{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-06-29","out_of_network":[{"name":"NCNTC R-T FLUOR WND IMG 1ST","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0598T","description":"NONCONTACT R-T FLUOR WND IMG 1ST ANATOMIC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2633.76,"providers":[{"billed_charge":6239.04,"npi":[1205395282]}]}]}]},{"name":"NCNTC R-T FLUOR WND IMG EA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0599T","description":"NONCONTACT R-T FLUOR WND IMG EA ADDL ANTMC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":325.47,"providers":[{"billed_charge":781.65,"npi":[1205395282]}]}]}]},{"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":"636001820"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":341814.94,"providers":[{"billed_charge":100494.00,"npi":[1043262488]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":135.11,"providers":[{"billed_charge":295.48,"npi":[1205395282]}]}]},{"tin":{"type":"ein","value":"264568726"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":51.56,"providers":[{"billed_charge":115.00,"npi":[1174566996]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1328.22,"providers":[{"billed_charge":8020.15,"npi":[1234567893]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":333408.44,"providers":[{"billed_charge":136269.00,"npi":[1154386431]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"472228529"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31736.41,"providers":[{"billed_charge":13349.60,"npi":[1992103857]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5511.46,"providers":[{"billed_charge":18371.36,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2792.35,"providers":[{"billed_charge":9307.08,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":214.10,"providers":[{"billed_charge":713.62,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.07,"providers":[{"billed_charge":10.22,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1050.78,"providers":[{"billed_charge":3502.60,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":200.78,"providers":[{"billed_charge":4457.78,"npi":[1154386431]}]},{"allowed_amount":673.49,"providers":[{"billed_charge":2244.87,"npi":[1154386431]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":697.50,"providers":[{"billed_charge":2325.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":292.35,"providers":[{"billed_charge":3110.00,"npi":[1154386431]}]},{"allowed_amount":705.00,"providers":[{"billed_charge":2350.00,"npi":[1154386431]}]}]}]},{"name":"DRUGS/NONPRSCPT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"257","description":"PHARMACY - NON-PRESCRIPTION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.17,"providers":[{"billed_charge":23.89,"npi":[1780235002]}]},{"allowed_amount":231.65,"providers":[{"billed_charge":3851.80,"npi":[1154386431]}]},{"allowed_amount":173.13,"providers":[{"billed_charge":577.06,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":443.18,"providers":[{"billed_charge":1477.26,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":995.72,"providers":[{"billed_charge":3318.75,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":175.62,"providers":[{"billed_charge":585.40,"npi":[1154386431]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1100.78,"providers":[{"billed_charge":3669.10,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":886.60,"providers":[{"billed_charge":2955.36,"npi":[1780235002]}]},{"allowed_amount":2174.33,"providers":[{"billed_charge":7247.49,"npi":[1154386431]}]},{"allowed_amount":1291.51,"providers":[{"billed_charge":41559.89,"npi":[1154386431]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18935.70,"providers":[{"billed_charge":85605.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13971.64,"providers":[{"billed_charge":25830.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15464.27,"providers":[{"billed_charge":31179.75,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5474.56,"providers":[{"billed_charge":7726.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":172.09,"providers":[{"billed_charge":194.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1071.74,"providers":[{"billed_charge":2635.50,"npi":[1841394418]}]},{"allowed_amount":2221.00,"providers":[{"billed_charge":9443.25,"npi":[1841394418]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3740.41,"providers":[{"billed_charge":12467.80,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1263.60,"providers":[{"billed_charge":4212.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":170.44,"providers":[{"billed_charge":568.04,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":45.90,"providers":[{"billed_charge":153.00,"npi":[1780235002]}]},{"allowed_amount":92.10,"providers":[{"billed_charge":307.00,"npi":[1154386431]}]},{"allowed_amount":174.00,"providers":[{"billed_charge":939.00,"npi":[1154386431]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":325.80,"providers":[{"billed_charge":1086.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":187.00,"providers":[{"billed_charge":3174.00,"npi":[1154386431]}]},{"allowed_amount":238.20,"providers":[{"billed_charge":794.00,"npi":[1154386431]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":727.83,"providers":[{"billed_charge":2426.10,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":818.32,"providers":[{"billed_charge":2727.70,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":101.10,"providers":[{"billed_charge":337.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":46.25,"providers":[{"billed_charge":154.15,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":653.40,"providers":[{"billed_charge":2177.86,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1593.60,"providers":[{"billed_charge":5312.00,"npi":[1154386431]}]},{"allowed_amount":2770.80,"providers":[{"billed_charge":19888.40,"npi":[1154386431]}]},{"allowed_amount":187.50,"providers":[{"billed_charge":625.00,"npi":[1780235002]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":370.84,"providers":[{"billed_charge":1012.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1345.76,"providers":[{"billed_charge":3473.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7241.79,"providers":[{"billed_charge":22963.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":917.05,"providers":[{"billed_charge":3160.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":242.96,"providers":[{"billed_charge":6747.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10.14,"providers":[{"billed_charge":82.00,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30266.35,"providers":[{"billed_charge":78280.50,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":554.71,"providers":[{"billed_charge":5234.50,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":103.52,"providers":[{"billed_charge":368.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"630385130"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":674.66,"providers":[{"billed_charge":1413.50,"npi":[1811913460]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5073.68,"providers":[{"billed_charge":47597.00,"npi":[1234567893]}]},{"allowed_amount":678.45,"providers":[{"billed_charge":69793.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1641.00,"providers":[{"billed_charge":22358.00,"npi":[1154386431]}]},{"allowed_amount":11004.90,"providers":[{"billed_charge":40436.00,"npi":[1154386431]}]},{"allowed_amount":2993.15,"providers":[{"billed_charge":7550.00,"npi":[1780235002]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":531.77,"providers":[{"billed_charge":904.12,"npi":[1487699203]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":42.79,"providers":[{"billed_charge":111.00,"npi":[1811973100]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10054.06,"providers":[{"billed_charge":35213.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1437.50,"providers":[{"billed_charge":2616.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8019.50,"providers":[{"billed_charge":14520.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2844.93,"providers":[{"billed_charge":8252.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":55.24,"providers":[{"billed_charge":808.00,"npi":[1992812382]}]},{"allowed_amount":1502.22,"providers":[{"billed_charge":5393.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":547.18,"providers":[{"billed_charge":7615.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":838.33,"providers":[{"billed_charge":16465.25,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"650460321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32.71,"providers":[{"billed_charge":22694.23,"npi":[1104897859]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4995.73,"providers":[{"billed_charge":5020.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18208.97,"providers":[{"billed_charge":104028.52,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1110.78,"providers":[{"billed_charge":2884.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":339.13,"providers":[{"billed_charge":3852.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6550.25,"providers":[{"billed_charge":89431.00,"npi":[1154386431]}]},{"allowed_amount":4.37,"providers":[{"billed_charge":314.00,"npi":[1154386431]}]},{"allowed_amount":27675.75,"providers":[{"billed_charge":72137.00,"npi":[1154386431]}]},{"allowed_amount":8310.54,"providers":[{"billed_charge":16508.00,"npi":[1780235002]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":56.22,"providers":[{"billed_charge":135.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":346.17,"providers":[{"billed_charge":2841.00,"npi":[1154386431]}]},{"allowed_amount":346.35,"providers":[{"billed_charge":8381.00,"npi":[1154386431]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1244.37,"providers":[{"billed_charge":8647.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":203.51,"providers":[{"billed_charge":462.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":640.00,"providers":[{"billed_charge":640.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2036.96,"providers":[{"billed_charge":15626.02,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5.44,"providers":[{"billed_charge":484.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4030.73,"providers":[{"billed_charge":17246.00,"npi":[1154386431]}]},{"allowed_amount":1590.00,"providers":[{"billed_charge":20551.00,"npi":[1154386431]}]},{"allowed_amount":1573.34,"providers":[{"billed_charge":4485.00,"npi":[1780235002]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.31,"providers":[{"billed_charge":80.50,"npi":[1780655332]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1505.68,"providers":[{"billed_charge":3387.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3197.09,"providers":[{"billed_charge":4521.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":456.06,"providers":[{"billed_charge":687.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1245.68,"providers":[{"billed_charge":1920.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3701.65,"providers":[{"billed_charge":27922.39,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2527.33,"providers":[{"billed_charge":8031.00,"npi":[1841394418]}]},{"allowed_amount":143.28,"providers":[{"billed_charge":882.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":581.99,"providers":[{"billed_charge":1498.75,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":970.09,"providers":[{"billed_charge":2229.00,"npi":[1780235002]}]},{"allowed_amount":2632.87,"providers":[{"billed_charge":7731.00,"npi":[1154386431]}]},{"allowed_amount":1802.35,"providers":[{"billed_charge":6844.00,"npi":[1154386431]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1903.72,"providers":[{"billed_charge":7424.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":755.11,"providers":[{"billed_charge":1536.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1544.27,"providers":[{"billed_charge":10409.19,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4.31,"providers":[{"billed_charge":460.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1547.89,"providers":[{"billed_charge":3422.00,"npi":[1154386431]}]},{"allowed_amount":209.65,"providers":[{"billed_charge":1464.00,"npi":[1154386431]}]},{"allowed_amount":526.93,"providers":[{"billed_charge":1123.00,"npi":[1780235002]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":920.48,"providers":[{"billed_charge":3536.00,"npi":[1043262488]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14323.34,"providers":[{"billed_charge":27219.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1034.61,"providers":[{"billed_charge":1930.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3397.25,"providers":[{"billed_charge":8449.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2670.72,"providers":[{"billed_charge":2760.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2318.32,"providers":[{"billed_charge":48549.63,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":217.07,"providers":[{"billed_charge":1011.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":531.94,"providers":[{"billed_charge":6091.00,"npi":[1234567893]}]},{"allowed_amount":758.53,"providers":[{"billed_charge":7677.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2276.73,"providers":[{"billed_charge":3298.00,"npi":[1780235002]}]},{"allowed_amount":8759.91,"providers":[{"billed_charge":14702.00,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1747.30,"providers":[{"billed_charge":3679.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3865.17,"providers":[{"billed_charge":9887.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2379.08,"providers":[{"billed_charge":6001.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3392.82,"providers":[{"billed_charge":13945.29,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":63.33,"providers":[{"billed_charge":279.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":520.83,"providers":[{"billed_charge":6009.00,"npi":[1154386431]}]},{"allowed_amount":365.65,"providers":[{"billed_charge":491.00,"npi":[1780235002]}]},{"allowed_amount":6123.93,"providers":[{"billed_charge":11303.00,"npi":[1154386431]}]}]}]},{"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":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":240.38,"providers":[{"billed_charge":620.50,"npi":[1841394418]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4709.56,"providers":[{"billed_charge":11550.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6964.59,"providers":[{"billed_charge":20195.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1053.40,"providers":[{"billed_charge":7949.90,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13132.92,"providers":[{"billed_charge":20310.00,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3736.11,"providers":[{"billed_charge":18151.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17735.83,"providers":[{"billed_charge":80587.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19264.05,"providers":[{"billed_charge":155842.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8119.84,"providers":[{"billed_charge":171544.90,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":312.64,"providers":[{"billed_charge":2599.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":865.84,"providers":[{"billed_charge":48854.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36725.39,"providers":[{"billed_charge":38531.00,"npi":[1154386431]}]},{"allowed_amount":3392.00,"providers":[{"billed_charge":16258.00,"npi":[1154386431]}]},{"allowed_amount":2465.31,"providers":[{"billed_charge":2952.00,"npi":[1780235002]}]}]}]},{"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":"636005396"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":85764.85,"providers":[{"billed_charge":332430.34,"npi":[1447145818]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":40970.61,"providers":[{"billed_charge":126992.41,"npi":[1841394418]}]}]}]},{"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":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1309.39,"providers":[{"billed_charge":2737.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31.96,"providers":[{"billed_charge":446.25,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":36.72,"providers":[{"billed_charge":142.28,"npi":[1234567893]}]},{"allowed_amount":143.95,"providers":[{"billed_charge":378.00,"npi":[1234567893]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":272.19,"providers":[{"billed_charge":2095.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":564.00,"providers":[{"billed_charge":2214.00,"npi":[1154386431]}]},{"allowed_amount":3853.38,"providers":[{"billed_charge":6234.00,"npi":[1154386431]}]}]}]},{"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":"999999999"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":679.11,"providers":[{"billed_charge":3115.00,"npi":[1234567893]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":348.55,"providers":[{"billed_charge":2358.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":199.58,"providers":[{"billed_charge":746.00,"npi":[1154386431]}]}]}]},{"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":"999999999"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4954.93,"providers":[{"billed_charge":18297.00,"npi":[1234567893]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41250.58,"providers":[{"billed_charge":64908.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":80323.99,"providers":[{"billed_charge":293096.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17197.74,"providers":[{"billed_charge":19464.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14606.54,"providers":[{"billed_charge":41841.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18465.43,"providers":[{"billed_charge":53784.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9142.63,"providers":[{"billed_charge":27735.50,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"650460321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20909.13,"providers":[{"billed_charge":42251.25,"npi":[1104897859]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":72434.14,"providers":[{"billed_charge":139123.25,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636005396"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2646.19,"providers":[{"billed_charge":10853.00,"npi":[1447145818]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40859.41,"providers":[{"billed_charge":42031.11,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":119778.41,"providers":[{"billed_charge":433273.67,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3746.20,"providers":[{"billed_charge":4478.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34898.36,"providers":[{"billed_charge":85479.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5252.05,"providers":[{"billed_charge":70114.00,"npi":[1154386431]}]},{"allowed_amount":73614.26,"providers":[{"billed_charge":133191.00,"npi":[1780235002]}]},{"allowed_amount":196795.48,"providers":[{"billed_charge":381985.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":452.44,"providers":[{"billed_charge":899.00,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3859.80,"providers":[{"billed_charge":8306.67,"npi":[1487699203]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":475.10,"providers":[{"billed_charge":1446.00,"npi":[1154386431]}]},{"allowed_amount":1522.30,"providers":[{"billed_charge":2464.00,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5227.07,"providers":[{"billed_charge":17159.55,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11240.14,"providers":[{"billed_charge":37493.98,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1334.86,"providers":[{"billed_charge":4449.50,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":331.65,"providers":[{"billed_charge":1105.32,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":14.68,"providers":[{"billed_charge":7225.27,"npi":[1841394418]}]},{"allowed_amount":38113.84,"providers":[{"billed_charge":147451.03,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.80,"providers":[{"billed_charge":486.00,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"650460321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.70,"providers":[{"billed_charge":5229.47,"npi":[1104897859]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5911.17,"providers":[{"billed_charge":19504.26,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":341.85,"providers":[{"billed_charge":1127.85,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6233.25,"providers":[{"billed_charge":21370.70,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"630385130"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.16,"providers":[{"billed_charge":27.20,"npi":[1811913460]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":247.47,"providers":[{"billed_charge":824.89,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7372.27,"providers":[{"billed_charge":33409.00,"npi":[1234567893]}]},{"allowed_amount":22006.84,"providers":[{"billed_charge":82891.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4294.24,"providers":[{"billed_charge":149111.32,"npi":[1154386431]}]},{"allowed_amount":92.85,"providers":[{"billed_charge":309.50,"npi":[1780235002]}]},{"allowed_amount":4564.88,"providers":[{"billed_charge":15183.91,"npi":[1780235002]}]},{"allowed_amount":18189.50,"providers":[{"billed_charge":59576.69,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":91.32,"providers":[{"billed_charge":304.40,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15.24,"providers":[{"billed_charge":50.80,"npi":[1487699203]}]}]}]},{"name":"CATARACT SURG W/IOL 1 STAGE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"66984","description":"EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":1572.22,"providers":[{"billed_charge":5869.08,"npi":[1234567893]}]}]}]},{"name":"INJECTION EYE DRUG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"67028","description":"INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":523.30,"providers":[{"billed_charge":3000.00,"npi":[1234567893]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"630572355"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":209.65,"providers":[{"billed_charge":980.00,"npi":[1124559505]}]},{"allowed_amount":29.95,"providers":[{"billed_charge":140.00,"npi":[1124559505]}]}]}]},{"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":"630572355"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":6.36,"providers":[{"billed_charge":22.00,"npi":[1124559505]}]},{"allowed_amount":280.10,"providers":[{"billed_charge":968.00,"npi":[1124559505]}]},{"allowed_amount":114.51,"providers":[{"billed_charge":396.00,"npi":[1124559505]}]}]},{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":34.15,"providers":[{"billed_charge":160.00,"npi":[1275582041]}]},{"allowed_amount":6.83,"providers":[{"billed_charge":32.00,"npi":[1275582041,1447783717]}]},{"allowed_amount":88.79,"providers":[{"billed_charge":416.00,"npi":[1275582041]}]}]},{"tin":{"type":"ein","value":"630581077"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":25.44,"providers":[{"billed_charge":216.00,"npi":[1811121585]}]},{"allowed_amount":19.10,"providers":[{"billed_charge":162.00,"npi":[1811121585]}]}]},{"tin":{"type":"ein","value":"820549580"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":38.11,"providers":[{"billed_charge":144.00,"npi":[1831393164]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":726.32,"providers":[{"billed_charge":1640.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1704.66,"providers":[{"billed_charge":7904.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2003.28,"providers":[{"billed_charge":5496.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3087.37,"providers":[{"billed_charge":13980.99,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":39.73,"providers":[{"billed_charge":343.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7480.01,"providers":[{"billed_charge":8910.00,"npi":[1154386431]}]},{"allowed_amount":456.90,"providers":[{"billed_charge":550.00,"npi":[1780235002]}]}]}]},{"name":"CT ABD & PELVIS W/O CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74176","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"630572355"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":60.81,"providers":[{"billed_charge":202.00,"npi":[1124559505]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"630572355"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":254.50,"providers":[{"billed_charge":928.00,"npi":[1124559505]}]},{"allowed_amount":63.69,"providers":[{"billed_charge":232.00,"npi":[1124559505]}]}]}]},{"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":"630572355"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":105.65,"providers":[{"billed_charge":210.00,"npi":[1124559505]}]}]}]},{"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":"630572355"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":133.19,"providers":[{"billed_charge":270.00,"npi":[1124559505]}]}]}]},{"name":"RADIATION PHYSICS CONSULT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77336","description":"CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT PARAMETERS, QUALITY ASSUR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":203.85,"providers":[{"billed_charge":1350.00,"npi":[1234567893]}]}]}]},{"name":"GUIDANCE FOR RADIAJ TX DLVR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77387","description":"GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","21"],"billing_class":"professional","payments":[{"allowed_amount":58.46,"providers":[{"billed_charge":700.00,"npi":[1234567893]}]},{"allowed_amount":2424.94,"providers":[{"billed_charge":29050.00,"npi":[1234567893]}]},{"allowed_amount":1577.27,"providers":[{"billed_charge":18900.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TREATMENT DELIVERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77407","description":"RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE","allowed_amounts":[{"tin":{"type":"ein","value":"631185834"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":920.04,"providers":[{"billed_charge":6830.00,"npi":[1225591878]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15180.66,"providers":[{"billed_charge":104260.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TREATMENT DELIVERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77412","description":"RADIATION TREATMENT DELIVERY, => 1 MEV; COMPLEX","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4280.77,"providers":[{"billed_charge":16510.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TX MANAGEMENT X5","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77427","description":"RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":1232.32,"providers":[{"billed_charge":8560.00,"npi":[1234567893]}]},{"allowed_amount":2932.54,"providers":[{"billed_charge":20330.00,"npi":[1234567893]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":60.90,"providers":[{"billed_charge":1116.00,"npi":[1497859052]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":570.15,"providers":[{"billed_charge":12150.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":97.31,"providers":[{"billed_charge":996.48,"npi":[1234567893]}]},{"allowed_amount":248.16,"providers":[{"billed_charge":2115.00,"npi":[1234567893]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":208.91,"providers":[{"billed_charge":2184.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":73.70,"providers":[{"billed_charge":299.00,"npi":[1234567893]}]},{"allowed_amount":106.98,"providers":[{"billed_charge":1141.56,"npi":[1234567893]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.02,"providers":[{"billed_charge":51.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.30,"providers":[{"billed_charge":198.00,"npi":[1457341307]}]},{"allowed_amount":220.50,"providers":[{"billed_charge":630.00,"npi":[1225484561]}]}]}]},{"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":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":1903.04,"providers":[{"billed_charge":8936.00,"npi":[1234567893]}]},{"allowed_amount":217.82,"providers":[{"billed_charge":1770.99,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.96,"providers":[{"billed_charge":716.10,"npi":[1992939417]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":93.96,"providers":[{"billed_charge":526.00,"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":25.08,"providers":[{"billed_charge":139.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"631176388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.65,"providers":[{"billed_charge":40.00,"npi":[1376681676]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":290.52,"providers":[{"billed_charge":3628.80,"npi":[1992939417]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":68.31,"providers":[{"billed_charge":309.00,"npi":[1234567893]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":89.81,"providers":[{"billed_charge":340.40,"npi":[1234567893]}]},{"allowed_amount":133.20,"providers":[{"billed_charge":950.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.59,"providers":[{"billed_charge":10.00,"npi":[1234567893]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":181.00,"providers":[{"billed_charge":980.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.92,"providers":[{"billed_charge":193.20,"npi":[1255566899]}]},{"allowed_amount":57.33,"providers":[{"billed_charge":1014.30,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.94,"providers":[{"billed_charge":30.00,"npi":[1023112307]}]}]}]},{"name":"GLUCOSE BLOOD TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82962","description":"GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE","allowed_amounts":[{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.84,"providers":[{"billed_charge":117.00,"npi":[1275361230]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":174.75,"providers":[{"billed_charge":1800.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.48,"providers":[{"billed_charge":138.60,"npi":[1992939417,1255566899]}]},{"allowed_amount":94.36,"providers":[{"billed_charge":970.20,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":92.34,"providers":[{"billed_charge":494.00,"npi":[1275361230]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":92.75,"providers":[{"billed_charge":1189.82,"npi":[1234567893]}]},{"allowed_amount":227.92,"providers":[{"billed_charge":1164.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":97.38,"providers":[{"billed_charge":1359.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":403.20,"providers":[{"billed_charge":4180.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":122.67,"providers":[{"billed_charge":1377.60,"npi":[1234567893]}]},{"allowed_amount":84.00,"providers":[{"billed_charge":488.00,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"721382190"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.10,"providers":[{"billed_charge":136.38,"npi":[1023876653]}]}]},{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":419.40,"providers":[{"billed_charge":4410.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":163.38,"providers":[{"billed_charge":1540.00,"npi":[1234567893]}]},{"allowed_amount":67.30,"providers":[{"billed_charge":661.29,"npi":[1234567893]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.72,"providers":[{"billed_charge":183.00,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":505.32,"providers":[{"billed_charge":1728.00,"npi":[1497859052]}]}]}]},{"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":"721382190"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":133.57,"providers":[{"billed_charge":211.28,"npi":[1023876653]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7.03,"providers":[{"billed_charge":41.00,"npi":[1477041804,1710586623]}]},{"allowed_amount":147.63,"providers":[{"billed_charge":861.00,"npi":[1326287665]}]},{"allowed_amount":56.24,"providers":[{"billed_charge":328.00,"npi":[1679109755]}]},{"allowed_amount":133.57,"providers":[{"billed_charge":779.00,"npi":[1073247565]}]},{"allowed_amount":77.33,"providers":[{"billed_charge":451.00,"npi":[1306407374,1003546698,1457014375]}]}]}]},{"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":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":17.59,"providers":[{"billed_charge":103.00,"npi":[1326287665]}]}]}]},{"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":"630758227"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":801.52,"providers":[{"billed_charge":3000.00,"npi":[1700958048]}]}]},{"tin":{"type":"ein","value":"630580312"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":335.36,"providers":[{"billed_charge":2699.20,"npi":[1821095167]}]}]},{"tin":{"type":"ein","value":"814465486"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":247.39,"providers":[{"billed_charge":636.00,"npi":[1477524890]}]},{"allowed_amount":82.46,"providers":[{"billed_charge":212.00,"npi":[1477524890]}]}]}]},{"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":"273605364"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":3485.34,"providers":[{"billed_charge":8246.31,"npi":[1316201809]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21750.00,"providers":[{"billed_charge":91000.00,"npi":[1134277577]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8450.00,"providers":[{"billed_charge":41600.00,"npi":[1487067237]}]}]},{"tin":{"type":"ein","value":"861851206"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":78.71,"providers":[{"billed_charge":1350.00,"npi":[1982460119]}]},{"allowed_amount":12348.00,"providers":[{"billed_charge":85050.00,"npi":[1134708597]}]}]}]},{"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":"471451344"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3677.47,"providers":[{"billed_charge":7375.00,"npi":[1326784968]}]}]}]},{"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":"462336113"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":125.25,"providers":[{"billed_charge":170.00,"npi":[1588350573]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1830.62,"providers":[{"billed_charge":2325.00,"npi":[1649890286]}]},{"allowed_amount":66.07,"providers":[{"billed_charge":75.00,"npi":[1710432190]}]},{"allowed_amount":326.34,"providers":[{"billed_charge":450.00,"npi":[1710432190]}]},{"allowed_amount":75.00,"providers":[{"billed_charge":75.00,"npi":[1649890286]}]}]},{"tin":{"type":"ein","value":"201935552"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":639.93,"providers":[{"billed_charge":1022.00,"npi":[1528744273]}]}]}]},{"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":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":911.20,"providers":[{"billed_charge":2080.00,"npi":[1234567893]}]}]}]},{"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":"822255717"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":121.28,"providers":[{"billed_charge":225.00,"npi":[1871265264]}]},{"allowed_amount":200.90,"providers":[{"billed_charge":450.00,"npi":[1871265264]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":4403.66,"providers":[{"billed_charge":6560.00,"npi":[1306167747]}]},{"allowed_amount":131.55,"providers":[{"billed_charge":160.00,"npi":[1134402795]}]},{"allowed_amount":903.80,"providers":[{"billed_charge":1120.00,"npi":[1134402795]}]}]},{"tin":{"type":"ein","value":"205914394"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1600.83,"providers":[{"billed_charge":3267.00,"npi":[1891312062]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":297.00,"npi":[1891312062]}]}]},{"tin":{"type":"ein","value":"882222490"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":100.45,"providers":[{"billed_charge":150.00,"npi":[1568116556]}]},{"allowed_amount":363.84,"providers":[{"billed_charge":450.00,"npi":[1568116556]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":3173.00,"providers":[{"billed_charge":6669.00,"npi":[1861983785]}]}]},{"tin":{"type":"ein","value":"824396647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":121.28,"providers":[{"billed_charge":175.00,"npi":[1639889629]}]}]},{"tin":{"type":"ein","value":"922406443"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":904.05,"providers":[{"billed_charge":1530.00,"npi":[1164207858]}]},{"allowed_amount":485.12,"providers":[{"billed_charge":680.00,"npi":[1164207858]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":501.00,"providers":[{"billed_charge":1053.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":352.95,"providers":[{"billed_charge":705.06,"npi":[1497847222]}]}]}]},{"name":"ESRD SRV 4 VISITS P MO 20+","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90960","description":"END-STAGE RENAL DISEASE (ESRD) RELATED SERVICES MONTHLY, FOR PATIENTS 20 YEARS OF AGE AND OLDER; WIT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["65"],"billing_class":"professional","payments":[{"allowed_amount":699.98,"providers":[{"billed_charge":1060.00,"npi":[1234567893]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3600.00,"providers":[{"billed_charge":17600.00,"npi":[1134277577]}]}]}]},{"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":1575.00,"providers":[{"billed_charge":19975.00,"npi":[1417392762]}]},{"allowed_amount":80325.00,"providers":[{"billed_charge":1018725.00,"npi":[1457232589]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1480.90,"providers":[{"billed_charge":88205.00,"npi":[1912670068]}]}]}]},{"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":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1991.95,"providers":[{"billed_charge":2245.00,"npi":[1154386431]}]}]}]},{"name":"CPTR OPHTH DX IMG POST SEGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92134","description":"SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERPRETATION AND RPT, UN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":704.26,"providers":[{"billed_charge":1708.00,"npi":[1234567893]}]}]}]},{"name":"ELECTROCARDIOGRAM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93000","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":843.10,"providers":[{"billed_charge":3127.00,"npi":[1234567893]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"831651180"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":16.13,"providers":[{"billed_charge":43.00,"npi":[1497740492]}]},{"allowed_amount":114.12,"providers":[{"billed_charge":645.00,"npi":[1497740492]}]},{"allowed_amount":23.19,"providers":[{"billed_charge":129.00,"npi":[1821048794]}]}]},{"tin":{"type":"ein","value":"475419443"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":37.40,"providers":[{"billed_charge":51.70,"npi":[1386165470]}]},{"allowed_amount":18.70,"providers":[{"billed_charge":25.85,"npi":[1386165470]}]}]},{"tin":{"type":"ein","value":"460902156"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":7.91,"providers":[{"billed_charge":22.00,"npi":[1386623775]}]},{"allowed_amount":476.70,"providers":[{"billed_charge":1364.00,"npi":[1386623775]}]}]},{"tin":{"type":"ein","value":"721608375"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":85.93,"providers":[{"billed_charge":120.00,"npi":[1447260914]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","21"],"billing_class":"professional","payments":[{"allowed_amount":3135.26,"providers":[{"billed_charge":14396.00,"npi":[1234567893]}]},{"allowed_amount":54.78,"providers":[{"billed_charge":124.00,"npi":[1234567893]}]},{"allowed_amount":1684.90,"providers":[{"billed_charge":6095.07,"npi":[1234567893]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":373.65,"providers":[{"billed_charge":748.10,"npi":[1234567893]}]}]}]},{"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":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":81.98,"providers":[{"billed_charge":120.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":93.26,"providers":[{"billed_charge":208.00,"npi":[1700615846]}]},{"allowed_amount":23.88,"providers":[{"billed_charge":52.00,"npi":[1689374563]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":753.59,"providers":[{"billed_charge":1856.10,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":180.34,"providers":[{"billed_charge":490.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":428.78,"providers":[{"billed_charge":930.00,"npi":[1124591177]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.50,"providers":[{"billed_charge":110.00,"npi":[1144569955]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3969.22,"providers":[{"billed_charge":13985.04,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.76,"providers":[{"billed_charge":78.00,"npi":[1932609492]}]}]},{"tin":{"type":"ein","value":"842788208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":267.64,"providers":[{"billed_charge":572.00,"npi":[1376367193]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2839.61,"providers":[{"billed_charge":10358.14,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.05,"providers":[{"billed_charge":86.00,"npi":[1932609492]}]},{"allowed_amount":186.20,"providers":[{"billed_charge":688.00,"npi":[1144569955]}]}]},{"tin":{"type":"ein","value":"842788208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":338.10,"providers":[{"billed_charge":660.00,"npi":[1376367193]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1693.79,"providers":[{"billed_charge":5612.02,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":18.68,"providers":[{"billed_charge":73.00,"npi":[1144569955]}]}]},{"tin":{"type":"ein","value":"842788208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":193.04,"providers":[{"billed_charge":380.00,"npi":[1376367193]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1532.86,"providers":[{"billed_charge":6330.68,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":153.05,"providers":[{"billed_charge":558.00,"npi":[1144569955]}]},{"allowed_amount":25.94,"providers":[{"billed_charge":93.00,"npi":[1932609492]}]}]},{"tin":{"type":"ein","value":"842788208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":337.19,"providers":[{"billed_charge":624.00,"npi":[1376367193]}]}]}]},{"name":"HYPERBARIC OXYGEN THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99183","description":"PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":203.56,"providers":[{"billed_charge":419.84,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4067.32,"providers":[{"billed_charge":7307.89,"npi":[1234567893]}]}]}]},{"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":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1269.92,"providers":[{"billed_charge":1600.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":332.01,"providers":[{"billed_charge":572.00,"npi":[1234567893]}]},{"allowed_amount":27891.95,"providers":[{"billed_charge":45140.07,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99205","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":164.23,"providers":[{"billed_charge":268.00,"npi":[1234567893]}]},{"allowed_amount":4303.74,"providers":[{"billed_charge":5738.10,"npi":[1234567893]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":29.48,"providers":[{"billed_charge":85.00,"npi":[1234567893]}]},{"allowed_amount":752.62,"providers":[{"billed_charge":1793.60,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"630695975"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":526.74,"providers":[{"billed_charge":1062.00,"npi":[1447291125]}]},{"allowed_amount":175.58,"providers":[{"billed_charge":354.00,"npi":[1982622577]}]}]},{"tin":{"type":"ein","value":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":514.62,"providers":[{"billed_charge":565.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4554.09,"providers":[{"billed_charge":9338.07,"npi":[1275361230]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1047.29,"providers":[{"billed_charge":1830.00,"npi":[1225484561]}]},{"allowed_amount":224.24,"providers":[{"billed_charge":560.00,"npi":[1457341307]}]},{"allowed_amount":526.74,"providers":[{"billed_charge":940.00,"npi":[1457341307]}]},{"allowed_amount":382.83,"providers":[{"billed_charge":1005.00,"npi":[1225484561]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1474.64,"providers":[{"billed_charge":2703.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"631176388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4258.12,"providers":[{"billed_charge":4900.00,"npi":[1376681676]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7440.60,"providers":[{"billed_charge":8640.00,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":202.60,"providers":[{"billed_charge":340.00,"npi":[1649890286]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":368.06,"providers":[{"billed_charge":475.00,"npi":[1902549991]}]}]},{"tin":{"type":"ein","value":"208104245"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1304.73,"providers":[{"billed_charge":3690.00,"npi":[1639152556]}]}]},{"tin":{"type":"ein","value":"630760576"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":149.24,"providers":[{"billed_charge":154.00,"npi":[1093866337]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":879.88,"providers":[{"billed_charge":1320.00,"npi":[1700615846]}]},{"allowed_amount":149.24,"providers":[{"billed_charge":220.00,"npi":[1689374563]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","10"],"billing_class":"professional","payments":[{"allowed_amount":54.77,"providers":[{"billed_charge":100.00,"npi":[1234567893]}]},{"allowed_amount":17410.91,"providers":[{"billed_charge":27976.21,"npi":[1234567893]}]},{"allowed_amount":244.86,"providers":[{"billed_charge":700.98,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":46.55,"providers":[{"billed_charge":150.00,"npi":[1053117366]}]}]}]},{"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":"850770765"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.88,"providers":[{"billed_charge":350.00,"npi":[1134512072]}]}]},{"tin":{"type":"ein","value":"630695975"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1127.07,"providers":[{"billed_charge":2385.00,"npi":[1982622577]}]}]},{"tin":{"type":"ein","value":"721382190"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2052.81,"providers":[{"billed_charge":2057.43,"npi":[1023876653]}]}]},{"tin":{"type":"ein","value":"475138029"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":123.95,"providers":[{"billed_charge":327.12,"npi":[1891175626]}]}]},{"tin":{"type":"ein","value":"272446754"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":133.05,"providers":[{"billed_charge":258.40,"npi":[1922696541]}]}]},{"tin":{"type":"ein","value":"260700568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":106.44,"providers":[{"billed_charge":152.09,"npi":[1972313419]}]}]},{"tin":{"type":"ein","value":"270952681"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":103.07,"providers":[{"billed_charge":195.00,"npi":[1942432794]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5608.73,"providers":[{"billed_charge":7155.00,"npi":[1356343271]}]}]},{"tin":{"type":"ein","value":"462054352"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":319.32,"providers":[{"billed_charge":1830.00,"npi":[1801528765]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2570.62,"providers":[{"billed_charge":3150.00,"npi":[1376121392]}]},{"allowed_amount":982.36,"providers":[{"billed_charge":1200.00,"npi":[1619618733]}]}]},{"tin":{"type":"ein","value":"201935552"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1448.81,"providers":[{"billed_charge":2142.31,"npi":[1528744273]}]}]},{"tin":{"type":"ein","value":"272568183"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5381.04,"providers":[{"billed_charge":7740.00,"npi":[1467676676]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22","10"],"billing_class":"professional","payments":[{"allowed_amount":2034.15,"providers":[{"billed_charge":4530.00,"npi":[1234567893]}]},{"allowed_amount":414.05,"providers":[{"billed_charge":1549.44,"npi":[1234567893]}]},{"allowed_amount":77900.15,"providers":[{"billed_charge":115667.32,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":417.49,"providers":[{"billed_charge":864.00,"npi":[1447097167]}]}]},{"tin":{"type":"ein","value":"462336113"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":302.78,"providers":[{"billed_charge":450.00,"npi":[1588350573]}]}]},{"tin":{"type":"ein","value":"932551504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2201.51,"providers":[{"billed_charge":4267.62,"npi":[1972312148]}]}]},{"tin":{"type":"ein","value":"205914394"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4726.01,"providers":[{"billed_charge":8937.72,"npi":[1760361877]}]}]},{"tin":{"type":"ein","value":"870970152"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":3091.79,"providers":[{"billed_charge":3375.00,"npi":[1073350955]}]},{"allowed_amount":241.53,"providers":[{"billed_charge":405.00,"npi":[1073350955]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1762.93,"providers":[{"billed_charge":3926.00,"npi":[1437278371]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":490.78,"providers":[{"billed_charge":990.00,"npi":[1457341307]}]},{"allowed_amount":2438.86,"providers":[{"billed_charge":3300.00,"npi":[1225484561]}]},{"allowed_amount":972.97,"providers":[{"billed_charge":1980.00,"npi":[1225484561]}]},{"allowed_amount":491.18,"providers":[{"billed_charge":660.00,"npi":[1457341307]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2618.05,"providers":[{"billed_charge":4975.00,"npi":[1184165748]}]},{"allowed_amount":6680.80,"providers":[{"billed_charge":10945.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"631176388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":751.38,"providers":[{"billed_charge":780.00,"npi":[1376681676]}]}]},{"tin":{"type":"ein","value":"931418808"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":744.78,"providers":[{"billed_charge":1260.00,"npi":[1710576905]}]},{"allowed_amount":136.88,"providers":[{"billed_charge":367.85,"npi":[1710576905]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1984.20,"providers":[{"billed_charge":2400.00,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":110.00,"providers":[{"billed_charge":110.00,"npi":[1649890286]}]},{"allowed_amount":342.20,"providers":[{"billed_charge":550.00,"npi":[1710432190]}]},{"allowed_amount":562.54,"providers":[{"billed_charge":770.00,"npi":[1649890286]}]}]},{"tin":{"type":"ein","value":"471589764"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2662.47,"providers":[{"billed_charge":5072.76,"npi":[1669054060]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":727.89,"providers":[{"billed_charge":2142.00,"npi":[1073247565]}]},{"allowed_amount":196.34,"providers":[{"billed_charge":612.00,"npi":[1003546698]}]},{"allowed_amount":204.61,"providers":[{"billed_charge":612.00,"npi":[1710603659]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["11","53"],"billing_class":"professional","payments":[{"allowed_amount":490.41,"providers":[{"billed_charge":716.00,"npi":[1578978052]}]},{"allowed_amount":68.44,"providers":[{"billed_charge":150.00,"npi":[1720754096]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":871.44,"providers":[{"billed_charge":966.00,"npi":[1234567893]}]},{"allowed_amount":192.39,"providers":[{"billed_charge":425.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":6743.92,"providers":[{"billed_charge":11644.00,"npi":[1234567893]}]},{"allowed_amount":110.77,"providers":[{"billed_charge":170.00,"npi":[1234567893]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99223","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":8880.36,"providers":[{"billed_charge":17466.84,"npi":[1234567893]}]},{"allowed_amount":899.99,"providers":[{"billed_charge":2033.00,"npi":[1234567893]}]}]}]},{"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":"880747037"},"service_code":["02","21"],"billing_class":"professional","payments":[{"allowed_amount":3709.16,"providers":[{"billed_charge":7050.00,"npi":[1346069960]}]},{"allowed_amount":972.93,"providers":[{"billed_charge":1575.00,"npi":[1609960889]}]},{"allowed_amount":324.31,"providers":[{"billed_charge":525.00,"npi":[1609960889]}]},{"allowed_amount":78.76,"providers":[{"billed_charge":150.00,"npi":[1346069960]}]}]},{"tin":{"type":"ein","value":"812854031"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":392.04,"providers":[{"billed_charge":665.17,"npi":[1730709544]}]},{"allowed_amount":287.61,"providers":[{"billed_charge":483.76,"npi":[1922720705]}]},{"allowed_amount":178.20,"providers":[{"billed_charge":302.35,"npi":[1780381087]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":382.55,"providers":[{"billed_charge":471.00,"npi":[1234567893]}]}]}]},{"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":"832572761"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":477.03,"providers":[{"billed_charge":817.88,"npi":[1386609055]}]},{"allowed_amount":886.66,"providers":[{"billed_charge":1518.92,"npi":[1336435551]}]}]},{"tin":{"type":"ein","value":"883208334"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1142.94,"providers":[{"billed_charge":1785.00,"npi":[1215233192]}]}]},{"tin":{"type":"ein","value":"851925206"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":335.35,"providers":[{"billed_charge":625.00,"npi":[1003075516]}]}]},{"tin":{"type":"ein","value":"631220194"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":67.07,"providers":[{"billed_charge":100.00,"npi":[1194947143]}]},{"allowed_amount":401.78,"providers":[{"billed_charge":600.00,"npi":[1265434450]}]}]},{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":534.91,"providers":[{"billed_charge":850.00,"npi":[1477170694]}]}]},{"tin":{"type":"ein","value":"844972784"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":467.35,"providers":[{"billed_charge":1464.00,"npi":[1114210085]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":488.57,"providers":[{"billed_charge":607.00,"npi":[1234567893]}]},{"allowed_amount":28635.57,"providers":[{"billed_charge":40730.03,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"834163880"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":174.93,"providers":[{"billed_charge":2100.00,"npi":[1952850620]}]},{"allowed_amount":670.70,"providers":[{"billed_charge":7000.00,"npi":[1275882656]}]}]},{"tin":{"type":"ein","value":"204744987"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":956.27,"providers":[{"billed_charge":2925.00,"npi":[1083697320]}]},{"allowed_amount":2192.95,"providers":[{"billed_charge":6075.00,"npi":[1053809863]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"592313481"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":218.00,"providers":[{"billed_charge":688.00,"npi":[1801113576]}]}]},{"tin":{"type":"ein","value":"834257679"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":880.67,"providers":[{"billed_charge":2156.00,"npi":[1801537816]}]}]},{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2974.54,"providers":[{"billed_charge":4400.00,"npi":[1972952109]}]},{"allowed_amount":2366.50,"providers":[{"billed_charge":3600.00,"npi":[1053974402]}]}]},{"tin":{"type":"ein","value":"812854031"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":259.29,"providers":[{"billed_charge":435.51,"npi":[1841086659]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":20869.53,"providers":[{"billed_charge":28116.68,"npi":[1234567893]}]},{"allowed_amount":101.69,"providers":[{"billed_charge":143.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"202208207"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":609.17,"providers":[{"billed_charge":1104.00,"npi":[1821002205]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"731723107"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":196.19,"providers":[{"billed_charge":360.00,"npi":[1235571001]}]}]}]},{"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":"650622859"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2613.96,"providers":[{"billed_charge":7818.00,"npi":[1982203329]}]},{"allowed_amount":6534.90,"providers":[{"billed_charge":19545.00,"npi":[1326553264]}]},{"allowed_amount":5227.92,"providers":[{"billed_charge":15636.00,"npi":[1417615246]}]},{"allowed_amount":3049.62,"providers":[{"billed_charge":9121.00,"npi":[1588554984]}]},{"allowed_amount":4356.60,"providers":[{"billed_charge":13030.00,"npi":[1609766211]}]}]},{"tin":{"type":"ein","value":"611956307"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":701.10,"providers":[{"billed_charge":2484.00,"npi":[1760986848]}]}]},{"tin":{"type":"ein","value":"800443600"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2080.38,"providers":[{"billed_charge":12012.00,"npi":[1598334963]}]}]}]},{"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":"650622859"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1907.61,"providers":[{"billed_charge":5832.00,"npi":[1790203461]}]},{"allowed_amount":3815.22,"providers":[{"billed_charge":11664.00,"npi":[1881851491]}]}]},{"tin":{"type":"ein","value":"611956307"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1693.14,"providers":[{"billed_charge":6180.00,"npi":[1720531023]}]},{"allowed_amount":339.50,"providers":[{"billed_charge":1236.00,"npi":[1922495878,1437787140]}]},{"allowed_amount":679.00,"providers":[{"billed_charge":2472.00,"npi":[1265057178]}]},{"allowed_amount":169.75,"providers":[{"billed_charge":618.00,"npi":[1710566179]}]},{"allowed_amount":1186.07,"providers":[{"billed_charge":4326.00,"npi":[1922493998]}]},{"allowed_amount":1016.32,"providers":[{"billed_charge":3708.00,"npi":[1629607205]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"472378825"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":217.36,"providers":[{"billed_charge":1500.00,"npi":[1598308215]}]},{"allowed_amount":163.02,"providers":[{"billed_charge":1125.00,"npi":[1215301130]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"334775328"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":437.97,"providers":[{"billed_charge":2623.85,"npi":[1376204214]}]},{"allowed_amount":1725.01,"providers":[{"billed_charge":9970.63,"npi":[1215685656]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":266.77,"providers":[{"billed_charge":1275.00,"npi":[1234567893]}]}]}]},{"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":"636001304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":367.00,"providers":[{"billed_charge":1751.40,"npi":[1760550321]}]}]},{"tin":{"type":"ein","value":"933130363"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":588.87,"providers":[{"billed_charge":1622.00,"npi":[1265211312]}]}]},{"tin":{"type":"ein","value":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4942.71,"providers":[{"billed_charge":8649.35,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"850580697"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6086.55,"providers":[{"billed_charge":19055.50,"npi":[1851917504]}]}]},{"tin":{"type":"ein","value":"631122893"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2224.02,"providers":[{"billed_charge":3636.00,"npi":[1316012032]}]}]},{"tin":{"type":"ein","value":"630574273"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":305.34,"providers":[{"billed_charge":420.00,"npi":[1760432884]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14144.55,"providers":[{"billed_charge":57390.12,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"201145982"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1776.28,"providers":[{"billed_charge":4484.34,"npi":[1275591794]}]}]},{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33783.69,"providers":[{"billed_charge":67753.26,"npi":[1538236211]}]}]},{"tin":{"type":"ein","value":"453639743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":121.29,"providers":[{"billed_charge":130.00,"npi":[1477830164]}]}]},{"tin":{"type":"ein","value":"636001318"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5656.06,"providers":[{"billed_charge":10686.20,"npi":[1407816713]}]}]},{"tin":{"type":"ein","value":"463413109"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43.62,"providers":[{"billed_charge":150.00,"npi":[1063847085]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2668.09,"providers":[{"billed_charge":5823.27,"npi":[1194737460]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5059.92,"providers":[{"billed_charge":10440.00,"npi":[1215160916]}]}]},{"tin":{"type":"ein","value":"872027148"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4066.36,"providers":[{"billed_charge":9983.86,"npi":[1982300422]}]}]},{"tin":{"type":"ein","value":"831651180"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5303.21,"providers":[{"billed_charge":13299.88,"npi":[1659071108]}]}]},{"tin":{"type":"ein","value":"630866817"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10914.58,"providers":[{"billed_charge":22300.50,"npi":[1013098300]}]}]},{"tin":{"type":"ein","value":"814571957"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":149.28,"providers":[{"billed_charge":452.00,"npi":[1164966164]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2093.76,"providers":[{"billed_charge":7024.32,"npi":[1659753846]}]},{"allowed_amount":14224.92,"providers":[{"billed_charge":49078.89,"npi":[1891240859]}]}]},{"tin":{"type":"ein","value":"636001175"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":734.00,"providers":[{"billed_charge":1659.31,"npi":[1174500078]}]}]},{"tin":{"type":"ein","value":"631219758"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":513.80,"providers":[{"billed_charge":1287.00,"npi":[1407186232]}]},{"allowed_amount":501.63,"providers":[{"billed_charge":1173.00,"npi":[1265406854]}]}]},{"tin":{"type":"ein","value":"630737822"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6011.46,"providers":[{"billed_charge":15151.50,"npi":[1851471932]}]}]},{"tin":{"type":"ein","value":"994776543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":312.54,"providers":[{"billed_charge":480.00,"npi":[1356207237]}]}]},{"tin":{"type":"ein","value":"631130184"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1868.39,"providers":[{"billed_charge":4548.05,"npi":[1558457176]}]}]},{"tin":{"type":"ein","value":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7954.74,"providers":[{"billed_charge":27032.10,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23715.54,"providers":[{"billed_charge":88952.76,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"630621090"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4205.82,"providers":[{"billed_charge":17621.53,"npi":[1508876467]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15136.01,"providers":[{"billed_charge":32300.48,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20648.33,"providers":[{"billed_charge":49675.29,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"581097948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":110.31,"providers":[{"billed_charge":114.00,"npi":[1730133471]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11127.44,"providers":[{"billed_charge":30320.00,"npi":[1942277124]}]}]}]},{"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":"831651180"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5986.80,"providers":[{"billed_charge":14647.88,"npi":[1659071108]}]}]},{"tin":{"type":"ein","value":"872027148"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3192.96,"providers":[{"billed_charge":7358.32,"npi":[1982300422]}]}]},{"tin":{"type":"ein","value":"630866817"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14368.32,"providers":[{"billed_charge":26100.00,"npi":[1013098300]}]}]},{"tin":{"type":"ein","value":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27271.56,"providers":[{"billed_charge":48714.69,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"631122893"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":798.24,"providers":[{"billed_charge":1282.94,"npi":[1316012032]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":46297.92,"providers":[{"billed_charge":163631.38,"npi":[1891240859]}]},{"allowed_amount":4347.64,"providers":[{"billed_charge":14870.34,"npi":[1659753846]}]}]},{"tin":{"type":"ein","value":"630737822"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4390.32,"providers":[{"billed_charge":7425.00,"npi":[1851471932]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8695.28,"providers":[{"billed_charge":31135.24,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22468.44,"providers":[{"billed_charge":94715.00,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35521.68,"providers":[{"billed_charge":101128.64,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"630621090"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3991.20,"providers":[{"billed_charge":19199.90,"npi":[1508876467]}]}]},{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":109876.72,"providers":[{"billed_charge":220743.12,"npi":[1538236211]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17960.40,"providers":[{"billed_charge":47094.00,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7114.32,"providers":[{"billed_charge":16100.94,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"636001318"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":55333.60,"providers":[{"billed_charge":100800.00,"npi":[1407816713]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7583.28,"providers":[{"billed_charge":13775.00,"npi":[1942277124]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5138.12,"providers":[{"billed_charge":13762.00,"npi":[1194737460]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7114.32,"providers":[{"billed_charge":14436.00,"npi":[1215160916]}]}]}]},{"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":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6721.92,"providers":[{"billed_charge":19177.84,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1470.42,"providers":[{"billed_charge":5157.00,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12897.24,"providers":[{"billed_charge":31327.10,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"994776543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7488.72,"providers":[{"billed_charge":14500.00,"npi":[1356207237]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1456.14,"providers":[{"billed_charge":6261.88,"npi":[1386710515]}]}]}]},{"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":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5203.44,"providers":[{"billed_charge":21489.00,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6049.80,"providers":[{"billed_charge":17196.03,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"850580697"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29955.60,"providers":[{"billed_charge":90450.00,"npi":[1851917504]}]}]},{"tin":{"type":"ein","value":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23964.48,"providers":[{"billed_charge":42806.16,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1344.40,"providers":[{"billed_charge":3581.50,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7988.16,"providers":[{"billed_charge":28631.60,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1664.20,"providers":[{"billed_charge":3375.00,"npi":[1215160916]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":336.10,"providers":[{"billed_charge":625.00,"npi":[1942277124]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":998.52,"providers":[{"billed_charge":2679.50,"npi":[1194737460]}]}]}]},{"name":"ADVNCED LIFE SUPPORT LEVEL 2","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0433","description":"ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)","allowed_amounts":[{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5148.54,"providers":[{"billed_charge":10343.52,"npi":[1538236211]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1167.44,"providers":[{"billed_charge":5120.68,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4550.55,"providers":[{"billed_charge":21854.06,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5259.35,"providers":[{"billed_charge":19675.40,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":709.74,"providers":[{"billed_charge":5551.68,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":787.46,"providers":[{"billed_charge":4493.06,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1101.19,"providers":[{"billed_charge":5359.18,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":943.21,"providers":[{"billed_charge":4102.12,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":852.42,"providers":[{"billed_charge":4546.52,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":111.35,"providers":[{"billed_charge":698.40,"npi":[1234567893]}]}]}]},{"name":"WALKER FOLD WHEELED ADJUSTBL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0143","description":"WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":923.31,"providers":[{"billed_charge":4034.31,"npi":[1234567893]}]}]}]},{"name":"HOS BED SEMI-ELEC W/RAIL W/M","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0260","description":"HOSPITAL BED, SEMI-ELECTRIC (HEAD AND FOOT ADJUSTMENT), WITH ANY TYPE SIDE RAILS, WITH MATTRESS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1544.44,"providers":[{"billed_charge":9502.64,"npi":[1234567893]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2526.56,"providers":[{"billed_charge":10522.44,"npi":[1234567893]}]}]}]},{"name":"RESP ASST DEVC BI-LEVL PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0470","description":"RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1009.59,"providers":[{"billed_charge":4982.11,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7594.93,"providers":[{"billed_charge":31507.20,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":539.89,"providers":[{"billed_charge":3521.59,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":13459.82,"providers":[{"billed_charge":82349.24,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":25362.19,"providers":[{"billed_charge":130308.67,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4624.21,"providers":[{"billed_charge":24730.00,"npi":[1234567893]}]}]}]},{"name":"E-STIM 1/>NOT WND CARE PART","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0283","description":"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":173.89,"providers":[{"billed_charge":792.20,"npi":[1234567893]}]}]}]},{"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":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":868.32,"providers":[{"billed_charge":1035.00,"npi":[1053974402]}]},{"allowed_amount":39.96,"providers":[{"billed_charge":45.00,"npi":[1972952109]}]}]}]},{"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":"474426818"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2098.14,"providers":[{"billed_charge":2098.14,"npi":[1114398799]}]}]}]},{"name":"INJ CEFTRIAXONE SODM PER 250","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0696","description":"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG","allowed_amounts":[{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.14,"providers":[{"billed_charge":8.80,"npi":[1700615846]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.56,"providers":[{"billed_charge":2.20,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.72,"providers":[{"billed_charge":136.50,"npi":[1124591177]}]}]}]},{"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":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.56,"providers":[{"billed_charge":3.00,"npi":[1700615846]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.91,"providers":[{"billed_charge":632.00,"npi":[1234567893]}]}]}]},{"name":"INJ TRIAMCINOLON ACETONID NO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J3301","description":"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG","allowed_amounts":[{"tin":{"type":"ein","value":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.96,"providers":[{"billed_charge":30.00,"npi":[1083604961]}]}]}]},{"name":"STANDARD WHEELCHAIR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0001","description":"STANDARD WHEELCHAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2598.25,"providers":[{"billed_charge":10085.61,"npi":[1234567893]}]}]}]},{"name":"ELEVATING LEGREST PAIR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0195","description":"ELEVATING LEGRESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":194.98,"providers":[{"billed_charge":715.12,"npi":[1234567893]}]}]}]},{"name":"HOME INFUS TX CATH CARE COMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S5501","description":"HOME INFUSION THERAPY, CATHETER CARE/MAINTENANCE, COMPLEX (MORE THAN ONE LUMEN), INCLUDES ADMINISTRA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":288.00,"providers":[{"billed_charge":960.00,"npi":[1234567893]}]}]}]}]}