{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-06-01","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":67150.00,"providers":[{"billed_charge":213300.00,"npi":[1033697099]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1593365.51,"providers":[{"billed_charge":787185.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":100818.72,"providers":[{"billed_charge":24411.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1161532.26,"providers":[{"billed_charge":290459.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":363931.87,"providers":[{"billed_charge":82305.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1701260.06,"providers":[{"billed_charge":490746.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"566017737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":412504.45,"providers":[{"billed_charge":83576.00,"npi":[1114993086]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":61782.86,"providers":[{"billed_charge":23904.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":454079.59,"providers":[{"billed_charge":137195.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":712219.28,"providers":[{"billed_charge":199416.00,"npi":[1932208576]}]}]}]},{"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":"274255298"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":50.81,"providers":[{"billed_charge":254.00,"npi":[1992772800]}]}]}]},{"name":"OB/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"112","description":"ROOM AND BOARD - PRIVATE -OB","allowed_amounts":[{"tin":{"type":"ein","value":"566017737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":67628.39,"providers":[{"billed_charge":35048.00,"npi":[1114993086]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"853777599"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":120652.97,"providers":[{"billed_charge":140196.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"873829558"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9900.00,"providers":[{"billed_charge":54000.00,"npi":[1588319503]}]}]},{"tin":{"type":"ein","value":"201943356"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":223328.88,"providers":[{"billed_charge":384342.86,"npi":[1922038082]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":46550.00,"providers":[{"billed_charge":240000.00,"npi":[1033697099]}]}]}]},{"name":"NURSERY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"170","description":"NURSERY -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"566017737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8354.86,"providers":[{"billed_charge":14217.00,"npi":[1114993086]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"560928089"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":29931.43,"providers":[{"billed_charge":92970.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":238779.41,"providers":[{"billed_charge":408045.00,"npi":[1477591055]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"566017737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":75072.40,"providers":[{"billed_charge":94342.00,"npi":[1114993086]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5641.00,"providers":[{"billed_charge":12375.98,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":297.15,"providers":[{"billed_charge":539.20,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3308.06,"providers":[{"billed_charge":5198.85,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7446.15,"providers":[{"billed_charge":13409.97,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"540551711"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":84.92,"providers":[{"billed_charge":283.05,"npi":[1336103738]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.40,"providers":[{"billed_charge":18.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.42,"providers":[{"billed_charge":1056.11,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"566011594"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":97.50,"providers":[{"billed_charge":639.85,"npi":[1508832833]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.81,"providers":[{"billed_charge":38.65,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1061.73,"providers":[{"billed_charge":5724.69,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"560585243"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":47.77,"providers":[{"billed_charge":1679.55,"npi":[1043218944]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":47.75,"providers":[{"billed_charge":118.65,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":599.54,"providers":[{"billed_charge":911.56,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2503.73,"providers":[{"billed_charge":3159.10,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":432.40,"providers":[{"billed_charge":1507.60,"npi":[1053358945]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":514.90,"providers":[{"billed_charge":2896.70,"npi":[1801848767]}]},{"allowed_amount":3.45,"providers":[{"billed_charge":6772.70,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3452.85,"providers":[{"billed_charge":5444.60,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11.95,"providers":[{"billed_charge":32.20,"npi":[1497708838]}]},{"allowed_amount":603.45,"providers":[{"billed_charge":3538.40,"npi":[1881647204]}]},{"allowed_amount":91.66,"providers":[{"billed_charge":132.70,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":395.21,"providers":[{"billed_charge":614.30,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"560529974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":218.85,"providers":[{"billed_charge":729.45,"npi":[1225088255]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.15,"providers":[{"billed_charge":5.15,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3712.46,"providers":[{"billed_charge":6347.20,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.52,"providers":[{"billed_charge":137.20,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":363.75,"providers":[{"billed_charge":1187.95,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":896.07,"providers":[{"billed_charge":4529.20,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3615.47,"providers":[{"billed_charge":5802.63,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":155.44,"providers":[{"billed_charge":872.20,"npi":[1972001469]}]}]}]},{"name":"DRUGS/INCIDNT OTHER DX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"254","description":"PHARMACY - DRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1558.24,"providers":[{"billed_charge":2057.95,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":425.67,"providers":[{"billed_charge":3870.65,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.04,"providers":[{"billed_charge":1947.10,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":244.84,"providers":[{"billed_charge":2160.50,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":323.57,"providers":[{"billed_charge":3783.95,"npi":[1932208576]}]}]}]},{"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":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":961.40,"providers":[{"billed_charge":8142.25,"npi":[1477591055]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4.00,"providers":[{"billed_charge":4.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1883.37,"providers":[{"billed_charge":8115.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12.17,"providers":[{"billed_charge":90.25,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.61,"providers":[{"billed_charge":80.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.40,"providers":[{"billed_charge":11.60,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1450.63,"providers":[{"billed_charge":18441.95,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2520.99,"providers":[{"billed_charge":6118.10,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":862.46,"providers":[{"billed_charge":4793.65,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.80,"providers":[{"billed_charge":11.00,"npi":[1932208576]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":116.29,"providers":[{"billed_charge":1340.88,"npi":[1427075027]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10497.56,"providers":[{"billed_charge":77750.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":155.88,"providers":[{"billed_charge":3412.00,"npi":[1346291309]}]},{"allowed_amount":5820.68,"providers":[{"billed_charge":34527.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30466.03,"providers":[{"billed_charge":113448.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14086.90,"providers":[{"billed_charge":45776.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"590724459"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":560.45,"providers":[{"billed_charge":429.00,"npi":[1306938071]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8159.83,"providers":[{"billed_charge":26833.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12230.51,"providers":[{"billed_charge":47087.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":514.31,"providers":[{"billed_charge":1585.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.18,"providers":[{"billed_charge":590.00,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7069.31,"providers":[{"billed_charge":31989.00,"npi":[1427075027]}]},{"allowed_amount":1063.67,"providers":[{"billed_charge":9850.45,"npi":[1891523718]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6719.50,"providers":[{"billed_charge":26269.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13924.41,"providers":[{"billed_charge":77472.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":201.82,"providers":[{"billed_charge":806.00,"npi":[1164495255]}]},{"allowed_amount":23532.27,"providers":[{"billed_charge":94145.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1272.51,"providers":[{"billed_charge":1959.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1364.42,"providers":[{"billed_charge":6171.00,"npi":[1619911104]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":84.55,"providers":[{"billed_charge":265.54,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1541.83,"providers":[{"billed_charge":6167.00,"npi":[1164495255]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":560.56,"providers":[{"billed_charge":7291.62,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":169.28,"providers":[{"billed_charge":490.06,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5539.94,"providers":[{"billed_charge":20299.26,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4128.95,"providers":[{"billed_charge":12867.64,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":636.73,"providers":[{"billed_charge":1793.61,"npi":[1932208576]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":65.57,"providers":[{"billed_charge":316.75,"npi":[1447200233]}]}]}]},{"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":698.81,"providers":[{"billed_charge":991.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":150498.94,"providers":[{"billed_charge":635915.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":926.96,"providers":[{"billed_charge":4327.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27.80,"providers":[{"billed_charge":192.00,"npi":[1346291309]}]},{"allowed_amount":1956.11,"providers":[{"billed_charge":12079.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5.69,"providers":[{"billed_charge":14.00,"npi":[1427030774]}]},{"allowed_amount":1435.13,"providers":[{"billed_charge":9728.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"50524222"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":152.00,"providers":[{"billed_charge":152.00,"npi":[1770662348]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11021.70,"providers":[{"billed_charge":26587.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":121132.94,"providers":[{"billed_charge":329730.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":256.97,"providers":[{"billed_charge":1400.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":82.74,"providers":[{"billed_charge":387.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":853.52,"providers":[{"billed_charge":4675.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":268.29,"providers":[{"billed_charge":2294.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1946.61,"providers":[{"billed_charge":11395.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":402.32,"providers":[{"billed_charge":2332.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"566011594"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1529.16,"providers":[{"billed_charge":5998.38,"npi":[1508832833]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":859.59,"providers":[{"billed_charge":10299.50,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"560585243"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4061.42,"providers":[{"billed_charge":19007.98,"npi":[1043218944]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2304.34,"providers":[{"billed_charge":14950.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"562093700"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":197.98,"providers":[{"billed_charge":806.75,"npi":[1699757393]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.72,"providers":[{"billed_charge":124.00,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":470.20,"providers":[{"billed_charge":3869.00,"npi":[1619911104]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23.97,"providers":[{"billed_charge":1416.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":455.95,"providers":[{"billed_charge":895.00,"npi":[1427030774]}]},{"allowed_amount":33570.58,"providers":[{"billed_charge":150690.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1489.31,"providers":[{"billed_charge":8525.00,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17205.09,"providers":[{"billed_charge":51827.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":83.00,"providers":[{"billed_charge":83.00,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1162.68,"providers":[{"billed_charge":4538.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1328.31,"providers":[{"billed_charge":3516.11,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7074.16,"providers":[{"billed_charge":20011.00,"npi":[1427075027]}]},{"allowed_amount":3025.47,"providers":[{"billed_charge":7939.23,"npi":[1891523718]}]}]},{"tin":{"type":"ein","value":"560611546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1289.39,"providers":[{"billed_charge":3801.00,"npi":[1093712655]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2985.71,"providers":[{"billed_charge":11700.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":786.69,"providers":[{"billed_charge":3625.00,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24592.71,"providers":[{"billed_charge":126430.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":96.67,"providers":[{"billed_charge":481.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2571.84,"providers":[{"billed_charge":6970.00,"npi":[1750353462]}]},{"allowed_amount":16.73,"providers":[{"billed_charge":232.00,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7575.68,"providers":[{"billed_charge":79558.00,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":350.60,"providers":[{"billed_charge":1004.00,"npi":[1295789907]}]},{"allowed_amount":115.18,"providers":[{"billed_charge":404.00,"npi":[1053358945]}]},{"allowed_amount":2811.29,"providers":[{"billed_charge":9305.15,"npi":[1053358945]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1966.00,"providers":[{"billed_charge":32557.00,"npi":[1801848767]}]},{"allowed_amount":20334.38,"providers":[{"billed_charge":61397.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":54326.70,"providers":[{"billed_charge":255225.00,"npi":[1881647204]}]},{"allowed_amount":8646.81,"providers":[{"billed_charge":41583.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"50524222"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1130.00,"providers":[{"billed_charge":1130.00,"npi":[1770662348]}]}]},{"tin":{"type":"ein","value":"561844262"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1077.77,"providers":[{"billed_charge":2188.00,"npi":[1801831102]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1422.11,"providers":[{"billed_charge":7045.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19670.89,"providers":[{"billed_charge":65297.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8285.60,"providers":[{"billed_charge":41081.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38145.62,"providers":[{"billed_charge":116136.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71652.35,"providers":[{"billed_charge":302866.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10228.06,"providers":[{"billed_charge":90733.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13872.39,"providers":[{"billed_charge":48666.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1712.04,"providers":[{"billed_charge":17747.86,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"550526150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4546.95,"providers":[{"billed_charge":5576.00,"npi":[1952390239]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":281.43,"providers":[{"billed_charge":867.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":807.89,"providers":[{"billed_charge":5039.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51.00,"providers":[{"billed_charge":22.00,"npi":[1427030774]}]},{"allowed_amount":1696.23,"providers":[{"billed_charge":6084.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":456.89,"providers":[{"billed_charge":1224.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":520.30,"providers":[{"billed_charge":2695.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":202.48,"providers":[{"billed_charge":850.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":196.26,"providers":[{"billed_charge":2529.56,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49.46,"providers":[{"billed_charge":316.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":104.35,"providers":[{"billed_charge":811.00,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":765.54,"providers":[{"billed_charge":4041.00,"npi":[1932208576]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":171.00,"providers":[{"billed_charge":4629.00,"npi":[1801848767]}]},{"allowed_amount":3919.81,"providers":[{"billed_charge":11508.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1580.41,"providers":[{"billed_charge":7197.00,"npi":[1346291309]}]},{"allowed_amount":11520.45,"providers":[{"billed_charge":38789.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7936.05,"providers":[{"billed_charge":24614.00,"npi":[1427030774]}]},{"allowed_amount":14.95,"providers":[{"billed_charge":39.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":258.51,"providers":[{"billed_charge":1188.00,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3487.36,"providers":[{"billed_charge":10027.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4485.22,"providers":[{"billed_charge":16409.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1420.41,"providers":[{"billed_charge":4687.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8525.87,"providers":[{"billed_charge":21267.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1428.70,"providers":[{"billed_charge":3305.00,"npi":[1427075027]}]},{"allowed_amount":611.95,"providers":[{"billed_charge":1985.12,"npi":[1891523718]}]}]},{"tin":{"type":"ein","value":"560611546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":132.69,"providers":[{"billed_charge":365.00,"npi":[1093712655]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.49,"providers":[{"billed_charge":216.00,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2739.96,"providers":[{"billed_charge":21428.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15628.03,"providers":[{"billed_charge":49047.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":210.38,"providers":[{"billed_charge":2010.41,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2566.75,"providers":[{"billed_charge":8410.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":412.27,"providers":[{"billed_charge":1429.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6065.33,"providers":[{"billed_charge":52257.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":88.28,"providers":[{"billed_charge":368.00,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":17.48,"providers":[{"billed_charge":99.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":334.51,"providers":[{"billed_charge":977.00,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1957.49,"providers":[{"billed_charge":14977.00,"npi":[1619911104]}]}]}]},{"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":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5626.47,"providers":[{"billed_charge":21953.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16288.68,"providers":[{"billed_charge":72120.00,"npi":[1881647204]}]},{"allowed_amount":1242.74,"providers":[{"billed_charge":6860.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":27981.77,"providers":[{"billed_charge":41850.00,"npi":[1427030774]}]},{"allowed_amount":24.08,"providers":[{"billed_charge":43.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8978.49,"providers":[{"billed_charge":14827.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31.01,"providers":[{"billed_charge":61.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12988.88,"providers":[{"billed_charge":23170.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1854.97,"providers":[{"billed_charge":8878.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10090.91,"providers":[{"billed_charge":45463.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1114.26,"providers":[{"billed_charge":4931.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17601.08,"providers":[{"billed_charge":82150.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7915.46,"providers":[{"billed_charge":20488.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7362.01,"providers":[{"billed_charge":30002.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":213.54,"providers":[{"billed_charge":2797.66,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41.00,"providers":[{"billed_charge":347.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9007.02,"providers":[{"billed_charge":45595.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":465.12,"providers":[{"billed_charge":1449.00,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4774.47,"providers":[{"billed_charge":13275.00,"npi":[1619911104]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":436.52,"providers":[{"billed_charge":941.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1373.12,"providers":[{"billed_charge":3953.00,"npi":[1881647204]}]},{"allowed_amount":121.77,"providers":[{"billed_charge":454.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3878.16,"providers":[{"billed_charge":15440.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.91,"providers":[{"billed_charge":111.00,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1025.51,"providers":[{"billed_charge":6952.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":975.02,"providers":[{"billed_charge":3608.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":326.07,"providers":[{"billed_charge":971.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1626.49,"providers":[{"billed_charge":3895.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":447.95,"providers":[{"billed_charge":1536.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1022.80,"providers":[{"billed_charge":8622.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3549.70,"providers":[{"billed_charge":10196.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":363.84,"providers":[{"billed_charge":1463.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1198.49,"providers":[{"billed_charge":9840.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":526.26,"providers":[{"billed_charge":5444.00,"npi":[1619911104]}]}]}]},{"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":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11395.51,"providers":[{"billed_charge":47309.00,"npi":[1801848767]}]},{"allowed_amount":180.50,"providers":[{"billed_charge":5606.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37086.30,"providers":[{"billed_charge":178702.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23565.57,"providers":[{"billed_charge":105547.00,"npi":[1881647204]}]},{"allowed_amount":1622.96,"providers":[{"billed_charge":10201.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10546.95,"providers":[{"billed_charge":69663.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1538.49,"providers":[{"billed_charge":14767.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7674.99,"providers":[{"billed_charge":29305.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1738.33,"providers":[{"billed_charge":8327.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1268.44,"providers":[{"billed_charge":4745.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":103.11,"providers":[{"billed_charge":595.00,"npi":[1508843566]}]},{"allowed_amount":17828.77,"providers":[{"billed_charge":63625.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":30311.29,"providers":[{"billed_charge":137250.00,"npi":[1447200233]}]},{"allowed_amount":254.57,"providers":[{"billed_charge":1207.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1977.95,"providers":[{"billed_charge":11736.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4238.80,"providers":[{"billed_charge":19472.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4491.43,"providers":[{"billed_charge":34699.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1941.59,"providers":[{"billed_charge":10868.00,"npi":[1619911104]}]}]}]},{"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":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":552.39,"providers":[{"billed_charge":1414.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11025.45,"providers":[{"billed_charge":43946.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1382.84,"providers":[{"billed_charge":7642.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3428.51,"providers":[{"billed_charge":8216.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5056.50,"providers":[{"billed_charge":20330.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17826.43,"providers":[{"billed_charge":51904.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2576.97,"providers":[{"billed_charge":7554.00,"npi":[1932208576]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5278.13,"providers":[{"billed_charge":18945.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":406.20,"providers":[{"billed_charge":1354.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39781.20,"providers":[{"billed_charge":141335.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59657.12,"providers":[{"billed_charge":232539.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":91271.86,"providers":[{"billed_charge":300642.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6718.42,"providers":[{"billed_charge":19659.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1537.76,"providers":[{"billed_charge":5640.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":178767.52,"providers":[{"billed_charge":544154.00,"npi":[1477591055]}]},{"allowed_amount":1044.78,"providers":[{"billed_charge":13064.00,"npi":[1477591055]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":46363.44,"providers":[{"billed_charge":218252.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":956.00,"providers":[{"billed_charge":10462.00,"npi":[1801848767]}]},{"allowed_amount":9587.18,"providers":[{"billed_charge":30654.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23573.86,"providers":[{"billed_charge":85507.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":48579.96,"providers":[{"billed_charge":192548.00,"npi":[1881647204]}]},{"allowed_amount":1139.84,"providers":[{"billed_charge":6361.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21085.25,"providers":[{"billed_charge":108740.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4844.29,"providers":[{"billed_charge":29717.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60610.89,"providers":[{"billed_charge":218850.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5475.53,"providers":[{"billed_charge":25738.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":828.57,"providers":[{"billed_charge":9766.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12618.78,"providers":[{"billed_charge":55268.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1032.04,"providers":[{"billed_charge":9044.00,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3560.34,"providers":[{"billed_charge":14725.00,"npi":[1932208576]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":160994.90,"providers":[{"billed_charge":955199.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2172.32,"providers":[{"billed_charge":9762.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":103.11,"providers":[{"billed_charge":2328.00,"npi":[1881647204]}]},{"allowed_amount":28690.59,"providers":[{"billed_charge":136438.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":420.39,"providers":[{"billed_charge":1429.00,"npi":[1427030774]}]},{"allowed_amount":46615.18,"providers":[{"billed_charge":316316.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31521.48,"providers":[{"billed_charge":147514.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":28414.49,"providers":[{"billed_charge":135898.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17692.06,"providers":[{"billed_charge":74473.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6802.39,"providers":[{"billed_charge":38807.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":25477.27,"providers":[{"billed_charge":204218.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":676.84,"providers":[{"billed_charge":2660.00,"npi":[1447200233]}]},{"allowed_amount":37708.10,"providers":[{"billed_charge":174556.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1662.10,"providers":[{"billed_charge":6231.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":45376.66,"providers":[{"billed_charge":200523.00,"npi":[1164495255]}]},{"allowed_amount":443.95,"providers":[{"billed_charge":9330.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15636.70,"providers":[{"billed_charge":134096.00,"npi":[1619911104]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24374.25,"providers":[{"billed_charge":58028.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3883.35,"providers":[{"billed_charge":7674.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":484.44,"providers":[{"billed_charge":3208.20,"npi":[1023435898]}]},{"allowed_amount":16957.07,"providers":[{"billed_charge":58971.93,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5916.32,"providers":[{"billed_charge":10100.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5713.05,"providers":[{"billed_charge":32605.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4062.02,"providers":[{"billed_charge":18294.34,"npi":[1932208576]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":151.82,"providers":[{"billed_charge":467.00,"npi":[1447200233]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":36.64,"providers":[{"billed_charge":144.00,"npi":[1942526447]}]}]},{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4941.35,"providers":[{"billed_charge":34883.94,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"223849199"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.24,"providers":[{"billed_charge":13.00,"npi":[1770198962,1992319115]}]}]},{"tin":{"type":"ein","value":"581319204"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":28.47,"providers":[{"billed_charge":200.00,"npi":[1114756335]}]},{"allowed_amount":21.15,"providers":[{"billed_charge":150.00,"npi":[1891592366]}]},{"allowed_amount":67.74,"providers":[{"billed_charge":475.00,"npi":[1124876016]}]},{"allowed_amount":3.48,"providers":[{"billed_charge":25.00,"npi":[1346088267]}]},{"allowed_amount":117.09,"providers":[{"billed_charge":825.00,"npi":[1720704000]}]},{"allowed_amount":64.91,"providers":[{"billed_charge":375.00,"npi":[1770803678]}]},{"allowed_amount":42.75,"providers":[{"billed_charge":300.00,"npi":[1780212175]}]},{"allowed_amount":58.36,"providers":[{"billed_charge":350.00,"npi":[1710912837]}]},{"allowed_amount":181.44,"providers":[{"billed_charge":1275.00,"npi":[1467174342]}]},{"allowed_amount":149.13,"providers":[{"billed_charge":1050.00,"npi":[1083375778]}]}]},{"tin":{"type":"ein","value":"800417857"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":30.00,"providers":[{"billed_charge":30.00,"npi":[1497332258]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":588.56,"providers":[{"billed_charge":6412.08,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"566000350"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":4.20,"providers":[{"billed_charge":15.75,"npi":[1497118335]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1101.12,"providers":[{"billed_charge":7515.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6251.61,"providers":[{"billed_charge":6251.61,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11256.00,"providers":[{"billed_charge":11256.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":306.09,"providers":[{"billed_charge":6136.00,"npi":[1932208576]}]}]}]},{"name":"BLOOD/STOR-PROC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"390","description":"BLOOD STORAGE AND PROCESSING - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.16,"providers":[{"billed_charge":197.00,"npi":[1164495255]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":85.83,"providers":[{"billed_charge":638.00,"npi":[1013918960]}]},{"allowed_amount":16891.37,"providers":[{"billed_charge":91083.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":517.52,"providers":[{"billed_charge":1918.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1771.81,"providers":[{"billed_charge":8395.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7676.91,"providers":[{"billed_charge":19285.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":101.41,"providers":[{"billed_charge":936.00,"npi":[1447200233]}]},{"allowed_amount":3970.90,"providers":[{"billed_charge":16291.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":690.80,"providers":[{"billed_charge":3775.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":429.98,"providers":[{"billed_charge":1952.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":707.19,"providers":[{"billed_charge":4833.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":102.96,"providers":[{"billed_charge":1241.00,"npi":[1477591055]}]},{"allowed_amount":5146.13,"providers":[{"billed_charge":18893.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":385.80,"providers":[{"billed_charge":1604.00,"npi":[1932208576]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":332.92,"providers":[{"billed_charge":2414.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":626.78,"providers":[{"billed_charge":5685.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":994.21,"providers":[{"billed_charge":5221.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1807.70,"providers":[{"billed_charge":9830.81,"npi":[1477591055]}]}]}]},{"name":"INHALATION SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"412","description":"RESPIRATORY SERVICES - INHALATION SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1131.27,"providers":[{"billed_charge":2581.00,"npi":[1427030774]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71.68,"providers":[{"billed_charge":314.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19.92,"providers":[{"billed_charge":111.00,"npi":[1477591055]}]},{"allowed_amount":35.84,"providers":[{"billed_charge":107.00,"npi":[1477591055]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":86.61,"providers":[{"billed_charge":426.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":499.34,"providers":[{"billed_charge":1488.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":315.88,"providers":[{"billed_charge":987.00,"npi":[1477591055]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":106.49,"providers":[{"billed_charge":471.00,"npi":[1013918960]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":64.51,"providers":[{"billed_charge":426.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":114.62,"providers":[{"billed_charge":608.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":174.18,"providers":[{"billed_charge":1077.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":329.12,"providers":[{"billed_charge":806.00,"npi":[1932208576]}]}]}]},{"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":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":197468.01,"providers":[{"billed_charge":345540.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":113524.19,"providers":[{"billed_charge":294192.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19971.48,"providers":[{"billed_charge":55197.00,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":456138.50,"providers":[{"billed_charge":1663245.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2049.59,"providers":[{"billed_charge":2199.95,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4016.29,"providers":[{"billed_charge":4427.00,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43360.49,"providers":[{"billed_charge":158745.00,"npi":[1427075027]}]},{"allowed_amount":6136.14,"providers":[{"billed_charge":38685.19,"npi":[1891523718]}]}]},{"tin":{"type":"ein","value":"560611546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2022.03,"providers":[{"billed_charge":3857.00,"npi":[1093712655]}]}]},{"tin":{"type":"ein","value":"566011594"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2512.93,"providers":[{"billed_charge":10253.26,"npi":[1508832833]}]}]},{"tin":{"type":"ein","value":"560585243"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6372.90,"providers":[{"billed_charge":35189.00,"npi":[1043218944]}]}]},{"tin":{"type":"ein","value":"560642846"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1627.24,"providers":[{"billed_charge":3982.00,"npi":[1942361308]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12851.46,"providers":[{"billed_charge":24512.00,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4483.73,"providers":[{"billed_charge":12023.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":160804.81,"providers":[{"billed_charge":570690.50,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1009.82,"providers":[{"billed_charge":2484.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9779.61,"providers":[{"billed_charge":23268.00,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":80380.00,"providers":[{"billed_charge":521548.67,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38235.29,"providers":[{"billed_charge":126641.45,"npi":[1053358945]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":105218.50,"providers":[{"billed_charge":295791.00,"npi":[1801848767]}]},{"allowed_amount":1154.00,"providers":[{"billed_charge":34370.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":634835.23,"providers":[{"billed_charge":2639007.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":331974.94,"providers":[{"billed_charge":1037052.00,"npi":[1881647204]}]},{"allowed_amount":76343.51,"providers":[{"billed_charge":171456.00,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"50524222"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":550.00,"providers":[{"billed_charge":550.00,"npi":[1770662348]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37183.03,"providers":[{"billed_charge":121967.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"561844262"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4607.52,"providers":[{"billed_charge":5022.00,"npi":[1801831102]}]}]},{"tin":{"type":"ein","value":"590724459"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":736.54,"providers":[{"billed_charge":3392.00,"npi":[1306938071]}]}]},{"tin":{"type":"ein","value":"560529974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1063.54,"providers":[{"billed_charge":1933.00,"npi":[1225088255]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12354.71,"providers":[{"billed_charge":25874.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":88451.45,"providers":[{"billed_charge":228490.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41954.20,"providers":[{"billed_charge":151017.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":204360.89,"providers":[{"billed_charge":640440.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":101128.52,"providers":[{"billed_charge":438277.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":374751.20,"providers":[{"billed_charge":918695.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":132415.78,"providers":[{"billed_charge":356636.43,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":78482.38,"providers":[{"billed_charge":266754.33,"npi":[1972001469]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3704.00,"providers":[{"billed_charge":22634.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1703.02,"providers":[{"billed_charge":7076.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":657.94,"providers":[{"billed_charge":2316.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1551.10,"providers":[{"billed_charge":5558.00,"npi":[1447200233]}]},{"allowed_amount":530.05,"providers":[{"billed_charge":498.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1595.18,"providers":[{"billed_charge":8610.00,"npi":[1477591055]}]},{"allowed_amount":4339.87,"providers":[{"billed_charge":20378.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":585.69,"providers":[{"billed_charge":2251.00,"npi":[1932208576]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4177.70,"providers":[{"billed_charge":13206.40,"npi":[1053358945]}]}]}]},{"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":"561031244"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":30081.16,"providers":[{"billed_charge":65204.00,"npi":[1114614518]}]}]}]},{"name":"MRI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"610","description":"MRI - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1472.12,"providers":[{"billed_charge":5058.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18576.34,"providers":[{"billed_charge":63943.00,"npi":[1477591055]}]},{"allowed_amount":469.96,"providers":[{"billed_charge":5339.00,"npi":[1477591055]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10631.03,"providers":[{"billed_charge":25466.90,"npi":[1649726738]}]},{"allowed_amount":0.61,"providers":[{"billed_charge":1917.80,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16789.46,"providers":[{"billed_charge":44707.05,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10564.11,"providers":[{"billed_charge":38652.70,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"237027004"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":56.05,"providers":[{"billed_charge":341.60,"npi":[1619969219]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1568.19,"providers":[{"billed_charge":19362.70,"npi":[1477591055]}]},{"allowed_amount":18261.38,"providers":[{"billed_charge":38509.70,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31.50,"providers":[{"billed_charge":105.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":812.00,"providers":[{"billed_charge":4199.36,"npi":[1427075027]}]},{"allowed_amount":5718.81,"providers":[{"billed_charge":12940.51,"npi":[1891523718]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":280.80,"providers":[{"billed_charge":591.97,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":383.18,"providers":[{"billed_charge":3976.61,"npi":[1164495255]}]},{"allowed_amount":23950.51,"providers":[{"billed_charge":62491.40,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":344.35,"providers":[{"billed_charge":1304.20,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2871.02,"providers":[{"billed_charge":10722.35,"npi":[1376139139]}]},{"allowed_amount":0.74,"providers":[{"billed_charge":200.40,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3069.46,"providers":[{"billed_charge":12877.10,"npi":[1619911104]}]}]},{"tin":{"type":"ein","value":"561484844"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.58,"providers":[{"billed_charge":147.35,"npi":[1750353462]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":78.46,"providers":[{"billed_charge":275.20,"npi":[1053358945]}]},{"allowed_amount":18455.90,"providers":[{"billed_charge":61355.00,"npi":[1053358945]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":793.10,"providers":[{"billed_charge":45204.15,"npi":[1801848767]}]},{"allowed_amount":4476.09,"providers":[{"billed_charge":32993.60,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6.48,"providers":[{"billed_charge":387.20,"npi":[1013918960]}]},{"allowed_amount":47864.64,"providers":[{"billed_charge":241056.70,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1330.55,"providers":[{"billed_charge":17908.60,"npi":[1346291309]}]},{"allowed_amount":33895.08,"providers":[{"billed_charge":120226.28,"npi":[1881647204]}]},{"allowed_amount":0.75,"providers":[{"billed_charge":3540.60,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"561844262"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":116.02,"providers":[{"billed_charge":386.71,"npi":[1801831102]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":606.50,"providers":[{"billed_charge":2012.20,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"590724459"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18.11,"providers":[{"billed_charge":2166.24,"npi":[1306938071]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.33,"providers":[{"billed_charge":936.75,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"560529974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":461.81,"providers":[{"billed_charge":922.95,"npi":[1225088255]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":179.79,"providers":[{"billed_charge":3169.30,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1849.41,"providers":[{"billed_charge":9982.65,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1247.40,"providers":[{"billed_charge":12394.65,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1.16,"providers":[{"billed_charge":1279.70,"npi":[1508843566]}]},{"allowed_amount":17664.58,"providers":[{"billed_charge":79287.23,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"440577118"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10.64,"providers":[{"billed_charge":35.46,"npi":[1093740128]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8175.99,"providers":[{"billed_charge":23441.50,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23284.38,"providers":[{"billed_charge":130749.92,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2487.24,"providers":[{"billed_charge":24679.47,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13157.65,"providers":[{"billed_charge":40077.16,"npi":[1023435898]}]},{"allowed_amount":101.25,"providers":[{"billed_charge":320.64,"npi":[1023435898]}]},{"allowed_amount":6208.84,"providers":[{"billed_charge":20874.70,"npi":[1023435898]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12037.73,"providers":[{"billed_charge":29239.88,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"566015416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.60,"providers":[{"billed_charge":6.60,"npi":[1366449282]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4448.96,"providers":[{"billed_charge":8229.17,"npi":[1164495255]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1457.99,"providers":[{"billed_charge":11315.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":437.40,"providers":[{"billed_charge":4610.00,"npi":[1932208576]}]}]}]},{"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":"560988142"},"service_code":["11","22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":58.50,"providers":[{"billed_charge":360.00,"npi":[1417029455]}]},{"allowed_amount":19.53,"providers":[{"billed_charge":120.00,"npi":[1417029455]}]},{"allowed_amount":6.51,"providers":[{"billed_charge":40.00,"npi":[1417029455]}]},{"allowed_amount":51.96,"providers":[{"billed_charge":320.00,"npi":[1417029455]}]}]},{"tin":{"type":"ein","value":"560954803"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":17.48,"providers":[{"billed_charge":98.00,"npi":[1689933616]}]},{"allowed_amount":113.70,"providers":[{"billed_charge":637.00,"npi":[1689933616]}]},{"allowed_amount":8.74,"providers":[{"billed_charge":49.00,"npi":[1689933616]}]}]}]},{"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":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":221.49,"providers":[{"billed_charge":549.00,"npi":[1114194537]}]}]},{"tin":{"type":"ein","value":"561014346"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":21.10,"providers":[{"billed_charge":40.00,"npi":[1861786063]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13346.74,"providers":[{"billed_charge":60300.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560636250"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4173.65,"providers":[{"billed_charge":12953.00,"npi":[1801848767]}]},{"allowed_amount":415.50,"providers":[{"billed_charge":3033.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":230.46,"providers":[{"billed_charge":1942.00,"npi":[1346291309]}]},{"allowed_amount":12241.97,"providers":[{"billed_charge":95818.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6781.14,"providers":[{"billed_charge":28321.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2734.38,"providers":[{"billed_charge":20541.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":595.36,"providers":[{"billed_charge":1712.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11499.18,"providers":[{"billed_charge":33950.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561118388"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3456.89,"providers":[{"billed_charge":15045.00,"npi":[1932208576]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":307.28,"providers":[{"billed_charge":2700.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560547479"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11523.17,"providers":[{"billed_charge":42571.00,"npi":[1508843566]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":454.95,"providers":[{"billed_charge":2301.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15411.06,"providers":[{"billed_charge":54954.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2167.50,"providers":[{"billed_charge":20355.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1037.06,"providers":[{"billed_charge":6384.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"560789196"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4036.33,"providers":[{"billed_charge":29000.00,"npi":[1164495255]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1173.44,"providers":[{"billed_charge":11210.00,"npi":[1619911104]}]}]}]},{"name":"X-RAY EXAM ABDOMEN 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74018","description":"RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"560954803"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":17.86,"providers":[{"billed_charge":98.00,"npi":[1689933616]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"581588823"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2739.81,"providers":[{"billed_charge":6284.00,"npi":[1477591055]}]},{"allowed_amount":357.62,"providers":[{"billed_charge":549.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"463176429"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1251.44,"providers":[{"billed_charge":10510.00,"npi":[1619911104]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14185.43,"providers":[{"billed_charge":138378.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9656.56,"providers":[{"billed_charge":46980.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":980.05,"providers":[{"billed_charge":2088.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6126.64,"providers":[{"billed_charge":21611.68,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3899.15,"providers":[{"billed_charge":20227.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7976.55,"providers":[{"billed_charge":29791.00,"npi":[1477591055]}]}]}]},{"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":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":829.42,"providers":[{"billed_charge":3752.00,"npi":[1114194537]}]}]}]},{"name":"ECHO EXAM OF ABDOMEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76705","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL","allowed_amounts":[{"tin":{"type":"ein","value":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.22,"providers":[{"billed_charge":532.00,"npi":[1114194537]}]}]}]},{"name":"OB US FOLLOW-UP PER FETUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76816","description":"ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FOLLOW-UP (EG, RE-EVALUATION OF FET","allowed_amounts":[{"tin":{"type":"ein","value":"884307716"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":3770.67,"providers":[{"billed_charge":4230.00,"npi":[1194974535]}]},{"allowed_amount":94.75,"providers":[{"billed_charge":115.00,"npi":[1194974535]}]}]},{"tin":{"type":"ein","value":"205372824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.39,"providers":[{"billed_charge":274.53,"npi":[1700139490]}]}]}]},{"name":"BREAST TOMOSYNTHESIS UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77061","description":"DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":555.55,"providers":[{"billed_charge":1375.00,"npi":[1114194537]}]}]}]},{"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":"560845796"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":986.82,"providers":[{"billed_charge":1713.50,"npi":[1043629504]}]}]},{"tin":{"type":"ein","value":"812719403"},"service_code":["11","15"],"billing_class":"professional","payments":[{"allowed_amount":2257.04,"providers":[{"billed_charge":6250.00,"npi":[1497293773]}]},{"allowed_amount":146.23,"providers":[{"billed_charge":375.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"262414332"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1380.00,"providers":[{"billed_charge":1380.00,"npi":[1891971354]}]}]},{"tin":{"type":"ein","value":"561348830"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":888.57,"providers":[{"billed_charge":5111.00,"npi":[1740643717]}]}]},{"tin":{"type":"ein","value":"20777195"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":406.70,"providers":[{"billed_charge":1788.00,"npi":[1821034968]}]}]},{"tin":{"type":"ein","value":"261561009"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3897.42,"providers":[{"billed_charge":7000.00,"npi":[1871026914]}]},{"allowed_amount":9797.40,"providers":[{"billed_charge":17850.00,"npi":[1770566903]}]},{"allowed_amount":2536.02,"providers":[{"billed_charge":4550.00,"npi":[1588246300]}]},{"allowed_amount":5265.64,"providers":[{"billed_charge":9450.00,"npi":[1447925151]}]},{"allowed_amount":1264.70,"providers":[{"billed_charge":2275.00,"npi":[1093706038]}]}]},{"tin":{"type":"ein","value":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3408.08,"providers":[{"billed_charge":41844.00,"npi":[1114194537]}]}]},{"tin":{"type":"ein","value":"561465117"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1209.07,"providers":[{"billed_charge":2760.00,"npi":[1881156552]}]},{"allowed_amount":315.07,"providers":[{"billed_charge":720.00,"npi":[1851888275]}]}]},{"tin":{"type":"ein","value":"560954803"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":203.28,"providers":[{"billed_charge":1134.00,"npi":[1851888275]}]}]}]},{"name":"DX MAMMO INCL CAD UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77065","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":666.66,"providers":[{"billed_charge":1776.00,"npi":[1114194537]}]}]}]},{"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":"560845796"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1247.06,"providers":[{"billed_charge":2173.04,"npi":[1043629504]}]}]},{"tin":{"type":"ein","value":"812719403"},"service_code":["11","15"],"billing_class":"professional","payments":[{"allowed_amount":4995.99,"providers":[{"billed_charge":14400.00,"npi":[1497293773]}]},{"allowed_amount":592.05,"providers":[{"billed_charge":1500.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"262414332"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5980.00,"providers":[{"billed_charge":5980.00,"npi":[1891971354]}]}]},{"tin":{"type":"ein","value":"561348830"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2163.74,"providers":[{"billed_charge":7695.00,"npi":[1740643717]}]}]},{"tin":{"type":"ein","value":"20777195"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":866.70,"providers":[{"billed_charge":2055.00,"npi":[1821034968]}]}]},{"tin":{"type":"ein","value":"261561009"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3088.48,"providers":[{"billed_charge":5525.00,"npi":[1093706038]}]},{"allowed_amount":13085.60,"providers":[{"billed_charge":23375.00,"npi":[1447925151]}]},{"allowed_amount":6185.92,"providers":[{"billed_charge":11050.00,"npi":[1588246300]}]},{"allowed_amount":23902.00,"providers":[{"billed_charge":43350.00,"npi":[1770566903]}]},{"allowed_amount":9512.32,"providers":[{"billed_charge":17000.00,"npi":[1871026914]}]}]},{"tin":{"type":"ein","value":"611614223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13336.26,"providers":[{"billed_charge":35873.00,"npi":[1114194537]}]}]},{"tin":{"type":"ein","value":"561465117"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2948.05,"providers":[{"billed_charge":7705.00,"npi":[1881156552]}]},{"allowed_amount":768.45,"providers":[{"billed_charge":2010.00,"npi":[1851888275]}]}]},{"tin":{"type":"ein","value":"560954803"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":256.66,"providers":[{"billed_charge":1442.00,"npi":[1851888275]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.28,"providers":[{"billed_charge":444.00,"npi":[1477591055]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":322.68,"providers":[{"billed_charge":5237.74,"npi":[1932166386]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1283.84,"providers":[{"billed_charge":5135.36,"npi":[1932166386]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8449.28,"providers":[{"billed_charge":137949.47,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":445.04,"providers":[{"billed_charge":5272.32,"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8557.66,"providers":[{"billed_charge":185497.49,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":620.19,"providers":[{"billed_charge":7389.92,"npi":[1234567893]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31.37,"providers":[{"billed_charge":537.15,"npi":[1932166386]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":200.68,"providers":[{"billed_charge":4161.01,"npi":[1932166386]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.80,"providers":[{"billed_charge":158.34,"npi":[1932166386]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"460498444"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":211.28,"providers":[{"billed_charge":2200.00,"npi":[1194423178]}]},{"allowed_amount":158.46,"providers":[{"billed_charge":1650.00,"npi":[1861769523]}]}]},{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1647.61,"providers":[{"billed_charge":5656.23,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1823.58,"providers":[{"billed_charge":11141.24,"npi":[1234567893]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.02,"providers":[{"billed_charge":4278.84,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.26,"providers":[{"billed_charge":555.20,"npi":[1234567893]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1799.03,"providers":[{"billed_charge":8088.22,"npi":[1932166386]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":795.92,"providers":[{"billed_charge":19717.82,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.10,"providers":[{"billed_charge":777.98,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3.89,"providers":[{"billed_charge":56.62,"npi":[1932166386]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":39.27,"providers":[{"billed_charge":118.64,"npi":[1932166386]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6778.16,"providers":[{"billed_charge":108487.44,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":946.41,"providers":[{"billed_charge":11085.20,"npi":[1234567893]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.78,"providers":[{"billed_charge":160.80,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":672.99,"providers":[{"billed_charge":14572.13,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.72,"providers":[{"billed_charge":531.46,"npi":[1234567893]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1503.51,"providers":[{"billed_charge":23484.18,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":321.02,"providers":[{"billed_charge":3859.52,"npi":[1234567893]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":53.65,"providers":[{"billed_charge":1002.40,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":660.67,"providers":[{"billed_charge":9819.08,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1588.10,"providers":[{"billed_charge":25653.78,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":83.48,"providers":[{"billed_charge":998.84,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":541.25,"providers":[{"billed_charge":8472.16,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":157.12,"providers":[{"billed_charge":1881.60,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":381.98,"providers":[{"billed_charge":5425.00,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":201.42,"providers":[{"billed_charge":2875.90,"npi":[1932166386]}]}]}]},{"name":"H PYLORI (C-13), BREATH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83013","description":"HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":283.81,"providers":[{"billed_charge":1884.58,"npi":[1932166386]}]}]}]},{"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":"473862292"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.13,"providers":[{"billed_charge":25.00,"npi":[1629779632]}]}]},{"tin":{"type":"ein","value":"581622664"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.75,"providers":[{"billed_charge":156.00,"npi":[1558172593]}]}]},{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3312.79,"providers":[{"billed_charge":49514.94,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"581319204"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14.84,"providers":[{"billed_charge":264.00,"npi":[1467174342]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":412.76,"providers":[{"billed_charge":4978.48,"npi":[1234567893]}]}]}]},{"name":"IMMUNOASSAY QUANT NOS NONAB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83520","description":"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31.54,"providers":[{"billed_charge":231.35,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":722.03,"providers":[{"billed_charge":8347.00,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":56.91,"providers":[{"billed_charge":671.50,"npi":[1234567893]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":938.24,"providers":[{"billed_charge":10795.42,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":76.93,"providers":[{"billed_charge":907.10,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":70.75,"providers":[{"billed_charge":1309.74,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":149.55,"providers":[{"billed_charge":2424.57,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.16,"providers":[{"billed_charge":241.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF NATRIURETIC PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83880","description":"NATRIURETIC PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":285.27,"providers":[{"billed_charge":2717.57,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":99.61,"providers":[{"billed_charge":1140.00,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":175.82,"providers":[{"billed_charge":2114.97,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1678.25,"providers":[{"billed_charge":25542.93,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.28,"providers":[{"billed_charge":147.12,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.20,"providers":[{"billed_charge":53.30,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":223.08,"providers":[{"billed_charge":2793.76,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF FREE TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84402","description":"TESTOSTERONE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":246.46,"providers":[{"billed_charge":3023.74,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1280.08,"providers":[{"billed_charge":18395.87,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.33,"providers":[{"billed_charge":690.29,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":231.98,"providers":[{"billed_charge":3281.09,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":996.87,"providers":[{"billed_charge":31607.08,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":127.47,"providers":[{"billed_charge":1551.28,"npi":[1234567893]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7512.00,"providers":[{"billed_charge":111384.78,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":353.67,"providers":[{"billed_charge":4216.80,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF THYROID (T3 OR T4)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84479","description":"THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.59,"providers":[{"billed_charge":2884.08,"npi":[1932166386]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":869.76,"providers":[{"billed_charge":22710.18,"npi":[1932166386]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":62.63,"providers":[{"billed_charge":1161.07,"npi":[1932166386]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4034.70,"providers":[{"billed_charge":46312.87,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":277.50,"providers":[{"billed_charge":3291.79,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":316.89,"providers":[{"billed_charge":3223.80,"npi":[1932166386]}]}]}]},{"name":"RBC SED RATE, NONAUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85651","description":"SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.58,"providers":[{"billed_charge":102.48,"npi":[1234567893]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.88,"providers":[{"billed_charge":1670.72,"npi":[1932166386]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":189.14,"providers":[{"billed_charge":2576.88,"npi":[1932166386]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES (ANA)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86039","description":"ANTINUCLEAR ANTIBODIES (ANA); TITER","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33.64,"providers":[{"billed_charge":290.55,"npi":[1932166386]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.65,"providers":[{"billed_charge":5337.58,"npi":[1932166386]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.82,"providers":[{"billed_charge":1196.73,"npi":[1932166386]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":149.17,"providers":[{"billed_charge":2499.68,"npi":[1932166386]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.24,"providers":[{"billed_charge":1033.80,"npi":[1932166386]}]}]}]},{"name":"TB TEST CELL IMMUN MEASURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86480","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":748.60,"providers":[{"billed_charge":8003.24,"npi":[1932166386]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":167.36,"providers":[{"billed_charge":2932.44,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.86,"providers":[{"billed_charge":34.16,"npi":[1234567893]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":94.47,"providers":[{"billed_charge":1460.36,"npi":[1932166386]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":64.54,"providers":[{"billed_charge":1018.66,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.18,"providers":[{"billed_charge":85.92,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":22.46,"providers":[{"billed_charge":390.95,"npi":[1932166386]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.18,"providers":[{"billed_charge":678.22,"npi":[1932166386]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":688.98,"providers":[{"billed_charge":12812.00,"npi":[1932166386]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":52.14,"providers":[{"billed_charge":981.80,"npi":[1932166386]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":263.30,"providers":[{"billed_charge":2080.73,"npi":[1932166386]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1048.52,"providers":[{"billed_charge":14271.50,"npi":[1932166386]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":459.21,"providers":[{"billed_charge":3609.36,"npi":[1932166386]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":255.96,"providers":[{"billed_charge":4102.52,"npi":[1932166386]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":217.91,"providers":[{"billed_charge":3469.62,"npi":[1932166386]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1322.39,"providers":[{"billed_charge":11551.27,"npi":[1932166386]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1542.17,"providers":[{"billed_charge":11648.05,"npi":[1932166386]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1263.00,"providers":[{"billed_charge":7155.64,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.55,"providers":[{"billed_charge":40.00,"npi":[1234567893]}]}]}]},{"name":"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"87494","description":" Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1631.12,"providers":[{"billed_charge":9447.56,"npi":[1932166386]}]}]}]},{"name":"HIV-1 QUANT&REVRSE TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87536","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION, INCLUDES REVERSE TRA","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":102.12,"providers":[{"billed_charge":954.97,"npi":[1932166386]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1263.00,"providers":[{"billed_charge":7142.40,"npi":[1932166386]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.72,"providers":[{"billed_charge":105.27,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1101.50,"providers":[{"billed_charge":8002.65,"npi":[1932166386]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1609.46,"providers":[{"billed_charge":15387.95,"npi":[1932166386]}]}]}]},{"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":"566000335"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":18.99,"providers":[{"billed_charge":144.00,"npi":[1447086228]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1044.17,"providers":[{"billed_charge":8399.43,"npi":[1932166386]}]}]}]},{"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":"560986500"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":119.44,"providers":[{"billed_charge":534.30,"npi":[1306340070]}]}]},{"tin":{"type":"ein","value":"561230477"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":960.30,"providers":[{"billed_charge":1760.00,"npi":[1205245800]}]},{"allowed_amount":873.00,"providers":[{"billed_charge":1600.00,"npi":[1790262426]}]},{"allowed_amount":87.30,"providers":[{"billed_charge":160.00,"npi":[1205245800]}]}]},{"tin":{"type":"ein","value":"560948235"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":279.76,"providers":[{"billed_charge":644.00,"npi":[1487730800]}]}]},{"tin":{"type":"ein","value":"560946593"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":385.19,"providers":[{"billed_charge":1620.00,"npi":[1598269680]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"843595332"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":404.16,"providers":[{"billed_charge":776.00,"npi":[1124853320]}]}]}]},{"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":"20707661"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":184.40,"providers":[{"billed_charge":480.00,"npi":[1821982240]}]}]}]},{"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":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":563.76,"providers":[{"billed_charge":830.32,"npi":[1629298872]}]},{"allowed_amount":1968.24,"providers":[{"billed_charge":2906.12,"npi":[1629298872]}]}]}]},{"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":"200462802"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":113.17,"providers":[{"billed_charge":312.50,"npi":[1891121372]}]},{"allowed_amount":302.55,"providers":[{"billed_charge":937.50,"npi":[1891121372]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":644.78,"providers":[{"billed_charge":650.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"852831568"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1879.75,"providers":[{"billed_charge":2995.68,"npi":[1780482950]}]},{"allowed_amount":2808.17,"providers":[{"billed_charge":5242.44,"npi":[1780482950]}]}]},{"tin":{"type":"ein","value":"843595332"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":334.00,"providers":[{"billed_charge":702.00,"npi":[1265219976,1689960056]}]},{"allowed_amount":2171.00,"providers":[{"billed_charge":4563.00,"npi":[1235131566]}]},{"allowed_amount":668.00,"providers":[{"billed_charge":1404.00,"npi":[1396884128]}]}]},{"tin":{"type":"ein","value":"920643498"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2165.43,"providers":[{"billed_charge":2700.00,"npi":[1083463400]}]},{"allowed_amount":3056.12,"providers":[{"billed_charge":3750.00,"npi":[1083463400]}]}]},{"tin":{"type":"ein","value":"271797732"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":359.29,"providers":[{"billed_charge":543.21,"npi":[1841038403]}]},{"allowed_amount":802.63,"providers":[{"billed_charge":1440.00,"npi":[1841038403]}]}]},{"tin":{"type":"ein","value":"863921371"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":236.23,"providers":[{"billed_charge":350.00,"npi":[1629571872]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"20707661"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":87.54,"providers":[{"billed_charge":640.00,"npi":[1174048805]}]}]}]},{"name":"TCRANIAL MAGN STIM TX DELI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90868","description":"THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MA","allowed_amounts":[{"tin":{"type":"ein","value":"853197881"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":501.57,"providers":[{"billed_charge":2100.00,"npi":[1932139458]}]}]}]},{"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":"811567573"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6724.50,"providers":[{"billed_charge":68750.00,"npi":[1649715517]}]}]},{"tin":{"type":"ein","value":"300921509"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2550.00,"providers":[{"billed_charge":9638.88,"npi":[1841884780]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":836.36,"providers":[{"billed_charge":2892.00,"npi":[1487866315]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"461281853"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4725.00,"providers":[{"billed_charge":59925.00,"npi":[1457232589]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7324.10,"providers":[{"billed_charge":34086.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2297.83,"providers":[{"billed_charge":7815.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5160.51,"providers":[{"billed_charge":19684.00,"npi":[1477591055]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"561692676"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":413.63,"providers":[{"billed_charge":1050.00,"npi":[1447962014]}]},{"allowed_amount":177.27,"providers":[{"billed_charge":450.00,"npi":[1447962014]}]}]}]},{"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":"223849199"},"service_code":["22","11","23","21"],"billing_class":"professional","payments":[{"allowed_amount":95.94,"providers":[{"billed_charge":288.00,"npi":[1558348227]}]},{"allowed_amount":117.26,"providers":[{"billed_charge":352.00,"npi":[1558348227]}]},{"allowed_amount":21.32,"providers":[{"billed_charge":64.00,"npi":[1558348227]}]},{"allowed_amount":42.64,"providers":[{"billed_charge":128.00,"npi":[1558348227]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1893.23,"providers":[{"billed_charge":14040.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"561509260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":282.59,"providers":[{"billed_charge":2632.00,"npi":[1497797088]}]}]},{"tin":{"type":"ein","value":"560554202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":77.94,"providers":[{"billed_charge":741.00,"npi":[1114974029]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":99.21,"providers":[{"billed_charge":348.00,"npi":[1053358945]}]},{"allowed_amount":55.77,"providers":[{"billed_charge":174.00,"npi":[1053358945]}]}]}]},{"name":"IMMUNOTHERAPY, ONE INJECTION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95115","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SIN","allowed_amounts":[{"tin":{"type":"ein","value":"560988429"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.18,"providers":[{"billed_charge":161.00,"npi":[1326212986]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"562261549"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":158.23,"providers":[{"billed_charge":482.00,"npi":[1679544829]}]}]}]},{"name":"SLEEP STUDY UNATT&RESP EFFT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95806","description":"SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFL","allowed_amounts":[{"tin":{"type":"ein","value":"331298313"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":358.05,"providers":[{"billed_charge":900.00,"npi":[1548267958]}]},{"allowed_amount":717.28,"providers":[{"billed_charge":2168.00,"npi":[1548267958]}]}]}]},{"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":"581728803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":46.14,"providers":[{"billed_charge":119.00,"npi":[1841651312]}]}]}]},{"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":"562237126"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":960.36,"providers":[{"billed_charge":2175.00,"npi":[1790793354]}]}]},{"tin":{"type":"ein","value":"451230023"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":187.41,"providers":[{"billed_charge":425.00,"npi":[1699450239]}]}]}]},{"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":"460796905"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":129.03,"providers":[{"billed_charge":275.00,"npi":[1659945624]}]}]},{"tin":{"type":"ein","value":"562223193"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":48.18,"providers":[{"billed_charge":148.00,"npi":[1366611097]}]}]},{"tin":{"type":"ein","value":"831578263"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":96.78,"providers":[{"billed_charge":200.00,"npi":[1093587255]}]}]},{"tin":{"type":"ein","value":"562237126"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":529.86,"providers":[{"billed_charge":1100.00,"npi":[1790793354]}]}]},{"tin":{"type":"ein","value":"562149141"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":336.42,"providers":[{"billed_charge":672.00,"npi":[1518772144]}]}]}]},{"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":"460796905"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":243.32,"providers":[{"billed_charge":550.00,"npi":[1659945624]}]}]},{"tin":{"type":"ein","value":"20777195"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":101.58,"providers":[{"billed_charge":261.00,"npi":[1285480160]}]}]},{"tin":{"type":"ein","value":"300504040"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.83,"providers":[{"billed_charge":82.00,"npi":[1851121412]}]}]},{"tin":{"type":"ein","value":"562071315"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":302.63,"providers":[{"billed_charge":1275.00,"npi":[1801313473]}]}]},{"tin":{"type":"ein","value":"831578263"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":134.52,"providers":[{"billed_charge":300.00,"npi":[1093587255]}]}]},{"tin":{"type":"ein","value":"262624323"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":82.85,"providers":[{"billed_charge":317.12,"npi":[1851081210]}]}]},{"tin":{"type":"ein","value":"331298313"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":206.95,"providers":[{"billed_charge":360.00,"npi":[1992285290]}]},{"allowed_amount":41.61,"providers":[{"billed_charge":72.00,"npi":[1235963216]}]}]},{"tin":{"type":"ein","value":"854354835"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.96,"providers":[{"billed_charge":432.00,"npi":[1932972171]}]}]},{"tin":{"type":"ein","value":"205738288"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":796.15,"providers":[{"billed_charge":3276.00,"npi":[1881286300]}]}]},{"tin":{"type":"ein","value":"753174935"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":494.13,"providers":[{"billed_charge":1560.00,"npi":[1780572107]}]},{"allowed_amount":346.68,"providers":[{"billed_charge":1105.00,"npi":[1477319028]}]},{"allowed_amount":223.89,"providers":[{"billed_charge":715.00,"npi":[1710863220]}]}]},{"tin":{"type":"ein","value":"562149141"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":557.98,"providers":[{"billed_charge":1250.00,"npi":[1518772144]}]}]}]},{"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":"262624323"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":156.78,"providers":[{"billed_charge":578.34,"npi":[1851081210]}]}]},{"tin":{"type":"ein","value":"854354835"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":94.68,"providers":[{"billed_charge":180.00,"npi":[1932972171]}]}]},{"tin":{"type":"ein","value":"205738288"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":656.41,"providers":[{"billed_charge":2520.00,"npi":[1881286300]}]}]},{"tin":{"type":"ein","value":"753174935"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":349.81,"providers":[{"billed_charge":975.00,"npi":[1710863220]}]},{"allowed_amount":746.16,"providers":[{"billed_charge":2080.00,"npi":[1780572107]}]},{"allowed_amount":367.91,"providers":[{"billed_charge":1040.00,"npi":[1477319028]}]}]}]},{"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":"300504040"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.24,"providers":[{"billed_charge":40.00,"npi":[1851121412]}]}]},{"tin":{"type":"ein","value":"205738288"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":401.96,"providers":[{"billed_charge":1659.00,"npi":[1881286300]}]}]},{"tin":{"type":"ein","value":"753174935"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":371.45,"providers":[{"billed_charge":1425.00,"npi":[1477319028]}]},{"allowed_amount":198.19,"providers":[{"billed_charge":750.00,"npi":[1710863220]}]}]}]},{"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":"465307606"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":19408.95,"providers":[{"billed_charge":41450.00,"npi":[1003457748]}]},{"allowed_amount":966.00,"providers":[{"billed_charge":2050.00,"npi":[1003457748]}]}]},{"tin":{"type":"ein","value":"863679826"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":1011.45,"providers":[{"billed_charge":3960.00,"npi":[1730756321]}]},{"allowed_amount":8498.10,"providers":[{"billed_charge":33300.00,"npi":[1730756321]}]}]},{"tin":{"type":"ein","value":"993383437"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1298.64,"providers":[{"billed_charge":6300.00,"npi":[1609391572]}]}]},{"tin":{"type":"ein","value":"920797533"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6726.68,"providers":[{"billed_charge":18927.04,"npi":[1437866472]}]}]}]},{"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":"465307606"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":921.94,"providers":[{"billed_charge":2000.00,"npi":[1003457748]}]},{"allowed_amount":139.14,"providers":[{"billed_charge":300.00,"npi":[1003457748]}]}]}]},{"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":"943419490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1459.42,"providers":[{"billed_charge":4200.00,"npi":[1689962144]}]}]},{"tin":{"type":"ein","value":"262624323"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":160.16,"providers":[{"billed_charge":511.44,"npi":[1851081210]}]}]},{"tin":{"type":"ein","value":"331298313"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":166.37,"providers":[{"billed_charge":270.00,"npi":[1992285290]}]}]},{"tin":{"type":"ein","value":"753174935"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":348.28,"providers":[{"billed_charge":845.00,"npi":[1710863220]}]},{"allowed_amount":1336.98,"providers":[{"billed_charge":3315.00,"npi":[1780572107]}]},{"allowed_amount":537.00,"providers":[{"billed_charge":1300.00,"npi":[1477319028]}]}]},{"tin":{"type":"ein","value":"205738288"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":239.61,"providers":[{"billed_charge":801.00,"npi":[1881286300]}]}]}]},{"name":"Under Established Patient","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98006","description":"Under Established Patient","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1325.28,"providers":[{"billed_charge":3012.00,"npi":[1710448790]}]}]}]},{"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":"460796905"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":186.30,"providers":[{"billed_charge":325.00,"npi":[1659945624]}]}]},{"tin":{"type":"ein","value":"831578263"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.34,"providers":[{"billed_charge":130.00,"npi":[1093587255]}]}]},{"tin":{"type":"ein","value":"814427499"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":173.31,"providers":[{"billed_charge":350.00,"npi":[1043925548]}]}]},{"tin":{"type":"ein","value":"562237126"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3015.24,"providers":[{"billed_charge":5655.00,"npi":[1790793354]}]}]},{"tin":{"type":"ein","value":"451230023"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1455.23,"providers":[{"billed_charge":3024.00,"npi":[1699450239]}]}]}]},{"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":"562149141"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":387.32,"providers":[{"billed_charge":640.00,"npi":[1518772144]}]}]}]},{"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":"451230023"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":91.60,"providers":[{"billed_charge":180.00,"npi":[1699450239]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"581466368"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1036.71,"providers":[{"billed_charge":2387.00,"npi":[1841385531]}]}]}]},{"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":"561892600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1551.79,"providers":[{"billed_charge":2580.00,"npi":[1093280117]}]}]},{"tin":{"type":"ein","value":"581466368"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":381.54,"providers":[{"billed_charge":663.00,"npi":[1841385531]}]}]},{"tin":{"type":"ein","value":"460498444"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.42,"providers":[{"billed_charge":282.00,"npi":[1194423178]}]},{"allowed_amount":77.21,"providers":[{"billed_charge":141.00,"npi":[1184690885]}]}]},{"tin":{"type":"ein","value":"882454417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":435.60,"providers":[{"billed_charge":882.90,"npi":[1679081319]}]}]},{"tin":{"type":"ein","value":"331298313"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":289.55,"providers":[{"billed_charge":359.70,"npi":[1659332369]}]}]},{"tin":{"type":"ein","value":"581319204"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":555.72,"providers":[{"billed_charge":1224.00,"npi":[1780212175]}]},{"allowed_amount":1013.71,"providers":[{"billed_charge":2295.00,"npi":[1467174342]}]},{"allowed_amount":1486.79,"providers":[{"billed_charge":2754.00,"npi":[1770803678]}]},{"allowed_amount":42.55,"providers":[{"billed_charge":153.00,"npi":[1083375778]}]},{"allowed_amount":828.84,"providers":[{"billed_charge":1836.00,"npi":[1720704000]}]},{"allowed_amount":55.63,"providers":[{"billed_charge":153.00,"npi":[1770803678]}]},{"allowed_amount":46.88,"providers":[{"billed_charge":153.00,"npi":[1720704000]}]},{"allowed_amount":85.10,"providers":[{"billed_charge":306.00,"npi":[1346088267]}]},{"allowed_amount":546.14,"providers":[{"billed_charge":1224.00,"npi":[1124876016]}]},{"allowed_amount":666.46,"providers":[{"billed_charge":1530.00,"npi":[1346088267]}]},{"allowed_amount":2235.99,"providers":[{"billed_charge":5049.00,"npi":[1083375778]}]}]},{"tin":{"type":"ein","value":"561209062"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":685.42,"providers":[{"billed_charge":1726.60,"npi":[1811924384]}]}]},{"tin":{"type":"ein","value":"871162022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":298.30,"providers":[{"billed_charge":520.00,"npi":[1780197111]}]}]},{"tin":{"type":"ein","value":"463984362"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":529.93,"providers":[{"billed_charge":1218.00,"npi":[1881260958]}]}]}]},{"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":"560529945"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5501.95,"providers":[{"billed_charge":12452.00,"npi":[1013982800]}]}]},{"tin":{"type":"ein","value":"566000350"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":116.50,"providers":[{"billed_charge":203.96,"npi":[1497118335]}]}]},{"tin":{"type":"ein","value":"561936354"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":143.08,"providers":[{"billed_charge":298.00,"npi":[1942611280]}]}]},{"tin":{"type":"ein","value":"870968775"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":312.75,"providers":[{"billed_charge":591.00,"npi":[1609516236]}]}]},{"tin":{"type":"ein","value":"260683186"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1302.74,"providers":[{"billed_charge":2744.72,"npi":[1033725585]}]}]},{"tin":{"type":"ein","value":"273821519"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":110.03,"providers":[{"billed_charge":207.00,"npi":[1952018061]}]}]},{"tin":{"type":"ein","value":"223849199"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1139.40,"providers":[{"billed_charge":3030.00,"npi":[1386169266]}]},{"allowed_amount":402.15,"providers":[{"billed_charge":909.00,"npi":[1275522492]}]}]},{"tin":{"type":"ein","value":"882512059"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1051.36,"providers":[{"billed_charge":4117.08,"npi":[1497501878]}]},{"allowed_amount":1004.64,"providers":[{"billed_charge":2619.96,"npi":[1497501878]}]}]},{"tin":{"type":"ein","value":"834464233"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":236.12,"providers":[{"billed_charge":750.00,"npi":[1285100040]}]},{"allowed_amount":73.16,"providers":[{"billed_charge":250.00,"npi":[1609657394]}]}]},{"tin":{"type":"ein","value":"561980160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":955.52,"providers":[{"billed_charge":1050.00,"npi":[1144800244]}]}]},{"tin":{"type":"ein","value":"566001537"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":189.80,"providers":[{"billed_charge":246.00,"npi":[1235702564]}]}]},{"tin":{"type":"ein","value":"473862292"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2249.45,"providers":[{"billed_charge":3990.00,"npi":[1629779632]}]}]},{"tin":{"type":"ein","value":"201582408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1024.19,"providers":[{"billed_charge":1920.00,"npi":[1578791422]}]}]},{"tin":{"type":"ein","value":"463277388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":226.52,"providers":[{"billed_charge":298.00,"npi":[1851927826]}]}]},{"tin":{"type":"ein","value":"460498444"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1366.32,"providers":[{"billed_charge":2688.00,"npi":[1861769523]}]}]},{"tin":{"type":"ein","value":"463774942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1114.77,"providers":[{"billed_charge":1490.00,"npi":[1699779454]}]},{"allowed_amount":3435.40,"providers":[{"billed_charge":5364.00,"npi":[1740055045]}]}]},{"tin":{"type":"ein","value":"882454417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3810.73,"providers":[{"billed_charge":7387.52,"npi":[1679081319]}]}]},{"tin":{"type":"ein","value":"561795828"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1808.13,"providers":[{"billed_charge":6385.20,"npi":[1013542315]}]}]},{"tin":{"type":"ein","value":"331298313"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1871.76,"providers":[{"billed_charge":2374.92,"npi":[1881057453]}]},{"allowed_amount":1691.82,"providers":[{"billed_charge":2111.04,"npi":[1073132262]}]},{"allowed_amount":1922.22,"providers":[{"billed_charge":2374.92,"npi":[1275080731]}]},{"allowed_amount":623.92,"providers":[{"billed_charge":791.64,"npi":[1962440107]}]}]},{"tin":{"type":"ein","value":"272763125"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":623.92,"providers":[{"billed_charge":791.64,"npi":[1821343625]}]}]},{"tin":{"type":"ein","value":"843569009"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":110.03,"providers":[{"billed_charge":244.37,"npi":[1023294261]}]}]},{"tin":{"type":"ein","value":"561892600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1753.46,"providers":[{"billed_charge":2916.00,"npi":[1609467638]}]},{"allowed_amount":1327.71,"providers":[{"billed_charge":2187.00,"npi":[1104451830]}]}]},{"tin":{"type":"ein","value":"560845796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.58,"providers":[{"billed_charge":263.88,"npi":[1780688440]}]},{"allowed_amount":1423.74,"providers":[{"billed_charge":2111.04,"npi":[1083460349]}]},{"allowed_amount":181.54,"providers":[{"billed_charge":263.88,"npi":[1033793807]}]}]},{"tin":{"type":"ein","value":"20777195"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":815.72,"providers":[{"billed_charge":1108.00,"npi":[1750325858]}]}]},{"tin":{"type":"ein","value":"581319204"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":594.12,"providers":[{"billed_charge":1326.00,"npi":[1083375778]}]},{"allowed_amount":2534.84,"providers":[{"billed_charge":4862.00,"npi":[1710912837]}]},{"allowed_amount":570.46,"providers":[{"billed_charge":1326.00,"npi":[1891592366]}]},{"allowed_amount":154.76,"providers":[{"billed_charge":442.00,"npi":[1710912837]}]},{"allowed_amount":1545.32,"providers":[{"billed_charge":3536.00,"npi":[1467174342]}]},{"allowed_amount":487.30,"providers":[{"billed_charge":1105.00,"npi":[1114756335]}]}]},{"tin":{"type":"ein","value":"581728803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":543.66,"providers":[{"billed_charge":873.00,"npi":[1841651312]}]}]}]},{"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":"562108670"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":167.57,"providers":[{"billed_charge":220.00,"npi":[1114931409]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":8933.40,"providers":[{"billed_charge":16128.00,"npi":[1629298872]}]},{"allowed_amount":2432.29,"providers":[{"billed_charge":4256.00,"npi":[1629298872]}]}]}]},{"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":"621692189"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2393.93,"providers":[{"billed_charge":6600.00,"npi":[1720433469]}]},{"allowed_amount":325.80,"providers":[{"billed_charge":1080.00,"npi":[1013504356]}]}]},{"tin":{"type":"ein","value":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":279.06,"providers":[{"billed_charge":385.80,"npi":[1629298872]}]},{"allowed_amount":3069.66,"providers":[{"billed_charge":4243.80,"npi":[1629298872]}]}]}]},{"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":"561789021"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2520.81,"providers":[{"billed_charge":6290.00,"npi":[1114411105]}]}]},{"tin":{"type":"ein","value":"272148485"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":440.00,"providers":[{"billed_charge":440.00,"npi":[1619921269]}]}]},{"tin":{"type":"ein","value":"621692189"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1446.54,"providers":[{"billed_charge":3150.00,"npi":[1720433469]}]}]},{"tin":{"type":"ein","value":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":13232.75,"providers":[{"billed_charge":20898.50,"npi":[1629298872]}]},{"allowed_amount":3359.85,"providers":[{"billed_charge":5254.48,"npi":[1629298872]}]}]},{"tin":{"type":"ein","value":"881540748"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":476.91,"providers":[{"billed_charge":1050.00,"npi":[1134148745]}]}]},{"tin":{"type":"ein","value":"831449198"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":328.90,"providers":[{"billed_charge":600.00,"npi":[1235559667]}]}]},{"tin":{"type":"ein","value":"561637604"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":275.54,"providers":[{"billed_charge":520.00,"npi":[1457645269]}]}]},{"tin":{"type":"ein","value":"561025986"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1158.21,"providers":[{"billed_charge":3135.65,"npi":[1114911930]}]}]},{"tin":{"type":"ein","value":"475510475"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2776.40,"providers":[{"billed_charge":8360.00,"npi":[1346241601]}]}]},{"tin":{"type":"ein","value":"581728803"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":103.30,"providers":[{"billed_charge":200.00,"npi":[1851572416]}]}]},{"tin":{"type":"ein","value":"562036719"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":985.44,"providers":[{"billed_charge":2100.00,"npi":[1841359486]}]}]}]},{"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":"20777195"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":359.96,"providers":[{"billed_charge":694.00,"npi":[1124606405]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99238","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS","allowed_amounts":[{"tin":{"type":"ein","value":"621692189"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":215.94,"providers":[{"billed_charge":330.00,"npi":[1720433469]}]}]},{"tin":{"type":"ein","value":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":949.94,"providers":[{"billed_charge":1435.80,"npi":[1629298872]}]},{"allowed_amount":4438.67,"providers":[{"billed_charge":6700.40,"npi":[1629298872]}]}]}]},{"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":"823693569"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4594.38,"providers":[{"billed_charge":7644.00,"npi":[1033163993]}]},{"allowed_amount":5026.60,"providers":[{"billed_charge":8372.00,"npi":[1962638213]}]}]}]},{"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":"561903275"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":382.42,"providers":[{"billed_charge":926.00,"npi":[1609525575]}]},{"allowed_amount":1729.08,"providers":[{"billed_charge":6477.00,"npi":[1164950267]}]}]},{"tin":{"type":"ein","value":"753108438"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":595.56,"providers":[{"billed_charge":2560.00,"npi":[1700568201]}]},{"allowed_amount":2098.66,"providers":[{"billed_charge":7680.00,"npi":[1265922983]}]}]},{"tin":{"type":"ein","value":"561752877"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2135.88,"providers":[{"billed_charge":9819.00,"npi":[1164162491]}]},{"allowed_amount":1891.81,"providers":[{"billed_charge":8728.00,"npi":[1659834794]}]},{"allowed_amount":1414.92,"providers":[{"billed_charge":6546.00,"npi":[1942883723]}]},{"allowed_amount":2597.02,"providers":[{"billed_charge":12001.00,"npi":[1396238622]}]},{"allowed_amount":2131.38,"providers":[{"billed_charge":9819.00,"npi":[1770518813]}]},{"allowed_amount":1656.74,"providers":[{"billed_charge":7637.00,"npi":[1417687427]}]},{"allowed_amount":472.39,"providers":[{"billed_charge":2182.00,"npi":[1629755947]}]},{"allowed_amount":403.44,"providers":[{"billed_charge":2182.00,"npi":[1437965837]}]}]},{"tin":{"type":"ein","value":"465477125"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1781.04,"providers":[{"billed_charge":7680.00,"npi":[1992515316]}]}]},{"tin":{"type":"ein","value":"50588771"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":472.50,"providers":[{"billed_charge":1134.00,"npi":[1942078845]}]},{"allowed_amount":2213.00,"providers":[{"billed_charge":5292.00,"npi":[1215612635]}]}]}]},{"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":"561903275"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":984.60,"providers":[{"billed_charge":3693.00,"npi":[1144858036]}]},{"allowed_amount":973.80,"providers":[{"billed_charge":2049.00,"npi":[1396905121]}]},{"allowed_amount":1305.60,"providers":[{"billed_charge":3828.00,"npi":[1023647468]}]}]},{"tin":{"type":"ein","value":"561763695"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2191.54,"providers":[{"billed_charge":9369.00,"npi":[1922611565]}]}]},{"tin":{"type":"ein","value":"561752877"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2404.71,"providers":[{"billed_charge":11074.00,"npi":[1164162491]}]},{"allowed_amount":1026.27,"providers":[{"billed_charge":4746.00,"npi":[1417687427]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"453764233"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":302.68,"providers":[{"billed_charge":774.64,"npi":[1275827834]}]}]}]},{"name":"BEHAV CHNG SMOKING 3-10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99406","description":"SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI","allowed_amounts":[{"tin":{"type":"ein","value":"834464233"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":13.65,"providers":[{"billed_charge":30.00,"npi":[1285100040]}]},{"allowed_amount":18.48,"providers":[{"billed_charge":60.00,"npi":[1285100040]}]}]}]},{"name":"ALS ROUTNE DISPSABLE SUPPLS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0398","description":"ALS ROUTINE DISPOSABLE SUPPLIES","allowed_amounts":[{"tin":{"type":"ein","value":"566000306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":337.85,"providers":[{"billed_charge":3339.00,"npi":[1588626519]}]}]}]},{"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":"566000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":279.08,"providers":[{"billed_charge":565.50,"npi":[1114924644]}]}]},{"tin":{"type":"ein","value":"566001967"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1460.19,"providers":[{"billed_charge":2704.84,"npi":[1639188162]}]}]},{"tin":{"type":"ein","value":"566000315"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":917.64,"providers":[{"billed_charge":988.65,"npi":[1144281858]}]}]},{"tin":{"type":"ein","value":"566000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1996.48,"providers":[{"billed_charge":4886.46,"npi":[1225083413]}]}]},{"tin":{"type":"ein","value":"566001526"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1027.60,"providers":[{"billed_charge":1670.40,"npi":[1619965274]}]}]},{"tin":{"type":"ein","value":"566001524"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":647.03,"providers":[{"billed_charge":1621.38,"npi":[1013949403]}]}]},{"tin":{"type":"ein","value":"566000335"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10614.18,"providers":[{"billed_charge":19455.48,"npi":[1861468803]}]}]},{"tin":{"type":"ein","value":"566000336"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1635.75,"providers":[{"billed_charge":4489.29,"npi":[1437250347]}]}]},{"tin":{"type":"ein","value":"566000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1379.92,"providers":[{"billed_charge":3103.18,"npi":[1114193844]}]}]},{"tin":{"type":"ein","value":"566000278"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4455.38,"providers":[{"billed_charge":15159.19,"npi":[1831146471]}]}]},{"tin":{"type":"ein","value":"550754517"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36.70,"providers":[{"billed_charge":98.75,"npi":[1700867447]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":178.16,"providers":[{"billed_charge":704.64,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"566000279"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2602.66,"providers":[{"billed_charge":6440.37,"npi":[1073574786]}]}]},{"tin":{"type":"ein","value":"566000450"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6541.79,"providers":[{"billed_charge":12273.26,"npi":[1043250350]}]}]},{"tin":{"type":"ein","value":"462546402"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":123.35,"providers":[{"billed_charge":340.51,"npi":[1376182741]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4429.23,"providers":[{"billed_charge":10816.20,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":348.96,"providers":[{"billed_charge":1406.40,"npi":[1477588101]}]}]},{"tin":{"type":"ein","value":"810567043"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":879.67,"providers":[{"billed_charge":1981.12,"npi":[1033205182]}]}]},{"tin":{"type":"ein","value":"566000309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9658.68,"providers":[{"billed_charge":18206.01,"npi":[1952349847]}]}]},{"tin":{"type":"ein","value":"566000306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4902.96,"providers":[{"billed_charge":12923.50,"npi":[1588626519]}]}]},{"tin":{"type":"ein","value":"566001814"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3478.00,"providers":[{"billed_charge":5831.84,"npi":[1790732550]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36604.45,"providers":[{"billed_charge":146023.70,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"566000348"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":132.12,"providers":[{"billed_charge":213.85,"npi":[1750463873]}]}]},{"tin":{"type":"ein","value":"566001537"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1438.64,"providers":[{"billed_charge":2824.60,"npi":[1922150812]}]}]},{"tin":{"type":"ein","value":"561944807"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1959.76,"providers":[{"billed_charge":3745.52,"npi":[1104913326]}]}]},{"tin":{"type":"ein","value":"566000305"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5183.60,"providers":[{"billed_charge":13066.38,"npi":[1780622498]}]}]},{"tin":{"type":"ein","value":"566000327"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29.08,"providers":[{"billed_charge":70.97,"npi":[1629178629]}]}]},{"tin":{"type":"ein","value":"814571957"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7199.94,"providers":[{"billed_charge":21922.00,"npi":[1164966164]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16422.46,"providers":[{"billed_charge":40022.61,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"566000322"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1765.39,"providers":[{"billed_charge":2274.24,"npi":[1407964125]}]}]},{"tin":{"type":"ein","value":"566000300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8433.66,"providers":[{"billed_charge":24907.60,"npi":[1932258506]}]}]},{"tin":{"type":"ein","value":"800519885"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":293.60,"providers":[{"billed_charge":741.04,"npi":[1467774018]}]}]},{"tin":{"type":"ein","value":"566000288"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4219.94,"providers":[{"billed_charge":6822.00,"npi":[1093752818]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":308.28,"providers":[{"billed_charge":378.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"272763125"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1636.82,"providers":[{"billed_charge":2455.06,"npi":[1487067062]}]}]},{"tin":{"type":"ein","value":"566000281"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2639.01,"providers":[{"billed_charge":5371.50,"npi":[1609855543]}]}]},{"tin":{"type":"ein","value":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34537.23,"providers":[{"billed_charge":70812.00,"npi":[1689786717]}]}]},{"tin":{"type":"ein","value":"566000280"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5517.93,"providers":[{"billed_charge":10197.90,"npi":[1538291760]}]}]},{"tin":{"type":"ein","value":"263867079"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2538.43,"providers":[{"billed_charge":4385.73,"npi":[1699907568]}]}]},{"tin":{"type":"ein","value":"237160139"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":777.89,"providers":[{"billed_charge":1777.44,"npi":[1598775751]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3095.76,"providers":[{"billed_charge":9600.00,"npi":[1689786717]}]}]}]},{"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":"566000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1237.44,"providers":[{"billed_charge":1800.00,"npi":[1114924644]}]}]},{"tin":{"type":"ein","value":"566001967"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4263.38,"providers":[{"billed_charge":8458.78,"npi":[1639188162]}]}]},{"tin":{"type":"ein","value":"566001526"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":387.58,"providers":[{"billed_charge":725.00,"npi":[1619965274]}]}]},{"tin":{"type":"ein","value":"566000315"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":925.00,"providers":[{"billed_charge":925.00,"npi":[1144281858]}]}]},{"tin":{"type":"ein","value":"566000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4537.28,"providers":[{"billed_charge":8747.00,"npi":[1225083413]}]}]},{"tin":{"type":"ein","value":"566000335"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30349.65,"providers":[{"billed_charge":50399.80,"npi":[1861468803]}]}]},{"tin":{"type":"ein","value":"566000336"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8577.87,"providers":[{"billed_charge":16306.92,"npi":[1437250347]}]}]},{"tin":{"type":"ein","value":"566000278"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7837.12,"providers":[{"billed_charge":24949.83,"npi":[1831146471]}]}]},{"tin":{"type":"ein","value":"566000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2887.36,"providers":[{"billed_charge":4442.74,"npi":[1114193844]}]}]},{"tin":{"type":"ein","value":"566000279"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15896.86,"providers":[{"billed_charge":38451.00,"npi":[1073574786]}]}]},{"tin":{"type":"ein","value":"566000450"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":55551.92,"providers":[{"billed_charge":104581.28,"npi":[1043250350]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33494.54,"providers":[{"billed_charge":84050.00,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4018.60,"providers":[{"billed_charge":16155.80,"npi":[1477588101]}]}]},{"tin":{"type":"ein","value":"566000309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21648.91,"providers":[{"billed_charge":40755.94,"npi":[1952349847]}]}]},{"tin":{"type":"ein","value":"566001814"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10464.66,"providers":[{"billed_charge":18686.16,"npi":[1790732550]}]}]},{"tin":{"type":"ein","value":"566000306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11206.12,"providers":[{"billed_charge":31424.82,"npi":[1588626519]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":179726.80,"providers":[{"billed_charge":525360.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"566001537"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2062.40,"providers":[{"billed_charge":4270.00,"npi":[1922150812]}]}]},{"tin":{"type":"ein","value":"566000305"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49424.87,"providers":[{"billed_charge":125642.42,"npi":[1780622498]}]}]},{"tin":{"type":"ein","value":"561944807"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2450.82,"providers":[{"billed_charge":4438.00,"npi":[1104913326]}]}]},{"tin":{"type":"ein","value":"814571957"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43782.55,"providers":[{"billed_charge":138315.10,"npi":[1164966164]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":101709.03,"providers":[{"billed_charge":360855.78,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"566000300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31393.98,"providers":[{"billed_charge":109200.00,"npi":[1932258506]}]}]},{"tin":{"type":"ein","value":"566000322"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6599.68,"providers":[{"billed_charge":8527.84,"npi":[1407964125]}]}]},{"tin":{"type":"ein","value":"566000288"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7751.60,"providers":[{"billed_charge":13600.00,"npi":[1093752818]}]}]},{"tin":{"type":"ein","value":"272763125"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6976.44,"providers":[{"billed_charge":14125.61,"npi":[1487067062]}]}]},{"tin":{"type":"ein","value":"566000281"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17972.68,"providers":[{"billed_charge":39194.32,"npi":[1609855543]}]}]},{"tin":{"type":"ein","value":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":98849.74,"providers":[{"billed_charge":193600.00,"npi":[1689786717]}]}]},{"tin":{"type":"ein","value":"566000280"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9394.81,"providers":[{"billed_charge":17457.00,"npi":[1538291760]}]}]}]},{"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":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4084.81,"providers":[{"billed_charge":15200.00,"npi":[1689786717]}]}]},{"tin":{"type":"ein","value":"550754517"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":217.09,"providers":[{"billed_charge":970.00,"npi":[1700867447]}]}]},{"tin":{"type":"ein","value":"237160139"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":214.99,"providers":[{"billed_charge":334.12,"npi":[1598775751]}]}]}]},{"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":"566001814"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5548.46,"providers":[{"billed_charge":9907.94,"npi":[1790732550]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":118329.12,"providers":[{"billed_charge":410736.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"814571957"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14889.86,"providers":[{"billed_charge":54880.00,"npi":[1164966164]}]}]},{"tin":{"type":"ein","value":"566000305"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6535.62,"providers":[{"billed_charge":16732.36,"npi":[1780622498]}]}]},{"tin":{"type":"ein","value":"566000335"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7754.54,"providers":[{"billed_charge":13109.12,"npi":[1861468803]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23390.64,"providers":[{"billed_charge":98546.96,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"566000300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10770.54,"providers":[{"billed_charge":33000.00,"npi":[1932258506]}]}]},{"tin":{"type":"ein","value":"566000279"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3439.80,"providers":[{"billed_charge":8004.20,"npi":[1073574786]}]}]},{"tin":{"type":"ein","value":"800519885"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":694.70,"providers":[{"billed_charge":1439.77,"npi":[1467774018]}]}]},{"tin":{"type":"ein","value":"566000288"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1631.90,"providers":[{"billed_charge":2875.00,"npi":[1093752818]}]}]},{"tin":{"type":"ein","value":"566000450"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8599.50,"providers":[{"billed_charge":16189.50,"npi":[1043250350]}]}]},{"tin":{"type":"ein","value":"462546402"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":924.58,"providers":[{"billed_charge":2590.32,"npi":[1376182741]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8943.48,"providers":[{"billed_charge":22438.00,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40933.62,"providers":[{"billed_charge":95200.00,"npi":[1689786717]}]}]},{"tin":{"type":"ein","value":"263867079"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3095.82,"providers":[{"billed_charge":5111.01,"npi":[1699907568]}]}]},{"tin":{"type":"ein","value":"566000309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7911.54,"providers":[{"billed_charge":14894.34,"npi":[1952349847]}]}]}]},{"name":"INCONTNCE GARMENT ANY TYPE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4520","description":"INCONTINENCE GARMENT, ANY TYPE, (E.G., BRIEF, DIAPER), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"541818883"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":887.82,"providers":[{"billed_charge":2959.38,"npi":[1063136638]}]}]}]},{"name":"DISPOSABLE UNDERPADS ALL SIZ","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4554","description":"DISPOSABLE UNDERPADS, ALL SIZES","allowed_amounts":[{"tin":{"type":"ein","value":"541818883"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1295.71,"providers":[{"billed_charge":1295.71,"npi":[1063136638]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2416.96,"providers":[{"billed_charge":8750.00,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4871.60,"providers":[{"billed_charge":27872.26,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1970.94,"providers":[{"billed_charge":11978.52,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":301.32,"providers":[{"billed_charge":1116.00,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2696.19,"providers":[{"billed_charge":10593.00,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1284.95,"providers":[{"billed_charge":6019.57,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":687.03,"providers":[{"billed_charge":2224.81,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1922.72,"providers":[{"billed_charge":4811.42,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":193.44,"providers":[{"billed_charge":1496.00,"npi":[1234567893]}]}]}]},{"name":"HYG I/DVC DISPBL/NON-DISPBL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A9286","description":"HYGIENIC ITEM OR DEVICE, DISPOSABLE OR NON-DISPOSABLE, ANY TYPE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"541818883"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":20.00,"providers":[{"billed_charge":66.70,"npi":[1063136638]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"541956451"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":54.00,"providers":[{"billed_charge":180.00,"npi":[1043251341]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":27.20,"providers":[{"billed_charge":179.00,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4513.58,"providers":[{"billed_charge":21202.00,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4871.51,"providers":[{"billed_charge":86957.28,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5900.00,"providers":[{"billed_charge":45237.92,"npi":[1234567893]}]}]}]},{"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":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":826.90,"providers":[{"billed_charge":1688.52,"npi":[1932166386]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274135348"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":3485.86,"providers":[{"billed_charge":8714.58,"npi":[1497135503]}]}]},{"tin":{"type":"ein","value":"274135289"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":2987.88,"providers":[{"billed_charge":7469.64,"npi":[1497135503]}]}]}]},{"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":"463774942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":343.66,"providers":[{"billed_charge":658.00,"npi":[1740055045]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.89,"providers":[{"billed_charge":464.00,"npi":[1013982800]}]}]}]},{"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":"881874285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":158.94,"providers":[{"billed_charge":510.00,"npi":[1114654142]}]}]}]},{"name":"SELF-HELP/PEER SVC PER 15MIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0038","description":"SELF-HELP/PEER SERVICES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56","53"],"billing_class":"professional","payments":[{"allowed_amount":675.10,"providers":[{"billed_charge":8164.00,"npi":[1700257664]}]},{"allowed_amount":60.20,"providers":[{"billed_charge":728.00,"npi":[1700257664]}]}]},{"tin":{"type":"ein","value":"993424109"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":356.90,"providers":[{"billed_charge":2510.44,"npi":[1093447666]}]}]},{"tin":{"type":"ein","value":"814186241"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":337.55,"providers":[{"billed_charge":2433.50,"npi":[1396288072]}]}]}]},{"name":"PORT GASEOUS O2 SYS RNTL;HOM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0738","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME COMPRESSOR USED TO FILL PORTABLE OXYGEN CYLINDERS; INCL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":555.90,"providers":[{"billed_charge":4855.20,"npi":[1234567893]}]}]}]},{"name":"PART HOSITALIZATN SRVC<24 HR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S0201","description":"PARTIAL HOSPITALIZATION SERVICES, LESS THAN 24 HOURS, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"921028195"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":268.98,"providers":[{"billed_charge":3630.00,"npi":[1255953683]}]}]}]},{"name":"CRISIS INTERVEN MENTL HLTH S","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9484","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56"],"billing_class":"professional","payments":[{"allowed_amount":2748.32,"providers":[{"billed_charge":23160.00,"npi":[1700257664]}]}]},{"tin":{"type":"ein","value":"561326126"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":8113.13,"providers":[{"billed_charge":18520.00,"npi":[1700175015]}]}]}]},{"name":"HABILITATION RES WAIVER; PER","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"T2016","description":"HABILITATION, RESIDENTIAL, WAIVER; PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["53","20"],"billing_class":"professional","payments":[{"allowed_amount":2880.00,"providers":[{"billed_charge":9600.00,"npi":[1700257664]}]},{"allowed_amount":1152.00,"providers":[{"billed_charge":3840.00,"npi":[1700257664]}]}]}]}]}