{
    "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": "ANES LWR INTST SCR COLSC",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "00812",
            "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCRE",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "861908119"
                    },
                    "service_code": ["22", "24"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 266.92,
                            "providers": [{
                                    "billed_charge": 5400.00,
                                    "npi": [1619633898]
                                }
                            ]
                        }, {
                            "allowed_amount": 213.83,
                            "providers": [{
                                    "billed_charge": 5400.00,
                                    "npi": [1619633898]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "OFFICE/OUTPATIENT VISIT EST",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "THERAPEUTIC EXERCISES",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "STREP A, DNA, AMP PROBE",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "FETAL BIOPHYS PROFIL W/O NST",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "OB US FOLLOW-UP PER FETUS",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FET",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "MANUAL THERAPY 1/> REGIONS",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "OB US DETAILED SNGL FETUS",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "ULTRSND, PREGNANT UTERUS, REAL TIME W IMG DOCUMENTATION, FETAL AND MATERNAL EVALUATION PLUS DETAILED",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "UMBILICAL ARTERY ECHO",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "OFFICE/OUTPATIENT VISIT NEW",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "510",
            "description": "OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "273695360"
                    },
                    "service_code": ["50"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 415.60,
                            "providers": [{
                                    "billed_charge": 2283.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 311.71,
                            "providers": [{
                                    "billed_charge": 3297.95,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 103.90,
                            "providers": [{
                                    "billed_charge": 1075.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 199.05,
                            "providers": [{
                                    "billed_charge": 1296.10,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.02,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 541.36,
                            "providers": [{
                                    "billed_charge": 1600.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 1852.04,
                            "providers": [{
                                    "billed_charge": 5925.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 196.04,
                            "providers": [{
                                    "billed_charge": 210.00,
                                    "npi": [1730454083]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.24,
                            "providers": [{
                                    "billed_charge": 5581.60,
                                    "npi": [1730454083]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "GRND MLGE PER STATUTE MILE",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "540",
            "description": "GROUND MILEAGE, PER STATUTE MILE",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "133957095"
                    },
                    "service_code": ["22"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 108.00,
                            "providers": [{
                                    "billed_charge": 129.42,
                                    "npi": [1174628473]
                                }
                            ]
                        }, {
                            "allowed_amount": 5179.22,
                            "providers": [{
                                    "billed_charge": 7110.22,
                                    "npi": [1174628473]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "AMB SERVICE BLS EMERGENCY TR",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "540",
            "description": "AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "133957095"
                    },
                    "service_code": ["22"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 108.00,
                            "providers": [{
                                    "billed_charge": 129.42,
                                    "npi": [1174628473]
                                }
                            ]
                        }, {
                            "allowed_amount": 5179.22,
                            "providers": [{
                                    "billed_charge": 7110.22,
                                    "npi": [1174628473]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "CT HEAD/BRAIN W/O DYE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "70450",
            "description": "COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "19", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 602.63,
                            "providers": [{
                                    "billed_charge": 7740.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 101.55,
                            "providers": [{
                                    "billed_charge": 1370.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 29.17,
                            "providers": [{
                                    "billed_charge": 733.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 3434.82,
                            "providers": [{
                                    "billed_charge": 44084.34,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "MRI BRAIN STEM W/O DYE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "70551",
            "description": "MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 87.85,
                            "providers": [{
                                    "billed_charge": 1095.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 87.26,
                            "providers": [{
                                    "billed_charge": 1043.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 90.11,
                            "providers": [{
                                    "billed_charge": 1043.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM CHEST 1 VIEW",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "71045",
            "description": "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 961.84,
                            "providers": [{
                                    "billed_charge": 16060.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 1873.53,
                            "providers": [{
                                    "billed_charge": 30318.77,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 32.75,
                            "providers": [{
                                    "billed_charge": 396.77,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "621203441"
                    },
                    "service_code": ["21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 31.68,
                            "providers": [{
                                    "billed_charge": 66.00,
                                    "npi": [1619088697]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM CHEST 2 VIEWS",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "71046",
            "description": "RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "20", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 350.70,
                            "providers": [{
                                    "billed_charge": 5412.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 26.00,
                            "providers": [{
                                    "billed_charge": 392.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 473.99,
                            "providers": [{
                                    "billed_charge": 6790.38,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 38.95,
                            "providers": [{
                                    "billed_charge": 608.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "CT ANGIOGRAPHY CHEST",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "71275",
            "description": "COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTR",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 211.31,
                            "providers": [{
                                    "billed_charge": 3580.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 108.23,
                            "providers": [{
                                    "billed_charge": 1665.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 2495.37,
                            "providers": [{
                                    "billed_charge": 40545.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM L-S SPINE 2/3 VWS",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "72100",
            "description": "RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "20"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 29.68,
                            "providers": [{
                                    "billed_charge": 392.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 13.44,
                            "providers": [{
                                    "billed_charge": 191.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 8.32,
                            "providers": [{
                                    "billed_charge": 201.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "CT NECK SPINE W/O DYE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "72125",
            "description": "COMPUTED TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 256.46,
                            "providers": [{
                                    "billed_charge": 2996.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM OF SHOULDER",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "73030",
            "description": "RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF 2 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "20"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 22.82,
                            "providers": [{
                                    "billed_charge": 306.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 139.96,
                            "providers": [{
                                    "billed_charge": 1868.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 11.41,
                            "providers": [{
                                    "billed_charge": 153.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM OF KNEE 3",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "73562",
            "description": "RADIOLOGIC EXAMINATION, KNEE; 3 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 11.41,
                            "providers": [{
                                    "billed_charge": 140.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM OF ANKLE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "73610",
            "description": "RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF 3 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 10.86,
                            "providers": [{
                                    "billed_charge": 141.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 11.80,
                            "providers": [{
                                    "billed_charge": 141.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM OF FOOT",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "73630",
            "description": "RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF 3 VIEWS",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 10.40,
                            "providers": [{
                                    "billed_charge": 133.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "X-RAY EXAM ABDOMEN 1 VIEW",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "74018",
            "description": "RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 10.97,
                            "providers": [{
                                    "billed_charge": 161.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "CT ABD & PELVIS W/O CONTRAST",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "74176",
            "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 103.30,
                            "providers": [{
                                    "billed_charge": 1860.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 412.08,
                            "providers": [{
                                    "billed_charge": 6954.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 1562.20,
                            "providers": [{
                                    "billed_charge": 24339.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "CT ABD & PELV W/CONTRAST",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "74177",
            "description": "COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 7662.34,
                            "providers": [{
                                    "billed_charge": 112557.88,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 869.72,
                            "providers": [{
                                    "billed_charge": 13790.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 652.64,
                            "providers": [{
                                    "billed_charge": 10660.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "843038369"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 93.61,
                            "providers": [{
                                    "billed_charge": 315.00,
                                    "npi": [1881230563]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "ULTRASOUND BREAST COMPLETE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "76641",
            "description": "ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "19"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1138.74,
                            "providers": [{
                                    "billed_charge": 15632.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 981.10,
                            "providers": [{
                                    "billed_charge": 13660.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "844522008"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 196.50,
                            "providers": [{
                                    "billed_charge": 2820.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "ECHO EXAM OF ABDOMEN",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "76705",
            "description": "ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23", "19"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 184.42,
                            "providers": [{
                                    "billed_charge": 1907.91,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.43,
                            "providers": [{
                                    "billed_charge": 462.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 161.88,
                            "providers": [{
                                    "billed_charge": 2310.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "TRANSVAGINAL US, NON-OB",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "76830",
            "description": "ULTRASOUND, TRANSVAGINAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 124.27,
                            "providers": [{
                                    "billed_charge": 1503.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 45.77,
                            "providers": [{
                                    "billed_charge": 501.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "BREAST TOMOSYNTHESIS UNI",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "77061",
            "description": "DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 33.40,
                            "providers": [{
                                    "billed_charge": 284.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "844522008"
                    },
                    "service_code": ["22", "19"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 743.59,
                            "providers": [{
                                    "billed_charge": 5286.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 1565.21,
                            "providers": [{
                                    "billed_charge": 10673.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "844522008"
                    },
                    "service_code": ["22", "19"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 144.83,
                            "providers": [{
                                    "billed_charge": 979.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 47.87,
                            "providers": [{
                                    "billed_charge": 319.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "844522008"
                    },
                    "service_code": ["22", "19"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2635.90,
                            "providers": [{
                                    "billed_charge": 17320.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 1067.95,
                            "providers": [{
                                    "billed_charge": 7227.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "460751479"
                    },
                    "service_code": ["10"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 240.62,
                            "providers": [{
                                    "billed_charge": 600.00,
                                    "npi": [1437334190]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "EXTREMITY STUDY",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "93970",
            "description": "DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILA",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "844522008"
                    },
                    "service_code": ["23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 288.97,
                            "providers": [{
                                    "billed_charge": 4571.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }, {
                            "allowed_amount": 178.37,
                            "providers": [{
                                    "billed_charge": 2612.00,
                                    "npi": [1255962783]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "873599459"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 226.38,
                            "providers": [{
                                    "billed_charge": 455.04,
                                    "npi": [1972257541]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "862142035"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1057.82,
                            "providers": [{
                                    "billed_charge": 4200.00,
                                    "npi": [1457931214]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "873599459"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 335.52,
                            "providers": [{
                                    "billed_charge": 634.40,
                                    "npi": [1972257541]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "873599459"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 284.80,
                            "providers": [{
                                    "billed_charge": 600.00,
                                    "npi": [1972257541]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "862142035"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 392.60,
                            "providers": [{
                                    "billed_charge": 1650.00,
                                    "npi": [1457931214]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "113538970"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 9181.40,
                            "providers": [{
                                    "billed_charge": 10000.00,
                                    "npi": [1134634843]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "873599459"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 366.56,
                            "providers": [{
                                    "billed_charge": 650.56,
                                    "npi": [1972257541]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "862142035"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 45.82,
                            "providers": [{
                                    "billed_charge": 150.00,
                                    "npi": [1457931214]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "882919668"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 916.30,
                            "providers": [{
                                    "billed_charge": 1500.00,
                                    "npi": [1861905978]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "113322995"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 736.22,
                            "providers": [{
                                    "billed_charge": 1630.00,
                                    "npi": [1497034748]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "161496961"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1511.68,
                            "providers": [{
                                    "billed_charge": 2340.00,
                                    "npi": [1942301635]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "474881081"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 17002.96,
                            "providers": [{
                                    "billed_charge": 41801.22,
                                    "npi": [1528437894]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "116000463"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1009.50,
                            "providers": [{
                                    "billed_charge": 1009.50,
                                    "npi": [1912009812]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "133062687"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2598.96,
                            "providers": [{
                                    "billed_charge": 2598.96,
                                    "npi": [1053351700]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "202081121"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2374.02,
                            "providers": [{
                                    "billed_charge": 2396.64,
                                    "npi": [1265542765]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "160954422"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 45.14,
                            "providers": [{
                                    "billed_charge": 45.14,
                                    "npi": [1366419509]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "132646815"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 10362.25,
                            "providers": [{
                                    "billed_charge": 12728.00,
                                    "npi": [1003878596]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "132655001"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 3474.00,
                            "providers": [{
                                    "billed_charge": 3474.00,
                                    "npi": [1083715460]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "112420013"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 9427.20,
                            "providers": [{
                                    "billed_charge": 10384.00,
                                    "npi": [1033343389]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "132655001"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 13440.00,
                            "providers": [{
                                    "billed_charge": 13440.00,
                                    "npi": [1083715460]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "112420013"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 23110.00,
                            "providers": [{
                                    "billed_charge": 23400.00,
                                    "npi": [1033343389]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "202081121"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 6719.66,
                            "providers": [{
                                    "billed_charge": 6719.66,
                                    "npi": [1265542765]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "132646815"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 3900.00,
                            "providers": [{
                                    "billed_charge": 3900.00,
                                    "npi": [1003878596]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "132655001"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 77536.00,
                            "providers": [{
                                    "billed_charge": 77560.00,
                                    "npi": [1083715460]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "112420013"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 41856.00,
                            "providers": [{
                                    "billed_charge": 44800.00,
                                    "npi": [1033343389]
                                }
                            ]
                        }
                    ]
                }
            ]
        }
    ]
}
