{"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":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":108.72,"providers":[{"billed_charge":165.20,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10.90,"providers":[{"billed_charge":37.05,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":115.42,"providers":[{"billed_charge":387.75,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37.00,"providers":[{"billed_charge":37.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59.25,"providers":[{"billed_charge":218.59,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20.83,"providers":[{"billed_charge":111.30,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52.35,"providers":[{"billed_charge":408.90,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":252.67,"providers":[{"billed_charge":2111.00,"npi":[1124025176]}]}]}]},{"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":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2529.40,"providers":[{"billed_charge":15020.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":665.33,"providers":[{"billed_charge":2674.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.81,"providers":[{"billed_charge":647.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1646.74,"providers":[{"billed_charge":5932.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":133.80,"providers":[{"billed_charge":1065.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":168.86,"providers":[{"billed_charge":1119.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2795.97,"providers":[{"billed_charge":15278.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":233.55,"providers":[{"billed_charge":1454.00,"npi":[1003864810]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":254.29,"providers":[{"billed_charge":2780.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1307.54,"providers":[{"billed_charge":2879.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":86.62,"providers":[{"billed_charge":846.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":565.16,"providers":[{"billed_charge":1849.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"426004813"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3272.82,"providers":[{"billed_charge":24685.00,"npi":[1376544320]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":534.34,"providers":[{"billed_charge":4881.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1027.52,"providers":[{"billed_charge":2337.00,"npi":[1871919381]}]},{"allowed_amount":3025.41,"providers":[{"billed_charge":16810.00,"npi":[1710396932]}]},{"allowed_amount":200.59,"providers":[{"billed_charge":796.00,"npi":[1871919381]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":312.91,"providers":[{"billed_charge":2582.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36.76,"providers":[{"billed_charge":352.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1721.80,"providers":[{"billed_charge":5516.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1959.59,"providers":[{"billed_charge":9989.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":126.00,"npi":[1376521575]}]},{"allowed_amount":2691.74,"providers":[{"billed_charge":11912.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3869.67,"providers":[{"billed_charge":21482.18,"npi":[1831170232]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":879.89,"providers":[{"billed_charge":6623.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1063.49,"providers":[{"billed_charge":7533.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4247.10,"providers":[{"billed_charge":30352.50,"npi":[1497859649]}]},{"allowed_amount":61.05,"providers":[{"billed_charge":947.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1314.25,"providers":[{"billed_charge":10872.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"370661172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":622.52,"providers":[{"billed_charge":3974.00,"npi":[1548278476]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3805.97,"providers":[{"billed_charge":26418.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1823.96,"providers":[{"billed_charge":14797.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"363479824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":275.87,"providers":[{"billed_charge":3146.00,"npi":[1902854623]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5760.81,"providers":[{"billed_charge":41244.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":33.55,"providers":[{"billed_charge":714.00,"npi":[1003864810]}]},{"allowed_amount":1238.82,"providers":[{"billed_charge":9782.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4448.58,"providers":[{"billed_charge":29343.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":962.87,"providers":[{"billed_charge":3368.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":182.46,"providers":[{"billed_charge":999.00,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"201673011"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":359.55,"providers":[{"billed_charge":1045.87,"npi":[1023754371]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":914.23,"providers":[{"billed_charge":2162.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3218.55,"providers":[{"billed_charge":4241.00,"npi":[1124025176]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":686.96,"providers":[{"billed_charge":4299.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":631.81,"providers":[{"billed_charge":4367.00,"npi":[1497859649]}]},{"allowed_amount":8.63,"providers":[{"billed_charge":162.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52.24,"providers":[{"billed_charge":394.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":520.32,"providers":[{"billed_charge":2736.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":360.60,"providers":[{"billed_charge":3133.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1084.99,"providers":[{"billed_charge":7248.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":111.81,"providers":[{"billed_charge":912.00,"npi":[1003864810]}]}]}]},{"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":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":69.94,"providers":[{"billed_charge":346.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1398.43,"providers":[{"billed_charge":7913.00,"npi":[1598756686]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":82.40,"providers":[{"billed_charge":380.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":110.69,"providers":[{"billed_charge":909.00,"npi":[1124025176]}]}]}]},{"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":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":188.82,"providers":[{"billed_charge":1036.00,"npi":[1598756686]}]}]}]},{"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":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":191.42,"providers":[{"billed_charge":1731.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":233.01,"providers":[{"billed_charge":2694.00,"npi":[1124025176]}]}]}]},{"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":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":891.86,"providers":[{"billed_charge":7358.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":891.86,"providers":[{"billed_charge":8642.00,"npi":[1124025176]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1203.37,"providers":[{"billed_charge":8554.00,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":137.28,"providers":[{"billed_charge":1508.32,"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":627.27,"providers":[{"billed_charge":4205.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1114.29,"providers":[{"billed_charge":12022.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9911.51,"providers":[{"billed_charge":104242.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1108.07,"providers":[{"billed_charge":14758.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8331.36,"providers":[{"billed_charge":81379.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9933.93,"providers":[{"billed_charge":98346.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":667.06,"providers":[{"billed_charge":3477.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21662.33,"providers":[{"billed_charge":211490.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3731.02,"providers":[{"billed_charge":40606.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9965.03,"providers":[{"billed_charge":127513.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1637.04,"providers":[{"billed_charge":11521.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3292.04,"providers":[{"billed_charge":23037.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11633.17,"providers":[{"billed_charge":93463.00,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"201673011"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":595.29,"providers":[{"billed_charge":3687.52,"npi":[1023754371]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":285.52,"providers":[{"billed_charge":939.41,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":0.67,"providers":[{"billed_charge":189.50,"npi":[1497859649]}]},{"allowed_amount":1136.96,"providers":[{"billed_charge":6050.25,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":657.38,"providers":[{"billed_charge":3865.25,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":402.16,"providers":[{"billed_charge":4278.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"370662580"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.32,"providers":[{"billed_charge":47.25,"npi":[1083617245]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":837.77,"providers":[{"billed_charge":2922.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":628.43,"providers":[{"billed_charge":3827.83,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"951816017"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":245.03,"providers":[{"billed_charge":816.76,"npi":[1831188275]}]}]},{"tin":{"type":"ein","value":"426004813"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7528.47,"providers":[{"billed_charge":31311.57,"npi":[1376544320]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":139.97,"providers":[{"billed_charge":1629.65,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1923.11,"providers":[{"billed_charge":14461.50,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":584.57,"providers":[{"billed_charge":8422.25,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":590.77,"providers":[{"billed_charge":908.60,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":63858.33,"providers":[{"billed_charge":170968.70,"npi":[1376521575]}]},{"allowed_amount":704.24,"providers":[{"billed_charge":2214.24,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":745.09,"providers":[{"billed_charge":2635.31,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"201673011"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":228.54,"providers":[{"billed_charge":1724.31,"npi":[1023754371]}]}]}]},{"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":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":311.50,"providers":[{"billed_charge":2650.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.79,"providers":[{"billed_charge":2177.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":747.60,"providers":[{"billed_charge":5100.00,"npi":[1124025176]}]}]}]},{"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":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":87.64,"providers":[{"billed_charge":260.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":110.89,"providers":[{"billed_charge":680.00,"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":"383852646"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":75.12,"providers":[{"billed_charge":573.00,"npi":[1114094042]}]}]},{"tin":{"type":"ein","value":"20715915"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":955.85,"providers":[{"billed_charge":3220.00,"npi":[1932184678]}]},{"allowed_amount":191.17,"providers":[{"billed_charge":644.00,"npi":[1679005243]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.65,"providers":[{"billed_charge":338.64,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":930.87,"providers":[{"billed_charge":15085.79,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":144.73,"providers":[{"billed_charge":1731.84,"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":814.34,"providers":[{"billed_charge":17771.22,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":102.81,"providers":[{"billed_charge":1231.88,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14.84,"providers":[{"billed_charge":177.52,"npi":[1234567893]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":56.43,"providers":[{"billed_charge":1405.12,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":394.52,"providers":[{"billed_charge":6604.59,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":148.35,"providers":[{"billed_charge":1776.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.85,"providers":[{"billed_charge":130.20,"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":79.08,"providers":[{"billed_charge":1715.96,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.05,"providers":[{"billed_charge":144.58,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":120.96,"providers":[{"billed_charge":1447.68,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33.08,"providers":[{"billed_charge":540.48,"npi":[1609812445]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.83,"providers":[{"billed_charge":764.40,"npi":[1234567893]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":301.05,"providers":[{"billed_charge":4549.20,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.88,"providers":[{"billed_charge":466.08,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.79,"providers":[{"billed_charge":190.41,"npi":[1609812445]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.96,"providers":[{"billed_charge":185.28,"npi":[1609812445]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.16,"providers":[{"billed_charge":241.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":189.67,"providers":[{"billed_charge":3031.95,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":120.70,"providers":[{"billed_charge":3864.08,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":869.34,"providers":[{"billed_charge":13322.90,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":179.52,"providers":[{"billed_charge":2150.40,"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":599.62,"providers":[{"billed_charge":6935.35,"npi":[1609812445]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.20,"providers":[{"billed_charge":1616.16,"npi":[1234567893]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.52,"providers":[{"billed_charge":178.32,"npi":[1609812445]}]}]}]},{"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":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.65,"providers":[{"billed_charge":362.16,"npi":[1609812445]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"431039532"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.74,"providers":[{"billed_charge":868.80,"npi":[1609812445]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16.08,"providers":[{"billed_charge":192.64,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":62.67,"providers":[{"billed_charge":545.54,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.60,"providers":[{"billed_charge":551.08,"npi":[1234567893]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":106.68,"providers":[{"billed_charge":1088.64,"npi":[1234567893]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"363661051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":186.08,"providers":[{"billed_charge":220.00,"npi":[1366181869]}]}]}]},{"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":"999999999"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":334.00,"providers":[{"billed_charge":702.00,"npi":[1234567893]}]},{"allowed_amount":163.19,"providers":[{"billed_charge":220.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"274348005"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":456.16,"providers":[{"billed_charge":1300.00,"npi":[1922611326]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97.48,"providers":[{"billed_charge":215.60,"npi":[1083662795]}]}]}]},{"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":"362894128"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.87,"providers":[{"billed_charge":150.00,"npi":[1851321467,1174831168]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":582.60,"providers":[{"billed_charge":2450.00,"npi":[1265923494]}]}]}]},{"name":"PRO FEE/LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"971","description":"PROFESSIONAL FEES - LABORATORY","allowed_amounts":[{"tin":{"type":"ein","value":"371119538"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38.48,"providers":[{"billed_charge":43.00,"npi":[1013071653]}]}]}]},{"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":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5219.92,"providers":[{"billed_charge":13200.00,"npi":[1265923494]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":109.28,"providers":[{"billed_charge":240.00,"npi":[1265923494]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":308.90,"providers":[{"billed_charge":406.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2699.27,"providers":[{"billed_charge":4830.00,"npi":[1265923494]}]}]}]},{"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":"364249586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1355.04,"providers":[{"billed_charge":3200.00,"npi":[1922989946]}]}]},{"tin":{"type":"ein","value":"363661051"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1753.06,"providers":[{"billed_charge":6900.00,"npi":[1366181869]}]},{"allowed_amount":76.22,"providers":[{"billed_charge":300.00,"npi":[1366181869]}]}]}]},{"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":"834471506"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1036.74,"providers":[{"billed_charge":3366.00,"npi":[1548082647]}]}]},{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1737.80,"providers":[{"billed_charge":3886.40,"npi":[1083662795]}]}]},{"tin":{"type":"ein","value":"934971906"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1413.94,"providers":[{"billed_charge":2570.00,"npi":[1639707532]}]}]}]},{"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":"362960158"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1325.41,"providers":[{"billed_charge":2867.48,"npi":[1770140915]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ","allowed_amounts":[{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2399.12,"providers":[{"billed_charge":5000.00,"npi":[1083662795]}]}]}]},{"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":"272791517"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1418.16,"providers":[{"billed_charge":5016.00,"npi":[1710294368]}]}]},{"tin":{"type":"ein","value":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13812.84,"providers":[{"billed_charge":61914.00,"npi":[1336107838]}]}]},{"tin":{"type":"ein","value":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1898.82,"providers":[{"billed_charge":3876.00,"npi":[1376554592]}]}]}]},{"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":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11047.04,"providers":[{"billed_charge":58840.00,"npi":[1336107838]}]}]},{"tin":{"type":"ein","value":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30970.76,"providers":[{"billed_charge":186880.00,"npi":[1376554592]}]}]}]},{"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":"272791517"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4369.05,"providers":[{"billed_charge":27000.00,"npi":[1710294368]}]}]},{"tin":{"type":"ein","value":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10234.29,"providers":[{"billed_charge":59850.00,"npi":[1336107838]}]}]}]},{"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":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3721.44,"providers":[{"billed_charge":25070.00,"npi":[1376554592]}]}]}]},{"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":"204747232"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1362.55,"providers":[{"billed_charge":2465.00,"npi":[1033142484]}]}]}]},{"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":"362668175"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":39.32,"providers":[{"billed_charge":55.00,"npi":[1669905394]}]}]}]},{"name":"APPL MODAL 1/MORE AREAS; LW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S8948","description":"APPLICATION OF A MODALITY (REQUIRING CONSTANT PROVIDER ATTENDANCE) TO ONE OR MORE AREAS; LOW-LEVEL L","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1188.00,"providers":[{"billed_charge":3960.00,"npi":[1265923494]}]}]}]},{"name":"VERT AXIAL DECOMPRS PER SESS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9090","description":"VERTEBRAL AXIAL DECOMPRESSION, PER SESSION","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":808.50,"providers":[{"billed_charge":2695.00,"npi":[1265923494]}]}]}]}]}