{"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":"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":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":72435.11,"providers":[{"billed_charge":25030.00,"npi":[1336603646]}]}]}]},{"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":"994966532"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":7644.00,"providers":[{"billed_charge":70200.00,"npi":[1700687837]}]}]}]},{"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":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":172583.52,"providers":[{"billed_charge":138085.00,"npi":[1962472860]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":436.95,"providers":[{"billed_charge":3472.85,"npi":[1881647204]}]},{"allowed_amount":25.79,"providers":[{"billed_charge":85.30,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":146.68,"providers":[{"billed_charge":2612.70,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":147.40,"providers":[{"billed_charge":934.50,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":101.20,"providers":[{"billed_charge":337.30,"npi":[1225088255]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":306.77,"providers":[{"billed_charge":2664.30,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"314394942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":55.94,"providers":[{"billed_charge":186.35,"npi":[1467484972]}]}]}]},{"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":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1769.60,"providers":[{"billed_charge":4740.90,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1458.45,"providers":[{"billed_charge":3724.90,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":245.41,"providers":[{"billed_charge":679.70,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2007.11,"providers":[{"billed_charge":5359.10,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":50779.12,"providers":[{"billed_charge":172582.00,"npi":[1649726738]}]},{"allowed_amount":63660.85,"providers":[{"billed_charge":245411.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30343.89,"providers":[{"billed_charge":52298.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":48568.43,"providers":[{"billed_charge":76150.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12133.20,"providers":[{"billed_charge":16509.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45453.54,"providers":[{"billed_charge":74254.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1073.93,"providers":[{"billed_charge":421866.69,"npi":[1649726738]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10730.12,"providers":[{"billed_charge":15634.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4944.96,"providers":[{"billed_charge":38223.00,"npi":[1649726738]}]},{"allowed_amount":17572.74,"providers":[{"billed_charge":53943.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":32.00,"providers":[{"billed_charge":844.00,"npi":[1881647204]}]},{"allowed_amount":267.79,"providers":[{"billed_charge":543.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"362604009"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":226.30,"providers":[{"billed_charge":457.00,"npi":[1588713440]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1928.44,"providers":[{"billed_charge":2649.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2725.22,"providers":[{"billed_charge":18563.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2612.61,"providers":[{"billed_charge":13579.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":552.63,"providers":[{"billed_charge":4183.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":976.72,"providers":[{"billed_charge":2235.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6196.83,"providers":[{"billed_charge":34546.00,"npi":[1336603646]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"560636250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37.48,"providers":[{"billed_charge":224.00,"npi":[1801848767]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":27363.53,"providers":[{"billed_charge":259213.00,"npi":[1649726738]}]},{"allowed_amount":275.95,"providers":[{"billed_charge":308033.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7864.00,"providers":[{"billed_charge":14558.00,"npi":[1881647204]}]},{"allowed_amount":16385.12,"providers":[{"billed_charge":26423.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32644.49,"providers":[{"billed_charge":182110.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5490.96,"providers":[{"billed_charge":7898.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"560529974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":758.87,"providers":[{"billed_charge":947.00,"npi":[1225088255]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37359.32,"providers":[{"billed_charge":209160.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":520.91,"providers":[{"billed_charge":1156.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":203.75,"providers":[{"billed_charge":716.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":25106.32,"providers":[{"billed_charge":136791.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7212.34,"providers":[{"billed_charge":44342.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1214.80,"providers":[{"billed_charge":2572.00,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":941.82,"providers":[{"billed_charge":3565.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":187.15,"providers":[{"billed_charge":3412.00,"npi":[1972503910]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3851.06,"providers":[{"billed_charge":54022.00,"npi":[1649726738]}]},{"allowed_amount":71.76,"providers":[{"billed_charge":16796.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":193.18,"providers":[{"billed_charge":1488.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":178.48,"providers":[{"billed_charge":925.00,"npi":[1336603646]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3676.17,"providers":[{"billed_charge":60695.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3866.78,"providers":[{"billed_charge":4107.00,"npi":[1881647204]}]},{"allowed_amount":306.00,"providers":[{"billed_charge":9305.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6485.01,"providers":[{"billed_charge":35843.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8640.31,"providers":[{"billed_charge":51633.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":120.00,"providers":[{"billed_charge":120.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1728.87,"providers":[{"billed_charge":9610.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10049.27,"providers":[{"billed_charge":60962.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":12230.09,"providers":[{"billed_charge":89047.00,"npi":[1649726738]}]},{"allowed_amount":17709.08,"providers":[{"billed_charge":108251.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":665.00,"providers":[{"billed_charge":665.00,"npi":[1881647204]}]},{"allowed_amount":1149.17,"providers":[{"billed_charge":2118.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9244.03,"providers":[{"billed_charge":14038.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27467.03,"providers":[{"billed_charge":40800.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1065.24,"providers":[{"billed_charge":1290.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18394.19,"providers":[{"billed_charge":26341.00,"npi":[1336603646]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":170.00,"npi":[1336603646]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":374.27,"providers":[{"billed_charge":10326.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2219.97,"providers":[{"billed_charge":15967.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4817.12,"providers":[{"billed_charge":37166.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":543.89,"providers":[{"billed_charge":3873.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5367.01,"providers":[{"billed_charge":38399.00,"npi":[1336603646]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1889.94,"providers":[{"billed_charge":102838.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/CYTOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"311","description":"LABORATORY PATHOLOGICAL - CYTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1894.40,"providers":[{"billed_charge":21317.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":33500.00,"npi":[1649726738]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":492.78,"providers":[{"billed_charge":787.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":21494.84,"providers":[{"billed_charge":107295.00,"npi":[1649726738]}]},{"allowed_amount":402.88,"providers":[{"billed_charge":77810.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1331.59,"providers":[{"billed_charge":2026.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10130.27,"providers":[{"billed_charge":48681.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6020.30,"providers":[{"billed_charge":28623.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":161.45,"providers":[{"billed_charge":1741.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8328.59,"providers":[{"billed_charge":40230.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15523.78,"providers":[{"billed_charge":56804.00,"npi":[1649726738]}]},{"allowed_amount":1928.04,"providers":[{"billed_charge":6200.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12781.12,"providers":[{"billed_charge":30984.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9504.91,"providers":[{"billed_charge":27584.00,"npi":[1851361778]}]},{"allowed_amount":79.71,"providers":[{"billed_charge":684.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11601.86,"providers":[{"billed_charge":34836.00,"npi":[1336603646]}]}]}]},{"name":"CHEMOTHER/INJ","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"331","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--INJECTED","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":118.62,"providers":[{"billed_charge":669.00,"npi":[1649726738]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":41276.10,"providers":[{"billed_charge":184992.00,"npi":[1649726738]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":43452.09,"providers":[{"billed_charge":76932.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18490.47,"providers":[{"billed_charge":185147.00,"npi":[1649726738]}]},{"allowed_amount":296.71,"providers":[{"billed_charge":3237.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6485.34,"providers":[{"billed_charge":32110.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10202.56,"providers":[{"billed_charge":45131.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23460.61,"providers":[{"billed_charge":112571.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9773.77,"providers":[{"billed_charge":102091.00,"npi":[1649726738]}]},{"allowed_amount":28872.73,"providers":[{"billed_charge":471207.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":65058.03,"providers":[{"billed_charge":286694.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49862.61,"providers":[{"billed_charge":228199.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4399.30,"providers":[{"billed_charge":19138.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":104782.05,"providers":[{"billed_charge":472014.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":645233.26,"providers":[{"billed_charge":1351615.98,"npi":[1649726738]}]},{"allowed_amount":49612.04,"providers":[{"billed_charge":117079.01,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8524.28,"providers":[{"billed_charge":13919.00,"npi":[1649726738]}]},{"allowed_amount":259928.94,"providers":[{"billed_charge":638926.00,"npi":[1649726738]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":678.43,"providers":[{"billed_charge":1720.00,"npi":[1891253522]}]},{"allowed_amount":158.80,"providers":[{"billed_charge":400.00,"npi":[1598327975]}]},{"allowed_amount":921.84,"providers":[{"billed_charge":2340.00,"npi":[1891253522]}]},{"allowed_amount":31.76,"providers":[{"billed_charge":80.00,"npi":[1598327975]}]},{"allowed_amount":1041.78,"providers":[{"billed_charge":2640.00,"npi":[1720899875]}]},{"allowed_amount":678.01,"providers":[{"billed_charge":1720.00,"npi":[1720899875]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5204.04,"providers":[{"billed_charge":74031.00,"npi":[1649726738]}]},{"allowed_amount":13301.17,"providers":[{"billed_charge":90594.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1184.01,"providers":[{"billed_charge":11729.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5620.59,"providers":[{"billed_charge":32904.00,"npi":[1336603646]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7998.43,"providers":[{"billed_charge":23173.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14064.32,"providers":[{"billed_charge":58991.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":116.44,"providers":[{"billed_charge":350.00,"npi":[1649726738]}]},{"allowed_amount":167.71,"providers":[{"billed_charge":350.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2556.98,"providers":[{"billed_charge":10146.00,"npi":[1649726738]}]}]}]},{"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":"560619359"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16494.02,"providers":[{"billed_charge":26158.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":565134.95,"providers":[{"billed_charge":1128938.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":66599.15,"providers":[{"billed_charge":95330.00,"npi":[1881647204]}]},{"allowed_amount":2303.18,"providers":[{"billed_charge":13643.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560529994"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8758.76,"providers":[{"billed_charge":16519.00,"npi":[1326010273]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":559548.84,"providers":[{"billed_charge":1495549.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":304649.39,"providers":[{"billed_charge":887092.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37769.93,"providers":[{"billed_charge":50064.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":75720.53,"providers":[{"billed_charge":230201.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11362.38,"providers":[{"billed_charge":35189.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":475645.58,"providers":[{"billed_charge":1359472.00,"npi":[1336603646]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11769.31,"providers":[{"billed_charge":51049.00,"npi":[1649726738]}]},{"allowed_amount":913.85,"providers":[{"billed_charge":23768.00,"npi":[1649726738]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":16332.88,"providers":[{"billed_charge":20274.00,"npi":[1649726738]}]},{"allowed_amount":709.15,"providers":[{"billed_charge":1828.00,"npi":[1649726738]}]}]}]},{"name":"OB-GYN CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"514","description":"CLINIC - OB-GYN CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15868.40,"providers":[{"billed_charge":33443.00,"npi":[1649726738]}]}]}]},{"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":"586076010"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":3904.90,"providers":[{"billed_charge":9334.85,"npi":[1316794639]}]}]},{"tin":{"type":"ein","value":"10932846"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":37754.28,"providers":[{"billed_charge":92492.47,"npi":[1437484862]}]}]},{"tin":{"type":"ein","value":"570672117"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":570.09,"providers":[{"billed_charge":1152.00,"npi":[1669535225]}]}]}]},{"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":1194310.18,"providers":[{"billed_charge":3591163.17,"npi":[1649726738]}]},{"allowed_amount":3335.23,"providers":[{"billed_charge":153702.20,"npi":[1649726738]}]},{"allowed_amount":1.13,"providers":[{"billed_charge":12570.60,"npi":[1639656713]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2753.16,"providers":[{"billed_charge":8812.05,"npi":[1881647204]}]},{"allowed_amount":520.37,"providers":[{"billed_charge":11181.75,"npi":[1881647204]}]},{"allowed_amount":503.71,"providers":[{"billed_charge":1678.95,"npi":[1346291309]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5311.97,"providers":[{"billed_charge":24658.90,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27820.21,"providers":[{"billed_charge":55180.30,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":0.33,"providers":[{"billed_charge":10050.80,"npi":[1255645644]}]},{"allowed_amount":2867.66,"providers":[{"billed_charge":10809.30,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"260599536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":133.98,"providers":[{"billed_charge":446.55,"npi":[1972001469]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1446.03,"providers":[{"billed_charge":4819.85,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.06,"providers":[{"billed_charge":1717.05,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9993.07,"providers":[{"billed_charge":41274.82,"npi":[1336603646]}]}]}]},{"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":89.67,"providers":[{"billed_charge":298.90,"npi":[1013918960]}]}]}]},{"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":"581839412"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":30.89,"providers":[{"billed_charge":90.00,"npi":[1942264981]}]},{"allowed_amount":77.93,"providers":[{"billed_charge":225.00,"npi":[1942264981]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":795.91,"providers":[{"billed_charge":11412.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7767.05,"providers":[{"billed_charge":58105.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6161.88,"providers":[{"billed_charge":38692.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":968.85,"providers":[{"billed_charge":4628.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7988.13,"providers":[{"billed_charge":60690.00,"npi":[1336603646]}]}]}]},{"name":"EEG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"740","description":"EEG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1562.09,"providers":[{"billed_charge":6596.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":335.28,"providers":[{"billed_charge":993.00,"npi":[1649726738]}]}]}]},{"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":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":825.15,"providers":[{"billed_charge":2125.00,"npi":[1497293773]}]}]}]},{"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":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":2007.51,"providers":[{"billed_charge":5100.00,"npi":[1497293773]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7014.40,"providers":[{"billed_charge":11808.00,"npi":[1649726738]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"844246379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":487.76,"providers":[{"billed_charge":2730.00,"npi":[1699530402]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":41.50,"providers":[{"billed_charge":372.84,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1.91,"providers":[{"billed_charge":10.00,"npi":[1891253522]}]},{"allowed_amount":93.59,"providers":[{"billed_charge":490.00,"npi":[1598327975]}]},{"allowed_amount":15.28,"providers":[{"billed_charge":80.00,"npi":[1598327975]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":29.28,"providers":[{"billed_charge":68.88,"npi":[1598327975]}]},{"allowed_amount":73.20,"providers":[{"billed_charge":172.20,"npi":[1598327975]}]}]}]},{"name":"CCPD/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"851","description":"CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"273836308"},"service_code":["12","65"],"billing_class":"institutional","payments":[{"allowed_amount":6290.00,"providers":[{"billed_charge":240121.86,"npi":[1649607573]}]},{"allowed_amount":510.00,"providers":[{"billed_charge":44473.86,"npi":[1649607573]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"202935692"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1716.93,"providers":[{"billed_charge":2241.00,"npi":[1306873716]}]}]}]},{"name":"SARSCOV & INF VIR A&B AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87428","description":"IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1912.00,"providers":[{"billed_charge":3200.00,"npi":[1598327975]}]},{"allowed_amount":418.25,"providers":[{"billed_charge":700.00,"npi":[1598327975]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":444.81,"providers":[{"billed_charge":1260.00,"npi":[1023098928]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":43.02,"providers":[{"billed_charge":120.00,"npi":[1023098928]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":444.81,"providers":[{"billed_charge":1260.00,"npi":[1023098928]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":106.17,"providers":[{"billed_charge":300.00,"npi":[1023098928]}]}]}]},{"name":"SARSCOV2 & INF A&B AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87636","description":"IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":242.48,"providers":[{"billed_charge":1200.00,"npi":[1316424666]}]},{"allowed_amount":121.24,"providers":[{"billed_charge":600.00,"npi":[1417354473]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":297.92,"providers":[{"billed_charge":840.00,"npi":[1023098928]}]}]}]},{"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":"202935692"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2174.67,"providers":[{"billed_charge":3212.00,"npi":[1306873716]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":105.51,"providers":[{"billed_charge":750.00,"npi":[1376642322]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":70.25,"providers":[{"billed_charge":165.30,"npi":[1598327975]}]},{"allowed_amount":28.10,"providers":[{"billed_charge":66.12,"npi":[1598327975]}]}]},{"tin":{"type":"ein","value":"202935692"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":535.50,"providers":[{"billed_charge":936.00,"npi":[1306873716]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":868.84,"providers":[{"billed_charge":2430.00,"npi":[1023098928]}]}]}]},{"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":"571122647"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":39.07,"providers":[{"billed_charge":215.00,"npi":[1174936090]}]},{"allowed_amount":430.92,"providers":[{"billed_charge":2250.00,"npi":[1174936090]}]}]},{"tin":{"type":"ein","value":"463666116"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":194.08,"providers":[{"billed_charge":300.00,"npi":[1609306315]}]}]},{"tin":{"type":"ein","value":"570523643"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":102.44,"providers":[{"billed_charge":1260.00,"npi":[1831483544]}]},{"allowed_amount":68.22,"providers":[{"billed_charge":840.00,"npi":[1831483544]}]}]}]},{"name":"PSTAY TREATMENT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"900","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11478.02,"providers":[{"billed_charge":11050.00,"npi":[1649726738]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":47.85,"providers":[{"billed_charge":117.00,"npi":[1891253522]}]}]},{"tin":{"type":"ein","value":"571021048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":369.79,"providers":[{"billed_charge":1224.00,"npi":[1134861289]}]}]}]},{"name":"IIV3 VACC NO PRSV 0.5 ML IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90656","description":"INFLUENZA VIRUS VACCINE, TRIVALENT (IIV3), SPLIT VIRUS, PRESERVATIVE FREE, 0.5 ML DOSAGE, FOR INTRAM","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":39.48,"providers":[{"billed_charge":90.00,"npi":[1891253522]}]},{"allowed_amount":19.74,"providers":[{"billed_charge":45.00,"npi":[1891253522]}]}]}]},{"name":"TDAP VACCINE 7 YRS/> IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90715","description":"TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS","allowed_amounts":[{"tin":{"type":"ein","value":"571021048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":303.04,"providers":[{"billed_charge":924.00,"npi":[1134861289]}]}]}]},{"name":"PSYCH DIAGNOSTIC EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90791","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":271.87,"providers":[{"billed_charge":408.00,"npi":[1831200310]}]},{"allowed_amount":1270.76,"providers":[{"billed_charge":1734.00,"npi":[1831200310]}]},{"allowed_amount":141.03,"providers":[{"billed_charge":204.00,"npi":[1831200310]}]},{"allowed_amount":1800.34,"providers":[{"billed_charge":2550.00,"npi":[1609979640]}]},{"allowed_amount":481.57,"providers":[{"billed_charge":816.00,"npi":[1508811324]}]},{"allowed_amount":204.00,"providers":[{"billed_charge":204.00,"npi":[1609979640]}]}]}]},{"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":"576000922"},"service_code":["02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":245.61,"providers":[{"billed_charge":264.00,"npi":[1508811324]}]},{"allowed_amount":77.17,"providers":[{"billed_charge":88.00,"npi":[1609979640]}]},{"allowed_amount":1855.71,"providers":[{"billed_charge":2376.00,"npi":[1508811324]}]},{"allowed_amount":69.09,"providers":[{"billed_charge":88.00,"npi":[1609979640]}]},{"allowed_amount":961.86,"providers":[{"billed_charge":1232.00,"npi":[1508811324]}]}]}]},{"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":"921714273"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":255.60,"providers":[{"billed_charge":600.00,"npi":[1427506575]}]},{"allowed_amount":1195.34,"providers":[{"billed_charge":3300.00,"npi":[1427506575]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":1360.26,"providers":[{"billed_charge":2625.00,"npi":[1508811324]}]},{"allowed_amount":650.42,"providers":[{"billed_charge":1050.00,"npi":[1508811324]}]},{"allowed_amount":812.34,"providers":[{"billed_charge":1575.00,"npi":[1508811324]}]}]}]},{"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":"576000922"},"service_code":["02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":1203.98,"providers":[{"billed_charge":2385.00,"npi":[1841374972]}]},{"allowed_amount":944.10,"providers":[{"billed_charge":1590.00,"npi":[1508811324]}]},{"allowed_amount":1205.70,"providers":[{"billed_charge":2385.00,"npi":[1841374972]}]},{"allowed_amount":6164.76,"providers":[{"billed_charge":12190.00,"npi":[1508811324]}]},{"allowed_amount":1999.18,"providers":[{"billed_charge":3975.00,"npi":[1508811324]}]}]},{"tin":{"type":"ein","value":"932266390"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":402.32,"providers":[{"billed_charge":1000.00,"npi":[1831428523]}]},{"allowed_amount":1910.58,"providers":[{"billed_charge":4750.00,"npi":[1831428523]}]},{"allowed_amount":3390.46,"providers":[{"billed_charge":7000.00,"npi":[1831428523]}]}]},{"tin":{"type":"ein","value":"822639811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":214.62,"providers":[{"billed_charge":350.00,"npi":[1962430892]}]}]}]},{"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":32018.23,"providers":[{"billed_charge":407490.00,"npi":[1457232589]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3405.03,"providers":[{"billed_charge":10550.00,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2704.74,"providers":[{"billed_charge":22509.00,"npi":[1649726738]}]},{"allowed_amount":3953.34,"providers":[{"billed_charge":21240.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1962.48,"providers":[{"billed_charge":10046.00,"npi":[1336603646]}]}]}]},{"name":"CARDIAC REHAB/MONITOR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93798","description":"PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL SERVICES FOR OUTPATIENT CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"874134822"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":106.17,"providers":[{"billed_charge":385.00,"npi":[1124089784]}]},{"allowed_amount":88.36,"providers":[{"billed_charge":308.00,"npi":[1124089784]}]}]}]},{"name":"CARDIAC REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"943","description":"OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1094.33,"providers":[{"billed_charge":2015.00,"npi":[1649726738]}]}]}]},{"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":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":312.22,"providers":[{"billed_charge":984.00,"npi":[1720899875]}]},{"allowed_amount":322.27,"providers":[{"billed_charge":1020.00,"npi":[1891253522]}]}]},{"tin":{"type":"ein","value":"934646081"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":46.07,"providers":[{"billed_charge":102.00,"npi":[1760513162]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1013.93,"providers":[{"billed_charge":3198.00,"npi":[1598327975]}]},{"allowed_amount":121.64,"providers":[{"billed_charge":390.00,"npi":[1598327975]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":83.25,"providers":[{"billed_charge":150.00,"npi":[1508811324]}]},{"allowed_amount":29.20,"providers":[{"billed_charge":50.00,"npi":[1609979640]}]}]}]},{"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":"464330157"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":867.89,"providers":[{"billed_charge":2310.00,"npi":[1053471078]}]}]},{"tin":{"type":"ein","value":"825120723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.14,"providers":[{"billed_charge":55.00,"npi":[1285356055]}]}]}]},{"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":"825120723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":45.34,"providers":[{"billed_charge":110.00,"npi":[1285356055]}]}]}]},{"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":"464330157"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.90,"providers":[{"billed_charge":250.00,"npi":[1053471078]}]}]},{"tin":{"type":"ein","value":"825120723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":26.80,"providers":[{"billed_charge":55.00,"npi":[1285356055]}]}]}]},{"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":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1134.79,"providers":[{"billed_charge":1260.00,"npi":[1093941346]}]}]}]},{"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":"933397174"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.33,"providers":[{"billed_charge":267.00,"npi":[1972059004]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":572.76,"providers":[{"billed_charge":1364.90,"npi":[1720899875]}]},{"allowed_amount":95.46,"providers":[{"billed_charge":257.00,"npi":[1720899875]}]},{"allowed_amount":462.38,"providers":[{"billed_charge":1285.00,"npi":[1891253522]}]},{"allowed_amount":1042.60,"providers":[{"billed_charge":2295.70,"npi":[1598327975]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":722.05,"providers":[{"billed_charge":1960.00,"npi":[1598327975]}]}]},{"tin":{"type":"ein","value":"582281023"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":390.74,"providers":[{"billed_charge":600.00,"npi":[1821625500]}]}]},{"tin":{"type":"ein","value":"571021048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4831.37,"providers":[{"billed_charge":11259.00,"npi":[1134861289]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":9800.52,"providers":[{"billed_charge":22833.00,"npi":[1720899875]}]},{"allowed_amount":7638.62,"providers":[{"billed_charge":17617.00,"npi":[1598327975]}]},{"allowed_amount":149.26,"providers":[{"billed_charge":354.00,"npi":[1720899875]}]},{"allowed_amount":679.92,"providers":[{"billed_charge":1593.00,"npi":[1891253522]}]},{"allowed_amount":994.94,"providers":[{"billed_charge":2301.00,"npi":[1598327975]}]},{"allowed_amount":15626.40,"providers":[{"billed_charge":36285.00,"npi":[1891253522]}]}]},{"tin":{"type":"ein","value":"202935692"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1833.00,"providers":[{"billed_charge":1833.00,"npi":[1306873716]}]}]},{"tin":{"type":"ein","value":"844246379"},"service_code":["11","12","10"],"billing_class":"professional","payments":[{"allowed_amount":77.38,"providers":[{"billed_charge":125.00,"npi":[1699530402]}]},{"allowed_amount":5797.21,"providers":[{"billed_charge":14500.00,"npi":[1699530402]}]},{"allowed_amount":6251.60,"providers":[{"billed_charge":10500.00,"npi":[1699530402]}]}]},{"tin":{"type":"ein","value":"570932597"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":266.64,"providers":[{"billed_charge":324.11,"npi":[1528088721]}]}]},{"tin":{"type":"ein","value":"570969793"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":761.04,"providers":[{"billed_charge":2364.30,"npi":[1760050512]}]}]}]},{"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":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":165.22,"providers":[{"billed_charge":264.00,"npi":[1831200310]}]},{"allowed_amount":586.24,"providers":[{"billed_charge":1384.00,"npi":[1508811324]}]},{"allowed_amount":610.15,"providers":[{"billed_charge":1456.00,"npi":[1508811324]}]},{"allowed_amount":354.35,"providers":[{"billed_charge":927.00,"npi":[1831200310]}]},{"allowed_amount":708.70,"providers":[{"billed_charge":1286.00,"npi":[1841374972]}]},{"allowed_amount":271.74,"providers":[{"billed_charge":662.00,"npi":[1841374972]}]}]},{"tin":{"type":"ein","value":"921714273"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1549.09,"providers":[{"billed_charge":4200.00,"npi":[1427506575]}]},{"allowed_amount":524.77,"providers":[{"billed_charge":1000.00,"npi":[1427506575]}]}]},{"tin":{"type":"ein","value":"853861695"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":413.79,"providers":[{"billed_charge":894.00,"npi":[1447831342]}]}]},{"tin":{"type":"ein","value":"570992733"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":129.83,"providers":[{"billed_charge":225.00,"npi":[1063905495]}]}]},{"tin":{"type":"ein","value":"570969793"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":238.46,"providers":[{"billed_charge":640.60,"npi":[1760050512]}]}]},{"tin":{"type":"ein","value":"473477374"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":417.21,"providers":[{"billed_charge":1326.13,"npi":[1750989869]}]}]},{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":3689.17,"providers":[{"billed_charge":8840.00,"npi":[1720899875]}]},{"allowed_amount":1849.09,"providers":[{"billed_charge":4420.00,"npi":[1598327975]}]},{"allowed_amount":8554.02,"providers":[{"billed_charge":20280.00,"npi":[1598327975]}]},{"allowed_amount":110.36,"providers":[{"billed_charge":260.00,"npi":[1891253522]}]},{"allowed_amount":6349.06,"providers":[{"billed_charge":15340.00,"npi":[1891253522]}]}]},{"tin":{"type":"ein","value":"202935692"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":6150.00,"providers":[{"billed_charge":6150.00,"npi":[1306873716]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":542.44,"providers":[{"billed_charge":1208.00,"npi":[1275776130]}]},{"allowed_amount":949.27,"providers":[{"billed_charge":2114.00,"npi":[1215146352]}]}]},{"tin":{"type":"ein","value":"571056849"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":220.72,"providers":[{"billed_charge":532.28,"npi":[1851082606]}]}]},{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":846.84,"providers":[{"billed_charge":2056.00,"npi":[1376642322]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":330.29,"providers":[{"billed_charge":504.00,"npi":[1316424666]}]},{"allowed_amount":551.75,"providers":[{"billed_charge":840.00,"npi":[1417354473]}]},{"allowed_amount":644.08,"providers":[{"billed_charge":1008.00,"npi":[1407321144]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4581.85,"providers":[{"billed_charge":6550.00,"npi":[1831452853]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99221","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":945.83,"providers":[{"billed_charge":3468.00,"npi":[1093943466]}]}]}]},{"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":623.63,"providers":[{"billed_charge":1120.00,"npi":[1629298872]}]},{"allowed_amount":377.65,"providers":[{"billed_charge":672.00,"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":"541436102"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":465.10,"providers":[{"billed_charge":643.00,"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":"200917382"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":70.61,"providers":[{"billed_charge":120.00,"npi":[1528059672]}]}]},{"tin":{"type":"ein","value":"541436102"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":2821.80,"providers":[{"billed_charge":4418.54,"npi":[1629298872]}]},{"allowed_amount":1608.40,"providers":[{"billed_charge":2507.82,"npi":[1629298872]}]}]}]},{"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":"541436102"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":81.97,"providers":[{"billed_charge":119.65,"npi":[1629298872]}]}]}]},{"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":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1716.04,"providers":[{"billed_charge":4712.00,"npi":[1568813327]}]},{"allowed_amount":6435.15,"providers":[{"billed_charge":17865.00,"npi":[1932290889]}]},{"allowed_amount":5148.12,"providers":[{"billed_charge":14292.00,"npi":[1003344169]}]},{"allowed_amount":2574.06,"providers":[{"billed_charge":7068.00,"npi":[1134357726,1053843623]}]},{"allowed_amount":1287.03,"providers":[{"billed_charge":3573.00,"npi":[1871316026,1356888499,1225431455]}]},{"allowed_amount":429.01,"providers":[{"billed_charge":1191.00,"npi":[1215312442]}]},{"allowed_amount":6006.14,"providers":[{"billed_charge":16674.00,"npi":[1366604944]}]},{"allowed_amount":4719.11,"providers":[{"billed_charge":13101.00,"npi":[1407343668]}]},{"allowed_amount":2145.05,"providers":[{"billed_charge":5227.00,"npi":[1639732050]}]},{"allowed_amount":3861.09,"providers":[{"billed_charge":10719.00,"npi":[1346732641]}]},{"allowed_amount":5577.13,"providers":[{"billed_charge":15314.00,"npi":[1689467714]},{"billed_charge":15483.00,"npi":[1437197886]}]},{"allowed_amount":4290.10,"providers":[{"billed_charge":11780.00,"npi":[1801271739]}]}]}]},{"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":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1250.14,"providers":[{"billed_charge":3452.00,"npi":[1598405656]}]},{"allowed_amount":2500.28,"providers":[{"billed_charge":6952.00,"npi":[1568813327]},{"billed_charge":6904.00,"npi":[1114017118]}]},{"allowed_amount":625.07,"providers":[{"billed_charge":1892.00,"npi":[1952580391]}]},{"allowed_amount":3750.42,"providers":[{"billed_charge":10090.00,"npi":[1932290889]},{"billed_charge":10356.00,"npi":[1003344169]}]},{"allowed_amount":5000.56,"providers":[{"billed_charge":13808.00,"npi":[1366604944]},{"billed_charge":13542.00,"npi":[1538140223]}]},{"allowed_amount":3125.35,"providers":[{"billed_charge":8630.00,"npi":[1376819920,1912584459]}]}]}]},{"name":"PREV VISIT EST AGE 18-39","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99395","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3299.02,"providers":[{"billed_charge":12070.00,"npi":[1720899875]}]},{"allowed_amount":3726.17,"providers":[{"billed_charge":13845.00,"npi":[1891253522]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":210.22,"providers":[{"billed_charge":756.00,"npi":[1891253522]}]},{"allowed_amount":4063.80,"providers":[{"billed_charge":15120.00,"npi":[1720899875]}]},{"allowed_amount":5079.75,"providers":[{"billed_charge":18900.00,"npi":[1891253522]}]}]}]},{"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":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":95.44,"providers":[{"billed_charge":544.00,"npi":[1891253522]}]}]}]},{"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":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1398.96,"providers":[{"billed_charge":4240.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2936.00,"providers":[{"billed_charge":8224.56,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000314"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":57.64,"providers":[{"billed_charge":149.80,"npi":[1013900257]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12590.30,"providers":[{"billed_charge":20667.60,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13897.33,"providers":[{"billed_charge":50638.42,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3956.26,"providers":[{"billed_charge":9261.64,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000399"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2173.73,"providers":[{"billed_charge":3880.50,"npi":[1891170056]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12463.21,"providers":[{"billed_charge":12863.59,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":612.99,"providers":[{"billed_charge":1014.54,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14775.57,"providers":[{"billed_charge":28126.81,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3543.39,"providers":[{"billed_charge":6990.45,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8956.05,"providers":[{"billed_charge":37605.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1344.95,"providers":[{"billed_charge":5365.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":908.75,"providers":[{"billed_charge":2125.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1187.63,"providers":[{"billed_charge":5938.24,"npi":[1407361512]}]},{"allowed_amount":38167.50,"providers":[{"billed_charge":146580.00,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6116.40,"providers":[{"billed_charge":10137.60,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"208396269"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":3.00,"npi":[1013127026]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4081.04,"providers":[{"billed_charge":11528.05,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1701.18,"providers":[{"billed_charge":3448.50,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1031.67,"providers":[{"billed_charge":2083.50,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2297.32,"providers":[{"billed_charge":4417.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":65.43,"providers":[{"billed_charge":126.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":878.12,"providers":[{"billed_charge":1600.40,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1005.58,"providers":[{"billed_charge":2055.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":132.12,"providers":[{"billed_charge":325.80,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21155.70,"providers":[{"billed_charge":43650.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4600.94,"providers":[{"billed_charge":13215.30,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9231.34,"providers":[{"billed_charge":15102.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"831579694"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1635.75,"providers":[{"billed_charge":2473.40,"npi":[1194200063]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2705.80,"providers":[{"billed_charge":4782.70,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":419.20,"providers":[{"billed_charge":1104.79,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2487.40,"providers":[{"billed_charge":4921.71,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4151.17,"providers":[{"billed_charge":8022.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1293.30,"providers":[{"billed_charge":2299.70,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":759.80,"providers":[{"billed_charge":1422.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":256.20,"providers":[{"billed_charge":547.77,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3640.64,"providers":[{"billed_charge":20756.40,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":46251.74,"providers":[{"billed_charge":266104.11,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13354.99,"providers":[{"billed_charge":31974.41,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4851.05,"providers":[{"billed_charge":9934.50,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":356.23,"providers":[{"billed_charge":860.01,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":711.98,"providers":[{"billed_charge":1355.20,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24921.56,"providers":[{"billed_charge":96876.44,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15700.26,"providers":[{"billed_charge":19251.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":920.43,"providers":[{"billed_charge":4212.45,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":544.59,"providers":[{"billed_charge":671.58,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"570996371"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4049.39,"providers":[{"billed_charge":8353.50,"npi":[1760409718]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15128.87,"providers":[{"billed_charge":22239.25,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5281.86,"providers":[{"billed_charge":13322.10,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":675.28,"providers":[{"billed_charge":928.00,"npi":[1720052723]}]}]}]},{"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":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4836.64,"providers":[{"billed_charge":52886.73,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1781.92,"providers":[{"billed_charge":10500.00,"npi":[1962768440]}]}]}]},{"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":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7326.18,"providers":[{"billed_charge":13970.52,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9309.88,"providers":[{"billed_charge":17250.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29020.32,"providers":[{"billed_charge":52371.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8464.26,"providers":[{"billed_charge":29988.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49896.56,"providers":[{"billed_charge":186086.71,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29826.44,"providers":[{"billed_charge":53650.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12617.31,"providers":[{"billed_charge":22475.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36275.40,"providers":[{"billed_charge":47916.05,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1616.19,"providers":[{"billed_charge":3400.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7658.14,"providers":[{"billed_charge":17575.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":70132.44,"providers":[{"billed_charge":134572.14,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9673.44,"providers":[{"billed_charge":19367.76,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2849.07,"providers":[{"billed_charge":16156.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":99152.76,"providers":[{"billed_charge":514610.65,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3676.23,"providers":[{"billed_charge":10746.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10882.62,"providers":[{"billed_charge":50210.01,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8061.20,"providers":[{"billed_charge":14000.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1633.88,"providers":[{"billed_charge":5796.88,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":471.31,"providers":[{"billed_charge":2356.54,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4030.60,"providers":[{"billed_charge":18070.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12091.80,"providers":[{"billed_charge":21750.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":46197.76,"providers":[{"billed_charge":79000.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3256.08,"providers":[{"billed_charge":6152.56,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":403.06,"providers":[{"billed_charge":950.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":806.12,"providers":[{"billed_charge":900.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1209.18,"providers":[{"billed_charge":2200.00,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49979.44,"providers":[{"billed_charge":93946.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6049.85,"providers":[{"billed_charge":14911.82,"npi":[1902120397]}]}]}]},{"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":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3606.38,"providers":[{"billed_charge":14645.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"570996371"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8909.88,"providers":[{"billed_charge":14700.00,"npi":[1760409718]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9970.58,"providers":[{"billed_charge":48817.30,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11667.70,"providers":[{"billed_charge":68750.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"831579694"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1697.12,"providers":[{"billed_charge":4800.00,"npi":[1194200063]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16759.06,"providers":[{"billed_charge":172267.95,"npi":[1891782595]}]}]}]},{"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":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":332.52,"providers":[{"billed_charge":600.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1713.75,"providers":[{"billed_charge":3875.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14395.50,"providers":[{"billed_charge":27762.90,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43106.34,"providers":[{"billed_charge":92921.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25276.92,"providers":[{"billed_charge":56100.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":64310.52,"providers":[{"billed_charge":234904.85,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20025.78,"providers":[{"billed_charge":26373.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3339.75,"providers":[{"billed_charge":5070.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6855.00,"providers":[{"billed_charge":10000.00,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":66865.74,"providers":[{"billed_charge":104994.07,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":245.46,"providers":[{"billed_charge":500.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7806.66,"providers":[{"billed_charge":10350.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7127.82,"providers":[{"billed_charge":14271.39,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32244.90,"providers":[{"billed_charge":61852.06,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":339.42,"providers":[{"billed_charge":600.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1963.68,"providers":[{"billed_charge":4800.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40730.40,"providers":[{"billed_charge":208870.40,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5089.30,"providers":[{"billed_charge":28762.50,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":343.98,"providers":[{"billed_charge":1194.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3394.20,"providers":[{"billed_charge":13570.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34960.26,"providers":[{"billed_charge":51500.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11200.86,"providers":[{"billed_charge":28245.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14595.06,"providers":[{"billed_charge":19221.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":48629.00,"providers":[{"billed_charge":64000.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3084.75,"providers":[{"billed_charge":5828.76,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10182.60,"providers":[{"billed_charge":22500.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3054.78,"providers":[{"billed_charge":3150.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4429.11,"providers":[{"billed_charge":9750.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53967.78,"providers":[{"billed_charge":74577.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3746.94,"providers":[{"billed_charge":9799.96,"npi":[1902120397]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":320.00,"providers":[{"billed_charge":800.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":677.60,"providers":[{"billed_charge":1694.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":538.80,"providers":[{"billed_charge":1347.00,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":336.96,"providers":[{"billed_charge":842.56,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":329.74,"providers":[{"billed_charge":824.32,"npi":[1649268798]}]}]}]},{"name":"FQHC VISIT ESTABLISHED PATIE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0467","description":"FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"571084051"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":708.00,"providers":[{"billed_charge":2301.00,"npi":[1760539654]}]}]}]},{"name":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0545","description":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","allowed_amounts":[{"tin":{"type":"ein","value":"571006773"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":89.13,"providers":[{"billed_charge":126.00,"npi":[1831693332]}]}]}]},{"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":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":27664.27,"providers":[{"billed_charge":64736.88,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":79119.68,"providers":[{"billed_charge":79239.00,"npi":[1235909367]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":3541.77,"providers":[{"billed_charge":3541.77,"npi":[1235909367]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"910963298"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.76,"providers":[{"billed_charge":110.00,"npi":[1457672792]}]}]}]},{"name":"MENTAL HLTH PART HOSP TX <24","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0035","description":"MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"992174368"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1800.00,"providers":[{"billed_charge":22500.00,"npi":[1083976971]}]}]}]},{"name":"ASTV CMTY TX PROGRM PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0040","description":"ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":351.28,"providers":[{"billed_charge":1405.20,"npi":[1508811324]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1.71,"providers":[{"billed_charge":100.00,"npi":[1598327975]}]},{"allowed_amount":29.74,"providers":[{"billed_charge":1600.00,"npi":[1598327975]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":29.60,"providers":[{"billed_charge":5200.00,"npi":[1598327975]}]},{"allowed_amount":3.44,"providers":[{"billed_charge":600.00,"npi":[1598327975]}]}]}]}]}