":[1720221542]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":56.00,"npi":[1073924189]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":28.00,"npi":[1720221542,1073924189]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"270391924"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":56.25,"providers":[{"billed_charge":150.00,"npi":[1831267376]}]},{"allowed_amount":694.89,"providers":[{"billed_charge":1050.00,"npi":[1831267376]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"260156636"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":218.96,"providers":[{"billed_charge":635.00,"npi":[1023616687]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":356.00,"providers":[{"billed_charge":1715.92,"npi":[1457065930]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1562.87,"providers":[{"billed_charge":7581.60,"npi":[1457065930]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":99.68,"providers":[{"billed_charge":304.00,"npi":[1790298149]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":249.20,"providers":[{"billed_charge":1540.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":398.72,"providers":[{"billed_charge":3840.00,"npi":[1326274168]}]},{"allowed_amount":186.90,"providers":[{"billed_charge":1800.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":837.48,"providers":[{"billed_charge":2520.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":220.35,"providers":[{"billed_charge":1092.00,"npi":[1669964243]}]}]},{"tin":{"type":"ein","value":"200792259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":124.60,"providers":[{"billed_charge":400.00,"npi":[1902939895]}]}]}]},{"name":"VASOPNEUMATIC DEVICE THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97016","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; VASOPNEUMATIC DEVICES","allowed_amounts":[{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.59,"providers":[{"billed_charge":408.00,"npi":[1528530037]}]}]}]},{"name":"ELECTRICAL STIMULATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97032","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":376.13,"providers":[{"billed_charge":2465.00,"npi":[1477969533]}]}]}]},{"name":"ULTRASOUND THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97035","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":102.43,"providers":[{"billed_charge":300.00,"npi":[1942704572]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"611513688"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":155.88,"providers":[{"billed_charge":210.00,"npi":[1619594009]}]}]},{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.79,"providers":[{"billed_charge":65.00,"npi":[1306438353]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":917.98,"providers":[{"billed_charge":3325.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":467.69,"providers":[{"billed_charge":2070.00,"npi":[1366069114]}]}]},{"tin":{"type":"ein","value":"872412497"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":311.80,"providers":[{"billed_charge":675.00,"npi":[1245730076]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.76,"providers":[{"billed_charge":92.64,"npi":[1821541566]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1986.37,"providers":[{"billed_charge":9120.00,"npi":[1326274168]}]},{"allowed_amount":796.86,"providers":[{"billed_charge":3600.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.81,"providers":[{"billed_charge":415.00,"npi":[1427644707]}]},{"allowed_amount":1033.07,"providers":[{"billed_charge":3818.00,"npi":[1669964243]}]},{"allowed_amount":1633.45,"providers":[{"billed_charge":5810.00,"npi":[1780233049]}]},{"allowed_amount":228.66,"providers":[{"billed_charge":747.00,"npi":[1376353805]}]}]},{"tin":{"type":"ein","value":"263541523"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.85,"providers":[{"billed_charge":80.00,"npi":[1124569223]}]}]},{"tin":{"type":"ein","value":"200792259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":779.55,"providers":[{"billed_charge":1650.00,"npi":[1902939895]}]}]},{"tin":{"type":"ein","value":"810719772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":135.69,"providers":[{"billed_charge":425.00,"npi":[1063722676]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2760.06,"providers":[{"billed_charge":8549.00,"npi":[1760062905]}]},{"allowed_amount":103.92,"providers":[{"billed_charge":332.00,"npi":[1063844769]}]},{"allowed_amount":1611.00,"providers":[{"billed_charge":5063.00,"npi":[1790298149]}]},{"allowed_amount":285.83,"providers":[{"billed_charge":913.00,"npi":[1275599979]}]},{"allowed_amount":138.57,"providers":[{"billed_charge":415.00,"npi":[1184811747]}]},{"allowed_amount":487.93,"providers":[{"billed_charge":1660.00,"npi":[1528530037]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1730.15,"providers":[{"billed_charge":5395.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":25.98,"providers":[{"billed_charge":100.00,"npi":[1114197084]}]},{"allowed_amount":259.80,"providers":[{"billed_charge":1000.00,"npi":[1619673209]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":259.83,"providers":[{"billed_charge":1200.00,"npi":[1730566621]}]}]},{"tin":{"type":"ein","value":"462833039"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50.24,"providers":[{"billed_charge":110.00,"npi":[1760787360]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"611513688"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":118.73,"providers":[{"billed_charge":160.00,"npi":[1619594009]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":738.05,"providers":[{"billed_charge":2400.00,"npi":[1063844769]}]},{"allowed_amount":25.67,"providers":[{"billed_charge":96.00,"npi":[1528530037]}]},{"allowed_amount":458.88,"providers":[{"billed_charge":1440.00,"npi":[1760062905]}]},{"allowed_amount":224.63,"providers":[{"billed_charge":672.00,"npi":[1790298149]}]}]},{"tin":{"type":"ein","value":"872412497"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":115.50,"providers":[{"billed_charge":260.00,"npi":[1245730076]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":118.73,"providers":[{"billed_charge":480.00,"npi":[1366069114]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":439.62,"providers":[{"billed_charge":1800.00,"npi":[1609450956]}]},{"allowed_amount":1222.59,"providers":[{"billed_charge":5040.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1760.74,"providers":[{"billed_charge":4940.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":705.96,"providers":[{"billed_charge":2500.00,"npi":[1114197084]}]},{"allowed_amount":837.52,"providers":[{"billed_charge":2900.00,"npi":[1619673209]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":202.16,"providers":[{"billed_charge":875.00,"npi":[1730566621]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2006.16,"providers":[{"billed_charge":7104.00,"npi":[1780233049]}]},{"allowed_amount":582.46,"providers":[{"billed_charge":2304.00,"npi":[1669964243]}]}]},{"tin":{"type":"ein","value":"263541523"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":901.43,"providers":[{"billed_charge":2080.00,"npi":[1124569223]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"611513688"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.59,"providers":[{"billed_charge":96.00,"npi":[1619594009]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":574.06,"providers":[{"billed_charge":1900.00,"npi":[1528530037]}]},{"allowed_amount":147.18,"providers":[{"billed_charge":456.00,"npi":[1275599979]}]},{"allowed_amount":490.60,"providers":[{"billed_charge":1520.00,"npi":[1063844769]}]},{"allowed_amount":73.59,"providers":[{"billed_charge":228.00,"npi":[1790298149]}]},{"allowed_amount":107.95,"providers":[{"billed_charge":380.00,"npi":[1457690786]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1793.49,"providers":[{"billed_charge":5840.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":196.24,"providers":[{"billed_charge":840.00,"npi":[1366069114]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":370.68,"providers":[{"billed_charge":1800.00,"npi":[1609450956]}]},{"allowed_amount":1033.04,"providers":[{"billed_charge":4980.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":343.43,"providers":[{"billed_charge":1400.00,"npi":[1619673209]}]},{"allowed_amount":466.12,"providers":[{"billed_charge":1900.00,"npi":[1114197084]}]},{"allowed_amount":49.07,"providers":[{"billed_charge":200.00,"npi":[1043728629]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1729.62,"providers":[{"billed_charge":5280.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.06,"providers":[{"billed_charge":152.00,"npi":[1427644707]}]},{"allowed_amount":396.01,"providers":[{"billed_charge":1444.00,"npi":[1669964243]}]},{"allowed_amount":693.98,"providers":[{"billed_charge":2280.00,"npi":[1780233049]}]}]},{"tin":{"type":"ein","value":"263541523"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":332.24,"providers":[{"billed_charge":1120.00,"npi":[1124569223]}]}]},{"tin":{"type":"ein","value":"200792259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":245.30,"providers":[{"billed_charge":750.00,"npi":[1902939895]}]}]},{"tin":{"type":"ein","value":"810719772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.60,"providers":[{"billed_charge":225.00,"npi":[1063722676]}]}]}]},{"name":"GROUP THERAPEUTIC PROCEDURES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97150","description":"THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)","allowed_amounts":[{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15.86,"providers":[{"billed_charge":50.00,"npi":[1063844769]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","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":"461228277"},"service_code":["11","12","10"],"billing_class":"professional","payments":[{"allowed_amount":13006.15,"providers":[{"billed_charge":13006.15,"npi":[1043750904]}]},{"allowed_amount":322.80,"providers":[{"billed_charge":322.80,"npi":[1770133456]}]},{"allowed_amount":16731.80,"providers":[{"billed_charge":16731.80,"npi":[1902506306]}]},{"allowed_amount":18251.65,"providers":[{"billed_charge":18251.65,"npi":[1770133456]}]},{"allowed_amount":215.20,"providers":[{"billed_charge":215.20,"npi":[1902506306]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"461228277"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":297.18,"providers":[{"billed_charge":360.00,"npi":[1902506306]}]},{"allowed_amount":3647.51,"providers":[{"billed_charge":4560.00,"npi":[1902506306]}]},{"allowed_amount":1939.01,"providers":[{"billed_charge":2430.00,"npi":[1770133456]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.91,"providers":[{"billed_charge":75.00,"npi":[1306438353]}]}]},{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2062.16,"providers":[{"billed_charge":7680.00,"npi":[1477969533]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4283.48,"providers":[{"billed_charge":11880.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"872412497"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.40,"providers":[{"billed_charge":290.00,"npi":[1245730076]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":276.80,"providers":[{"billed_charge":1000.00,"npi":[1366069114]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":515.54,"providers":[{"billed_charge":1800.00,"npi":[1609450956]}]},{"allowed_amount":1224.84,"providers":[{"billed_charge":4320.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":190.30,"providers":[{"billed_charge":630.00,"npi":[1376353805]}]},{"allowed_amount":1301.64,"providers":[{"billed_charge":4515.00,"npi":[1780233049]}]}]},{"tin":{"type":"ein","value":"263541523"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":551.49,"providers":[{"billed_charge":1054.00,"npi":[1124569223]}]}]},{"tin":{"type":"ein","value":"200792259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":346.00,"providers":[{"billed_charge":550.00,"npi":[1902939895]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":207.60,"providers":[{"billed_charge":630.00,"npi":[1063844769]}]},{"allowed_amount":242.20,"providers":[{"billed_charge":735.00,"npi":[1760062905]}]},{"allowed_amount":34.60,"providers":[{"billed_charge":105.00,"npi":[1275599979,1528530037]}]}]},{"tin":{"type":"ein","value":"382376857"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":96.88,"providers":[{"billed_charge":363.00,"npi":[1326008954]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":577.82,"providers":[{"billed_charge":1700.00,"npi":[1619673209]}]},{"allowed_amount":775.04,"providers":[{"billed_charge":2300.00,"npi":[1114197084]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2455.19,"providers":[{"billed_charge":6750.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":425.58,"providers":[{"billed_charge":1625.00,"npi":[1730566621]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"474877540"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":223.10,"providers":[{"billed_charge":360.00,"npi":[1093318040]}]}]},{"tin":{"type":"ein","value":"842520730"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":148.80,"providers":[{"billed_charge":225.00,"npi":[1568493815]}]}]},{"tin":{"type":"ein","value":"462479137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1296.12,"providers":[{"billed_charge":2100.00,"npi":[1710321005]}]}]},{"tin":{"type":"ein","value":"141863189"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.20,"providers":[{"billed_charge":60.00,"npi":[1073229654]}]}]}]},{"name":"REM THER MNTR DV SPLY MSCSKL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98977","description":"REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D","allowed_amounts":[{"tin":{"type":"ein","value":"382780694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":85.32,"providers":[{"billed_charge":300.00,"npi":[1134531098]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"383584702"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":842.16,"providers":[{"billed_charge":1200.00,"npi":[1215021472]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3241.22,"providers":[{"billed_charge":15429.20,"npi":[1457065930]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"811972562"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":142.95,"providers":[{"billed_charge":429.00,"npi":[1528770070]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":571.80,"providers":[{"billed_charge":1716.00,"npi":[1851094940]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"382406558"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":163.71,"providers":[{"billed_charge":330.00,"npi":[1427489293]}]},{"allowed_amount":56.74,"providers":[{"billed_charge":110.00,"npi":[1427092147]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20","10"],"billing_class":"professional","payments":[{"allowed_amount":711.30,"providers":[{"billed_charge":3397.80,"npi":[1457065930]}]},{"allowed_amount":94.84,"providers":[{"billed_charge":453.04,"npi":[1457065930]}]},{"allowed_amount":29.80,"providers":[{"billed_charge":226.52,"npi":[1457065930]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":308.68,"providers":[{"billed_charge":1056.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"381914289"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":200.64,"providers":[{"billed_charge":380.00,"npi":[1275252322]}]}]},{"tin":{"type":"ein","value":"842580415"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":231.51,"providers":[{"billed_charge":555.00,"npi":[1275863102]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":592.02,"providers":[{"billed_charge":1128.00,"npi":[1689791501]}]},{"allowed_amount":441.59,"providers":[{"billed_charge":846.00,"npi":[1407475494]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":77.17,"providers":[{"billed_charge":234.69,"npi":[1528489762]}]},{"allowed_amount":635.53,"providers":[{"billed_charge":1642.83,"npi":[1396368734]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":308.68,"providers":[{"billed_charge":726.32,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"823482082"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":463.02,"providers":[{"billed_charge":1320.00,"npi":[1295497279]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20","10"],"billing_class":"professional","payments":[{"allowed_amount":2855.29,"providers":[{"billed_charge":13391.04,"npi":[1457065930]}]},{"allowed_amount":14507.96,"providers":[{"billed_charge":68040.96,"npi":[1457065930]}]},{"allowed_amount":952.34,"providers":[{"billed_charge":6152.64,"npi":[1457065930]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2178.96,"providers":[{"billed_charge":2760.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"452755654"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2392.27,"providers":[{"billed_charge":4650.00,"npi":[1497344048]}]}]},{"tin":{"type":"ein","value":"842071867"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":77.17,"providers":[{"billed_charge":274.00,"npi":[1225624174]}]}]},{"tin":{"type":"ein","value":"863366964"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":72.79,"providers":[{"billed_charge":195.00,"npi":[1699199125]}]}]},{"tin":{"type":"ein","value":"383584702"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1290.16,"providers":[{"billed_charge":1800.00,"npi":[1215021472]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1713.66,"providers":[{"billed_charge":4160.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"300281587"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":771.70,"providers":[{"billed_charge":1200.00,"npi":[1871026195]}]}]},{"tin":{"type":"ein","value":"320288530"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":540.19,"providers":[{"billed_charge":840.00,"npi":[1477207942]}]}]},{"tin":{"type":"ein","value":"932988328"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2623.78,"providers":[{"billed_charge":9260.58,"npi":[1801674908]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1525.20,"providers":[{"billed_charge":3276.00,"npi":[1234567893]}]},{"allowed_amount":584.70,"providers":[{"billed_charge":1274.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"382406558"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1971.72,"providers":[{"billed_charge":2025.00,"npi":[1427092147]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"813787598"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1950.11,"providers":[{"billed_charge":6458.00,"npi":[1528886157]}]}]},{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1152.36,"providers":[{"billed_charge":1260.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1741.40,"providers":[{"billed_charge":7480.00,"npi":[1285231662]}]},{"allowed_amount":3134.52,"providers":[{"billed_charge":13464.00,"npi":[1952016941]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3700.22,"providers":[{"billed_charge":12716.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"813667937"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2304.72,"providers":[{"billed_charge":3420.00,"npi":[1538422548]}]},{"allowed_amount":485.50,"providers":[{"billed_charge":950.00,"npi":[1538422548]}]}]},{"tin":{"type":"ein","value":"382692114"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":512.16,"providers":[{"billed_charge":700.00,"npi":[1083807176]}]}]},{"tin":{"type":"ein","value":"270199411"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":256.08,"providers":[{"billed_charge":480.00,"npi":[1801902911]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":640.20,"providers":[{"billed_charge":1150.90,"npi":[1396368734]}]},{"allowed_amount":6402.00,"providers":[{"billed_charge":11509.00,"npi":[1275055626]}]}]},{"tin":{"type":"ein","value":"871098976"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":102.71,"providers":[{"billed_charge":374.00,"npi":[1356197594]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":108.83,"providers":[{"billed_charge":511.76,"npi":[1457065930]}]},{"allowed_amount":8369.91,"providers":[{"billed_charge":39405.52,"npi":[1457065930]}]}]},{"tin":{"type":"ein","value":"832004627"},"service_code":["20","10"],"billing_class":"professional","payments":[{"allowed_amount":512.16,"providers":[{"billed_charge":700.00,"npi":[1255772604]}]},{"allowed_amount":97.10,"providers":[{"billed_charge":175.00,"npi":[1255772604]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7042.20,"providers":[{"billed_charge":9075.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":577.78,"providers":[{"billed_charge":1400.00,"npi":[1043507833]}]},{"allowed_amount":1238.10,"providers":[{"billed_charge":3000.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"842847032"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":727.10,"providers":[{"billed_charge":980.00,"npi":[1770303083]}]}]},{"tin":{"type":"ein","value":"883425147"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":435.32,"providers":[{"billed_charge":1496.00,"npi":[1629852603]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3201.00,"providers":[{"billed_charge":3750.00,"npi":[1629459904]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"382081222"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":1564.72,"providers":[{"billed_charge":1616.00,"npi":[1972584191]}]},{"allowed_amount":391.18,"providers":[{"billed_charge":404.00,"npi":[1972584191]}]}]},{"tin":{"type":"ein","value":"463857474"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":260.78,"providers":[{"billed_charge":400.00,"npi":[1730464561]}]},{"allowed_amount":130.39,"providers":[{"billed_charge":200.00,"npi":[1730464561]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"382760876"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":98.02,"providers":[{"billed_charge":140.00,"npi":[1215432646]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1071.34,"providers":[{"billed_charge":1633.00,"npi":[1730157173]}]}]},{"tin":{"type":"ein","value":"843331851"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":147.04,"providers":[{"billed_charge":150.00,"npi":[1871611251]}]}]},{"tin":{"type":"ein","value":"364827394"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":245.06,"providers":[{"billed_charge":320.00,"npi":[1588026124]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"223883792"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":118.83,"providers":[{"billed_charge":150.00,"npi":[1144239559]}]}]},{"tin":{"type":"ein","value":"814061406"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2495.43,"providers":[{"billed_charge":2940.00,"npi":[1376500496]}]},{"allowed_amount":356.49,"providers":[{"billed_charge":420.00,"npi":[1508120627]}]}]},{"tin":{"type":"ein","value":"382789107"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1109.08,"providers":[{"billed_charge":1764.00,"npi":[1083607691]}]}]},{"tin":{"type":"ein","value":"382262467"},"service_code":["51","21"],"billing_class":"professional","payments":[{"allowed_amount":237.66,"providers":[{"billed_charge":250.00,"npi":[1386657427]}]},{"allowed_amount":1663.62,"providers":[{"billed_charge":1750.00,"npi":[1386657427]}]}]},{"tin":{"type":"ein","value":"833394001"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5386.96,"providers":[{"billed_charge":16072.00,"npi":[1447554654]}]}]},{"tin":{"type":"ein","value":"461377771"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1782.45,"providers":[{"billed_charge":1950.00,"npi":[1003893934]}]}]},{"tin":{"type":"ein","value":"260333260"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":158.44,"providers":[{"billed_charge":190.00,"npi":[1194259986]}]}]},{"tin":{"type":"ein","value":"383536668"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5606.56,"providers":[{"billed_charge":5610.00,"npi":[1184661670]}]}]},{"tin":{"type":"ein","value":"208023767"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":316.88,"providers":[{"billed_charge":400.00,"npi":[1447875976]}]}]},{"tin":{"type":"ein","value":"853978891"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":6365.00,"providers":[{"billed_charge":6365.00,"npi":[1417156332]}]}]},{"tin":{"type":"ein","value":"383481310"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":158.44,"providers":[{"billed_charge":200.00,"npi":[1841272259]}]}]},{"tin":{"type":"ein","value":"870805677"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":5300.00,"providers":[{"billed_charge":5300.00,"npi":[1750393690]}]}]},{"tin":{"type":"ein","value":"262719426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":316.88,"providers":[{"billed_charge":480.00,"npi":[1043237951]}]}]},{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3744.42,"providers":[{"billed_charge":4800.00,"npi":[1255372058]}]}]},{"tin":{"type":"ein","value":"994713628"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":633.76,"providers":[{"billed_charge":880.00,"npi":[1396971263]}]}]},{"tin":{"type":"ein","value":"752398395"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":7100.73,"providers":[{"billed_charge":7500.00,"npi":[1124029335]}]}]},{"tin":{"type":"ein","value":"923132739"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":420.00,"providers":[{"billed_charge":420.00,"npi":[1992048607]}]},{"allowed_amount":3734.08,"providers":[{"billed_charge":4095.00,"npi":[1992048607]}]}]},{"tin":{"type":"ein","value":"381359063"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":891.27,"providers":[{"billed_charge":900.00,"npi":[1740568377]}]}]},{"tin":{"type":"ein","value":"822784244"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1132.89,"providers":[{"billed_charge":1749.00,"npi":[1679764997]}]}]},{"tin":{"type":"ein","value":"834368857"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2500.00,"providers":[{"billed_charge":2500.00,"npi":[1518495225]}]}]},{"tin":{"type":"ein","value":"822279075"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":443.24,"providers":[{"billed_charge":600.00,"npi":[1124130539]}]}]},{"tin":{"type":"ein","value":"990777079"},"service_code":["02","51"],"billing_class":"professional","payments":[{"allowed_amount":312.88,"providers":[{"billed_charge":1580.40,"npi":[1699833897]}]},{"allowed_amount":75.22,"providers":[{"billed_charge":395.10,"npi":[1699833897]}]}]},{"tin":{"type":"ein","value":"463319049"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":230.00,"providers":[{"billed_charge":230.00,"npi":[1366412066]}]}]},{"tin":{"type":"ein","value":"814043627"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4396.71,"providers":[{"billed_charge":6475.00,"npi":[1821239302]}]}]},{"tin":{"type":"ein","value":"823744003"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":189.22,"providers":[{"billed_charge":220.00,"npi":[1740661982]}]}]},{"tin":{"type":"ein","value":"363540368"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":237.66,"providers":[{"billed_charge":300.00,"npi":[1053321232]}]}]},{"tin":{"type":"ein","value":"811672122"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":633.76,"providers":[{"billed_charge":2400.00,"npi":[1881258820]}]}]},{"tin":{"type":"ein","value":"382407635"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1491.81,"providers":[{"billed_charge":2060.00,"npi":[1902970619]}]}]},{"tin":{"type":"ein","value":"593807952"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1045.00,"providers":[{"billed_charge":1045.00,"npi":[1669446050]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"270391924"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":823.29,"providers":[{"billed_charge":1000.00,"npi":[1831267376]}]},{"allowed_amount":117.61,"providers":[{"billed_charge":200.00,"npi":[1831267376]}]}]},{"tin":{"type":"ein","value":"814048754"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1587.78,"providers":[{"billed_charge":1755.00,"npi":[1033501242]}]}]},{"tin":{"type":"ein","value":"383433632"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1293.71,"providers":[{"billed_charge":1650.00,"npi":[1699330829]}]}]},{"tin":{"type":"ein","value":"382550047"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1528.93,"providers":[{"billed_charge":2405.00,"npi":[1922673342]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":143.92,"providers":[{"billed_charge":658.00,"npi":[1972562171]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":174.65,"providers":[{"billed_charge":969.00,"npi":[1124327366]}]},{"allowed_amount":2321.15,"providers":[{"billed_charge":12597.00,"npi":[1992325542]}]},{"allowed_amount":2806.44,"providers":[{"billed_charge":15504.00,"npi":[1326088030]}]},{"allowed_amount":729.02,"providers":[{"billed_charge":3876.00,"npi":[1497800767]}]},{"allowed_amount":12086.87,"providers":[{"billed_charge":64923.00,"npi":[1619910106]}]},{"allowed_amount":4703.14,"providers":[{"billed_charge":25194.00,"npi":[1255373130]}]},{"allowed_amount":893.36,"providers":[{"billed_charge":5814.00,"npi":[1477294999]}]},{"allowed_amount":534.09,"providers":[{"billed_charge":2907.00,"npi":[1710079074]}]},{"allowed_amount":1068.18,"providers":[{"billed_charge":5814.00,"npi":[1073896346]}]},{"allowed_amount":1098.60,"providers":[{"billed_charge":5814.00,"npi":[1306056106]}]},{"allowed_amount":1423.50,"providers":[{"billed_charge":7752.00,"npi":[1124642095]}]},{"allowed_amount":359.44,"providers":[{"billed_charge":1938.00,"npi":[1568774008]}]},{"allowed_amount":1458.04,"providers":[{"billed_charge":7752.00,"npi":[1417306184]}]}]},{"tin":{"type":"ein","value":"454019145"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":369.58,"providers":[{"billed_charge":2052.00,"npi":[1780621425]}]}]},{"tin":{"type":"ein","value":"383561854"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1633.35,"providers":[{"billed_charge":3180.00,"npi":[1407059884]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":369.57,"providers":[{"billed_charge":1881.00,"npi":[1093378507]}]},{"allowed_amount":615.95,"providers":[{"billed_charge":3135.00,"npi":[1700827490,1689849002,1063783181]}]},{"allowed_amount":1884.78,"providers":[{"billed_charge":11286.00,"npi":[1184661928]}]},{"allowed_amount":1724.66,"providers":[{"billed_charge":8778.00,"npi":[1972562171]}]},{"allowed_amount":3079.75,"providers":[{"billed_charge":15675.00,"npi":[1306883541]}]},{"allowed_amount":862.33,"providers":[{"billed_charge":4389.00,"npi":[1598040677,1922628676]}]},{"allowed_amount":1355.09,"providers":[{"billed_charge":6897.00,"npi":[1063767457,1154553964]}]},{"allowed_amount":554.37,"providers":[{"billed_charge":1881.00,"npi":[1003875287]}]},{"allowed_amount":1108.71,"providers":[{"billed_charge":5643.00,"npi":[1922462183,1508204587]}]},{"allowed_amount":1989.49,"providers":[{"billed_charge":11913.00,"npi":[1629455993]}]},{"allowed_amount":123.19,"providers":[{"billed_charge":627.00,"npi":[1356900054,1114661980]}]},{"allowed_amount":3511.01,"providers":[{"billed_charge":11913.00,"npi":[1679829667]}]},{"allowed_amount":739.14,"providers":[{"billed_charge":3762.00,"npi":[1023373503,1275278814]}]},{"allowed_amount":246.38,"providers":[{"billed_charge":1254.00,"npi":[1245686831,1558894378,1588985923,1790359792]}]},{"allowed_amount":1675.36,"providers":[{"billed_charge":10032.00,"npi":[1467949446]}]},{"allowed_amount":1601.47,"providers":[{"billed_charge":8151.00,"npi":[1427255835]}]},{"allowed_amount":1478.28,"providers":[{"billed_charge":7524.00,"npi":[1154068286]}]}]},{"tin":{"type":"ein","value":"992212966"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":147.83,"providers":[{"billed_charge":463.80,"npi":[1487183984]}]},{"allowed_amount":886.98,"providers":[{"billed_charge":2782.80,"npi":[1588289003]}]},{"allowed_amount":2513.11,"providers":[{"billed_charge":7884.60,"npi":[1730292343]}]},{"allowed_amount":1478.30,"providers":[{"billed_charge":4638.00,"npi":[1861832552]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":5601.96,"providers":[{"billed_charge":13816.00,"npi":[1104137025]}]},{"allowed_amount":2777.37,"providers":[{"billed_charge":6840.00,"npi":[1598028003]}]},{"allowed_amount":933.66,"providers":[{"billed_charge":2280.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"843515632"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1047.90,"providers":[{"billed_charge":9204.00,"npi":[1134185051]}]},{"allowed_amount":349.30,"providers":[{"billed_charge":3068.00,"npi":[1700883204]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":775.25,"providers":[{"billed_charge":4227.00,"npi":[1598250946,1679198972]}]},{"allowed_amount":1013.88,"providers":[{"billed_charge":5636.00,"npi":[1467434357]}]},{"allowed_amount":1058.40,"providers":[{"billed_charge":5636.00,"npi":[1417306184]}]},{"allowed_amount":521.78,"providers":[{"billed_charge":2818.00,"npi":[1306056106,1326089848,1255540894]}]},{"allowed_amount":1580.18,"providers":[{"billed_charge":8454.00,"npi":[1144631292,1033670724]}]},{"allowed_amount":2921.73,"providers":[{"billed_charge":15499.00,"npi":[1619910106]}]},{"allowed_amount":5508.61,"providers":[{"billed_charge":29589.00,"npi":[1124642095]}]},{"allowed_amount":1781.95,"providers":[{"billed_charge":9863.00,"npi":[1184151631]}]},{"allowed_amount":1043.56,"providers":[{"billed_charge":5636.00,"npi":[1346816774,1710079074]}]},{"allowed_amount":2285.06,"providers":[{"billed_charge":12681.00,"npi":[1982832861]}]},{"allowed_amount":1778.12,"providers":[{"billed_charge":9863.00,"npi":[1962468090,1326088030]}]},{"allowed_amount":7036.61,"providers":[{"billed_charge":38043.00,"npi":[1073896346]}]},{"allowed_amount":648.46,"providers":[{"billed_charge":4227.00,"npi":[1871235622]}]},{"allowed_amount":3894.92,"providers":[{"billed_charge":21135.00,"npi":[1215135553]}]},{"allowed_amount":764.24,"providers":[{"billed_charge":4227.00,"npi":[1811334386]}]},{"allowed_amount":1297.03,"providers":[{"billed_charge":7045.00,"npi":[1144516352]}]},{"allowed_amount":253.47,"providers":[{"billed_charge":1409.00,"npi":[1588015879,1831684083]}]},{"allowed_amount":4457.39,"providers":[{"billed_charge":23953.00,"npi":[1992325542]}]},{"allowed_amount":2168.03,"providers":[{"billed_charge":15499.00,"npi":[1477294999]}]},{"allowed_amount":6007.89,"providers":[{"billed_charge":32407.00,"npi":[1497800767]}]},{"allowed_amount":268.31,"providers":[{"billed_charge":1409.00,"npi":[1740696400,1124327366,1245646868,1326616863,1063653673]}]},{"allowed_amount":397.10,"providers":[{"billed_charge":2818.00,"npi":[1194306837]}]},{"allowed_amount":790.09,"providers":[{"billed_charge":4227.00,"npi":[1700824968,1851973838]}]},{"allowed_amount":1848.49,"providers":[{"billed_charge":9863.00,"npi":[1942865894,1275196669]}]},{"allowed_amount":3980.13,"providers":[{"billed_charge":21135.00,"npi":[1346251816]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2325.31,"providers":[{"billed_charge":11986.00,"npi":[1598040677]}]},{"allowed_amount":178.87,"providers":[{"billed_charge":922.00,"npi":[1700827490]}]},{"allowed_amount":894.35,"providers":[{"billed_charge":4610.00,"npi":[1356900054]}]},{"allowed_amount":1430.96,"providers":[{"billed_charge":7376.00,"npi":[1063783181]}]},{"allowed_amount":1073.22,"providers":[{"billed_charge":5532.00,"npi":[1922462183]}]},{"allowed_amount":1252.09,"providers":[{"billed_charge":6454.00,"npi":[1427444843]}]},{"allowed_amount":1609.83,"providers":[{"billed_charge":8298.00,"npi":[1972562171]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1368.00,"providers":[{"billed_charge":3344.00,"npi":[1710349543,1750901443]},{"billed_charge":3394.00,"npi":[1770228785]}]},{"allowed_amount":13680.00,"providers":[{"billed_charge":33590.00,"npi":[1104137025]}]},{"allowed_amount":4104.00,"providers":[{"billed_charge":10082.00,"npi":[1598028003]}]},{"allowed_amount":16416.00,"providers":[{"billed_charge":40278.00,"npi":[1114330974]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST ","allowed_amounts":[{"tin":{"type":"ein","value":"381357020"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":291.25,"providers":[{"billed_charge":750.00,"npi":[1639721087]}]}]},{"tin":{"type":"ein","value":"383433632"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1078.70,"providers":[{"billed_charge":2250.00,"npi":[1699330829]}]},{"allowed_amount":3883.32,"providers":[{"billed_charge":8100.00,"npi":[1053517540]}]},{"allowed_amount":1725.92,"providers":[{"billed_charge":3600.00,"npi":[1134575798]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"272480925"},"service_code":["11","31"],"billing_class":"professional","payments":[{"allowed_amount":73.41,"providers":[{"billed_charge":130.00,"npi":[1790940526]}]},{"allowed_amount":2495.94,"providers":[{"billed_charge":4420.00,"npi":[1790940526]}]},{"allowed_amount":249.60,"providers":[{"billed_charge":520.00,"npi":[1689706525]}]},{"allowed_amount":1185.60,"providers":[{"billed_charge":2470.00,"npi":[1922348184]}]}]},{"tin":{"type":"ein","value":"874406123"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":561.60,"providers":[{"billed_charge":1125.00,"npi":[1851855845]}]},{"allowed_amount":374.40,"providers":[{"billed_charge":750.00,"npi":[1548705783]}]}]},{"tin":{"type":"ein","value":"815217550"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":436.80,"providers":[{"billed_charge":1400.00,"npi":[1437207271]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"205326061"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1068.30,"providers":[{"billed_charge":1450.00,"npi":[1912941477]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":387.79,"providers":[{"billed_charge":950.00,"npi":[1558354159]}]}]},{"tin":{"type":"ein","value":"381914289"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.55,"providers":[{"billed_charge":44.00,"npi":[1275252322]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"20753921"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2063.40,"providers":[{"billed_charge":2063.40,"npi":[1215982749]}]}]},{"tin":{"type":"ein","value":"382142110"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":276.33,"providers":[{"billed_charge":1685.68,"npi":[1881627503]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":41846.12,"providers":[{"billed_charge":115459.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"386005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21.81,"providers":[{"billed_charge":54.40,"npi":[1134164585]}]}]},{"tin":{"type":"ein","value":"386006931"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":508.90,"providers":[{"billed_charge":1172.60,"npi":[1003139361]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1468.54,"providers":[{"billed_charge":3232.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1025.07,"providers":[{"billed_charge":2222.40,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":58220.43,"providers":[{"billed_charge":234938.80,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"386008155"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":159.94,"providers":[{"billed_charge":424.00,"npi":[1669416947]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10374.29,"providers":[{"billed_charge":34772.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1155.93,"providers":[{"billed_charge":3975.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":433.50,"providers":[{"billed_charge":1450.80,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"386006334"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":145.40,"providers":[{"billed_charge":330.00,"npi":[1538568902]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11777.40,"providers":[{"billed_charge":29471.24,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4725.50,"providers":[{"billed_charge":10353.75,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"382783846"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":363.50,"providers":[{"billed_charge":880.40,"npi":[1629016274]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10112.57,"providers":[{"billed_charge":56968.80,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"386031668"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":123.59,"providers":[{"billed_charge":273.60,"npi":[1730119504]}]}]},{"tin":{"type":"ein","value":"381712300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36.35,"providers":[{"billed_charge":74.25,"npi":[1811010416]}]}]},{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30171.60,"providers":[{"billed_charge":68032.85,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":625.22,"providers":[{"billed_charge":1524.25,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"386006926"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":183.60,"providers":[{"billed_charge":613.70,"npi":[1790724656]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1381.44,"providers":[{"billed_charge":4306.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8429.20,"providers":[{"billed_charge":20941.97,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":683.38,"providers":[{"billed_charge":2201.20,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2021.06,"providers":[{"billed_charge":6330.92,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3104.29,"providers":[{"billed_charge":6130.45,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"382285796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21.81,"providers":[{"billed_charge":73.50,"npi":[1689621047]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4580.10,"providers":[{"billed_charge":11508.52,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386006306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":305.34,"providers":[{"billed_charge":780.90,"npi":[1982644241]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12039.07,"providers":[{"billed_charge":36321.60,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"386007299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29.08,"providers":[{"billed_charge":64.60,"npi":[1649210154]}]}]},{"tin":{"type":"ein","value":"381869375"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36.35,"providers":[{"billed_charge":76.80,"npi":[1669618989]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4847.27,"providers":[{"billed_charge":12002.40,"npi":[1699863704]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2304.72,"providers":[{"billed_charge":10800.00,"npi":[1124056296]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":37707.88,"providers":[{"billed_charge":111350.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":63253.32,"providers":[{"billed_charge":236000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382142110"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":405.47,"providers":[{"billed_charge":2406.67,"npi":[1881627503]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9735.25,"providers":[{"billed_charge":32122.32,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24733.67,"providers":[{"billed_charge":65382.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2838.29,"providers":[{"billed_charge":7097.72,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32888.61,"providers":[{"billed_charge":115900.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7298.46,"providers":[{"billed_charge":20342.00,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31941.44,"providers":[{"billed_charge":63448.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":87581.52,"providers":[{"billed_charge":217758.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1216.41,"providers":[{"billed_charge":6150.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14596.92,"providers":[{"billed_charge":38285.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9325.81,"providers":[{"billed_charge":18775.00,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31221.19,"providers":[{"billed_charge":177408.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7298.46,"providers":[{"billed_charge":18000.00,"npi":[1699863704]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42466.60,"providers":[{"billed_charge":139650.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":64625.32,"providers":[{"billed_charge":374340.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3841.20,"providers":[{"billed_charge":15300.00,"npi":[1699863704]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":312693.92,"providers":[{"billed_charge":594950.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4780.16,"providers":[{"billed_charge":10500.00,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16389.12,"providers":[{"billed_charge":45075.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9901.76,"providers":[{"billed_charge":27060.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6145.92,"providers":[{"billed_charge":17290.62,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":41997.12,"providers":[{"billed_charge":59950.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18437.76,"providers":[{"billed_charge":29700.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12291.84,"providers":[{"billed_charge":19800.00,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":79329.90,"providers":[{"billed_charge":131530.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27932.13,"providers":[{"billed_charge":54905.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4780.16,"providers":[{"billed_charge":12432.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4438.72,"providers":[{"billed_charge":20150.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1433.28,"providers":[{"billed_charge":3405.00,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2731.52,"providers":[{"billed_charge":7392.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":64190.72,"providers":[{"billed_charge":367500.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12291.84,"providers":[{"billed_charge":30600.00,"npi":[1699863704]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18161.91,"providers":[{"billed_charge":137520.00,"npi":[1720046188]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19480.00,"providers":[{"billed_charge":48700.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":666.00,"providers":[{"billed_charge":1665.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1523.20,"providers":[{"billed_charge":3808.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":752.00,"providers":[{"billed_charge":1880.00,"npi":[1720046188]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"824763691"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1724.46,"providers":[{"billed_charge":3150.00,"npi":[1730792664]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;6-","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6012","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"383545312"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2170.41,"providers":[{"billed_charge":7095.00,"npi":[1467912477]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"800959432"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":5054.00,"providers":[{"billed_charge":5054.00,"npi":[1538109244]}]}]}]},{"name":"INJ DEFEROXAMINE MESYTE 500","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0895","description":"INJECTION, DEFEROXAMINE MESYLATE, 500 MG","allowed_amounts":[{"tin":{"type":"ein","value":"383491714"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1275.38,"providers":[{"billed_charge":4251.84,"npi":[1720112535]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":36.37,"providers":[{"billed_charge":2070.00,"npi":[1457065930]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":22.34,"providers":[{"billed_charge":225.76,"npi":[1457065930]}]}]}]},{"name":"HOME INFUS TX CHELATION; PER","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9355","description":"HOME INFUSION THERAPY, CHELATION THERAPY; ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, C","allowed_amounts":[{"tin":{"type":"ein","value":"383491714"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5749.10,"providers":[{"billed_charge":8600.00,"npi":[1720112535]}]}]}]}]}