{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-03-31","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"851648079"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":8050.00,"providers":[{"billed_charge":44800.00,"npi":[1861089690]}]}]}]},{"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":"350868157"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":256164.89,"providers":[{"billed_charge":106794.00,"npi":[1841245594]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"436003859"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58.66,"providers":[{"billed_charge":195.51,"npi":[1699769901]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":380.85,"providers":[{"billed_charge":5906.65,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31.86,"providers":[{"billed_charge":820.05,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4.53,"providers":[{"billed_charge":1227.74,"npi":[1063457380]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":705.52,"providers":[{"billed_charge":7711.05,"npi":[1841245594]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":618.66,"providers":[{"billed_charge":3201.14,"npi":[1063457380]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32191.07,"providers":[{"billed_charge":81206.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5889.53,"providers":[{"billed_charge":16113.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26267.60,"providers":[{"billed_charge":52591.02,"npi":[1063457380]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":641.44,"providers":[{"billed_charge":1432.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"356001583"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":196.92,"providers":[{"billed_charge":1876.30,"npi":[1356428429]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1243.69,"providers":[{"billed_charge":4108.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"610444707"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":163.74,"providers":[{"billed_charge":1379.84,"npi":[1689282147]}]},{"allowed_amount":473.38,"providers":[{"billed_charge":2510.96,"npi":[1689282147]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":16.00,"npi":[1174571129]}]},{"allowed_amount":42.84,"providers":[{"billed_charge":397.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":29.59,"providers":[{"billed_charge":842.30,"npi":[1063457380]}]},{"allowed_amount":3059.13,"providers":[{"billed_charge":33356.93,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"351151208"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":219.28,"providers":[{"billed_charge":3763.00,"npi":[1699757401]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1244.94,"providers":[{"billed_charge":32070.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":543.99,"providers":[{"billed_charge":7681.75,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"922355855"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.76,"providers":[{"billed_charge":534.00,"npi":[1144914532]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11.74,"providers":[{"billed_charge":39.17,"npi":[1831116441]}]},{"allowed_amount":236.37,"providers":[{"billed_charge":302.70,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3905.98,"providers":[{"billed_charge":36510.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"356001583"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":600.65,"providers":[{"billed_charge":9601.50,"npi":[1356428429]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16360.05,"providers":[{"billed_charge":132747.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1834.56,"providers":[{"billed_charge":27738.00,"npi":[1174571129]}]},{"allowed_amount":9.40,"providers":[{"billed_charge":229.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":14.88,"providers":[{"billed_charge":259.17,"npi":[1063457380]}]},{"allowed_amount":2949.49,"providers":[{"billed_charge":31000.94,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":658.97,"providers":[{"billed_charge":1070.00,"npi":[1234567893]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":361.52,"providers":[{"billed_charge":5349.00,"npi":[1457366189]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":135.72,"providers":[{"billed_charge":5126.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":87.02,"providers":[{"billed_charge":786.68,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":207.83,"providers":[{"billed_charge":1983.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4051.53,"providers":[{"billed_charge":35617.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":359.17,"providers":[{"billed_charge":5111.00,"npi":[1174571129]}]},{"allowed_amount":8.63,"providers":[{"billed_charge":240.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8.63,"providers":[{"billed_charge":222.01,"npi":[1063457380]}]},{"allowed_amount":1210.24,"providers":[{"billed_charge":18262.12,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":203.25,"providers":[{"billed_charge":7712.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":734.85,"providers":[{"billed_charge":1360.00,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":114.89,"providers":[{"billed_charge":804.00,"npi":[1457366189]}]},{"allowed_amount":577.65,"providers":[{"billed_charge":3116.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14575.35,"providers":[{"billed_charge":54758.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3620.19,"providers":[{"billed_charge":7693.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1940.00,"providers":[{"billed_charge":10599.01,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2124.28,"providers":[{"billed_charge":27803.00,"npi":[1851833230]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7.32,"providers":[{"billed_charge":193.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":309.15,"providers":[{"billed_charge":6500.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":238.66,"providers":[{"billed_charge":2376.96,"npi":[1063457380]}]}]}]},{"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":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":150.39,"providers":[{"billed_charge":631.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":199.40,"providers":[{"billed_charge":2279.00,"npi":[1841245594]}]},{"allowed_amount":1195.24,"providers":[{"billed_charge":19545.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2315.56,"providers":[{"billed_charge":23400.73,"npi":[1063457380]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6449.86,"providers":[{"billed_charge":19664.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4851.48,"providers":[{"billed_charge":13764.06,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2489.34,"providers":[{"billed_charge":4445.00,"npi":[1851833230]}]}]}]},{"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":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10335.48,"providers":[{"billed_charge":15368.00,"npi":[1851833230]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10367.65,"providers":[{"billed_charge":81134.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6286.77,"providers":[{"billed_charge":19945.27,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":820.48,"providers":[{"billed_charge":904.00,"npi":[1851833230]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41214.55,"providers":[{"billed_charge":281915.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":966.79,"providers":[{"billed_charge":6540.55,"npi":[1063457380]}]},{"allowed_amount":16997.26,"providers":[{"billed_charge":68404.90,"npi":[1063457380]}]}]}]},{"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":86.45,"providers":[{"billed_charge":342.00,"npi":[1942526447]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2635.20,"providers":[{"billed_charge":6628.80,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":357.77,"providers":[{"billed_charge":3427.69,"npi":[1234567893]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":855.69,"providers":[{"billed_charge":6608.00,"npi":[1841245594]}]}]}]},{"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":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":203.46,"providers":[{"billed_charge":1582.63,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22767.35,"providers":[{"billed_charge":87191.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32832.31,"providers":[{"billed_charge":60026.94,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18568.14,"providers":[{"billed_charge":101727.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":196167.56,"providers":[{"billed_charge":301788.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39004.95,"providers":[{"billed_charge":65396.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":227762.09,"providers":[{"billed_charge":633848.69,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":244427.60,"providers":[{"billed_charge":1021352.00,"npi":[1851833230]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2668.17,"providers":[{"billed_charge":75255.00,"npi":[1003866740]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1124.13,"providers":[{"billed_charge":18518.50,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20.82,"providers":[{"billed_charge":69.38,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":435.37,"providers":[{"billed_charge":2974.21,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4.22,"providers":[{"billed_charge":4668.39,"npi":[1457366189]}]},{"allowed_amount":48613.84,"providers":[{"billed_charge":214145.29,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8943.95,"providers":[{"billed_charge":14921.25,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":396.47,"providers":[{"billed_charge":1500.90,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2475.43,"providers":[{"billed_charge":54255.06,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49.20,"providers":[{"billed_charge":164.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71.81,"providers":[{"billed_charge":18306.10,"npi":[1851833230]}]}]},{"tin":{"type":"ein","value":"941603784"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":254.10,"providers":[{"billed_charge":847.00,"npi":[1417901091]}]}]}]},{"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":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":84.01,"providers":[{"billed_charge":395.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3303.42,"providers":[{"billed_charge":21889.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":60.07,"providers":[{"billed_charge":328.89,"npi":[1063457380]}]},{"allowed_amount":2827.83,"providers":[{"billed_charge":20777.45,"npi":[1063457380]}]}]}]},{"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":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":340.94,"providers":[{"billed_charge":9937.60,"npi":[1063457380]}]}]}]},{"name":"ULTRASOUND BREAST LIMITED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76642","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":725.40,"providers":[{"billed_charge":6251.00,"npi":[1659725323]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":442.93,"providers":[{"billed_charge":2976.00,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.66,"providers":[{"billed_charge":200.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":340.83,"providers":[{"billed_charge":1407.00,"npi":[1790049377]}]},{"allowed_amount":779.04,"providers":[{"billed_charge":3240.00,"npi":[1366647034]}]},{"allowed_amount":7644.33,"providers":[{"billed_charge":32041.00,"npi":[1659725323]}]}]},{"tin":{"type":"ein","value":"992145793"},"service_code":["22","11","19"],"billing_class":"professional","payments":[{"allowed_amount":39.66,"providers":[{"billed_charge":90.00,"npi":[1467846881]}]},{"allowed_amount":1234.14,"providers":[{"billed_charge":2790.00,"npi":[1467846881]}]},{"allowed_amount":159.03,"providers":[{"billed_charge":360.00,"npi":[1467846881]}]}]}]},{"name":"DX MAMMO INCL CAD UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77065","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":63.51,"providers":[{"billed_charge":319.00,"npi":[1659725323]}]}]}]},{"name":"DX MAMMO INCL CAD BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77066","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1421.10,"providers":[{"billed_charge":7442.00,"npi":[1659725323]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":1701.21,"providers":[{"billed_charge":8887.20,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":187.31,"providers":[{"billed_charge":550.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":9448.26,"providers":[{"billed_charge":47512.00,"npi":[1659725323]}]},{"allowed_amount":421.26,"providers":[{"billed_charge":2065.00,"npi":[1790049377]}]},{"allowed_amount":962.88,"providers":[{"billed_charge":4867.00,"npi":[1366647034]}]}]},{"tin":{"type":"ein","value":"992145793"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":1563.92,"providers":[{"billed_charge":3441.00,"npi":[1467846881]}]},{"allowed_amount":251.96,"providers":[{"billed_charge":555.00,"npi":[1467846881]}]}]}]},{"name":"GUIDANCE FOR RADIAJ TX DLVR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77387","description":"GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN","allowed_amounts":[{"tin":{"type":"ein","value":"352091937"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":27.97,"providers":[{"billed_charge":165.00,"npi":[1033616289]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4079.28,"providers":[{"billed_charge":10496.64,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":280.87,"providers":[{"billed_charge":3160.75,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4162.50,"providers":[{"billed_charge":10658.44,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":297.46,"providers":[{"billed_charge":3670.65,"npi":[1234567893]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"351302836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":123.28,"providers":[{"billed_charge":690.00,"npi":[1548945389]}]}]}]},{"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":"271700231"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":96.00,"providers":[{"billed_charge":96.00,"npi":[1821319526]}]},{"allowed_amount":320.00,"providers":[{"billed_charge":320.00,"npi":[1821319526]}]},{"allowed_amount":256.00,"providers":[{"billed_charge":256.00,"npi":[1821319526]}]}]},{"tin":{"type":"ein","value":"814267664"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":184.87,"providers":[{"billed_charge":1106.00,"npi":[1770130122]}]},{"allowed_amount":26.41,"providers":[{"billed_charge":158.00,"npi":[1770130122]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":299.33,"providers":[{"billed_charge":757.18,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3480.96,"providers":[{"billed_charge":8880.00,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":441.76,"providers":[{"billed_charge":4235.86,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":311.75,"providers":[{"billed_charge":792.54,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":633.30,"providers":[{"billed_charge":1583.40,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.56,"providers":[{"billed_charge":1579.86,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.56,"providers":[{"billed_charge":1093.15,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":209.88,"providers":[{"billed_charge":517.94,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":308.70,"providers":[{"billed_charge":793.80,"npi":[1811154388]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.21,"providers":[{"billed_charge":74.32,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1440.54,"providers":[{"billed_charge":3689.80,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":206.84,"providers":[{"billed_charge":2658.01,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":126.84,"providers":[{"billed_charge":304.09,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":171.36,"providers":[{"billed_charge":437.00,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":151.47,"providers":[{"billed_charge":1734.17,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":505.82,"providers":[{"billed_charge":1238.88,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":103.79,"providers":[{"billed_charge":1226.92,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":290.49,"providers":[{"billed_charge":739.64,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":39.39,"providers":[{"billed_charge":642.59,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2963.52,"providers":[{"billed_charge":7627.20,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":421.40,"providers":[{"billed_charge":4326.05,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.44,"providers":[{"billed_charge":118.58,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":22.64,"providers":[{"billed_charge":271.04,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1947.52,"providers":[{"billed_charge":4972.80,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":191.07,"providers":[{"billed_charge":1856.82,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":117.78,"providers":[{"billed_charge":304.09,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":113.10,"providers":[{"billed_charge":274.72,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":598.90,"providers":[{"billed_charge":1476.81,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":72.66,"providers":[{"billed_charge":190.30,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.39,"providers":[{"billed_charge":385.99,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.51,"providers":[{"billed_charge":190.00,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":132.99,"providers":[{"billed_charge":1147.70,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":98.26,"providers":[{"billed_charge":245.63,"npi":[1811154388]}]}]}]},{"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":46.88,"providers":[{"billed_charge":520.00,"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":210.60,"providers":[{"billed_charge":1268.96,"npi":[1093753303]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"820936345"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14.06,"providers":[{"billed_charge":46.04,"npi":[1649905258]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":105.45,"providers":[{"billed_charge":615.00,"npi":[1801541719]}]},{"allowed_amount":63.27,"providers":[{"billed_charge":369.00,"npi":[1366914426]}]},{"allowed_amount":21.09,"providers":[{"billed_charge":123.00,"npi":[1144717927]}]}]}]},{"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":439.23,"providers":[{"billed_charge":3102.00,"npi":[1093753303]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":186.25,"providers":[{"billed_charge":503.31,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":261.24,"providers":[{"billed_charge":2853.12,"npi":[1234567893]}]}]}]},{"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":"411656670"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":421.22,"providers":[{"billed_charge":1920.00,"npi":[1689899817]}]}]},{"tin":{"type":"ein","value":"310744468"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":172.69,"providers":[{"billed_charge":600.00,"npi":[1750542171]}]}]},{"tin":{"type":"ein","value":"351604525"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":799.44,"providers":[{"billed_charge":5140.00,"npi":[1093057911]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":438.33,"providers":[{"billed_charge":1987.00,"npi":[1234567893]}]},{"allowed_amount":64.71,"providers":[{"billed_charge":825.00,"npi":[1234567893]}]},{"allowed_amount":330.09,"providers":[{"billed_charge":4125.00,"npi":[1234567893]}]},{"allowed_amount":175.48,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["22","24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":236.87,"providers":[{"billed_charge":695.00,"npi":[1801117387]}]},{"allowed_amount":559.22,"providers":[{"billed_charge":1610.00,"npi":[1053930487]}]},{"allowed_amount":21.57,"providers":[{"billed_charge":275.00,"npi":[1508928672,1598154452,1366738809]}]},{"allowed_amount":987.65,"providers":[{"billed_charge":2760.00,"npi":[1053930487]}]},{"allowed_amount":474.54,"providers":[{"billed_charge":6050.00,"npi":[1194767780]}]},{"allowed_amount":7838.43,"providers":[{"billed_charge":21985.00,"npi":[1841448180]}]},{"allowed_amount":128.82,"providers":[{"billed_charge":360.00,"npi":[1841448180,1366738809]}]},{"allowed_amount":1596.18,"providers":[{"billed_charge":20350.00,"npi":[1053930487]}]},{"allowed_amount":64.71,"providers":[{"billed_charge":825.00,"npi":[1194767780]}]},{"allowed_amount":946.90,"providers":[{"billed_charge":2750.00,"npi":[1194767780]}]},{"allowed_amount":946.57,"providers":[{"billed_charge":2640.00,"npi":[1194767780]}]},{"allowed_amount":42.94,"providers":[{"billed_charge":120.00,"npi":[1801117387]}]}]},{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1159.36,"providers":[{"billed_charge":22023.60,"npi":[1083903058]}]}]}]},{"name":"IMMUNOHISTO ANTB 1ST STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88342","description":"IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":40.34,"providers":[{"billed_charge":300.00,"npi":[1194767780]}]},{"allowed_amount":20.17,"providers":[{"billed_charge":121.00,"npi":[1194767780]}]},{"allowed_amount":190.53,"providers":[{"billed_charge":450.00,"npi":[1841448180]}]},{"allowed_amount":167.36,"providers":[{"billed_charge":422.00,"npi":[1194767780]}]}]}]},{"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":"356067049"},"service_code":["11","60"],"billing_class":"professional","payments":[{"allowed_amount":17.46,"providers":[{"billed_charge":48.30,"npi":[1083141287]}]},{"allowed_amount":261.36,"providers":[{"billed_charge":676.20,"npi":[1083141287]}]}]}]},{"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":"851648079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":847.26,"providers":[{"billed_charge":17055.00,"npi":[1861089690]}]}]},{"tin":{"type":"ein","value":"833632697"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5890.00,"providers":[{"billed_charge":15500.00,"npi":[1154979615]}]}]}]},{"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":"833632697"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1709.92,"providers":[{"billed_charge":11100.00,"npi":[1780220251]}]}]}]},{"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":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.53,"providers":[{"billed_charge":125.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"842463346"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112.68,"providers":[{"billed_charge":240.00,"npi":[1578551495]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["02","19","10"],"billing_class":"professional","payments":[{"allowed_amount":167.64,"providers":[{"billed_charge":585.00,"npi":[1467279794]}]},{"allowed_amount":111.76,"providers":[{"billed_charge":170.00,"npi":[1467279794]}]},{"allowed_amount":55.88,"providers":[{"billed_charge":195.00,"npi":[1467279794]}]}]}]},{"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":"873927295"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":100.74,"providers":[{"billed_charge":130.00,"npi":[1518639558]}]},{"allowed_amount":338.16,"providers":[{"billed_charge":360.00,"npi":[1518639558]}]}]},{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9691.95,"providers":[{"billed_charge":12950.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"842463346"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1136.15,"providers":[{"billed_charge":2080.00,"npi":[1578551495]}]}]},{"tin":{"type":"ein","value":"873075048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":471.06,"providers":[{"billed_charge":600.00,"npi":[1063309599]}]}]},{"tin":{"type":"ein","value":"263021772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":459.83,"providers":[{"billed_charge":1125.00,"npi":[1609473834]}]}]},{"tin":{"type":"ein","value":"351147323"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":84.09,"providers":[{"billed_charge":276.00,"npi":[1851162762]}]}]},{"tin":{"type":"ein","value":"823874275"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":224.78,"providers":[{"billed_charge":350.00,"npi":[1568016798]}]},{"allowed_amount":346.65,"providers":[{"billed_charge":525.00,"npi":[1568016798]}]}]},{"tin":{"type":"ein","value":"842385515"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":84.09,"providers":[{"billed_charge":130.00,"npi":[1629433370]}]}]},{"tin":{"type":"ein","value":"820783414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1167.37,"providers":[{"billed_charge":2100.00,"npi":[1023428208]}]}]},{"tin":{"type":"ein","value":"813929887"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":84.09,"providers":[{"billed_charge":200.00,"npi":[1629570650]}]},{"allowed_amount":84.54,"providers":[{"billed_charge":200.00,"npi":[1629570650]}]}]},{"tin":{"type":"ein","value":"814409045"},"service_code":["11","12","02"],"billing_class":"professional","payments":[{"allowed_amount":252.27,"providers":[{"billed_charge":450.00,"npi":[1821468794]}]},{"allowed_amount":169.08,"providers":[{"billed_charge":300.00,"npi":[1821468794]}]},{"allowed_amount":1352.64,"providers":[{"billed_charge":2400.00,"npi":[1821468794]}]}]},{"tin":{"type":"ein","value":"932834934"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1465.23,"providers":[{"billed_charge":2600.00,"npi":[1356934582]}]},{"allowed_amount":4868.29,"providers":[{"billed_charge":9800.00,"npi":[1356934582]}]}]}]},{"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":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":873.37,"providers":[{"billed_charge":1400.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":185.24,"providers":[{"billed_charge":341.00,"npi":[1578243028]}]}]},{"tin":{"type":"ein","value":"351135451"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":704.56,"providers":[{"billed_charge":4531.00,"npi":[1760952535]}]}]}]},{"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":"833632697"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":65325.00,"providers":[{"billed_charge":100500.00,"npi":[1154979615]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":573.80,"providers":[{"billed_charge":17737.00,"npi":[1003866740]}]}]}]},{"name":"SPECIAL EYE EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92060","description":"SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR PARETIC ","allowed_amounts":[{"tin":{"type":"ein","value":"824133617"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":186.90,"providers":[{"billed_charge":204.00,"npi":[1255367686]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"463204426"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":691.68,"providers":[{"billed_charge":1380.00,"npi":[1538784236]}]}]},{"tin":{"type":"ein","value":"800071212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":57.64,"providers":[{"billed_charge":125.00,"npi":[1699089276]}]}]},{"tin":{"type":"ein","value":"331195715"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":405.98,"providers":[{"billed_charge":1120.00,"npi":[1750270484]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":17552.90,"providers":[{"billed_charge":75859.16,"npi":[1912166075]}]}]}]},{"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":"351180407"},"service_code":["22","81"],"billing_class":"professional","payments":[{"allowed_amount":6.92,"providers":[{"billed_charge":17.00,"npi":[1487658761]}]},{"allowed_amount":35.99,"providers":[{"billed_charge":85.00,"npi":[1487658761]}]}]}]},{"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":"611389493"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.77,"providers":[{"billed_charge":37.00,"npi":[1992701833]}]}]}]},{"name":"DEVEL TST PHYS/QHP 1ST HR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96112","description":"DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":44.76,"providers":[{"billed_charge":44.76,"npi":[1912166075]}]}]}]},{"name":"THER/PROPH/DIAG INJ IV PUSH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96374","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); INTRAVENOUS PUSH, SI","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":323.20,"providers":[{"billed_charge":5720.22,"npi":[1851504518]}]}]}]},{"name":"TX/PRO/DX INJ NEW DRUG ADDON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96375","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); EACH ADDNL SEQUENTIA","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":134.80,"providers":[{"billed_charge":3024.00,"npi":[1851504518]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.84,"providers":[{"billed_charge":100.00,"npi":[1275306763]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.00,"providers":[{"billed_charge":28.00,"npi":[1801887138]}]},{"allowed_amount":218.79,"providers":[{"billed_charge":560.00,"npi":[1801838743]}]}]}]},{"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":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":46.60,"providers":[{"billed_charge":112.00,"npi":[1801887138]}]},{"allowed_amount":35.36,"providers":[{"billed_charge":84.00,"npi":[1396889788]}]},{"allowed_amount":70.31,"providers":[{"billed_charge":168.00,"npi":[1801838743]}]}]}]},{"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":"205497203"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":70.33,"providers":[{"billed_charge":110.00,"npi":[1255322822]}]}]},{"tin":{"type":"ein","value":"462356266"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":179.46,"providers":[{"billed_charge":858.00,"npi":[1659147098]}]}]},{"tin":{"type":"ein","value":"201147631"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":617.40,"providers":[{"billed_charge":1680.00,"npi":[1558808907]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.03,"providers":[{"billed_charge":105.00,"npi":[1982420378]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":752.35,"providers":[{"billed_charge":2660.00,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"351720796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2561.22,"providers":[{"billed_charge":7750.00,"npi":[1760607253]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":753.50,"providers":[{"billed_charge":1938.00,"npi":[1801838743]}]},{"allowed_amount":332.41,"providers":[{"billed_charge":855.00,"npi":[1801887138]}]},{"allowed_amount":176.24,"providers":[{"billed_charge":456.00,"npi":[1396889788]}]}]},{"tin":{"type":"ein","value":"351955872"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":530.27,"providers":[{"billed_charge":1923.00,"npi":[1689340333]}]}]},{"tin":{"type":"ein","value":"262975531"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.06,"providers":[{"billed_charge":150.00,"npi":[1417540519]}]}]},{"tin":{"type":"ein","value":"871365424"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":617.96,"providers":[{"billed_charge":2800.00,"npi":[1588478457]}]}]},{"tin":{"type":"ein","value":"351361243"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.46,"providers":[{"billed_charge":248.00,"npi":[1003598749]}]}]},{"tin":{"type":"ein","value":"743234365"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.59,"providers":[{"billed_charge":210.00,"npi":[1841747490]}]}]},{"tin":{"type":"ein","value":"852554859"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":109.58,"providers":[{"billed_charge":445.00,"npi":[1679390934]}]}]}]},{"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":"871365424"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":221.74,"providers":[{"billed_charge":1125.00,"npi":[1588478457]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1207.72,"providers":[{"billed_charge":5096.00,"npi":[1982420378]}]},{"allowed_amount":595.88,"providers":[{"billed_charge":2496.00,"npi":[1871023978]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1689.56,"providers":[{"billed_charge":5180.00,"npi":[1912166075]}]}]}]},{"name":"THER IVNTJ 1ST 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97129","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2281.14,"providers":[{"billed_charge":6114.68,"npi":[1912166075]}]}]}]},{"name":"THER IVNTJ EA ADDL 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97130","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6595.70,"providers":[{"billed_charge":18557.84,"npi":[1912166075]}]}]}]},{"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":"871365424"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.14,"providers":[{"billed_charge":75.00,"npi":[1588478457]}]}]},{"tin":{"type":"ein","value":"852554859"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.68,"providers":[{"billed_charge":504.00,"npi":[1679390934]}]}]}]},{"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":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19936.43,"providers":[{"billed_charge":35360.00,"npi":[1437662731]}]},{"allowed_amount":11274.40,"providers":[{"billed_charge":19920.00,"npi":[1245019769]}]}]},{"tin":{"type":"ein","value":"812674567"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6436.12,"providers":[{"billed_charge":14150.00,"npi":[1881042885]}]}]},{"tin":{"type":"ein","value":"350965639"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":60640.32,"providers":[{"billed_charge":117520.00,"npi":[1891917449]}]}]},{"tin":{"type":"ein","value":"202605791"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29935.53,"providers":[{"billed_charge":65200.00,"npi":[1447867924]}]}]},{"tin":{"type":"ein","value":"473746811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":57738.75,"providers":[{"billed_charge":143381.25,"npi":[1801470836]}]}]},{"tin":{"type":"ein","value":"453668959"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19279.25,"providers":[{"billed_charge":80570.00,"npi":[1982389656]}]},{"allowed_amount":13517.25,"providers":[{"billed_charge":56490.00,"npi":[1336772748]}]}]}]},{"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":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":203.76,"providers":[{"billed_charge":450.00,"npi":[1245019769]}]},{"allowed_amount":1105.09,"providers":[{"billed_charge":2450.00,"npi":[1437662731]}]}]},{"tin":{"type":"ein","value":"473746811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4888.60,"providers":[{"billed_charge":17820.00,"npi":[1801470836]}]}]},{"tin":{"type":"ein","value":"453668959"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":818.74,"providers":[{"billed_charge":3619.00,"npi":[1982389656]}]},{"allowed_amount":330.98,"providers":[{"billed_charge":1463.00,"npi":[1982389656]}]},{"allowed_amount":749.06,"providers":[{"billed_charge":3311.00,"npi":[1336772748]}]}]}]},{"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":"462011273"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":52.61,"providers":[{"billed_charge":80.00,"npi":[1215216072]}]}]},{"tin":{"type":"ein","value":"873621436"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2430.74,"providers":[{"billed_charge":3680.00,"npi":[1811681638]}]}]},{"tin":{"type":"ein","value":"871365424"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":343.71,"providers":[{"billed_charge":1950.00,"npi":[1588478457]}]}]},{"tin":{"type":"ein","value":"202605791"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":214.00,"providers":[{"billed_charge":520.00,"npi":[1588247142]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":714.67,"providers":[{"billed_charge":2970.00,"npi":[1871023978]}]},{"allowed_amount":2746.79,"providers":[{"billed_charge":11330.00,"npi":[1275306763]}]},{"allowed_amount":105.22,"providers":[{"billed_charge":440.00,"npi":[1972258523]}]},{"allowed_amount":1873.20,"providers":[{"billed_charge":7810.00,"npi":[1982420378]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":33582.06,"providers":[{"billed_charge":91308.20,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"824133617"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":402.84,"providers":[{"billed_charge":426.00,"npi":[1255367686]}]}]}]},{"name":"SENSORY INTEGRATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97533","description":"SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIR","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":307.25,"providers":[{"billed_charge":463.82,"npi":[1912166075]}]}]}]},{"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":"351814334"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":74.28,"providers":[{"billed_charge":206.00,"npi":[1275530800]}]}]},{"tin":{"type":"ein","value":"471007264"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":74.21,"providers":[{"billed_charge":172.00,"npi":[1225264245]}]}]},{"tin":{"type":"ein","value":"743234365"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":448.24,"providers":[{"billed_charge":577.85,"npi":[1841747490]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":519.96,"providers":[{"billed_charge":1078.00,"npi":[1801887138]}]},{"allowed_amount":1262.76,"providers":[{"billed_charge":2618.00,"npi":[1801838743]}]},{"allowed_amount":74.28,"providers":[{"billed_charge":154.00,"npi":[1396889788]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":47.40,"providers":[{"billed_charge":110.00,"npi":[1396889788]}]}]}]},{"name":"REM THER MNTR 1ST 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98980","description":"REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":507.76,"providers":[{"billed_charge":580.11,"npi":[1245420314]}]}]}]},{"name":"REM THER MNTR EA ADDL 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98981","description":"REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":912.06,"providers":[{"billed_charge":1038.07,"npi":[1245420314]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99202","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":102.00,"providers":[{"billed_charge":292.00,"npi":[1234567893]}]}]}]},{"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":"811448348"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":521.91,"providers":[{"billed_charge":792.20,"npi":[1558734889]}]},{"allowed_amount":83.88,"providers":[{"billed_charge":125.82,"npi":[1427282763]}]}]},{"tin":{"type":"ein","value":"814267664"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":76.36,"providers":[{"billed_charge":152.30,"npi":[1770130122]}]},{"allowed_amount":361.77,"providers":[{"billed_charge":761.50,"npi":[1770130122]}]}]},{"tin":{"type":"ein","value":"351097350"},"service_code":["02","50"],"billing_class":"professional","payments":[{"allowed_amount":46.83,"providers":[{"billed_charge":150.00,"npi":[1659974806]}]},{"allowed_amount":657.51,"providers":[{"billed_charge":1170.00,"npi":[1033539481]}]},{"allowed_amount":1304.04,"providers":[{"billed_charge":2340.00,"npi":[1548766181]}]},{"allowed_amount":93.66,"providers":[{"billed_charge":300.00,"npi":[1548766181]}]}]},{"tin":{"type":"ein","value":"351875364"},"service_code":["50","10"],"billing_class":"professional","payments":[{"allowed_amount":71.30,"providers":[{"billed_charge":157.00,"npi":[1194589804]}]},{"allowed_amount":356.50,"providers":[{"billed_charge":785.00,"npi":[1265021406]}]},{"allowed_amount":149.89,"providers":[{"billed_charge":471.00,"npi":[1265021406]}]}]},{"tin":{"type":"ein","value":"351972384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1537.38,"providers":[{"billed_charge":1620.00,"npi":[1164040135]}]}]}]},{"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":"351302836"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":317.63,"providers":[{"billed_charge":600.00,"npi":[1548945389]}]},{"allowed_amount":599.62,"providers":[{"billed_charge":1600.00,"npi":[1548945389]}]}]},{"tin":{"type":"ein","value":"142007519"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":246.47,"providers":[{"billed_charge":524.00,"npi":[1851702229]}]}]},{"tin":{"type":"ein","value":"351516588"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":89.21,"providers":[{"billed_charge":140.00,"npi":[1053394023]}]},{"allowed_amount":4601.35,"providers":[{"billed_charge":5320.00,"npi":[1053394023]}]}]},{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":364.61,"providers":[{"billed_charge":905.40,"npi":[1083141287]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":100.42,"providers":[{"billed_charge":306.00,"npi":[1801541719]}]}]},{"tin":{"type":"ein","value":"351972384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":354.42,"providers":[{"billed_charge":392.00,"npi":[1104935147]}]}]},{"tin":{"type":"ein","value":"350211370"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":170.16,"providers":[{"billed_charge":484.44,"npi":[1235164732]}]},{"allowed_amount":688.82,"providers":[{"billed_charge":1951.52,"npi":[1821423393]}]},{"allowed_amount":1304.35,"providers":[{"billed_charge":3647.06,"npi":[1821423393]}]}]}]},{"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":"825430908"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":126.96,"providers":[{"billed_charge":288.00,"npi":[1720733447]}]},{"allowed_amount":70.48,"providers":[{"billed_charge":144.00,"npi":[1043530165]}]}]},{"tin":{"type":"ein","value":"471628951"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":560.00,"providers":[{"billed_charge":1152.00,"npi":[1760834147]}]},{"allowed_amount":704.80,"providers":[{"billed_charge":1440.00,"npi":[1730426958]}]}]}]},{"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":"824707194"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":92.34,"providers":[{"billed_charge":175.76,"npi":[1245918465]}]}]}]},{"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":"351183940"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":319.38,"providers":[{"billed_charge":2950.00,"npi":[1861785396]}]}]}]},{"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":"825090313"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5955.64,"providers":[{"billed_charge":15000.00,"npi":[1265857114]}]}]}]},{"name":"HOME VISIT NEW PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99344","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":111.46,"providers":[{"billed_charge":361.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99348","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":5449.34,"providers":[{"billed_charge":14863.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99349","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":8569.25,"providers":[{"billed_charge":21590.00,"npi":[1770167280]}]}]}]},{"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":"311575051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.35,"providers":[{"billed_charge":283.00,"npi":[1518720432]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1100.48,"providers":[{"billed_charge":1100.48,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001134"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":162.00,"providers":[{"billed_charge":162.00,"npi":[1023127206]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3208.37,"providers":[{"billed_charge":3211.89,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":61203.84,"providers":[{"billed_charge":122722.21,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"271130459"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1906.20,"providers":[{"billed_charge":8073.00,"npi":[1952683229]}]}]},{"tin":{"type":"ein","value":"356001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":304.80,"providers":[{"billed_charge":304.80,"npi":[1841418324]}]}]},{"tin":{"type":"ein","value":"356001141"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":70.00,"providers":[{"billed_charge":70.00,"npi":[1003853375]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31565.34,"providers":[{"billed_charge":31567.14,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1333.32,"providers":[{"billed_charge":1512.00,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":521.60,"providers":[{"billed_charge":521.60,"npi":[1114072964]}]}]},{"tin":{"type":"ein","value":"356001127"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":660.00,"providers":[{"billed_charge":660.00,"npi":[1871146365]}]}]},{"tin":{"type":"ein","value":"830966826"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1027.60,"providers":[{"billed_charge":5180.00,"npi":[1780338756]}]}]},{"tin":{"type":"ein","value":"351311688"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":225.00,"providers":[{"billed_charge":225.00,"npi":[1841246998]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":79740.84,"providers":[{"billed_charge":80721.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38549.48,"providers":[{"billed_charge":39775.00,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"351549572"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20516.43,"providers":[{"billed_charge":20533.87,"npi":[1215973888]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4372.20,"providers":[{"billed_charge":4372.20,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2300.13,"providers":[{"billed_charge":2300.13,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18518.84,"providers":[{"billed_charge":24092.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":176853.60,"providers":[{"billed_charge":176853.60,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":98215.04,"providers":[{"billed_charge":98400.00,"npi":[1558681700]}]}]}]},{"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":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27077.20,"providers":[{"billed_charge":36350.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12989.76,"providers":[{"billed_charge":33637.80,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2152.16,"providers":[{"billed_charge":2200.00,"npi":[1558681700]}]}]}]},{"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":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8651.84,"providers":[{"billed_charge":8651.84,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13937.76,"providers":[{"billed_charge":26252.88,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":143568.06,"providers":[{"billed_charge":143568.06,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6927.96,"providers":[{"billed_charge":7824.00,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12165.28,"providers":[{"billed_charge":12250.00,"npi":[1558681700]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1684.44,"providers":[{"billed_charge":6565.56,"npi":[1234567893]}]}]}]},{"name":"ADMN SET SM VOL NONFLTR NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7005","description":"ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, NONDISPOSABLE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":345.48,"providers":[{"billed_charge":520.00,"npi":[1669415394]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":350.55,"providers":[{"billed_charge":2007.00,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":648.48,"providers":[{"billed_charge":3006.20,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1664.91,"providers":[{"billed_charge":6375.12,"npi":[1234567893]}]}]}]},{"name":"PILLW NASL CANNULA TYPE INTF","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7033","description":"PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":327.36,"providers":[{"billed_charge":1626.78,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2886.55,"providers":[{"billed_charge":12438.88,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":842.34,"providers":[{"billed_charge":4035.97,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":373.12,"providers":[{"billed_charge":1303.08,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1395.47,"providers":[{"billed_charge":4219.68,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":244.56,"providers":[{"billed_charge":1972.82,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2977.70,"providers":[{"billed_charge":13045.21,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351925619"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":947.28,"providers":[{"billed_charge":1633.16,"npi":[1427870310]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":479.31,"providers":[{"billed_charge":2400.00,"npi":[1669415394]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4922.25,"providers":[{"billed_charge":79249.78,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351925619"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3145.23,"providers":[{"billed_charge":4950.00,"npi":[1427870310]}]}]}]},{"name":"BREAST PUMP ELECTRIC ANY TYP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0603","description":"BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":9013.06,"providers":[{"billed_charge":35000.00,"npi":[1669415394]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3076.00,"providers":[{"billed_charge":22980.60,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":91.82,"providers":[{"billed_charge":420.00,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":513.57,"providers":[{"billed_charge":1332.39,"npi":[1811154388]}]}]}]},{"name":"DX DIGTL BRST TOMOSYN UNI/BI","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0279","description":"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":3721.20,"providers":[{"billed_charge":9303.00,"npi":[1659725323]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"351972384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":136.47,"providers":[{"billed_charge":276.00,"npi":[1104935147]}]}]}]},{"name":"ALCOHL&/RX SRVC; SUB-AC DTOX","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0010","description":"ALCOHOL AND/OR DRUG SERVICES; SUBACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)","allowed_amounts":[{"tin":{"type":"ein","value":"850661429"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":1175.13,"providers":[{"billed_charge":4700.34,"npi":[1659913739]}]}]}]},{"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":"621740366"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":1193.25,"providers":[{"billed_charge":4633.36,"npi":[1649274317]}]}]}]},{"name":"MENTAL HLTH PART HOSP TX <24","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0035","description":"MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"992174368"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":20700.00,"providers":[{"billed_charge":258750.00,"npi":[1083976971]}]}]}]},{"name":"INJ CEFTRIAXONE SODM PER 250","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0696","description":"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":33.84,"providers":[{"billed_charge":532.08,"npi":[1851504518]}]}]}]},{"name":"INJECTION DAPTOMYCIN 1 MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0878","description":"INJECTION, DAPTOMYCIN, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["11","19"],"billing_class":"professional","payments":[{"allowed_amount":264.03,"providers":[{"billed_charge":27846.00,"npi":[1851504518]}]},{"allowed_amount":291.59,"providers":[{"billed_charge":30758.00,"npi":[1851504518]}]}]}]},{"name":"INJ HEPARIN SODIUM 10 UNITS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1642","description":"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.90,"providers":[{"billed_charge":387.96,"npi":[1851504518]}]}]}]},{"name":"INTNSVE OP PSYC SVC PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9480","description":"INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"880953475"},"service_code":["52"],"billing_class":"professional","payments":[{"allowed_amount":17500.00,"providers":[{"billed_charge":55000.00,"npi":[1679286272]}]}]}]}]}