{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-04-28","out_of_network":[{"name":"NCNTC R-T FLUOR WND IMG 1ST","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0598T","description":"NONCONTACT R-T FLUOR WND IMG 1ST ANATOMIC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["22","12"],"billing_class":"professional","payments":[{"allowed_amount":164.61,"providers":[{"billed_charge":389.94,"npi":[1114399375]}]},{"allowed_amount":2394.67,"providers":[{"billed_charge":5729.28,"npi":[1114399375]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":541.90,"providers":[{"billed_charge":882.10,"npi":[1114399375]}]}]},{"tin":{"type":"ein","value":"640662976"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":867.54,"providers":[{"billed_charge":3153.00,"npi":[1982754974]}]}]},{"tin":{"type":"ein","value":"621519754"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":66.36,"providers":[{"billed_charge":227.00,"npi":[1679174403]}]},{"allowed_amount":1615.81,"providers":[{"billed_charge":5448.00,"npi":[1679174403]}]},{"allowed_amount":139.34,"providers":[{"billed_charge":454.00,"npi":[1679174403]}]}]},{"tin":{"type":"ein","value":"646001567"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":899.82,"providers":[{"billed_charge":5760.00,"npi":[1356742894]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"646001587"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":228215.01,"providers":[{"billed_charge":221393.70,"npi":[1225041809]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31.39,"providers":[{"billed_charge":104.54,"npi":[1558365890]}]},{"allowed_amount":441.58,"providers":[{"billed_charge":28921.25,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"872688291"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.63,"providers":[{"billed_charge":9.50,"npi":[1063177228]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":262.54,"providers":[{"billed_charge":2433.35,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":63.34,"providers":[{"billed_charge":211.11,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":473.82,"providers":[{"billed_charge":1579.37,"npi":[1578568481]}]},{"allowed_amount":5323.86,"providers":[{"billed_charge":5472.35,"npi":[1578568481]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":46.40,"providers":[{"billed_charge":1671.52,"npi":[1558365890]}]},{"allowed_amount":25.44,"providers":[{"billed_charge":84.80,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1404.04,"providers":[{"billed_charge":6670.37,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":71.88,"providers":[{"billed_charge":239.50,"npi":[1558365890]}]},{"allowed_amount":142.50,"providers":[{"billed_charge":669.26,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":699.07,"providers":[{"billed_charge":1516.91,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2787.28,"providers":[{"billed_charge":4976.00,"npi":[1558365890]}]},{"allowed_amount":401.06,"providers":[{"billed_charge":2579.00,"npi":[1558365890]}]},{"allowed_amount":2809.00,"providers":[{"billed_charge":15162.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24219.98,"providers":[{"billed_charge":61733.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2353.09,"providers":[{"billed_charge":6100.82,"npi":[1760789903]}]},{"allowed_amount":117.99,"providers":[{"billed_charge":306.13,"npi":[1932143989]}]},{"allowed_amount":3703.47,"providers":[{"billed_charge":9901.43,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":187.55,"providers":[{"billed_charge":559.75,"npi":[1841394418]}]},{"allowed_amount":905.00,"providers":[{"billed_charge":2747.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2153.08,"providers":[{"billed_charge":3827.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3801.02,"providers":[{"billed_charge":7935.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":451.87,"providers":[{"billed_charge":781.00,"npi":[1811973100]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":272.40,"providers":[{"billed_charge":908.01,"npi":[1144227539]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":335.54,"providers":[{"billed_charge":542.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2543.57,"providers":[{"billed_charge":3497.00,"npi":[1558365890]}]},{"allowed_amount":12.00,"providers":[{"billed_charge":377.00,"npi":[1558365890]}]},{"allowed_amount":937.00,"providers":[{"billed_charge":17630.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"440577118"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":161.02,"providers":[{"billed_charge":333.36,"npi":[1093740128]}]}]},{"tin":{"type":"ein","value":"473637912"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":207.94,"providers":[{"billed_charge":1026.00,"npi":[1215449954]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":30.00,"npi":[1912341439]}]},{"allowed_amount":11179.48,"providers":[{"billed_charge":25335.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":270.94,"providers":[{"billed_charge":703.01,"npi":[1932143989]}]},{"allowed_amount":6120.97,"providers":[{"billed_charge":12454.53,"npi":[1760789903]}]},{"allowed_amount":12200.91,"providers":[{"billed_charge":24825.68,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":32.71,"providers":[{"billed_charge":222.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":683.23,"providers":[{"billed_charge":2464.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1981.35,"providers":[{"billed_charge":5353.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2188.54,"providers":[{"billed_charge":5032.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4000.05,"providers":[{"billed_charge":31061.96,"npi":[1578568481]}]},{"allowed_amount":13768.00,"providers":[{"billed_charge":26136.00,"npi":[1578568481]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":156.48,"providers":[{"billed_charge":5575.00,"npi":[1558365890]}]},{"allowed_amount":8005.33,"providers":[{"billed_charge":12172.00,"npi":[1558365890]}]},{"allowed_amount":2913.00,"providers":[{"billed_charge":37228.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9928.93,"providers":[{"billed_charge":52043.00,"npi":[1912341439]}]},{"allowed_amount":62.11,"providers":[{"billed_charge":750.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":560.66,"providers":[{"billed_charge":1184.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":61.80,"providers":[{"billed_charge":452.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3019.99,"providers":[{"billed_charge":12696.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1210.17,"providers":[{"billed_charge":2817.65,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7159.54,"providers":[{"billed_charge":17472.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2109.72,"providers":[{"billed_charge":8676.00,"npi":[1578568481]}]},{"allowed_amount":5514.00,"providers":[{"billed_charge":7982.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":576.31,"providers":[{"billed_charge":1458.00,"npi":[1811973100]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":38.89,"providers":[{"billed_charge":1602.00,"npi":[1558365890]}]},{"allowed_amount":1883.92,"providers":[{"billed_charge":3260.00,"npi":[1558365890]}]},{"allowed_amount":1049.00,"providers":[{"billed_charge":12498.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11.63,"providers":[{"billed_charge":145.00,"npi":[1912341439]}]},{"allowed_amount":2289.14,"providers":[{"billed_charge":13735.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":480.41,"providers":[{"billed_charge":1744.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":861.12,"providers":[{"billed_charge":2060.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1110.00,"providers":[{"billed_charge":1110.00,"npi":[1578568481]}]},{"allowed_amount":161.25,"providers":[{"billed_charge":1295.00,"npi":[1578568481]}]}]}]},{"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":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1100.89,"providers":[{"billed_charge":7180.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.63,"providers":[{"billed_charge":267.75,"npi":[1841394418]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2.49,"providers":[{"billed_charge":75.00,"npi":[1558365890]}]},{"allowed_amount":75.00,"providers":[{"billed_charge":238.00,"npi":[1558365890]}]},{"allowed_amount":698.01,"providers":[{"billed_charge":771.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2.49,"providers":[{"billed_charge":31.00,"npi":[1912341439]}]},{"allowed_amount":596.04,"providers":[{"billed_charge":2574.00,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":856.29,"providers":[{"billed_charge":2180.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2669.90,"providers":[{"billed_charge":23435.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1764.02,"providers":[{"billed_charge":5342.15,"npi":[1932143989]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1143.52,"providers":[{"billed_charge":2242.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7179.33,"providers":[{"billed_charge":26080.00,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":998.84,"providers":[{"billed_charge":3394.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7412.32,"providers":[{"billed_charge":78084.00,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":401.52,"providers":[{"billed_charge":4432.00,"npi":[1558365890]}]},{"allowed_amount":13091.66,"providers":[{"billed_charge":52694.00,"npi":[1558365890]}]},{"allowed_amount":22154.00,"providers":[{"billed_charge":41808.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27883.81,"providers":[{"billed_charge":358347.00,"npi":[1912341439]}]}]}]},{"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":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.65,"providers":[{"billed_charge":80.00,"npi":[1700557915]}]},{"allowed_amount":239.42,"providers":[{"billed_charge":610.00,"npi":[1114395050]}]}]},{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3351.09,"providers":[{"billed_charge":13230.00,"npi":[1942526447]}]}]},{"tin":{"type":"ein","value":"871016907"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.28,"providers":[{"billed_charge":160.00,"npi":[1982247888]}]}]},{"tin":{"type":"ein","value":"464786388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":45.44,"providers":[{"billed_charge":216.00,"npi":[1326650110]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":5.00,"providers":[{"billed_charge":10.00,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"640362400"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":6.82,"providers":[{"billed_charge":7.00,"npi":[1629365853]}]},{"allowed_amount":95.66,"providers":[{"billed_charge":98.00,"npi":[1629365853]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.16,"providers":[{"billed_charge":90.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":188.37,"providers":[{"billed_charge":780.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":84.92,"providers":[{"billed_charge":220.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15.44,"providers":[{"billed_charge":32.00,"npi":[1255975405]}]}]},{"tin":{"type":"ein","value":"834721464"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":4.83,"providers":[{"billed_charge":29.00,"npi":[1588141725]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.15,"providers":[{"billed_charge":120.00,"npi":[1194956755]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":58592.58,"providers":[{"billed_charge":97946.00,"npi":[1558365890]}]},{"allowed_amount":1177.88,"providers":[{"billed_charge":18926.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"872688291"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6132.45,"providers":[{"billed_charge":16835.06,"npi":[1063177228]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":118886.62,"providers":[{"billed_charge":472336.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1343.68,"providers":[{"billed_charge":4720.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2757.32,"providers":[{"billed_charge":4421.34,"npi":[1760789903]}]},{"allowed_amount":11874.41,"providers":[{"billed_charge":17882.94,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15345.09,"providers":[{"billed_charge":16851.11,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14396.69,"providers":[{"billed_charge":23888.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31060.95,"providers":[{"billed_charge":38778.00,"npi":[1578568481]}]},{"allowed_amount":477.50,"providers":[{"billed_charge":3645.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7142.00,"providers":[{"billed_charge":14061.00,"npi":[1811973100]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"640632268"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":6985.20,"providers":[{"billed_charge":9505.00,"npi":[1073634226]}]}]},{"tin":{"type":"ein","value":"640506107"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":38346.40,"providers":[{"billed_charge":117904.00,"npi":[1134151442]}]}]},{"tin":{"type":"ein","value":"640732896"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":7749.76,"providers":[{"billed_charge":15071.44,"npi":[1477919603]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":2542.81,"providers":[{"billed_charge":5352.29,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"640592416"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":943.35,"providers":[{"billed_charge":2412.00,"npi":[1528312519]}]},{"allowed_amount":32776.47,"providers":[{"billed_charge":59293.86,"npi":[1841220357]}]}]}]},{"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":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":166.89,"providers":[{"billed_charge":420.41,"npi":[1558365890]}]},{"allowed_amount":2606.96,"providers":[{"billed_charge":13465.96,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"872688291"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":159.93,"providers":[{"billed_charge":434.76,"npi":[1063177228]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1145.80,"providers":[{"billed_charge":4888.70,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1135.57,"providers":[{"billed_charge":4002.00,"npi":[1760789903]}]},{"allowed_amount":141.20,"providers":[{"billed_charge":366.40,"npi":[1932143989]}]},{"allowed_amount":2016.95,"providers":[{"billed_charge":6360.40,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.63,"providers":[{"billed_charge":1433.86,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":374.37,"providers":[{"billed_charge":1284.52,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":165.36,"providers":[{"billed_charge":551.20,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3224.89,"providers":[{"billed_charge":10534.18,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2092.83,"providers":[{"billed_charge":25639.85,"npi":[1578568481]}]},{"allowed_amount":4272.49,"providers":[{"billed_charge":14418.48,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1.50,"providers":[{"billed_charge":2469.79,"npi":[1811973100]}]},{"allowed_amount":165.13,"providers":[{"billed_charge":550.39,"npi":[1811973100]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"640899562"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":6552.00,"providers":[{"billed_charge":8400.00,"npi":[1518219773]}]}]}]},{"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":"640409419"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":187.35,"providers":[{"billed_charge":990.00,"npi":[1497312664]}]}]},{"tin":{"type":"ein","value":"640863698"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":31.48,"providers":[{"billed_charge":200.00,"npi":[1306993282]}]},{"allowed_amount":95.36,"providers":[{"billed_charge":600.00,"npi":[1306993282]}]}]}]},{"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":"640501324"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":103.88,"providers":[{"billed_charge":455.00,"npi":[1891792842]}]},{"allowed_amount":111.90,"providers":[{"billed_charge":490.00,"npi":[1073775466]}]},{"allowed_amount":39.96,"providers":[{"billed_charge":175.00,"npi":[1073775466]}]},{"allowed_amount":287.21,"providers":[{"billed_charge":1260.00,"npi":[1891792842]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":35.00,"npi":[1891792842]}]}]},{"tin":{"type":"ein","value":"640409419"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":103.86,"providers":[{"billed_charge":442.00,"npi":[1497312664]}]},{"allowed_amount":15.98,"providers":[{"billed_charge":68.00,"npi":[1497312664]}]},{"allowed_amount":56.00,"providers":[{"billed_charge":238.00,"npi":[1285841916]}]},{"allowed_amount":111.96,"providers":[{"billed_charge":476.00,"npi":[1285841916]}]}]},{"tin":{"type":"ein","value":"640863698"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":104.32,"providers":[{"billed_charge":525.00,"npi":[1366479115]}]},{"allowed_amount":13.58,"providers":[{"billed_charge":70.00,"npi":[1366479115]}]},{"allowed_amount":207.40,"providers":[{"billed_charge":1050.00,"npi":[1306993282]}]},{"allowed_amount":117.94,"providers":[{"billed_charge":595.00,"npi":[1366479115]}]},{"allowed_amount":101.92,"providers":[{"billed_charge":525.00,"npi":[1306993282]}]},{"allowed_amount":33.94,"providers":[{"billed_charge":175.00,"npi":[1306993282]}]}]},{"tin":{"type":"ein","value":"640509457"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":24.00,"providers":[{"billed_charge":138.00,"npi":[1952725178]}]}]}]},{"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":"640409419"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":47.80,"providers":[{"billed_charge":205.00,"npi":[1497312664]}]},{"allowed_amount":19.12,"providers":[{"billed_charge":82.00,"npi":[1497312664]}]}]},{"tin":{"type":"ein","value":"640863698"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":8.13,"providers":[{"billed_charge":42.00,"npi":[1306993282,1366479115]}]},{"allowed_amount":16.26,"providers":[{"billed_charge":84.00,"npi":[1306993282]}]},{"allowed_amount":17.69,"providers":[{"billed_charge":84.00,"npi":[1306993282]}]},{"allowed_amount":9.56,"providers":[{"billed_charge":42.00,"npi":[1366479115]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":156.01,"providers":[{"billed_charge":356.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2364.43,"providers":[{"billed_charge":32566.00,"npi":[1912341439]}]}]}]},{"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":"640501324"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":283.23,"providers":[{"billed_charge":960.00,"npi":[1639666597]}]}]}]},{"name":"FETAL BIOPHYS PROFIL W/O NST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76819","description":"FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING","allowed_amounts":[{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":434.54,"providers":[{"billed_charge":1575.00,"npi":[1013930122]}]}]}]},{"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":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":483.11,"providers":[{"billed_charge":1470.00,"npi":[1396306957]}]},{"allowed_amount":1635.93,"providers":[{"billed_charge":4200.00,"npi":[1013930122]}]}]}]},{"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":"640501324"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":78.93,"providers":[{"billed_charge":384.00,"npi":[1891792842]}]},{"allowed_amount":52.71,"providers":[{"billed_charge":256.00,"npi":[1891792842]}]},{"allowed_amount":656.85,"providers":[{"billed_charge":3200.00,"npi":[1639666597]}]},{"allowed_amount":157.59,"providers":[{"billed_charge":768.00,"npi":[1639666597]}]}]},{"tin":{"type":"ein","value":"412007905"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":42.56,"providers":[{"billed_charge":220.00,"npi":[1548223001]}]},{"allowed_amount":148.87,"providers":[{"billed_charge":770.00,"npi":[1477930162]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":2891.68,"providers":[{"billed_charge":3256.00,"npi":[1780683508]}]},{"allowed_amount":3676.92,"providers":[{"billed_charge":4144.00,"npi":[1780683508]}]}]},{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4920.09,"providers":[{"billed_charge":16250.00,"npi":[1336187947]}]}]}]},{"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":"640501324"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":766.39,"providers":[{"billed_charge":2944.00,"npi":[1639666597]}]},{"allowed_amount":33.29,"providers":[{"billed_charge":128.00,"npi":[1891792842]}]},{"allowed_amount":266.68,"providers":[{"billed_charge":1024.00,"npi":[1639666597]}]},{"allowed_amount":132.88,"providers":[{"billed_charge":512.00,"npi":[1891792842]}]}]},{"tin":{"type":"ein","value":"412007905"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":54.80,"providers":[{"billed_charge":280.00,"npi":[1548223001]}]},{"allowed_amount":189.77,"providers":[{"billed_charge":981.00,"npi":[1477930162]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":3332.35,"providers":[{"billed_charge":4000.00,"npi":[1780683508]}]},{"allowed_amount":4997.85,"providers":[{"billed_charge":6000.00,"npi":[1780683508]}]}]},{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12021.40,"providers":[{"billed_charge":43824.00,"npi":[1336187947]}]}]}]},{"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":"464786388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.60,"providers":[{"billed_charge":35.00,"npi":[1326650110]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33.25,"providers":[{"billed_charge":333.09,"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":"871016907"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14.22,"providers":[{"billed_charge":45.84,"npi":[1982247888]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.03,"providers":[{"billed_charge":64.00,"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":"815000928"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1494.05,"providers":[{"billed_charge":2520.00,"npi":[1770367716]}]}]}]},{"name":"URINALYSIS NONAUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81000","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":28.14,"providers":[{"billed_charge":70.00,"npi":[1841076403]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"320158728"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.55,"providers":[{"billed_charge":1485.00,"npi":[1417770876]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.80,"providers":[{"billed_charge":50.00,"npi":[1700557915]}]},{"allowed_amount":51.84,"providers":[{"billed_charge":540.00,"npi":[1114395050]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3.84,"providers":[{"billed_charge":28.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":1.92,"providers":[{"billed_charge":30.00,"npi":[1730774290]}]},{"allowed_amount":4.80,"providers":[{"billed_charge":75.00,"npi":[1730774290]}]}]},{"tin":{"type":"ein","value":"834721464"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":2.40,"providers":[{"billed_charge":58.00,"npi":[1588141725]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":120.78,"providers":[{"billed_charge":858.00,"npi":[1396306957]}]},{"allowed_amount":112.06,"providers":[{"billed_charge":676.00,"npi":[1013930122]}]}]}]},{"name":"ANES LWR INTST NDSC NOS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"811","description":"ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; NOT ","allowed_amounts":[{"tin":{"type":"ein","value":"882294882"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":412.03,"providers":[{"billed_charge":1650.00,"npi":[1588898910]}]}]}]},{"name":"NFCT DS BV RNA VAG FLU ALG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81513","description":"NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":213.96,"providers":[{"billed_charge":1069.74,"npi":[1093753303]}]}]}]},{"name":"ASSAY, BLD/SERUM CHOLESTEROL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82465","description":"CHOLESTEROL, SERUM OR WHOLE BLOOD, TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"320158728"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.45,"providers":[{"billed_charge":459.00,"npi":[1417770876]}]}]}]},{"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":"871016907"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.32,"providers":[{"billed_charge":32.70,"npi":[1982247888]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.56,"providers":[{"billed_charge":84.00,"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":"320158728"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":108.90,"providers":[{"billed_charge":1815.00,"npi":[1417770876]}]}]},{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":19.80,"providers":[{"billed_charge":102.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"464786388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.72,"providers":[{"billed_charge":30.00,"npi":[1326650110]}]}]},{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":77.70,"providers":[{"billed_charge":250.00,"npi":[1841076403]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.90,"providers":[{"billed_charge":364.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":270.60,"providers":[{"billed_charge":1394.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"208339281"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":38.85,"providers":[{"billed_charge":125.00,"npi":[1841799616]}]}]}]},{"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":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.75,"providers":[{"billed_charge":26.00,"npi":[1255975405]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":60.08,"providers":[{"billed_charge":200.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":555.74,"providers":[{"billed_charge":1850.00,"npi":[1114701570]}]}]}]},{"name":"SARSCOV & INF VIR A&B AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87428","description":"IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":567.53,"providers":[{"billed_charge":1425.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":543.66,"providers":[{"billed_charge":1781.00,"npi":[1760353411]}]}]}]},{"name":"STREP A AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87430","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, STREPTOCOCCUS, GROUP A; (EG, ENZYME IMM","allowed_amounts":[{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7.14,"providers":[{"billed_charge":46.00,"npi":[1306551395]}]},{"allowed_amount":28.56,"providers":[{"billed_charge":184.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":9.25,"providers":[{"billed_charge":35.00,"npi":[1659775732]}]},{"allowed_amount":55.50,"providers":[{"billed_charge":210.00,"npi":[1659775732]}]}]},{"tin":{"type":"ein","value":"463878759"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":39.30,"providers":[{"billed_charge":230.00,"npi":[1205528833]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":162.88,"providers":[{"billed_charge":868.00,"npi":[1043670722]}]}]}]},{"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":"621695507"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":87.75,"providers":[{"billed_charge":550.00,"npi":[1093753303,1942526447]}]},{"allowed_amount":1983.15,"providers":[{"billed_charge":12430.00,"npi":[1093753303]}]}]}]},{"name":"RSV DNA/RNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87634","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY SYNCYTIAL VIRUS, AMPLIFIED PROB","allowed_amounts":[{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.68,"providers":[{"billed_charge":300.00,"npi":[1043670722]}]}]}]},{"name":"STREP B, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87653","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":17.55,"providers":[{"billed_charge":98.78,"npi":[1942526447]}]},{"allowed_amount":140.40,"providers":[{"billed_charge":790.24,"npi":[1942526447]}]}]}]},{"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":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":10810.80,"providers":[{"billed_charge":136974.86,"npi":[1093753303]}]},{"allowed_amount":1684.80,"providers":[{"billed_charge":18283.98,"npi":[1942526447]}]},{"allowed_amount":386.10,"providers":[{"billed_charge":10206.68,"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":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":28.12,"providers":[{"billed_charge":188.00,"npi":[1023687910]}]},{"allowed_amount":112.48,"providers":[{"billed_charge":752.00,"npi":[1306551395]}]}]},{"tin":{"type":"ein","value":"473740923"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7.74,"providers":[{"billed_charge":28.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":140.70,"providers":[{"billed_charge":500.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.04,"providers":[{"billed_charge":360.00,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":625.67,"providers":[{"billed_charge":2492.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":147.63,"providers":[{"billed_charge":861.00,"npi":[1922695964]}]},{"allowed_amount":358.53,"providers":[{"billed_charge":2091.00,"npi":[1316829252]}]},{"allowed_amount":119.51,"providers":[{"billed_charge":697.00,"npi":[1578346755]}]},{"allowed_amount":217.93,"providers":[{"billed_charge":1321.00,"npi":[1346038205]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":260.11,"providers":[{"billed_charge":1152.92,"npi":[1730774290]}]},{"allowed_amount":492.10,"providers":[{"billed_charge":2181.20,"npi":[1730774290]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":650.83,"providers":[{"billed_charge":1850.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":158.31,"providers":[{"billed_charge":927.00,"npi":[1346038205]}]},{"allowed_amount":281.44,"providers":[{"billed_charge":1648.00,"npi":[1316829252]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":175.90,"providers":[{"billed_charge":2010.00,"npi":[1730774290]}]},{"allowed_amount":580.47,"providers":[{"billed_charge":6633.00,"npi":[1730774290]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":140.60,"providers":[{"billed_charge":740.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":237.59,"providers":[{"billed_charge":874.00,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":253.08,"providers":[{"billed_charge":900.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":91.39,"providers":[{"billed_charge":442.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":112.48,"providers":[{"billed_charge":498.56,"npi":[1730774290]}]},{"allowed_amount":56.24,"providers":[{"billed_charge":249.28,"npi":[1730774290]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14.06,"providers":[{"billed_charge":82.00,"npi":[1316829252]}]}]}]},{"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":212.96,"providers":[{"billed_charge":1504.00,"npi":[1942526447]}]},{"allowed_amount":3154.47,"providers":[{"billed_charge":22278.00,"npi":[1093753303]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88304","description":"LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.21,"providers":[{"billed_charge":81.00,"npi":[1598898967]}]}]},{"tin":{"type":"ein","value":"640678600"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":12.66,"providers":[{"billed_charge":250.00,"npi":[1790777142]}]},{"allowed_amount":30.68,"providers":[{"billed_charge":625.00,"npi":[1790777142]}]}]}]},{"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":517.92,"providers":[{"billed_charge":4246.80,"npi":[1720405814]}]},{"allowed_amount":1258.74,"providers":[{"billed_charge":9253.30,"npi":[1598898967]}]}]},{"tin":{"type":"ein","value":"640867628"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":16.77,"providers":[{"billed_charge":200.00,"npi":[1164525309]}]},{"allowed_amount":334.54,"providers":[{"billed_charge":4000.00,"npi":[1164525309]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":428.33,"providers":[{"billed_charge":1220.00,"npi":[1659574127]}]}]},{"tin":{"type":"ein","value":"640678600"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":3228.21,"providers":[{"billed_charge":31365.00,"npi":[1790777142]}]},{"allowed_amount":126.25,"providers":[{"billed_charge":1230.00,"npi":[1790777142]}]}]},{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":4134.56,"providers":[{"billed_charge":41222.00,"npi":[1861464760]}]}]}]},{"name":"SPECIAL STAINS GROUP 1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88312","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN","allowed_amounts":[{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":799.40,"providers":[{"billed_charge":4958.00,"npi":[1861464760]}]}]}]},{"name":"SPECIAL STAINS GROUP 2","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88313","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT","allowed_amounts":[{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":269.58,"providers":[{"billed_charge":2800.00,"npi":[1861464760]}]}]}]},{"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":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":129.72,"providers":[{"billed_charge":224.00,"npi":[1114395050]}]}]}]},{"name":"BH/INTENS OP/PSYCH","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"905","description":"INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"581795523"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1853.94,"providers":[{"billed_charge":45760.00,"npi":[1821137035]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4650.00,"providers":[{"billed_charge":85932.00,"npi":[1912670068]}]}]}]},{"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":"461590861"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":114.06,"providers":[{"billed_charge":222.00,"npi":[1710334057]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["11","22","10"],"billing_class":"professional","payments":[{"allowed_amount":2216.15,"providers":[{"billed_charge":2275.00,"npi":[1326468679]}]},{"allowed_amount":168.75,"providers":[{"billed_charge":175.00,"npi":[1326468679]}]},{"allowed_amount":175.00,"providers":[{"billed_charge":175.00,"npi":[1326468679]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"640834532"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":464.22,"providers":[{"billed_charge":600.00,"npi":[1073091963]}]}]},{"tin":{"type":"ein","value":"874345955"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":456.24,"providers":[{"billed_charge":1200.00,"npi":[1396383501]}]}]},{"tin":{"type":"ein","value":"640662976"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":90.03,"providers":[{"billed_charge":116.00,"npi":[1881258267]}]},{"allowed_amount":1940.82,"providers":[{"billed_charge":2552.00,"npi":[1881258267]}]}]}]},{"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":"461590861"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":75.25,"providers":[{"billed_charge":153.00,"npi":[1710334057]}]}]}]},{"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":"640522444"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":250.41,"providers":[{"billed_charge":615.00,"npi":[1932710902]}]}]},{"tin":{"type":"ein","value":"646029322"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":1353.77,"providers":[{"billed_charge":2007.04,"npi":[1346084092]}]}]},{"tin":{"type":"ein","value":"854131067"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2657.38,"providers":[{"billed_charge":6000.00,"npi":[1912531005]}]}]},{"tin":{"type":"ein","value":"933198947"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":929.68,"providers":[{"billed_charge":1080.00,"npi":[1376308882]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":2200.60,"providers":[{"billed_charge":6080.00,"npi":[1811682099]}]}]},{"tin":{"type":"ein","value":"920812575"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1069.50,"providers":[{"billed_charge":1701.00,"npi":[1619749017]}]},{"allowed_amount":695.20,"providers":[{"billed_charge":1323.00,"npi":[1619749017]}]}]}]},{"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":"934312932"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2400.00,"providers":[{"billed_charge":16000.00,"npi":[1275388761]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2467.79,"providers":[{"billed_charge":28600.00,"npi":[1184450967]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"833494125"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5580.40,"providers":[{"billed_charge":59900.00,"npi":[1609409762]}]}]},{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8100.00,"providers":[{"billed_charge":108540.00,"npi":[1912670068]}]}]},{"tin":{"type":"ein","value":"461281853"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":23310.00,"providers":[{"billed_charge":295630.00,"npi":[1457232589]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"274396698"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":11.12,"providers":[{"billed_charge":30.00,"npi":[1821527391]}]}]},{"tin":{"type":"ein","value":"201668701"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":51.53,"providers":[{"billed_charge":465.85,"npi":[1487841847]}]},{"allowed_amount":57.54,"providers":[{"billed_charge":532.40,"npi":[1487841847]}]}]},{"tin":{"type":"ein","value":"646010232"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":9.98,"providers":[{"billed_charge":72.70,"npi":[1528178415]}]}]},{"tin":{"type":"ein","value":"264253264"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":24.69,"providers":[{"billed_charge":135.00,"npi":[1154356764]}]}]},{"tin":{"type":"ein","value":"640834917"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":24.42,"providers":[{"billed_charge":45.00,"npi":[1427554823]}]},{"allowed_amount":16.28,"providers":[{"billed_charge":30.00,"npi":[1427554823]}]}]},{"tin":{"type":"ein","value":"640682111"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":298.32,"providers":[{"billed_charge":2028.00,"npi":[1962507061]}]},{"allowed_amount":498.12,"providers":[{"billed_charge":3432.00,"npi":[1962507061]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":136.82,"providers":[{"billed_charge":1280.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.89,"providers":[{"billed_charge":20.00,"npi":[1396306957]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":131.19,"providers":[{"billed_charge":418.00,"npi":[1316829252]}]},{"allowed_amount":9.77,"providers":[{"billed_charge":33.00,"npi":[1346038205]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"646001528"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":268.57,"providers":[{"billed_charge":740.00,"npi":[1336973734]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":522.54,"providers":[{"billed_charge":1748.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"463878759"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":57.27,"providers":[{"billed_charge":200.00,"npi":[1205528833]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.11,"providers":[{"billed_charge":294.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":127.30,"providers":[{"billed_charge":420.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":474.51,"providers":[{"billed_charge":1260.00,"npi":[1275216467]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":19.98,"providers":[{"billed_charge":66.00,"npi":[1316829252]}]}]},{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":230.16,"providers":[{"billed_charge":900.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":35.64,"providers":[{"billed_charge":105.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":171.46,"providers":[{"billed_charge":337.48,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.04,"providers":[{"billed_charge":80.00,"npi":[1306551395]}]},{"allowed_amount":62.06,"providers":[{"billed_charge":240.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":100.17,"providers":[{"billed_charge":266.00,"npi":[1659775732]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":158.33,"providers":[{"billed_charge":900.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.47,"providers":[{"billed_charge":24.72,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":63.06,"providers":[{"billed_charge":402.00,"npi":[1609323450]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":32.09,"providers":[{"billed_charge":105.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":572.34,"providers":[{"billed_charge":1330.00,"npi":[1760353411]}]}]}]},{"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":"453806985"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":395.60,"providers":[{"billed_charge":1443.00,"npi":[1639822422]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.39,"providers":[{"billed_charge":48.00,"npi":[1871685552]}]}]}]},{"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":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":322.83,"providers":[{"billed_charge":588.00,"npi":[1588759955]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":265.46,"providers":[{"billed_charge":736.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"263078685"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":359.81,"providers":[{"billed_charge":1705.00,"npi":[1477719847]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":411.52,"providers":[{"billed_charge":756.00,"npi":[1871685552]}]}]}]},{"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":"833518366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":843.72,"providers":[{"billed_charge":1440.00,"npi":[1215554423]}]}]},{"tin":{"type":"ein","value":"640507572"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":442.77,"providers":[{"billed_charge":666.00,"npi":[1669485926]}]}]},{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":335.14,"providers":[{"billed_charge":1105.00,"npi":[1063397933]}]},{"allowed_amount":647.67,"providers":[{"billed_charge":2080.00,"npi":[1649029547]}]},{"allowed_amount":339.91,"providers":[{"billed_charge":1105.00,"npi":[1386529253]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":492.48,"providers":[{"billed_charge":3920.00,"npi":[1457894255]}]},{"allowed_amount":242.05,"providers":[{"billed_charge":1960.00,"npi":[1659114635]}]},{"allowed_amount":771.69,"providers":[{"billed_charge":6160.00,"npi":[1710235874]}]},{"allowed_amount":782.32,"providers":[{"billed_charge":6160.00,"npi":[1679982078]}]},{"allowed_amount":260.96,"providers":[{"billed_charge":2100.00,"npi":[1417724253]}]},{"allowed_amount":159.58,"providers":[{"billed_charge":1260.00,"npi":[1699536698]}]}]},{"tin":{"type":"ein","value":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":347.77,"providers":[{"billed_charge":520.00,"npi":[1750435301]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1198.82,"providers":[{"billed_charge":2520.00,"npi":[1871685552]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":268.95,"providers":[{"billed_charge":1246.00,"npi":[1376339218]}]},{"allowed_amount":174.92,"providers":[{"billed_charge":801.00,"npi":[1295353514]}]},{"allowed_amount":1370.31,"providers":[{"billed_charge":6230.00,"npi":[1790506954]}]},{"allowed_amount":880.08,"providers":[{"billed_charge":4005.00,"npi":[1295322063]}]},{"allowed_amount":4128.60,"providers":[{"billed_charge":18779.00,"npi":[1124904172]}]}]},{"tin":{"type":"ein","value":"640906618"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":599.19,"providers":[{"billed_charge":3875.00,"npi":[1053207787]}]}]},{"tin":{"type":"ein","value":"640891283"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1264.09,"providers":[{"billed_charge":2800.00,"npi":[1487947818]}]}]},{"tin":{"type":"ein","value":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2681.10,"providers":[{"billed_charge":5327.36,"npi":[1649670845]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1541.13,"providers":[{"billed_charge":4836.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":733.72,"providers":[{"billed_charge":1850.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"384037386"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.19,"providers":[{"billed_charge":89.00,"npi":[1477068385]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1524.69,"providers":[{"billed_charge":6942.00,"npi":[1578452660]}]}]},{"tin":{"type":"ein","value":"833275776"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":71.94,"providers":[{"billed_charge":244.35,"npi":[1033407044]}]}]},{"tin":{"type":"ein","value":"203941865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":34.11,"providers":[{"billed_charge":81.21,"npi":[1134010218]}]}]},{"tin":{"type":"ein","value":"825523767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.19,"providers":[{"billed_charge":75.00,"npi":[1679683627]}]}]}]},{"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":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":357.77,"providers":[{"billed_charge":1040.00,"npi":[1386529253]}]},{"allowed_amount":89.60,"providers":[{"billed_charge":260.00,"npi":[1063397933]}]},{"allowed_amount":323.97,"providers":[{"billed_charge":910.00,"npi":[1649029547]}]}]},{"tin":{"type":"ein","value":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":595.12,"providers":[{"billed_charge":1153.80,"npi":[1649670845]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":235.33,"providers":[{"billed_charge":1680.00,"npi":[1417724253]}]},{"allowed_amount":1133.68,"providers":[{"billed_charge":7810.00,"npi":[1710235874]}]},{"allowed_amount":506.58,"providers":[{"billed_charge":3640.00,"npi":[1659114635]}]},{"allowed_amount":198.48,"providers":[{"billed_charge":1400.00,"npi":[1699536698]}]},{"allowed_amount":356.95,"providers":[{"billed_charge":2520.00,"npi":[1679982078]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":356.32,"providers":[{"billed_charge":1120.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":411.02,"providers":[{"billed_charge":1881.00,"npi":[1295322063]}]},{"allowed_amount":721.99,"providers":[{"billed_charge":3168.00,"npi":[1790506954]}]},{"allowed_amount":3449.02,"providers":[{"billed_charge":15147.00,"npi":[1124904172]}]},{"allowed_amount":242.10,"providers":[{"billed_charge":1089.00,"npi":[1376339218]}]},{"allowed_amount":173.99,"providers":[{"billed_charge":792.00,"npi":[1295353514]}]},{"allowed_amount":42.70,"providers":[{"billed_charge":198.00,"npi":[1134150816]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":917.89,"providers":[{"billed_charge":4158.00,"npi":[1578452660]}]}]},{"tin":{"type":"ein","value":"833275776"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":53.37,"providers":[{"billed_charge":186.48,"npi":[1912523911]}]},{"allowed_amount":106.73,"providers":[{"billed_charge":372.96,"npi":[1033407044]}]}]},{"tin":{"type":"ein","value":"825523767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":106.75,"providers":[{"billed_charge":375.00,"npi":[1679683627]}]}]}]},{"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":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":193.62,"providers":[{"billed_charge":383.10,"npi":[1649670845]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.71,"providers":[{"billed_charge":1170.00,"npi":[1457894255]}]},{"allowed_amount":420.98,"providers":[{"billed_charge":3250.00,"npi":[1679982078]}]},{"allowed_amount":16.50,"providers":[{"billed_charge":130.00,"npi":[1710235874]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.43,"providers":[{"billed_charge":840.00,"npi":[1790506954]}]},{"allowed_amount":18.59,"providers":[{"billed_charge":84.00,"npi":[1295353514]}]},{"allowed_amount":1238.92,"providers":[{"billed_charge":5628.00,"npi":[1124904172]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":239.93,"providers":[{"billed_charge":1092.00,"npi":[1578452660]}]}]},{"tin":{"type":"ein","value":"640891283"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":483.40,"providers":[{"billed_charge":1092.00,"npi":[1487947818]}]}]}]},{"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":"883979874"},"service_code":["99","11","12"],"billing_class":"professional","payments":[{"allowed_amount":22492.18,"providers":[{"billed_charge":313000.00,"npi":[1780064949]}]},{"allowed_amount":3089.98,"providers":[{"billed_charge":43000.00,"npi":[1780064949]}]},{"allowed_amount":75417.07,"providers":[{"billed_charge":1049500.00,"npi":[1780064949]}]}]}]},{"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":"883979874"},"service_code":["11","12","02","10"],"billing_class":"professional","payments":[{"allowed_amount":287.44,"providers":[{"billed_charge":4000.00,"npi":[1780064949]}]},{"allowed_amount":610.81,"providers":[{"billed_charge":8500.00,"npi":[1780064949]}]},{"allowed_amount":7401.58,"providers":[{"billed_charge":103000.00,"npi":[1780064949]}]},{"allowed_amount":9772.96,"providers":[{"billed_charge":136000.00,"npi":[1780064949]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":453.46,"providers":[{"billed_charge":1170.00,"npi":[1386529253]}]},{"allowed_amount":393.11,"providers":[{"billed_charge":975.00,"npi":[1063397933]}]},{"allowed_amount":733.21,"providers":[{"billed_charge":1885.00,"npi":[1649029547]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":591.80,"providers":[{"billed_charge":4050.00,"npi":[1457894255]}]},{"allowed_amount":136.41,"providers":[{"billed_charge":900.00,"npi":[1699536698]}]},{"allowed_amount":68.64,"providers":[{"billed_charge":450.00,"npi":[1417724253]}]},{"allowed_amount":291.58,"providers":[{"billed_charge":1950.00,"npi":[1659114635]}]},{"allowed_amount":952.03,"providers":[{"billed_charge":6300.00,"npi":[1679982078]}]},{"allowed_amount":642.62,"providers":[{"billed_charge":4122.00,"npi":[1710235874]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":353.58,"providers":[{"billed_charge":938.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"384037386"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50.95,"providers":[{"billed_charge":214.00,"npi":[1477068385]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1124.82,"providers":[{"billed_charge":3150.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":747.32,"providers":[{"billed_charge":3210.00,"npi":[1295322063]}]},{"allowed_amount":1555.74,"providers":[{"billed_charge":6527.00,"npi":[1124904172]}]},{"allowed_amount":101.23,"providers":[{"billed_charge":428.00,"npi":[1376339218]}]},{"allowed_amount":308.33,"providers":[{"billed_charge":1284.00,"npi":[1790506954]}]},{"allowed_amount":173.93,"providers":[{"billed_charge":749.00,"npi":[1295353514]}]}]},{"tin":{"type":"ein","value":"640906618"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1007.53,"providers":[{"billed_charge":6300.00,"npi":[1053207787]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1332.24,"providers":[{"billed_charge":5671.00,"npi":[1578452660]}]}]},{"tin":{"type":"ein","value":"203941865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":90.16,"providers":[{"billed_charge":193.20,"npi":[1134010218]}]}]},{"tin":{"type":"ein","value":"833275776"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":271.49,"providers":[{"billed_charge":900.18,"npi":[1033407044]}]}]},{"tin":{"type":"ein","value":"270918901"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":339.34,"providers":[{"billed_charge":889.46,"npi":[1851730444]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.77,"providers":[{"billed_charge":45.00,"npi":[1871685552]}]}]},{"tin":{"type":"ein","value":"640931880"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":653.75,"providers":[{"billed_charge":840.00,"npi":[1881781631]}]}]}]},{"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":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":100.98,"providers":[{"billed_charge":141.00,"npi":[1588759955]}]}]},{"tin":{"type":"ein","value":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":723.01,"providers":[{"billed_charge":960.00,"npi":[1750435301]}]}]},{"tin":{"type":"ein","value":"263078685"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1244.76,"providers":[{"billed_charge":2405.00,"npi":[1477719847]}]}]},{"tin":{"type":"ein","value":"453806985"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1109.46,"providers":[{"billed_charge":1980.00,"npi":[1639822422]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1481.45,"providers":[{"billed_charge":2050.00,"npi":[1871685552]}]}]},{"tin":{"type":"ein","value":"640931880"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":859.55,"providers":[{"billed_charge":950.00,"npi":[1881781631]}]}]}]},{"name":"CHIROPRACTIC MANJ 5 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98942","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"464657769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2679.37,"providers":[{"billed_charge":4275.00,"npi":[1083042170]}]}]},{"tin":{"type":"ein","value":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":350.36,"providers":[{"billed_charge":496.00,"npi":[1588759955]}]}]}]},{"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":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":87.54,"providers":[{"billed_charge":135.00,"npi":[1750435301]}]}]}]},{"name":"MED SERV EVE/WKEND/HOLIDAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99051","description":"SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOU","allowed_amounts":[{"tin":{"type":"ein","value":"275099507"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":114.33,"providers":[{"billed_charge":140.00,"npi":[1447980107]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":124.34,"providers":[{"billed_charge":245.00,"npi":[1659775732]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":556.92,"providers":[{"billed_charge":600.00,"npi":[1093344699]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":139.23,"providers":[{"billed_charge":395.00,"npi":[1316829252]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":256.64,"providers":[{"billed_charge":442.00,"npi":[1730774290]}]}]}]},{"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":"646001549"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":90.00,"npi":[1982669636]}]}]},{"tin":{"type":"ein","value":"202030531"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":1313.08,"providers":[{"billed_charge":4004.00,"npi":[1740790658]}]},{"allowed_amount":208.44,"providers":[{"billed_charge":462.00,"npi":[1740790658]}]}]},{"tin":{"type":"ein","value":"646001528"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":260.55,"providers":[{"billed_charge":462.00,"npi":[1780624510]}]},{"allowed_amount":1215.90,"providers":[{"billed_charge":2156.00,"npi":[1336973734]}]}]},{"tin":{"type":"ein","value":"455538630"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1841.26,"providers":[{"billed_charge":3537.40,"npi":[1275295792]}]},{"allowed_amount":864.05,"providers":[{"billed_charge":1650.65,"npi":[1538624580]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":102.42,"providers":[{"billed_charge":253.28,"npi":[1114701570]}]},{"allowed_amount":4135.05,"providers":[{"billed_charge":7345.70,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":86.85,"providers":[{"billed_charge":115.00,"npi":[1275216467]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":465.55,"providers":[{"billed_charge":715.00,"npi":[1194956755]}]}]},{"tin":{"type":"ein","value":"208339281"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":10690.56,"providers":[{"billed_charge":10730.00,"npi":[1841799616]}]}]},{"tin":{"type":"ein","value":"861149236"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":69.48,"providers":[{"billed_charge":170.00,"npi":[1326556184]}]}]},{"tin":{"type":"ein","value":"923527145"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":611.74,"providers":[{"billed_charge":900.00,"npi":[1619211992]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":539.88,"providers":[{"billed_charge":1013.16,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"811097331"},"service_code":["02","72"],"billing_class":"professional","payments":[{"allowed_amount":51.21,"providers":[{"billed_charge":300.00,"npi":[1497426548]}]},{"allowed_amount":1553.31,"providers":[{"billed_charge":6600.00,"npi":[1497426548]}]}]},{"tin":{"type":"ein","value":"510466372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1772.16,"providers":[{"billed_charge":3000.00,"npi":[1316750045]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":178.13,"providers":[{"billed_charge":332.00,"npi":[1598865362]}]},{"allowed_amount":751.68,"providers":[{"billed_charge":1328.00,"npi":[1225326093]}]},{"allowed_amount":2136.73,"providers":[{"billed_charge":3818.00,"npi":[1659775732]}]},{"allowed_amount":409.65,"providers":[{"billed_charge":830.00,"npi":[1619165560]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":168.82,"providers":[{"billed_charge":282.00,"npi":[1679219588]}]},{"allowed_amount":75.30,"providers":[{"billed_charge":141.00,"npi":[1679219588]}]},{"allowed_amount":1814.85,"providers":[{"billed_charge":3772.00,"npi":[1477135267]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1397.25,"providers":[{"billed_charge":1859.00,"npi":[1528947645]}]}]},{"tin":{"type":"ein","value":"461561484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8274.06,"providers":[{"billed_charge":12655.00,"npi":[1568089977]}]}]},{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":29491.20,"providers":[{"billed_charge":32000.00,"npi":[1841076403]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1379.80,"providers":[{"billed_charge":2166.68,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1647.18,"providers":[{"billed_charge":3841.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"471613586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1350.18,"providers":[{"billed_charge":2470.00,"npi":[1922767938]}]}]},{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1876.39,"providers":[{"billed_charge":2132.00,"npi":[1114395050]}]}]},{"tin":{"type":"ein","value":"640829371"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1570.38,"providers":[{"billed_charge":4142.00,"npi":[1720809940]}]},{"allowed_amount":653.92,"providers":[{"billed_charge":1744.00,"npi":[1356921076]}]},{"allowed_amount":169.37,"providers":[{"billed_charge":436.00,"npi":[1295296408]}]}]},{"tin":{"type":"ein","value":"202695060"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2458.04,"providers":[{"billed_charge":3510.00,"npi":[1427113000]}]},{"allowed_amount":204.12,"providers":[{"billed_charge":405.00,"npi":[1427113000]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":704.82,"providers":[{"billed_charge":1690.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"831597932"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":115.45,"providers":[{"billed_charge":130.00,"npi":[1659846129]}]},{"allowed_amount":2078.33,"providers":[{"billed_charge":2470.00,"npi":[1659846129]}]}]},{"tin":{"type":"ein","value":"640650533"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1178.57,"providers":[{"billed_charge":1680.00,"npi":[1538178777]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1020.98,"providers":[{"billed_charge":1380.00,"npi":[1013930122]}]}]},{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":2178.84,"providers":[{"billed_charge":3900.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"472217226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":93.11,"providers":[{"billed_charge":100.00,"npi":[1164521548]}]}]},{"tin":{"type":"ein","value":"464128425"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":213.45,"providers":[{"billed_charge":750.00,"npi":[1396297453]}]}]},{"tin":{"type":"ein","value":"640522444"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":197.74,"providers":[{"billed_charge":380.00,"npi":[1447350541]}]}]},{"tin":{"type":"ein","value":"461590861"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2281.70,"providers":[{"billed_charge":3792.00,"npi":[1548754211]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1437.78,"providers":[{"billed_charge":2560.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"646000892"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":629.37,"providers":[{"billed_charge":1441.08,"npi":[1831927581]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1855.98,"providers":[{"billed_charge":2834.00,"npi":[1609323450]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2976.00,"providers":[{"billed_charge":2976.00,"npi":[1760353411]}]}]}]},{"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":"640507572"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5617.25,"providers":[{"billed_charge":7600.00,"npi":[1427591627]}]}]},{"tin":{"type":"ein","value":"923029503"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2311.37,"providers":[{"billed_charge":9100.00,"npi":[1194393603]}]},{"allowed_amount":2367.89,"providers":[{"billed_charge":6650.00,"npi":[1194393603]}]}]},{"tin":{"type":"ein","value":"640834532"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":755.65,"providers":[{"billed_charge":929.10,"npi":[1073091963]}]}]},{"tin":{"type":"ein","value":"871016907"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1920.00,"providers":[{"billed_charge":1920.00,"npi":[1982247888]}]}]},{"tin":{"type":"ein","value":"640586958"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":613.44,"providers":[{"billed_charge":816.00,"npi":[1598382640]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":12799.48,"providers":[{"billed_charge":24044.00,"npi":[1811221401]}]},{"allowed_amount":339.37,"providers":[{"billed_charge":961.76,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":275.22,"providers":[{"billed_charge":302.00,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":809.79,"providers":[{"billed_charge":1224.00,"npi":[1679219588]}]}]},{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8051.56,"providers":[{"billed_charge":17325.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"834721464"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":2279.10,"providers":[{"billed_charge":5130.00,"npi":[1588141725]}]}]},{"tin":{"type":"ein","value":"463368718"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":784.96,"providers":[{"billed_charge":1080.00,"npi":[1265015218]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1439.56,"providers":[{"billed_charge":3322.00,"npi":[1437278371]}]},{"allowed_amount":625.90,"providers":[{"billed_charge":1510.00,"npi":[1437278371]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1226.36,"providers":[{"billed_charge":1800.00,"npi":[1255975405]}]},{"allowed_amount":1202.70,"providers":[{"billed_charge":1500.00,"npi":[1013930122]}]},{"allowed_amount":497.40,"providers":[{"billed_charge":750.00,"npi":[1396306957]}]}]},{"tin":{"type":"ein","value":"851259233"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":515.26,"providers":[{"billed_charge":750.00,"npi":[1558853366]}]}]},{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":736.16,"providers":[{"billed_charge":1659.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"421633186"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1564.26,"providers":[{"billed_charge":2208.00,"npi":[1376814533]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":498.82,"providers":[{"billed_charge":875.00,"npi":[1306551395]}]},{"allowed_amount":899.52,"providers":[{"billed_charge":1575.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"275099507"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1190.24,"providers":[{"billed_charge":1801.62,"npi":[1447980107]}]}]},{"tin":{"type":"ein","value":"815000928"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":12384.52,"providers":[{"billed_charge":20130.00,"npi":[1770367716]}]},{"allowed_amount":206.82,"providers":[{"billed_charge":495.00,"npi":[1770367716]}]}]},{"tin":{"type":"ein","value":"640468873"},"service_code":["22","11","72"],"billing_class":"professional","payments":[{"allowed_amount":670.00,"providers":[{"billed_charge":670.00,"npi":[1306445069]}]},{"allowed_amount":943.20,"providers":[{"billed_charge":670.00,"npi":[1033671557]}]},{"allowed_amount":665.34,"providers":[{"billed_charge":804.00,"npi":[1306445069]}]}]},{"tin":{"type":"ein","value":"640362400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":560.45,"providers":[{"billed_charge":606.00,"npi":[1629365853]}]}]},{"tin":{"type":"ein","value":"320439952"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8183.08,"providers":[{"billed_charge":12349.00,"npi":[1285332064]}]},{"allowed_amount":5223.87,"providers":[{"billed_charge":7689.00,"npi":[1043974678]}]}]},{"tin":{"type":"ein","value":"923893466"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2831.84,"providers":[{"billed_charge":3032.00,"npi":[1902815566]}]},{"allowed_amount":144.30,"providers":[{"billed_charge":152.00,"npi":[1275769796]}]}]},{"tin":{"type":"ein","value":"646001528"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1298.70,"providers":[{"billed_charge":1602.00,"npi":[1538553607]}]}]},{"tin":{"type":"ein","value":"455538630"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":552.04,"providers":[{"billed_charge":1041.15,"npi":[1275295792]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3499.06,"providers":[{"billed_charge":6131.22,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7782.50,"providers":[{"billed_charge":8430.00,"npi":[1275216467]}]}]},{"tin":{"type":"ein","value":"474987773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.24,"providers":[{"billed_charge":200.18,"npi":[1497301915]}]}]},{"tin":{"type":"ein","value":"510466372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2391.97,"providers":[{"billed_charge":3550.00,"npi":[1316750045]}]}]},{"tin":{"type":"ein","value":"640662976"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":227.08,"providers":[{"billed_charge":336.00,"npi":[1881258267]}]},{"allowed_amount":323.22,"providers":[{"billed_charge":336.00,"npi":[1053548545]}]},{"allowed_amount":2396.27,"providers":[{"billed_charge":3360.00,"npi":[1881258267]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1032.78,"providers":[{"billed_charge":1235.00,"npi":[1316524838]}]},{"allowed_amount":1235.00,"providers":[{"billed_charge":1235.00,"npi":[1568036184]}]},{"allowed_amount":25224.00,"providers":[{"billed_charge":25441.00,"npi":[1497765705]}]},{"allowed_amount":988.00,"providers":[{"billed_charge":988.00,"npi":[1952874851]}]},{"allowed_amount":3458.00,"providers":[{"billed_charge":3458.00,"npi":[1316524838]}]}]},{"tin":{"type":"ein","value":"461561484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1243.20,"providers":[{"billed_charge":2100.00,"npi":[1568089977]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1066.32,"providers":[{"billed_charge":1617.02,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":4836.12,"providers":[{"billed_charge":11139.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"471613586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1234.98,"providers":[{"billed_charge":2040.00,"npi":[1922767938]}]}]},{"tin":{"type":"ein","value":"205884933"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":739.76,"providers":[{"billed_charge":1325.00,"npi":[1174338891]}]}]},{"tin":{"type":"ein","value":"640829371"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":346.32,"providers":[{"billed_charge":762.00,"npi":[1356921076]}]}]},{"tin":{"type":"ein","value":"464786388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":577.20,"providers":[{"billed_charge":960.00,"npi":[1326650110]}]}]},{"tin":{"type":"ein","value":"874345955"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3643.28,"providers":[{"billed_charge":7400.00,"npi":[1396383501]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":405.50,"providers":[{"billed_charge":1195.00,"npi":[1154827079]}]},{"allowed_amount":177.42,"providers":[{"billed_charge":478.00,"npi":[1154827079]}]},{"allowed_amount":3385.92,"providers":[{"billed_charge":7887.00,"npi":[1336981836]}]},{"allowed_amount":590.53,"providers":[{"billed_charge":1673.00,"npi":[1154827079]}]}]},{"tin":{"type":"ein","value":"934244735"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5928.00,"providers":[{"billed_charge":5928.00,"npi":[1922559772]}]}]},{"tin":{"type":"ein","value":"463878759"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1385.56,"providers":[{"billed_charge":2124.00,"npi":[1023847506]}]},{"allowed_amount":2024.10,"providers":[{"billed_charge":3186.00,"npi":[1205528833]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":106.34,"providers":[{"billed_charge":146.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"720993441"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2858.15,"providers":[{"billed_charge":3420.00,"npi":[1174346613]}]}]},{"tin":{"type":"ein","value":"273156796"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1380.48,"providers":[{"billed_charge":1948.10,"npi":[1326511031]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1830.50,"providers":[{"billed_charge":5508.00,"npi":[1922695964]}]},{"allowed_amount":1087.54,"providers":[{"billed_charge":3501.00,"npi":[1346038205]}]},{"allowed_amount":1747.00,"providers":[{"billed_charge":5202.00,"npi":[1316829252]}]}]},{"tin":{"type":"ein","value":"646010232"},"service_code":["11","22","02"],"billing_class":"professional","payments":[{"allowed_amount":3355.41,"providers":[{"billed_charge":3500.00,"npi":[1346446671]}]},{"allowed_amount":154.19,"providers":[{"billed_charge":175.00,"npi":[1649341256]}]},{"allowed_amount":1871.73,"providers":[{"billed_charge":1925.00,"npi":[1952961500]}]},{"allowed_amount":2404.34,"providers":[{"billed_charge":2450.00,"npi":[1427673532]}]},{"allowed_amount":2865.30,"providers":[{"billed_charge":3500.00,"npi":[1659003580]}]},{"allowed_amount":257.24,"providers":[{"billed_charge":350.00,"npi":[1346446671]}]},{"allowed_amount":209.29,"providers":[{"billed_charge":350.00,"npi":[1659003580]}]},{"allowed_amount":128.62,"providers":[{"billed_charge":175.00,"npi":[1730379231]}]},{"allowed_amount":1019.56,"providers":[{"billed_charge":1050.00,"npi":[1730379231]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1817.37,"providers":[{"billed_charge":1820.00,"npi":[1760353411]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":2338.96,"providers":[{"billed_charge":4883.24,"npi":[1730774290]}]},{"allowed_amount":1382.42,"providers":[{"billed_charge":2636.92,"npi":[1730774290]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"646010232"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1885.20,"providers":[{"billed_charge":1888.00,"npi":[1346446671]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"931868295"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":95.22,"providers":[{"billed_charge":100.00,"npi":[1578248928]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["02","21"],"billing_class":"professional","payments":[{"allowed_amount":1590.38,"providers":[{"billed_charge":2925.00,"npi":[1164104543]}]},{"allowed_amount":118.14,"providers":[{"billed_charge":225.00,"npi":[1992371330]}]},{"allowed_amount":39.38,"providers":[{"billed_charge":75.00,"npi":[1164104543]}]},{"allowed_amount":568.68,"providers":[{"billed_charge":1050.00,"npi":[1992371330]}]},{"allowed_amount":41.86,"providers":[{"billed_charge":75.00,"npi":[1184476624]}]},{"allowed_amount":1142.32,"providers":[{"billed_charge":2100.00,"npi":[1679235212]}]}]},{"tin":{"type":"ein","value":"880747037"},"service_code":["02","21"],"billing_class":"professional","payments":[{"allowed_amount":2299.37,"providers":[{"billed_charge":3675.00,"npi":[1609960889]}]},{"allowed_amount":2097.06,"providers":[{"billed_charge":3975.00,"npi":[1346069960]}]},{"allowed_amount":755.88,"providers":[{"billed_charge":1200.00,"npi":[1609960889]}]},{"allowed_amount":41.86,"providers":[{"billed_charge":75.00,"npi":[1972320604]}]}]}]},{"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":"640507572"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":367.60,"providers":[{"billed_charge":500.00,"npi":[1679925408]}]},{"allowed_amount":91.90,"providers":[{"billed_charge":125.00,"npi":[1679925408]}]}]},{"tin":{"type":"ein","value":"810904111"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":3997.23,"providers":[{"billed_charge":12000.00,"npi":[1386725570]}]}]},{"tin":{"type":"ein","value":"932472974"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":845.18,"providers":[{"billed_charge":1456.00,"npi":[1114214038]}]},{"allowed_amount":433.60,"providers":[{"billed_charge":728.00,"npi":[1669851846]}]}]},{"tin":{"type":"ein","value":"870698522"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3951.24,"providers":[{"billed_charge":6840.00,"npi":[1649380536]}]}]},{"tin":{"type":"ein","value":"824421335"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1452.36,"providers":[{"billed_charge":2982.00,"npi":[1003043043]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":271.11,"providers":[{"billed_charge":409.00,"npi":[1598382640]}]},{"allowed_amount":1227.98,"providers":[{"billed_charge":1932.00,"npi":[1598382640]}]}]},{"tin":{"type":"ein","value":"621519754"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1334.46,"providers":[{"billed_charge":3150.00,"npi":[1891590816]}]}]},{"tin":{"type":"ein","value":"640735747"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":265.21,"providers":[{"billed_charge":345.00,"npi":[1326335902]}]}]},{"tin":{"type":"ein","value":"873202097"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":176.76,"providers":[{"billed_charge":450.00,"npi":[1033724349]}]}]}]},{"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":"621650432"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2334.77,"providers":[{"billed_charge":5510.00,"npi":[1386778199]}]}]},{"tin":{"type":"ein","value":"932472974"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4021.58,"providers":[{"billed_charge":6575.00,"npi":[1417481896]}]}]},{"tin":{"type":"ein","value":"824421335"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2010.18,"providers":[{"billed_charge":3560.00,"npi":[1003043043]}]}]},{"tin":{"type":"ein","value":"640735747"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":698.53,"providers":[{"billed_charge":1085.00,"npi":[1457345456]}]},{"allowed_amount":1436.48,"providers":[{"billed_charge":1705.00,"npi":[1275820847]}]}]},{"tin":{"type":"ein","value":"882728544"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":804.45,"providers":[{"billed_charge":1752.00,"npi":[1326071804]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"646001549"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":492.54,"providers":[{"billed_charge":826.32,"npi":[1255946018]}]},{"allowed_amount":2215.26,"providers":[{"billed_charge":3718.44,"npi":[1730358201]}]},{"allowed_amount":742.08,"providers":[{"billed_charge":1364.19,"npi":[1124117171]}]}]},{"tin":{"type":"ein","value":"646008276"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":672.75,"providers":[{"billed_charge":778.50,"npi":[1043396591]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1802.89,"providers":[{"billed_charge":2938.00,"npi":[1609416544]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"646001528"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":728.16,"providers":[{"billed_charge":984.00,"npi":[1972728590]}]}]},{"tin":{"type":"ein","value":"646010232"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":329.34,"providers":[{"billed_charge":1100.00,"npi":[1346263753]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":848.12,"providers":[{"billed_charge":2326.00,"npi":[1225547185]}]}]},{"tin":{"type":"ein","value":"811218105"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4042.62,"providers":[{"billed_charge":32112.00,"npi":[1033797550]}]}]},{"tin":{"type":"ein","value":"471301699"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":752.91,"providers":[{"billed_charge":4602.00,"npi":[1740228253]}]}]},{"tin":{"type":"ein","value":"263453190"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":9329.32,"providers":[{"billed_charge":27126.00,"npi":[1013943752]}]},{"allowed_amount":19930.82,"providers":[{"billed_charge":57951.00,"npi":[1609815000]}]}]}]},{"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":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1236.06,"providers":[{"billed_charge":3458.00,"npi":[1124078944]}]}]},{"tin":{"type":"ein","value":"263453190"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":9888.48,"providers":[{"billed_charge":28096.00,"npi":[1609815000]}]}]}]},{"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":"621545731"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":2575.35,"providers":[{"billed_charge":6003.00,"npi":[1396097788]}]},{"allowed_amount":291.69,"providers":[{"billed_charge":667.00,"npi":[1396097788]}]}]},{"tin":{"type":"ein","value":"640735747"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3589.83,"providers":[{"billed_charge":7500.00,"npi":[1275820847]}]}]}]},{"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":"320158728"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":676.27,"providers":[{"billed_charge":1530.00,"npi":[1417770876]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":195.92,"providers":[{"billed_charge":420.00,"npi":[1396306957]}]},{"allowed_amount":115.41,"providers":[{"billed_charge":210.00,"npi":[1013930122]}]}]}]},{"name":"CARE MGMT SVC BHVL HLTH COND","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99484","description":"CARE MANAGEMENT SERVICES FOR BEHAVIORAL HEALTH CONDITIONS, AT LEAST 20 MINUTES OF CLINICAL STAFF TIM","allowed_amounts":[{"tin":{"type":"ein","value":"815000928"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1471.88,"providers":[{"billed_charge":2448.00,"npi":[1770367716]}]}]}]},{"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":"721275309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14652.56,"providers":[{"billed_charge":14652.56,"npi":[1619071941]}]}]},{"tin":{"type":"ein","value":"646001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":244.92,"providers":[{"billed_charge":120.00,"npi":[1366504847]}]}]},{"tin":{"type":"ein","value":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":114992.02,"providers":[{"billed_charge":209478.50,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"640642403"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":336.60,"providers":[{"billed_charge":336.60,"npi":[1215033865]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":72173.42,"providers":[{"billed_charge":516373.94,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":399.85,"providers":[{"billed_charge":1100.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18090.77,"providers":[{"billed_charge":14013.34,"npi":[1528596814]}]},{"allowed_amount":16544.21,"providers":[{"billed_charge":12804.71,"npi":[1760831630]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54600.71,"providers":[{"billed_charge":44483.69,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"646001540"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":37030.59,"providers":[{"billed_charge":36327.00,"npi":[1629058094]}]}]},{"tin":{"type":"ein","value":"640868008"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":78588.05,"providers":[{"billed_charge":59509.85,"npi":[1770533176]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":111309.33,"providers":[{"billed_charge":126490.34,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":484253.75,"providers":[{"billed_charge":878691.00,"npi":[1932821063]}]}]}]},{"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":"721275309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43020.77,"providers":[{"billed_charge":43020.77,"npi":[1619071941]}]}]},{"tin":{"type":"ein","value":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":126659.00,"providers":[{"billed_charge":192780.00,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"646001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4771.65,"providers":[{"billed_charge":3000.00,"npi":[1366504847]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":797.70,"providers":[{"billed_charge":2535.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":86609.07,"providers":[{"billed_charge":976363.94,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19389.21,"providers":[{"billed_charge":15803.13,"npi":[1760831630]}]},{"allowed_amount":24247.32,"providers":[{"billed_charge":19197.09,"npi":[1528596814]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":303018.64,"providers":[{"billed_charge":299663.81,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"646001540"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":85712.06,"providers":[{"billed_charge":84800.00,"npi":[1629058094]}]}]},{"tin":{"type":"ein","value":"640868008"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":121452.75,"providers":[{"billed_charge":85443.60,"npi":[1770533176]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":266812.52,"providers":[{"billed_charge":299023.00,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":871597.91,"providers":[{"billed_charge":1297655.00,"npi":[1932821063]}]}]}]},{"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":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3572.76,"providers":[{"billed_charge":58752.34,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8587.94,"providers":[{"billed_charge":8587.94,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3475.23,"providers":[{"billed_charge":5471.00,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":69159.60,"providers":[{"billed_charge":144510.00,"npi":[1932821063]}]}]}]},{"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":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16302.86,"providers":[{"billed_charge":28200.00,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12506.39,"providers":[{"billed_charge":191908.13,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35794.30,"providers":[{"billed_charge":41788.00,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":286038.60,"providers":[{"billed_charge":488150.00,"npi":[1932821063]}]}]}]},{"name":"INFUS SET EXT INSULIN PUMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4230","description":"INFUSION SET FOR EXTERNAL INSULIN PUMP, NONNEEDLE CANNULA TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"593271823"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1108.50,"providers":[{"billed_charge":6499.50,"npi":[1295827780]}]}]}]},{"name":"SYRINGE NDLE EXT INSULIN PUM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4232","description":"SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3 CC","allowed_amounts":[{"tin":{"type":"ein","value":"593271823"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":857.85,"providers":[{"billed_charge":2597.63,"npi":[1295827780]}]}]}]},{"name":"SPLY ALW NONIMPL CGM 1 MO SP=1 UOS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4239","description":"SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":16482.48,"providers":[{"billed_charge":49029.36,"npi":[1234567893]}]}]}]},{"name":"SENSOR; INVSV INTRSTL GLU MO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A9276","description":"SENSOR; INVASIVE (E.G., SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONI","allowed_amounts":[{"tin":{"type":"ein","value":"593271823"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":20418.00,"providers":[{"billed_charge":28941.84,"npi":[1295827780]}]}]}]},{"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":"640936379"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1060.55,"providers":[{"billed_charge":2740.00,"npi":[1811708019]}]}]}]},{"name":"FQHC VISIT ESTABLISHED PATIE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0467","description":"FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"640829371"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":2234.40,"providers":[{"billed_charge":7448.00,"npi":[1356921076]}]},{"allowed_amount":1470.00,"providers":[{"billed_charge":4900.00,"npi":[1720809940]}]},{"allowed_amount":999.60,"providers":[{"billed_charge":3332.00,"npi":[1295296408]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 1-7","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0480","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1523.06,"providers":[{"billed_charge":7552.38,"npi":[1225110497]}]}]}]},{"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":"640507572"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.03,"providers":[{"billed_charge":494.00,"npi":[1427591627]}]}]},{"tin":{"type":"ein","value":"640834532"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":96.34,"providers":[{"billed_charge":115.00,"npi":[1073091963]}]}]},{"tin":{"type":"ein","value":"630790569"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":16.40,"providers":[{"billed_charge":38.00,"npi":[1578025789]}]}]}]},{"name":"ALCOHL&/RX SRVC; INTENSV OP;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0015","description":"ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"923029503"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":83125.00,"providers":[{"billed_charge":332500.00,"npi":[1124635354]}]},{"allowed_amount":9375.00,"providers":[{"billed_charge":37500.00,"npi":[1508722588]}]},{"allowed_amount":23750.00,"providers":[{"billed_charge":95000.00,"npi":[1619825460]}]}]}]},{"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":"831851747"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":361.14,"providers":[{"billed_charge":600.00,"npi":[1548277700]}]}]}]},{"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":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":10.62,"providers":[{"billed_charge":1120.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.16,"providers":[{"billed_charge":624.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":27.55,"providers":[{"billed_charge":547.50,"npi":[1275216467]}]}]}]},{"name":"Injection, methylprednisolone acetate, 1 mg","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1010","description":"Injection, methylprednisolone acetate, 1 mg ","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":48.96,"providers":[{"billed_charge":480.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":91.80,"providers":[{"billed_charge":900.00,"npi":[1760353411]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":4.90,"providers":[{"billed_charge":285.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.62,"providers":[{"billed_charge":36.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.53,"providers":[{"billed_charge":200.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.94,"providers":[{"billed_charge":33.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.89,"providers":[{"billed_charge":200.00,"npi":[1760353411]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":9.97,"providers":[{"billed_charge":280.00,"npi":[1275216467]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.12,"providers":[{"billed_charge":40.00,"npi":[1336981836]}]}]}]},{"name":"LOCM 300-399 MG/ML I CONC PE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"Q9967","description":"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML","allowed_amounts":[{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112.50,"providers":[{"billed_charge":1125.00,"npi":[1336187947]}]}]}]},{"name":"GLBAL FEE URGNT CARE CENTERS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9083","description":"GLOBAL FEE URGENT CARE CENTERS","allowed_amounts":[{"tin":{"type":"ein","value":"640914383"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":24400.00,"providers":[{"billed_charge":26962.00,"npi":[1013524495]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":200.00,"providers":[{"billed_charge":221.00,"npi":[1760216543]}]}]}]}]}