{ "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": "PSTAY/PVT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "114", "description": "ROOM AND BOARD - PRIVATE -PSYCHIATRIC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "481172106" }, "service_code": ["21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1042930.31, "providers": [{ "billed_charge": 2152234.83, "npi": [1154314789] } ] } ] } ] }, { "name": "PHARMACY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "250", "description": "PHARMACY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "486005089" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 302.23, "providers": [{ "billed_charge": 1007.40, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29.87, "providers": [{ "billed_charge": 99.50, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1216.46, "providers": [{ "billed_charge": 4054.65, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 627.29, "providers": [{ "billed_charge": 701.35, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 724.29, "providers": [{ "billed_charge": 1551.10, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1440.67, "providers": [{ "billed_charge": 2619.39, "npi": [1366515488] } ] }, { "allowed_amount": 128.79, "providers": [{ "billed_charge": 234.14, "npi": [1154400232] } ] }, { "allowed_amount": 106.45, "providers": [{ "billed_charge": 193.55, "npi": [1366515488] } ] }, { "allowed_amount": 1547.38, "providers": [{ "billed_charge": 2813.44, "npi": [1154400232] } ] }, { "allowed_amount": 1250.01, "providers": [{ "billed_charge": 2272.71, "npi": [1154400232] } ] }, { "allowed_amount": 3787.48, "providers": [{ "billed_charge": 6886.32, "npi": [1366515488] } ] }, { "allowed_amount": 386.31, "providers": [{ "billed_charge": 702.39, "npi": [1154400232] } ] }, { "allowed_amount": 82273.94, "providers": [{ "billed_charge": 149588.99, "npi": [1366515488] } ] } ] }, { "tin": { "type": "ein", "value": "480640918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 116.15, "providers": [{ "billed_charge": 116.15, "npi": [1639261811] } ] } ] }, { "tin": { "type": "ein", "value": "480543721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 36.16, "providers": [{ "billed_charge": 713.81, "npi": [1689317190] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 686.28, "providers": [{ "billed_charge": 1797.20, "npi": [1194782409] } ] } ] } ] }, { "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": "486005089" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 315.41, "providers": [{ "billed_charge": 1051.25, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 262.24, "providers": [{ "billed_charge": 2408.00, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 283.78, "providers": [{ "billed_charge": 3205.00, "npi": [1194782409] } ] } ] } ] }, { "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": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11.47, "providers": [{ "billed_charge": 1178.24, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "331234289" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 8.52, "providers": [{ "billed_charge": 9.15, "npi": [1205654076] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17.90, "providers": [{ "billed_charge": 43.65, "npi": [1194782409] } ] } ] } ] }, { "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": "440605373" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 755.15, "providers": [{ "billed_charge": 1373.00, "npi": [1366515488] } ] }, { "allowed_amount": 540.10, "providers": [{ "billed_charge": 982.00, "npi": [1366515488] } ] }, { "allowed_amount": 333.30, "providers": [{ "billed_charge": 606.00, "npi": [1366515488] } ] } ] } ] }, { "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": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2271.33, "providers": [{ "billed_charge": 5593.02, "npi": [1245643576] } ] }, { "allowed_amount": 354.57, "providers": [{ "billed_charge": 1641.05, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 287.76, "providers": [{ "billed_charge": 1092.38, "npi": [1194782409] } ] } ] } ] }, { "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": "486005089" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1584.06, "providers": [{ "billed_charge": 5279.91, "npi": [1548229149] } ] } ] } ] }, { "name": "LABORATORY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "300", "description": "LABORATORY - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742849611" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 727.37, "providers": [{ "billed_charge": 1592.00, "npi": [1316911878] } ] } ] }, { "tin": { "type": "ein", "value": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18656.09, "providers": [{ "billed_charge": 54183.00, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 16.24, "providers": [{ "billed_charge": 40.00, "npi": [1245643576] } ] }, { "allowed_amount": 504.86, "providers": [{ "billed_charge": 700.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2590.20, "providers": [{ "billed_charge": 4317.00, "npi": [1598839045] } ] }, { "allowed_amount": 699.00, "providers": [{ "billed_charge": 1165.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "820581689" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 312.00, "providers": [{ "billed_charge": 312.00, "npi": [1760489223] } ] }, { "allowed_amount": 51.00, "providers": [{ "billed_charge": 51.00, "npi": [1760489223] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18221.92, "providers": [{ "billed_charge": 80618.12, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "832312217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1611.61, "providers": [{ "billed_charge": 6271.24, "npi": [1750921029] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 17886.31, "providers": [{ "billed_charge": 92642.70, "npi": [1194782409] } ] } ] }, { "tin": { "type": "ein", "value": "481226830" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1506.42, "providers": [{ "billed_charge": 1665.02, "npi": [1700985116] } ] } ] }, { "tin": { "type": "ein", "value": "843362602" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3858.86, "providers": [{ "billed_charge": 6159.00, "npi": [1639185457] } ] } ] }, { "tin": { "type": "ein", "value": "352635546" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 248.00, "providers": [{ "billed_charge": 2027.19, "npi": [1336623198] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 174.03, "providers": [{ "billed_charge": 354710.00, "npi": [1154303337] } ] } ] }, { "tin": { "type": "ein", "value": "486005089" }, "service_code": ["23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 15.59, "providers": [{ "billed_charge": 44.90, "npi": [1548229149] } ] }, { "allowed_amount": 22232.07, "providers": [{ "billed_charge": 25472.50, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "923209338" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 459.80, "providers": [{ "billed_charge": 6250.00, "npi": [1558132365] } ] } ] }, { "tin": { "type": "ein", "value": "562518746" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3387.38, "providers": [{ "billed_charge": 5645.00, "npi": [1427151992] } ] } ] }, { "tin": { "type": "ein", "value": "480630224" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 25.00, "providers": [{ "billed_charge": 25.00, "npi": [1902872997] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 66.00, "providers": [{ "billed_charge": 120.00, "npi": [1154400232] } ] }, { "allowed_amount": 52.80, "providers": [{ "billed_charge": 96.00, "npi": [1366515488] } ] } ] }, { "tin": { "type": "ein", "value": "481226856" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 49.60, "providers": [{ "billed_charge": 67.00, "npi": [1902914823] } ] } ] }, { "tin": { "type": "ein", "value": "480640918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5805.79, "providers": [{ "billed_charge": 8292.90, "npi": [1639261811] } ] } ] }, { "tin": { "type": "ein", "value": "331234289" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7645.97, "providers": [{ "billed_charge": 42033.30, "npi": [1205654076] } ] } ] }, { "tin": { "type": "ein", "value": "440545297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 326.68, "providers": [{ "billed_charge": 51022.00, "npi": [1063494177] } ] } ] } ] }, { "name": "LAB/CHEMISTRY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "301", "description": "LABORATORY - CHEMISTRY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 711.03, "providers": [{ "billed_charge": 9329.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "730757033" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 477.07, "providers": [{ "billed_charge": 477.07, "npi": [1891703716] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 44.26, "providers": [{ "billed_charge": 109.00, "npi": [1245643576] } ] }, { "allowed_amount": 11905.06, "providers": [{ "billed_charge": 16090.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3909.00, "providers": [{ "billed_charge": 6515.00, "npi": [1598839045] } ] }, { "allowed_amount": 13030.80, "providers": [{ "billed_charge": 21718.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2112.55, "providers": [{ "billed_charge": 3841.00, "npi": [1154400232] } ] }, { "allowed_amount": 36590.40, "providers": [{ "billed_charge": 66528.00, "npi": [1366515488] } ] }, { "allowed_amount": 812.90, "providers": [{ "billed_charge": 1478.00, "npi": [1154400232] } ] }, { "allowed_amount": 1293.60, "providers": [{ "billed_charge": 2352.00, "npi": [1366515488] } ] }, { "allowed_amount": 112.75, "providers": [{ "billed_charge": 205.00, "npi": [1154400232] } ] }, { "allowed_amount": 26620.00, "providers": [{ "billed_charge": 48400.00, "npi": [1366515488] } ] } ] }, { "tin": { "type": "ein", "value": "480543721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 782.15, "providers": [{ "billed_charge": 6370.41, "npi": [1689317190] } ] } ] }, { "tin": { "type": "ein", "value": "832312217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 134.04, "providers": [{ "billed_charge": 454.94, "npi": [1750921029] } ] } ] }, { "tin": { "type": "ein", "value": "730606129" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1765.63, "providers": [{ "billed_charge": 3379.00, "npi": [1215914254] } ] } ] } ] }, { "name": "LAB/IMMUNOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "302", "description": "LABORATORY - IMMUNOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "730757033" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 407.65, "providers": [{ "billed_charge": 407.65, "npi": [1891703716] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10106.80, "providers": [{ "billed_charge": 18376.00, "npi": [1366515488] } ] }, { "allowed_amount": 70.40, "providers": [{ "billed_charge": 128.00, "npi": [1154400232] } ] }, { "allowed_amount": 105.60, "providers": [{ "billed_charge": 192.00, "npi": [1366515488] } ] }, { "allowed_amount": 9882.95, "providers": [{ "billed_charge": 17969.00, "npi": [1366515488] } ] } ] } ] }, { "name": "LAB/HEMATOLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "305", "description": "LABORATORY - HEMATOLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 18.27, "providers": [{ "billed_charge": 45.00, "npi": [1245643576] } ] }, { "allowed_amount": 3277.48, "providers": [{ "billed_charge": 3786.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 648.00, "providers": [{ "billed_charge": 1080.00, "npi": [1598839045] } ] }, { "allowed_amount": 957.60, "providers": [{ "billed_charge": 1596.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4389.55, "providers": [{ "billed_charge": 7981.00, "npi": [1366515488] } ] }, { "allowed_amount": 2431.00, "providers": [{ "billed_charge": 4420.00, "npi": [1366515488] } ] }, { "allowed_amount": 484.55, "providers": [{ "billed_charge": 881.00, "npi": [1154400232] } ] }, { "allowed_amount": 580.25, "providers": [{ "billed_charge": 1055.00, "npi": [1366515488] } ] }, { "allowed_amount": 946.55, "providers": [{ "billed_charge": 1721.00, "npi": [1154400232] } ] }, { "allowed_amount": 52.80, "providers": [{ "billed_charge": 96.00, "npi": [1366515488] } ] } ] }, { "tin": { "type": "ein", "value": "730606129" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 109.92, "providers": [{ "billed_charge": 280.00, "npi": [1215914254] } ] } ] } ] }, { "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": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2933.78, "providers": [{ "billed_charge": 6721.00, "npi": [1245643576] } ] }, { "allowed_amount": 40.61, "providers": [{ "billed_charge": 100.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1973.40, "providers": [{ "billed_charge": 3588.00, "npi": [1366515488] } ] }, { "allowed_amount": 7224.25, "providers": [{ "billed_charge": 13135.00, "npi": [1154400232] } ] }, { "allowed_amount": 3715.80, "providers": [{ "billed_charge": 6756.00, "npi": [1366515488] } ] }, { "allowed_amount": 4889.50, "providers": [{ "billed_charge": 8890.00, "npi": [1366515488] } ] }, { "allowed_amount": 640.20, "providers": [{ "billed_charge": 1164.00, "npi": [1154400232] } ] }, { "allowed_amount": 6141.30, "providers": [{ "billed_charge": 11166.00, "npi": [1366515488] } ] }, { "allowed_amount": 3900.60, "providers": [{ "billed_charge": 7092.00, "npi": [1154400232] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 12891.30, "providers": [{ "billed_charge": 29318.00, "npi": [1154303337] } ] } ] } ] }, { "name": "LAB/UROLOGY", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "307", "description": "LABORATORY - UROLOGY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 319.88, "providers": [{ "billed_charge": 321.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 116.60, "providers": [{ "billed_charge": 212.00, "npi": [1366515488] } ] }, { "allowed_amount": 73.70, "providers": [{ "billed_charge": 134.00, "npi": [1154400232] } ] }, { "allowed_amount": 101.20, "providers": [{ "billed_charge": 184.00, "npi": [1366515488] } ] }, { "allowed_amount": 36.85, "providers": [{ "billed_charge": 67.00, "npi": [1154400232] } ] } ] } ] }, { "name": "LAB/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "309", "description": "LABORATORY - OTHER LABORATORY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480640918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 145.41, "providers": [{ "billed_charge": 151.65, "npi": [1639261811] } ] } ] } ] }, { "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": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4320.28, "providers": [{ "billed_charge": 5845.00, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 734.43, "providers": [{ "billed_charge": 735.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3967.59, "providers": [{ "billed_charge": 14875.00, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2832.00, "providers": [{ "billed_charge": 4720.00, "npi": [1598839045] } ] }, { "allowed_amount": 540.60, "providers": [{ "billed_charge": 901.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "20", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4340.60, "providers": [{ "billed_charge": 7892.00, "npi": [1154400232] } ] }, { "allowed_amount": 3002.45, "providers": [{ "billed_charge": 5459.00, "npi": [1366515488] } ] }, { "allowed_amount": 2067.45, "providers": [{ "billed_charge": 3759.00, "npi": [1154400232] } ] }, { "allowed_amount": 4214.10, "providers": [{ "billed_charge": 7662.00, "npi": [1366515488] } ] }, { "allowed_amount": 11937.20, "providers": [{ "billed_charge": 21704.00, "npi": [1154400232] } ] }, { "allowed_amount": 3577.20, "providers": [{ "billed_charge": 6504.00, "npi": [1366515488] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3604.08, "providers": [{ "billed_charge": 13087.53, "npi": [1194782409] } ] } ] } ] }, { "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": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 262.00, "providers": [{ "billed_charge": 262.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4823.97, "providers": [{ "billed_charge": 35845.00, "npi": [1154303337] } ] } ] } ] }, { "name": "CT SCAN", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "350", "description": "CT SCAN - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "331234289" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4261.24, "providers": [{ "billed_charge": 37351.84, "npi": [1205654076] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 22616.42, "providers": [{ "billed_charge": 619520.00, "npi": [1154303337] } ] } ] }, { "tin": { "type": "ein", "value": "440545297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1395.34, "providers": [{ "billed_charge": 18833.00, "npi": [1063494177] } ] } ] } ] }, { "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": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 558.53, "providers": [{ "billed_charge": 2236.70, "npi": [1194782409] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1342.59, "providers": [{ "billed_charge": 56674.00, "npi": [1154303337] } ] } ] } ] }, { "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": "486005089" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 485.60, "providers": [{ "billed_charge": 1399.00, "npi": [1548229149] } ] }, { "allowed_amount": 28963.37, "providers": [{ "billed_charge": 29925.80, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 92.19, "providers": [{ "billed_charge": 1830.00, "npi": [1679280192] } ] }, { "allowed_amount": 12405.71, "providers": [{ "billed_charge": 53928.00, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 100.22, "providers": [{ "billed_charge": 542.42, "npi": [1194782409] } ] }, { "allowed_amount": 6712.35, "providers": [{ "billed_charge": 47131.88, "npi": [1194782409] } ] } ] } ] }, { "name": "ROUTINE VENIPUNCTURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "36415", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2091.97, "providers": [{ "billed_charge": 8190.00, "npi": [1942526447] } ] } ] }, { "tin": { "type": "ein", "value": "481154210" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 219.69, "providers": [{ "billed_charge": 575.00, "npi": [1285224907] } ] } ] }, { "tin": { "type": "ein", "value": "205949265" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.60, "providers": [{ "billed_charge": 24.96, "npi": [1437410446] } ] } ] }, { "tin": { "type": "ein", "value": "481091875" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.33, "providers": [{ "billed_charge": 20.00, "npi": [1568274942] } ] } ] } ] }, { "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": "440605373" }, "service_code": ["22", "23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5617.15, "providers": [{ "billed_charge": 10213.00, "npi": [1366515488] } ] }, { "allowed_amount": 2482.70, "providers": [{ "billed_charge": 4514.00, "npi": [1366515488] } ] }, { "allowed_amount": 11250.80, "providers": [{ "billed_charge": 20456.00, "npi": [1366515488] } ] } ] } ] }, { "name": "PHYS THERP/VISIT", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "421", "description": "PHYSICAL THERAPY/VISIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1863.00, "providers": [{ "billed_charge": 3105.00, "npi": [1598839045] } ] } ] } ] }, { "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": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3756.67, "providers": [{ "billed_charge": 24676.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57036.98, "providers": [{ "billed_charge": 102877.00, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 43448.63, "providers": [{ "billed_charge": 51621.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 10015.80, "providers": [{ "billed_charge": 16693.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 50428.07, "providers": [{ "billed_charge": 125251.19, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "832312217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 784.94, "providers": [{ "billed_charge": 6390.81, "npi": [1750921029] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 32521.42, "providers": [{ "billed_charge": 85572.17, "npi": [1194782409] } ] } ] }, { "tin": { "type": "ein", "value": "843362602" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7655.01, "providers": [{ "billed_charge": 12228.00, "npi": [1639185457] } ] } ] }, { "tin": { "type": "ein", "value": "730606129" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5985.51, "providers": [{ "billed_charge": 16505.00, "npi": [1215914254] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 255163.01, "providers": [{ "billed_charge": 1168133.00, "npi": [1154303337] } ] } ] }, { "tin": { "type": "ein", "value": "486005089" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 57406.36, "providers": [{ "billed_charge": 77027.40, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "562518746" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2450.45, "providers": [{ "billed_charge": 5111.00, "npi": [1427151992] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["23", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 94532.35, "providers": [{ "billed_charge": 171877.00, "npi": [1154400232] } ] }, { "allowed_amount": 60661.70, "providers": [{ "billed_charge": 110294.00, "npi": [1366515488] } ] }, { "allowed_amount": 5123.80, "providers": [{ "billed_charge": 9316.00, "npi": [1366515488] } ] }, { "allowed_amount": 2561.90, "providers": [{ "billed_charge": 4658.00, "npi": [1154400232] } ] } ] }, { "tin": { "type": "ein", "value": "480640918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7788.07, "providers": [{ "billed_charge": 14806.61, "npi": [1639261811] } ] } ] }, { "tin": { "type": "ein", "value": "480543721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7658.33, "providers": [{ "billed_charge": 31661.15, "npi": [1689317190] } ] } ] }, { "tin": { "type": "ein", "value": "440565393" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1568.46, "providers": [{ "billed_charge": 8236.00, "npi": [1942241799] } ] } ] }, { "tin": { "type": "ein", "value": "331234289" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 30727.51, "providers": [{ "billed_charge": 116254.61, "npi": [1205654076] } ] } ] }, { "tin": { "type": "ein", "value": "440545297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29794.71, "providers": [{ "billed_charge": 127846.00, "npi": [1063494177] } ] } ] } ] }, { "name": "URGENT CARE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "456", "description": "EMERGENCY ROOM - URGENT CARE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "440605373" }, "service_code": ["20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4296.60, "providers": [{ "billed_charge": 7812.00, "npi": [1154400232] } ] } ] } ] }, { "name": "OTHER EMER ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "459", "description": "EMERGENCY ROOM - OTHER EMERGENCY ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 9450.59, "providers": [{ "billed_charge": 38510.27, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4099.50, "providers": [{ "billed_charge": 20042.59, "npi": [1194782409] } ] } ] } ] }, { "name": "CLINIC", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "510", "description": "CLINIC - GENERAL CLASSIFICATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 138.00, "providers": [{ "billed_charge": 230.00, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "21"], "billing_class": "institutional", "payments": [{ "allowed_amount": 11625.90, "providers": [{ "billed_charge": 21138.00, "npi": [1154400232] } ] }, { "allowed_amount": 181.50, "providers": [{ "billed_charge": 330.00, "npi": [1366515488] } ] }, { "allowed_amount": 18991.50, "providers": [{ "billed_charge": 34530.00, "npi": [1366515488] } ] } ] } ] }, { "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": "821883948" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 169.81, "providers": [{ "billed_charge": 566.00, "npi": [1649794157] } ] } ] }, { "tin": { "type": "ein", "value": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 7268.67, "providers": [{ "billed_charge": 24253.82, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3465.74, "providers": [{ "billed_charge": 6788.38, "npi": [1245643576] } ] }, { "allowed_amount": 663.21, "providers": [{ "billed_charge": 1633.13, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "480725111" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1425.46, "providers": [{ "billed_charge": 2375.78, "npi": [1598839045] } ] }, { "allowed_amount": 113783.19, "providers": [{ "billed_charge": 189638.64, "npi": [1598839045] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 6764.09, "providers": [{ "billed_charge": 28030.50, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "832312217" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 498.59, "providers": [{ "billed_charge": 2255.61, "npi": [1750921029] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5321.53, "providers": [{ "billed_charge": 20346.70, "npi": [1194782409] } ] } ] }, { "tin": { "type": "ein", "value": "843362602" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 790.19, "providers": [{ "billed_charge": 1255.25, "npi": [1639185457] } ] } ] }, { "tin": { "type": "ein", "value": "481203262" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 656.86, "providers": [{ "billed_charge": 77956.80, "npi": [1154303337] } ] } ] }, { "tin": { "type": "ein", "value": "730606129" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55.16, "providers": [{ "billed_charge": 183.75, "npi": [1215914254] } ] } ] }, { "tin": { "type": "ein", "value": "486005089" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 174.31, "providers": [{ "billed_charge": 502.20, "npi": [1548229149] } ] }, { "allowed_amount": 3757.78, "providers": [{ "billed_charge": 10822.87, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "440605373" }, "service_code": ["22", "23", "20"], "billing_class": "institutional", "payments": [{ "allowed_amount": 99.95, "providers": [{ "billed_charge": 181.72, "npi": [1154400232] } ] }, { "allowed_amount": 24781.85, "providers": [{ "billed_charge": 45057.81, "npi": [1366515488] } ] }, { "allowed_amount": 1091.12, "providers": [{ "billed_charge": 1983.88, "npi": [1366515488] } ] }, { "allowed_amount": 38749.41, "providers": [{ "billed_charge": 70453.46, "npi": [1154400232] } ] }, { "allowed_amount": 816.48, "providers": [{ "billed_charge": 1484.49, "npi": [1154400232] } ] } ] }, { "tin": { "type": "ein", "value": "480640918" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 672.80, "providers": [{ "billed_charge": 1273.00, "npi": [1639261811] } ] } ] }, { "tin": { "type": "ein", "value": "480543721" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 379.78, "providers": [{ "billed_charge": 1844.81, "npi": [1689317190] } ] } ] }, { "tin": { "type": "ein", "value": "440565393" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1.00, "providers": [{ "billed_charge": 3027.55, "npi": [1942241799] } ] } ] }, { "tin": { "type": "ein", "value": "331234289" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1600.25, "providers": [{ "billed_charge": 2967.44, "npi": [1205654076] } ] } ] }, { "tin": { "type": "ein", "value": "440545297" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 196.41, "providers": [{ "billed_charge": 3648.95, "npi": [1063494177] } ] } ] } ] }, { "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": "824944510" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.49, "providers": [{ "billed_charge": 96.00, "npi": [1467866178] } ] }, { "allowed_amount": 40.98, "providers": [{ "billed_charge": 192.00, "npi": [1427492909] } ] }, { "allowed_amount": 34.15, "providers": [{ "billed_charge": 140.00, "npi": [1427492909] } ] } ] }, { "tin": { "type": "ein", "value": "481191854" }, "service_code": ["22", "23", "31", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 32.00, "providers": [{ "billed_charge": 130.00, "npi": [1467866178] } ] }, { "allowed_amount": 6.39, "providers": [{ "billed_charge": 26.00, "npi": [1518429448, 1467866178] } ] }, { "allowed_amount": 102.39, "providers": [{ "billed_charge": 416.00, "npi": [1467866178] } ] }, { "allowed_amount": 19.22, "providers": [{ "billed_charge": 78.00, "npi": [1467866178] } ] } ] }, { "tin": { "type": "ein", "value": "481200790" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.45, "providers": [{ "billed_charge": 33.00, "npi": [1699062232] } ] }, { "allowed_amount": 51.23, "providers": [{ "billed_charge": 264.00, "npi": [1376511766] } ] }, { "allowed_amount": 102.49, "providers": [{ "billed_charge": 528.00, "npi": [1376511766] } ] }, { "allowed_amount": 108.78, "providers": [{ "billed_charge": 561.00, "npi": [1699062232] } ] }, { "allowed_amount": 121.41, "providers": [{ "billed_charge": 627.00, "npi": [1538368451] } ] }, { "allowed_amount": 31.94, "providers": [{ "billed_charge": 165.00, "npi": [1538368451] } ] } ] } ] }, { "name": "X-RAY EXAM CHEST 2 VIEWS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "71046", "description": "RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824944510" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.40, "providers": [{ "billed_charge": 78.00, "npi": [1427492909] } ] } ] }, { "tin": { "type": "ein", "value": "481191854" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 99.93, "providers": [{ "billed_charge": 416.00, "npi": [1518429448] } ] }, { "allowed_amount": 23.07, "providers": [{ "billed_charge": 96.00, "npi": [1518429448] } ] } ] }, { "tin": { "type": "ein", "value": "830516935" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 55.20, "providers": [{ "billed_charge": 130.00, "npi": [1285784801] } ] } ] } ] }, { "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": "486005089" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1239.09, "providers": [{ "billed_charge": 1666.70, "npi": [1548229149] } ] } ] }, { "tin": { "type": "ein", "value": "446005747" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1201.16, "providers": [{ "billed_charge": 2684.00, "npi": [1629062799] } ] } ] }, { "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1805.64, "providers": [{ "billed_charge": 2076.00, "npi": [1245643576] } ] } ] }, { "tin": { "type": "ein", "value": "883089376" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1591.94, "providers": [{ "billed_charge": 5624.00, "npi": [1679280192] } ] } ] }, { "tin": { "type": "ein", "value": "480543789" }, "service_code": ["22", "23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 55.20, "providers": [{ "billed_charge": 509.37, "npi": [1194782409] } ] }, { "allowed_amount": 1250.81, "providers": [{ "billed_charge": 6112.44, "npi": [1194782409] } ] } ] } ] }, { "name": "X-RAY EXAM OF FOOT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "73630", "description": "RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF 3 VIEWS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "830516935" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.81, "providers": [{ "billed_charge": 28.00, "npi": [1285784801] } ] }, { "allowed_amount": 285.92, "providers": [{ "billed_charge": 720.00, "npi": [1285784801] } ] } ] } ] }, { "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": "481200790" }, "service_code": ["23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 832.00, "providers": [{ "billed_charge": 5187.00, "npi": [1376511766] } ] }, { "allowed_amount": 320.00, "providers": [{ "billed_charge": 1995.00, "npi": [1699062232] } ] }, { "allowed_amount": 704.64, "providers": [{ "billed_charge": 4389.00, "npi": [1538368451] } ] }, { "allowed_amount": 127.24, "providers": [{ "billed_charge": 798.00, "npi": [1376511766] } ] } ] } ] }, { "name": "TREATMENT ROOM", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "761", "description": "TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "486026835" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 2988.86, "providers": [{ "billed_charge": 3632.00, "npi": [1245643576] } ] } ] } ] }, { "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": "824944510" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.20, "providers": [{ "billed_charge": 636.00, "npi": [1306093851] } ] }, { "allowed_amount": 845.57, "providers": [{ "billed_charge": 4028.00, "npi": [1821314410] } ] }, { "allowed_amount": 590.20, "providers": [{ "billed_charge": 2756.00, "npi": [1306093851] } ] }, { "allowed_amount": 272.40, "providers": [{ "billed_charge": 1272.00, "npi": [1821314410] } ] }, { "allowed_amount": 141.87, "providers": [{ "billed_charge": 742.00, "npi": [1346569464] } ] }, { "allowed_amount": 686.67, "providers": [{ "billed_charge": 3286.00, "npi": [1346569464] } ] } ] }, { "tin": { "type": "ein", "value": "830516935" }, "service_code": ["19"], "billing_class": "professional", "payments": [{ "allowed_amount": 946.24, "providers": [{ "billed_charge": 2170.00, "npi": [1285784801] } ] } ] }, { "tin": { "type": "ein", "value": "811690730" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 84.46, "providers": [{ "billed_charge": 200.00, "npi": [1063906550] } ] } ] }, { "tin": { "type": "ein", "value": "481200790" }, "service_code": ["22", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 361.02, "providers": [{ "billed_charge": 1836.00, "npi": [1861460875] } ] }, { "allowed_amount": 21.24, "providers": [{ "billed_charge": 108.00, "npi": [1083135180] } ] }, { "allowed_amount": 975.90, "providers": [{ "billed_charge": 4968.00, "npi": [1083135180] } ] }, { "allowed_amount": 148.68, "providers": [{ "billed_charge": 756.00, "npi": [1881676286] } ] } ] }, { "tin": { "type": "ein", "value": "481001941" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.20, "providers": [{ "billed_charge": 800.00, "npi": [1083135180] } ] } ] } ] }, { "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": "824944510" }, "service_code": ["22", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.69, "providers": [{ "billed_charge": 931.00, "npi": [1306093851] } ] }, { "allowed_amount": 716.75, "providers": [{ "billed_charge": 3325.00, "npi": [1306093851] } ] }, { "allowed_amount": 838.60, "providers": [{ "billed_charge": 3990.00, "npi": [1346569464] } ] }, { "allowed_amount": 401.38, "providers": [{ "billed_charge": 1862.00, "npi": [1821314410] } ] }, { "allowed_amount": 236.53, "providers": [{ "billed_charge": 1197.00, "npi": [1346569464] } ] }, { "allowed_amount": 1010.62, "providers": [{ "billed_charge": 4788.00, "npi": [1821314410] } ] } ] }, { "tin": { "type": "ein", "value": "830516935" }, "service_code": ["19"], "billing_class": "professional", "payments": [{ "allowed_amount": 1195.67, "providers": [{ "billed_charge": 2821.00, "npi": [1285784801] } ] } ] }, { "tin": { "type": "ein", "value": "811690730" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 80.18, "providers": [{ "billed_charge": 228.00, "npi": [1063906550] } ] }, { "allowed_amount": 26.83, "providers": [{ "billed_charge": 76.00, "npi": [1063906550] } ] } ] }, { "tin": { "type": "ein", "value": "481200790" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 1234.10, "providers": [{ "billed_charge": 10166.00, "npi": [1083135180] } ] }, { "allowed_amount": 187.81, "providers": [{ "billed_charge": 1547.00, "npi": [1881676286] } ] }, { "allowed_amount": 26.83, "providers": [{ "billed_charge": 221.00, "npi": [1083135180] } ] }, { "allowed_amount": 456.17, "providers": [{ "billed_charge": 3757.00, "npi": [1861460875] } ] } ] }, { "tin": { "type": "ein", "value": "481001941" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 740.33, "providers": [{ "billed_charge": 2413.00, "npi": [1083135180] } ] } ] } ] }, { "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": "431899877" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.84, "providers": [{ "billed_charge": 980.00, "npi": [1710276415] } ] } ] }, { "tin": { "type": "ein", "value": "481154210" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.14, "providers": [{ "billed_charge": 52.00, "npi": [1285224907] } ] } ] } ] }, { "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.60, "providers": [{ "billed_charge": 160.72, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "10925970" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 29120.00, "providers": [{ "billed_charge": 159296.00, "npi": [1659640134] } ] } ] } ] }, { "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": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.00, "providers": [{ "billed_charge": 222.00, "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.16, "providers": [{ "billed_charge": 90.48, "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": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.64, "providers": [{ "billed_charge": 40.90, "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": "824814166" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.65, "providers": [{ "billed_charge": 177.50, "npi": [1922519669] } ] } ] }, { "tin": { "type": "ein", "value": "481154210" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.97, "providers": [{ "billed_charge": 396.00, "npi": [1285224907] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.98, "providers": [{ "billed_charge": 169.97, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "480946497" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.30, "providers": [{ "billed_charge": 400.00, "npi": [1922588599] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 19.44, "providers": [{ "billed_charge": 58.26, "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": "431899877" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.92, "providers": [{ "billed_charge": 700.00, "npi": [1710276415] } ] } ] }, { "tin": { "type": "ein", "value": "481154210" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.92, "providers": [{ "billed_charge": 120.00, "npi": [1285224907] } ] } ] } ] }, { "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": "431899877" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.00, "providers": [{ "billed_charge": 500.00, "npi": [1710276415] } ] } ] } ] }, { "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": "431899877" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.62, "providers": [{ "billed_charge": 450.00, "npi": [1710276415] } ] } ] } ] }, { "name": "HPV HIGH-RISK TYPES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87624", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 824.85, "providers": [{ "billed_charge": 5170.00, "npi": [1093753303] } ] } ] } ] }, { "name": "Infectious Agent Antigen Detection", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87626", "description": "the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.59, "providers": [{ "billed_charge": 167.00, "npi": [1234567893] } ] } ] } ] }, { "name": "STREP B, DNA, AMP PROBE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87653", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 122.85, "providers": [{ "billed_charge": 691.46, "npi": [1942526447] } ] } ] } ] }, { "name": "DETECT AGNT MULT, DNA, AMPLI", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87801", "description": "INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.20, "providers": [{ "billed_charge": 733.26, "npi": [1093753303] } ] }, { "allowed_amount": 3229.20, "providers": [{ "billed_charge": 36577.42, "npi": [1093753303] } ] }, { "allowed_amount": 140.40, "providers": [{ "billed_charge": 1222.90, "npi": [1942526447] } ] } ] } ] }, { "name": "CYTOPATH, CONCENTRATE TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88108", "description": "CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "481202402" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.31, "providers": [{ "billed_charge": 114.00, "npi": [1578192977] } ] } ] } ] }, { "name": "CYTOPATH C/V AUTO FLUID REDO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88175", "description": "CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "621695507" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 958.32, "providers": [{ "billed_charge": 6768.00, "npi": [1093753303] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 107.73, "providers": [{ "billed_charge": 765.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TISSUE EXAM BY PATHOLOGIST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "88304", "description": "LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "481070050" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.97, "providers": [{ "billed_charge": 196.00, "npi": [1336681915] } ] }, { "allowed_amount": 4.95, "providers": [{ "billed_charge": 129.00, "npi": [1336681915] } ] } ] } ] }, { "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": "481070050" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 261.49, "providers": [{ "billed_charge": 2336.00, "npi": [1548670938] } ] }, { "allowed_amount": 196.44, "providers": [{ "billed_charge": 1752.00, "npi": [1336681915] } ] }, { "allowed_amount": 169.58, "providers": [{ "billed_charge": 2600.00, "npi": [1548670938] } ] }, { "allowed_amount": 84.78, "providers": [{ "billed_charge": 1300.00, "npi": [1336681915] } ] } ] }, { "tin": { "type": "ein", "value": "10817694" }, "service_code": ["81", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.92, "providers": [{ "billed_charge": 354.00, "npi": [1558882837] } ] }, { "allowed_amount": 83.61, "providers": [{ "billed_charge": 875.00, "npi": [1700861192] } ] }, { "allowed_amount": 84.79, "providers": [{ "billed_charge": 885.00, "npi": [1780664920] } ] }, { "allowed_amount": 268.35, "providers": [{ "billed_charge": 2950.00, "npi": [1780664920] } ] }, { "allowed_amount": 16.91, "providers": [{ "billed_charge": 177.00, "npi": [1518463611] } ] }, { "allowed_amount": 32.74, "providers": [{ "billed_charge": 275.00, "npi": [1558882837] } ] }, { "allowed_amount": 203.50, "providers": [{ "billed_charge": 2124.00, "npi": [1700861192] } ] }, { "allowed_amount": 515.62, "providers": [{ "billed_charge": 5273.00, "npi": [1083761472] } ] } ] }, { "tin": { "type": "ein", "value": "481202402" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 272.98, "providers": [{ "billed_charge": 777.00, "npi": [1770519555] } ] }, { "allowed_amount": 39.00, "providers": [{ "billed_charge": 111.00, "npi": [1619472255] } ] }, { "allowed_amount": 1949.85, "providers": [{ "billed_charge": 5550.00, "npi": [1619472255] } ] }, { "allowed_amount": 1559.14, "providers": [{ "billed_charge": 4440.00, "npi": [1134624612] } ] } ] }, { "tin": { "type": "ein", "value": "841331556" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 175.48, "providers": [{ "billed_charge": 900.00, "npi": [1669659090] } ] } ] }, { "tin": { "type": "ein", "value": "486099245" }, "service_code": ["22", "11"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.52, "providers": [{ "billed_charge": 632.00, "npi": [1447284963] } ] }, { "allowed_amount": 687.58, "providers": [{ "billed_charge": 3160.00, "npi": [1447284963] } ] } ] }, { "tin": { "type": "ein", "value": "480800674" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.96, "providers": [{ "billed_charge": 166.00, "npi": [1629463393] } ] } ] }, { "tin": { "type": "ein", "value": "854208910" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 203.48, "providers": [{ "billed_charge": 1800.00, "npi": [1760914279] } ] } ] } ] }, { "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": "923397233" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 439.09, "providers": [{ "billed_charge": 840.00, "npi": [1962027847] } ] }, { "allowed_amount": 916.77, "providers": [{ "billed_charge": 2040.00, "npi": [1962027847] } ] } ] }, { "tin": { "type": "ein", "value": "832447880" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1361.50, "providers": [{ "billed_charge": 3300.00, "npi": [1790485621] } ] }, { "allowed_amount": 1527.37, "providers": [{ "billed_charge": 4050.00, "npi": [1790485621] } ] } ] } ] }, { "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": "833436335" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 560.05, "providers": [{ "billed_charge": 685.00, "npi": [1720400690] } ] }, { "allowed_amount": 224.02, "providers": [{ "billed_charge": 280.00, "npi": [1720400690] } ] }, { "allowed_amount": 1914.20, "providers": [{ "billed_charge": 2290.00, "npi": [1720400690] } ] } ] }, { "tin": { "type": "ein", "value": "852159462" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1351.20, "providers": [{ "billed_charge": 3000.00, "npi": [1407473747] } ] }, { "allowed_amount": 112.01, "providers": [{ "billed_charge": 250.00, "npi": [1598914400] } ] }, { "allowed_amount": 4278.80, "providers": [{ "billed_charge": 9500.00, "npi": [1598914400] } ] } ] }, { "tin": { "type": "ein", "value": "480990763" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.22, "providers": [{ "billed_charge": 320.00, "npi": [1487392841] } ] }, { "allowed_amount": 3125.13, "providers": [{ "billed_charge": 4160.00, "npi": [1487392841] } ] } ] }, { "tin": { "type": "ein", "value": "993577571" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.22, "providers": [{ "billed_charge": 400.00, "npi": [1629506704] } ] }, { "allowed_amount": 366.36, "providers": [{ "billed_charge": 600.00, "npi": [1629506704] } ] } ] }, { "tin": { "type": "ein", "value": "811846294" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 100.61, "providers": [{ "billed_charge": 175.00, "npi": [1518472505] } ] }, { "allowed_amount": 731.20, "providers": [{ "billed_charge": 1050.00, "npi": [1518472505] } ] } ] }, { "tin": { "type": "ein", "value": "842202661" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 3920.35, "providers": [{ "billed_charge": 5250.00, "npi": [1467146670] } ] } ] }, { "tin": { "type": "ein", "value": "871380052" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 610.60, "providers": [{ "billed_charge": 800.00, "npi": [1710355730] } ] } ] }, { "tin": { "type": "ein", "value": "831036823" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 489.93, "providers": [{ "billed_charge": 825.00, "npi": [1154042786] } ] }, { "allowed_amount": 1454.21, "providers": [{ "billed_charge": 1980.00, "npi": [1154042786] } ] } ] }, { "tin": { "type": "ein", "value": "832447880" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 6196.28, "providers": [{ "billed_charge": 8745.00, "npi": [1700434818] } ] }, { "allowed_amount": 1417.84, "providers": [{ "billed_charge": 1980.00, "npi": [1174286322] } ] }, { "allowed_amount": 2194.60, "providers": [{ "billed_charge": 3300.00, "npi": [1700434818] } ] }, { "allowed_amount": 939.69, "providers": [{ "billed_charge": 1485.00, "npi": [1174286322] } ] } ] }, { "tin": { "type": "ein", "value": "821722723" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 732.72, "providers": [{ "billed_charge": 1020.00, "npi": [1457156630] } ] } ] }, { "tin": { "type": "ein", "value": "881391127" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 488.48, "providers": [{ "billed_charge": 800.00, "npi": [1871266734] } ] }, { "allowed_amount": 2902.96, "providers": [{ "billed_charge": 5800.00, "npi": [1871266734] } ] } ] }, { "tin": { "type": "ein", "value": "991114292" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 244.24, "providers": [{ "billed_charge": 330.00, "npi": [1770310872] } ] } ] }, { "tin": { "type": "ein", "value": "831512464" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 11151.81, "providers": [{ "billed_charge": 14540.00, "npi": [1093530867] } ] }, { "allowed_amount": 3618.75, "providers": [{ "billed_charge": 4730.00, "npi": [1528651114] } ] }, { "allowed_amount": 503.05, "providers": [{ "billed_charge": 800.00, "npi": [1093530867] } ] }, { "allowed_amount": 389.44, "providers": [{ "billed_charge": 610.00, "npi": [1528651114] } ] } ] }, { "tin": { "type": "ein", "value": "810699631" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 704.27, "providers": [{ "billed_charge": 1400.00, "npi": [1508263146] } ] } ] }, { "tin": { "type": "ein", "value": "863724027" }, "service_code": ["02"], "billing_class": "professional", "payments": [{ "allowed_amount": 1082.08, "providers": [{ "billed_charge": 1760.00, "npi": [1356017339] } ] } ] }, { "tin": { "type": "ein", "value": "742840463" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3621.70, "providers": [{ "billed_charge": 6000.00, "npi": [1821669060] } ] } ] }, { "tin": { "type": "ein", "value": "823222902" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 967.33, "providers": [{ "billed_charge": 1580.00, "npi": [1174347066] } ] }, { "allowed_amount": 905.49, "providers": [{ "billed_charge": 1645.00, "npi": [1174347066] } ] } ] }, { "tin": { "type": "ein", "value": "863728427" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1703.60, "providers": [{ "billed_charge": 1780.00, "npi": [1821976028] } ] } ] }, { "tin": { "type": "ein", "value": "480697159" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1926.02, "providers": [{ "billed_charge": 2304.00, "npi": [1841464856] } ] } ] }, { "tin": { "type": "ein", "value": "480970362" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 155.58, "providers": [{ "billed_charge": 240.00, "npi": [1831069715] } ] }, { "allowed_amount": 156.39, "providers": [{ "billed_charge": 240.00, "npi": [1144082264] } ] }, { "allowed_amount": 1876.68, "providers": [{ "billed_charge": 2880.00, "npi": [1831069715] } ] } ] }, { "tin": { "type": "ein", "value": "10681723" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 244.24, "providers": [{ "billed_charge": 331.08, "npi": [1164265674] } ] } ] } ] }, { "name": "GROUP PSYCHOTHERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "90853", "description": "GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480666889" }, "service_code": ["11", "57"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.73, "providers": [{ "billed_charge": 50.00, "npi": [1154477933] } ] }, { "allowed_amount": 90.92, "providers": [{ "billed_charge": 200.00, "npi": [1154477933] } ] } ] }, { "tin": { "type": "ein", "value": "486000798" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 3262.89, "providers": [{ "billed_charge": 13025.00, "npi": [1831180033] } ] }, { "allowed_amount": 159.24, "providers": [{ "billed_charge": 276.00, "npi": [1053045096] } ] }, { "allowed_amount": 1364.07, "providers": [{ "billed_charge": 4162.50, "npi": [1285186593] } ] } ] }, { "tin": { "type": "ein", "value": "480697159" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 117.96, "providers": [{ "billed_charge": 600.00, "npi": [1841464856] } ] } ] }, { "tin": { "type": "ein", "value": "480642318" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 578.17, "providers": [{ "billed_charge": 2870.00, "npi": [1447883459] } ] } ] } ] }, { "name": "PSYCHIATRIC CARE INTENSIVE 4", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "913", "description": "PSYCHIATRIC CARE INTENSIVE 4-6 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "461281853" }, "service_code": ["22"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4725.00, "providers": [{ "billed_charge": 59925.00, "npi": [1457232589] } ] } ] } ] }, { "name": "SPEECH/HEARING THERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "92507", "description": "TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "922652120" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 291.50, "providers": [{ "billed_charge": 475.00, "npi": [1184336653] } ] } ] }, { "tin": { "type": "ein", "value": "800812785" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 291.50, "providers": [{ "billed_charge": 550.00, "npi": [1629782669] } ] } ] } ] }, { "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": "480993446" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.68, "providers": [{ "billed_charge": 224.00, "npi": [1710400411] } ] } ] } ] }, { "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": "480993446" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 51.75, "providers": [{ "billed_charge": 130.00, "npi": [1710400411] } ] } ] }, { "tin": { "type": "ein", "value": "800677957" }, "service_code": ["22", "23", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 96.41, "providers": [{ "billed_charge": 224.00, "npi": [1851886055] } ] }, { "allowed_amount": 168.73, "providers": [{ "billed_charge": 392.00, "npi": [1851886055] } ] }, { "allowed_amount": 12.05, "providers": [{ "billed_charge": 28.00, "npi": [1851886055] } ] } ] }, { "tin": { "type": "ein", "value": "481163756" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 27.45, "providers": [{ "billed_charge": 63.00, "npi": [1477084481] } ] }, { "allowed_amount": 18.30, "providers": [{ "billed_charge": 42.00, "npi": [1841670965] } ] }, { "allowed_amount": 36.60, "providers": [{ "billed_charge": 84.00, "npi": [1740398361] } ] } ] } ] }, { "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": "481156958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 339.99, "providers": [{ "billed_charge": 1092.00, "npi": [1790758043] } ] } ] } ] }, { "name": "GLUC MONITOR, CONT, PHYS I&R", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "95251", "description": "AMBULATORY CONTINUOUS GLUCOSE MONITORING OF INTERSTITIAL TISSUE FLUID VIA A SUBCUTANEOUS SENSOR FOR ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "824814166" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.97, "providers": [{ "billed_charge": 100.00, "npi": [1922519669] } ] } ] } ] }, { "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": "742847917" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.37, "providers": [{ "billed_charge": 523.16, "npi": [1013718204] } ] } ] } ] }, { "name": "THER/PROPH/DIAG IV INF INIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "96365", "description": "INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); INITIAL, U", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480734011" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 206.82, "providers": [{ "billed_charge": 328.00, "npi": [1215739826] } ] } ] } ] }, { "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": "203379224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.86, "providers": [{ "billed_charge": 250.00, "npi": [1558466441] } ] } ] }, { "tin": { "type": "ein", "value": "874046762" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 65.40, "providers": [{ "billed_charge": 120.00, "npi": [1497097133] } ] } ] } ] }, { "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": "203379224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.85, "providers": [{ "billed_charge": 160.00, "npi": [1558466441] } ] } ] }, { "tin": { "type": "ein", "value": "43586885" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 83.09, "providers": [{ "billed_charge": 322.00, "npi": [1629061858] } ] } ] }, { "tin": { "type": "ein", "value": "201065429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 317.64, "providers": [{ "billed_charge": 783.00, "npi": [1366100075] } ] }, { "allowed_amount": 23.84, "providers": [{ "billed_charge": 58.00, "npi": [1629485297] } ] }, { "allowed_amount": 141.99, "providers": [{ "billed_charge": 348.00, "npi": [1972484087] } ] }, { "allowed_amount": 142.34, "providers": [{ "billed_charge": 348.00, "npi": [1144037912] } ] }, { "allowed_amount": 390.21, "providers": [{ "billed_charge": 957.00, "npi": [1932766540] } ] }, { "allowed_amount": 226.13, "providers": [{ "billed_charge": 551.00, "npi": [1326728338] } ] }, { "allowed_amount": 46.63, "providers": [{ "billed_charge": 116.00, "npi": [1053200675] } ] } ] } ] }, { "name": "ULTRASOUND THERAPY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97035", "description": "APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "43586885" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.64, "providers": [{ "billed_charge": 90.00, "npi": [1629061858] } ] } ] } ] }, { "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": "900416737" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.73, "providers": [{ "billed_charge": 270.00, "npi": [1841173697] } ] }, { "allowed_amount": 583.42, "providers": [{ "billed_charge": 1305.00, "npi": [1942876495] } ] }, { "allowed_amount": 138.63, "providers": [{ "billed_charge": 315.00, "npi": [1811575137] } ] }, { "allowed_amount": 656.96, "providers": [{ "billed_charge": 1440.00, "npi": [1477379840] } ] }, { "allowed_amount": 324.15, "providers": [{ "billed_charge": 720.00, "npi": [1386487825] } ] }, { "allowed_amount": 19.85, "providers": [{ "billed_charge": 45.00, "npi": [1003520198] } ] } ] }, { "tin": { "type": "ein", "value": "481158274" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1003.55, "providers": [{ "billed_charge": 2958.00, "npi": [1063824134] } ] } ] }, { "tin": { "type": "ein", "value": "300032372" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 531.75, "providers": [{ "billed_charge": 1125.00, "npi": [1326686569] } ] } ] }, { "tin": { "type": "ein", "value": "454311285" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 396.39, "providers": [{ "billed_charge": 1200.00, "npi": [1649764887] } ] } ] }, { "tin": { "type": "ein", "value": "843580063" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 705.73, "providers": [{ "billed_charge": 1120.00, "npi": [1790525327] } ] } ] }, { "tin": { "type": "ein", "value": "474013840" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1014.83, "providers": [{ "billed_charge": 3283.00, "npi": [1962398792] } ] }, { "allowed_amount": 334.93, "providers": [{ "billed_charge": 1072.00, "npi": [1558232694] } ] } ] }, { "tin": { "type": "ein", "value": "201065429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2504.66, "providers": [{ "billed_charge": 7326.00, "npi": [1144037912] } ] }, { "allowed_amount": 299.91, "providers": [{ "billed_charge": 888.00, "npi": [1710727656] } ] }, { "allowed_amount": 1494.52, "providers": [{ "billed_charge": 4366.00, "npi": [1932766540] } ] }, { "allowed_amount": 1219.70, "providers": [{ "billed_charge": 3478.00, "npi": [1366100075] } ] }, { "allowed_amount": 292.34, "providers": [{ "billed_charge": 814.00, "npi": [1912883653] } ] }, { "allowed_amount": 372.08, "providers": [{ "billed_charge": 1110.00, "npi": [1952100513] } ] }, { "allowed_amount": 297.36, "providers": [{ "billed_charge": 814.00, "npi": [1053200675] } ] }, { "allowed_amount": 358.27, "providers": [{ "billed_charge": 1036.00, "npi": [1629485297] } ] }, { "allowed_amount": 303.36, "providers": [{ "billed_charge": 888.00, "npi": [1487480430] } ] }, { "allowed_amount": 156.73, "providers": [{ "billed_charge": 444.00, "npi": [1669213609] } ] }, { "allowed_amount": 225.92, "providers": [{ "billed_charge": 666.00, "npi": [1629955687] } ] }, { "allowed_amount": 1363.36, "providers": [{ "billed_charge": 3996.00, "npi": [1326728338] } ] }, { "allowed_amount": 1210.03, "providers": [{ "billed_charge": 3478.00, "npi": [1417718412] } ] } ] } ] }, { "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": "900416737" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 252.05, "providers": [{ "billed_charge": 550.00, "npi": [1477379840] } ] }, { "allowed_amount": 379.98, "providers": [{ "billed_charge": 800.00, "npi": [1386487825] } ] }, { "allowed_amount": 116.78, "providers": [{ "billed_charge": 250.00, "npi": [1811575137] } ] }, { "allowed_amount": 584.22, "providers": [{ "billed_charge": 1300.00, "npi": [1942876495] } ] }, { "allowed_amount": 22.36, "providers": [{ "billed_charge": 50.00, "npi": [1003520198] } ] }, { "allowed_amount": 46.75, "providers": [{ "billed_charge": 100.00, "npi": [1841173697] } ] } ] }, { "tin": { "type": "ein", "value": "481158274" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 238.24, "providers": [{ "billed_charge": 606.00, "npi": [1063824134] } ] } ] }, { "tin": { "type": "ein", "value": "474013840" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1215.16, "providers": [{ "billed_charge": 3381.00, "npi": [1962398792] } ] }, { "allowed_amount": 298.20, "providers": [{ "billed_charge": 828.00, "npi": [1558232694] } ] } ] }, { "tin": { "type": "ein", "value": "201065429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 562.15, "providers": [{ "billed_charge": 1197.00, "npi": [1417718412] } ] }, { "allowed_amount": 1045.54, "providers": [{ "billed_charge": 2268.00, "npi": [1932766540] } ] }, { "allowed_amount": 55.90, "providers": [{ "billed_charge": 126.00, "npi": [1629955687] } ] }, { "allowed_amount": 138.60, "providers": [{ "billed_charge": 315.00, "npi": [1972484087] } ] }, { "allowed_amount": 2308.25, "providers": [{ "billed_charge": 4977.00, "npi": [1144037912] } ] }, { "allowed_amount": 329.22, "providers": [{ "billed_charge": 693.00, "npi": [1710727656] } ] }, { "allowed_amount": 455.95, "providers": [{ "billed_charge": 1008.00, "npi": [1952100513] } ] }, { "allowed_amount": 1038.67, "providers": [{ "billed_charge": 2268.00, "npi": [1326728338] } ] }, { "allowed_amount": 444.13, "providers": [{ "billed_charge": 945.00, "npi": [1629485297] } ] }, { "allowed_amount": 150.89, "providers": [{ "billed_charge": 315.00, "npi": [1669213609] } ] }, { "allowed_amount": 789.45, "providers": [{ "billed_charge": 1701.00, "npi": [1366100075] } ] } ] } ] }, { "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": "900416737" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.05, "providers": [{ "billed_charge": 45.00, "npi": [1477379840] } ] }, { "allowed_amount": 96.81, "providers": [{ "billed_charge": 225.00, "npi": [1841173697] } ] }, { "allowed_amount": 18.77, "providers": [{ "billed_charge": 45.00, "npi": [1003520198] } ] } ] }, { "tin": { "type": "ein", "value": "481158274" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 823.66, "providers": [{ "billed_charge": 2444.00, "npi": [1063824134] } ] } ] }, { "tin": { "type": "ein", "value": "320493400" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.27, "providers": [{ "billed_charge": 288.00, "npi": [1073409173] } ] }, { "allowed_amount": 23.68, "providers": [{ "billed_charge": 72.00, "npi": [1316614860] } ] } ] }, { "tin": { "type": "ein", "value": "474013840" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.98, "providers": [{ "billed_charge": 248.00, "npi": [1558232694] } ] }, { "allowed_amount": 585.07, "providers": [{ "billed_charge": 1860.00, "npi": [1962398792] } ] } ] }, { "tin": { "type": "ein", "value": "201065429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 654.69, "providers": [{ "billed_charge": 1944.00, "npi": [1417718412] } ] }, { "allowed_amount": 94.72, "providers": [{ "billed_charge": 288.00, "npi": [1972484087] } ] }, { "allowed_amount": 892.32, "providers": [{ "billed_charge": 2664.00, "npi": [1932766540] } ] }, { "allowed_amount": 146.44, "providers": [{ "billed_charge": 432.00, "npi": [1366100075] } ] }, { "allowed_amount": 123.66, "providers": [{ "billed_charge": 360.00, "npi": [1710727656] } ] }, { "allowed_amount": 365.27, "providers": [{ "billed_charge": 1080.00, "npi": [1669213609] } ] }, { "allowed_amount": 1445.23, "providers": [{ "billed_charge": 4320.00, "npi": [1144037912] } ] } ] } ] }, { "name": "ADAPTIVE BEHAVIOR TX BY TECH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97153", "description": "ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883979874" }, "service_code": ["99", "12"], "billing_class": "professional", "payments": [{ "allowed_amount": 13940.84, "providers": [{ "billed_charge": 194000.00, "npi": [1780064949] } ] }, { "allowed_amount": 9772.96, "providers": [{ "billed_charge": 136000.00, "npi": [1780064949] } ] } ] } ] }, { "name": "ADAPT BEHAVIOR TX PHYS/QHP", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97155", "description": "ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883979874" }, "service_code": ["02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 646.74, "providers": [{ "billed_charge": 9000.00, "npi": [1780064949] } ] }, { "allowed_amount": 1149.76, "providers": [{ "billed_charge": 16000.00, "npi": [1780064949] } ] } ] } ] }, { "name": "THERAPEUTIC ACTIVITIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "97530", "description": "THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU", "allowed_amounts": [{ "tin": { "type": "ein", "value": "900416737" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 665.09, "providers": [{ "billed_charge": 1300.00, "npi": [1942876495] } ] }, { "allowed_amount": 360.68, "providers": [{ "billed_charge": 700.00, "npi": [1386487825] } ] }, { "allowed_amount": 78.84, "providers": [{ "billed_charge": 150.00, "npi": [1841173697] } ] }, { "allowed_amount": 26.39, "providers": [{ "billed_charge": 50.00, "npi": [1003520198] } ] }, { "allowed_amount": 524.50, "providers": [{ "billed_charge": 1000.00, "npi": [1477379840] } ] } ] }, { "tin": { "type": "ein", "value": "454311285" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 624.50, "providers": [{ "billed_charge": 1800.00, "npi": [1649764887] } ] } ] }, { "tin": { "type": "ein", "value": "320493400" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.64, "providers": [{ "billed_charge": 237.00, "npi": [1356222426] } ] } ] }, { "tin": { "type": "ein", "value": "201065429" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2058.18, "providers": [{ "billed_charge": 5056.00, "npi": [1326728338] } ] }, { "allowed_amount": 227.56, "providers": [{ "billed_charge": 553.00, "npi": [1669213609] } ] }, { "allowed_amount": 2942.74, "providers": [{ "billed_charge": 7110.00, "npi": [1144037912] } ] }, { "allowed_amount": 1076.84, "providers": [{ "billed_charge": 2607.00, "npi": [1366100075] } ] }, { "allowed_amount": 705.76, "providers": [{ "billed_charge": 1738.00, "npi": [1952100513] } ] }, { "allowed_amount": 2447.60, "providers": [{ "billed_charge": 5925.00, "npi": [1932766540] } ] }, { "allowed_amount": 2713.11, "providers": [{ "billed_charge": 6636.00, "npi": [1417718412] } ] }, { "allowed_amount": 191.28, "providers": [{ "billed_charge": 474.00, "npi": [1487480430] } ] }, { "allowed_amount": 161.60, "providers": [{ "billed_charge": 395.00, "npi": [1629955687, 1629485297] } ] } ] } ] }, { "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": "510653340" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 136.92, "providers": [{ "billed_charge": 208.00, "npi": [1861213142] } ] }, { "allowed_amount": 73.60, "providers": [{ "billed_charge": 104.00, "npi": [1750307120] } ] } ] }, { "tin": { "type": "ein", "value": "843580063" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1882.64, "providers": [{ "billed_charge": 3300.00, "npi": [1790525327] } ] } ] }, { "tin": { "type": "ein", "value": "203379224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1540.81, "providers": [{ "billed_charge": 2700.00, "npi": [1558466441] } ] } ] }, { "tin": { "type": "ein", "value": "271802023" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.60, "providers": [{ "billed_charge": 120.00, "npi": [1386877991] } ] } ] }, { "tin": { "type": "ein", "value": "43586885" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1232.37, "providers": [{ "billed_charge": 2628.00, "npi": [1629061858] } ] } ] }, { "tin": { "type": "ein", "value": "874046762" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2499.04, "providers": [{ "billed_charge": 4380.00, "npi": [1497097133] } ] } ] }, { "tin": { "type": "ein", "value": "352679191" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 479.32, "providers": [{ "billed_charge": 1120.00, "npi": [1588476279] } ] } ] }, { "tin": { "type": "ein", "value": "513927797" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 316.96, "providers": [{ "billed_charge": 320.00, "npi": [1093461956] } ] } ] } ] }, { "name": "CHIROPRACT MANJ XTRSPINL 1/>", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "98943", "description": "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "874046762" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 413.28, "providers": [{ "billed_charge": 810.00, "npi": [1497097133] } ] } ] }, { "tin": { "type": "ein", "value": "352679191" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 324.24, "providers": [{ "billed_charge": 420.00, "npi": [1588476279] } ] } ] } ] }, { "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": "480993446" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 548.49, "providers": [{ "billed_charge": 1053.00, "npi": [1851181275] } ] }, { "allowed_amount": 1075.50, "providers": [{ "billed_charge": 1755.00, "npi": [1710400411] } ] } ] }, { "tin": { "type": "ein", "value": "463900147" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 422.31, "providers": [{ "billed_charge": 1155.00, "npi": [1063248128] } ] } ] } ] }, { "name": "OFFICE/OUTPATIENT VISIT EST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99211", "description": "OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M", "allowed_amounts": [{ "tin": { "type": "ein", "value": "480678363" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.96, "providers": [{ "billed_charge": 100.00, "npi": [1588559983] } ] } ] } ] }, { "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": "814518279" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 681.03, "providers": [{ "billed_charge": 1378.44, "npi": [1639151020] } ] } ] }, { "tin": { "type": "ein", "value": "481193556" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 368.31, "providers": [{ "billed_charge": 636.00, "npi": [1952112930] } ] } ] }, { "tin": { "type": "ein", "value": "480576039" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1563.75, "providers": [{ "billed_charge": 3122.00, "npi": [1407680234] } ] } ] }, { "tin": { "type": "ein", "value": "481178846" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.40, "providers": [{ "billed_charge": 251.37, "npi": [1821615014] } ] } ] }, { "tin": { "type": "ein", "value": "481159444" }, "service_code": ["19"], "billing_class": "professional", "payments": [{ "allowed_amount": 429.28, "providers": [{ "billed_charge": 1232.00, "npi": [1831926195] } ] } ] }, { "tin": { "type": "ein", "value": "271119304" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 1205.91, "providers": [{ "billed_charge": 5280.00, "npi": [1326129743] } ] } ] }, { "tin": { "type": "ein", "value": "481159633" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 747.74, "providers": [{ "billed_charge": 948.00, "npi": [1205712452] } ] } ] }, { "tin": { "type": "ein", "value": "481005740" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4172.20, "providers": [{ "billed_charge": 5500.00, "npi": [1356005557] } ] } ] }, { "tin": { "type": "ein", "value": "481154210" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 7582.35, "providers": [{ "billed_charge": 10591.00, "npi": [1285224907] } ] } ] }, { "tin": { "type": "ein", "value": "742842747" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 747.76, "providers": [{ "billed_charge": 1200.00, "npi": [1578180907] } ] } ] }, { "tin": { "type": "ein", "value": "205949265" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 983.71, "providers": [{ "billed_charge": 2275.00, "npi": [1437410446] } ] } ] }, { "tin": { "type": "ein", "value": "742847917" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 751.89, "providers": [{ "billed_charge": 1944.30, "npi": [1013718204] } ] } ] }, { "tin": { "type": "ein", "value": "800505355" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2624.26, "providers": [{ "billed_charge": 4452.00, "npi": [1790547784] } ] } ] }, { "tin": { "type": "ein", "value": "200670621" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1266.54, "providers": [{ "billed_charge": 2332.00, "npi": [1154805737] } ] } ] }, { "tin": { "type": "ein", "value": "480993446" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1936.10, "providers": [{ "billed_charge": 3060.00, "npi": [1942065628] } ] } ] }, { "tin": { "type": "ein", "value": "481163756" }, "service_code": ["10"], "billing_class": "professional", "payments": [{ "allowed_amount": 375.62, "providers": [{ "billed_charge": 2373.00, "npi": [1124373238] } ] } ] } ] }, { "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": "824814166" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 854.73, "providers": [{ "billed_charge": 1520.00, "npi": [1922519669] } ] } ] }, { "tin": { "type": "ein", "value": "742822588" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 637.57, "providers": [{ "billed_charge": 1200.00, "npi": [1871346619] } ] }, { "allowed_amount": 417.25, "providers": [{ "billed_charge": 1200.00, "npi": [1871346619] } ] } ] }, { "tin": { "type": "ein", "value": "923397233" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1348.26, "providers": [{ "billed_charge": 2080.00, "npi": [1962027847] } ] }, { "allowed_amount": 1239.92, "providers": [{ "billed_charge": 2880.00, "npi": [1962027847] } ] } ] }, { "tin": { "type": "ein", "value": "486000798" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1010.79, "providers": [{ "billed_charge": 1035.00, "npi": [1669070132] } ] }, { "allowed_amount": 342.57, "providers": [{ "billed_charge": 345.00, "npi": [1124495049] } ] }, { "allowed_amount": 114.19, "providers": [{ "billed_charge": 115.00, "npi": [1730116070] } ] } ] }, { "tin": { "type": "ein", "value": "821720770" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 479.18, "providers": [{ "billed_charge": 1225.00, "npi": [1285379164] } ] }, { "allowed_amount": 6412.73, "providers": [{ "billed_charge": 10500.00, "npi": [1285379164] } ] } ] }, { "tin": { "type": "ein", "value": "481091875" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 1551.39, "providers": [{ "billed_charge": 2600.00, "npi": [1568274942] } ] } ] }, { "tin": { "type": "ein", "value": "753002264" }, "service_code": ["02", "50"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.06, "providers": [{ "billed_charge": 184.00, "npi": [1316713589] } ] }, { "allowed_amount": 1363.12, "providers": [{ "billed_charge": 2208.00, "npi": [1316713589] } ] } ] }, { "tin": { "type": "ein", "value": "480805658" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.85, "providers": [{ "billed_charge": 200.00, "npi": [1891283875] } ] } ] }, { "tin": { "type": "ein", "value": "480576039" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 767.51, "providers": [{ "billed_charge": 1542.00, "npi": [1730964453] } ] } ] }, { "tin": { "type": "ein", "value": "480678906" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 523.22, "providers": [{ "billed_charge": 929.00, "npi": [1982206835] } ] } ] }, { "tin": { "type": "ein", "value": "832447880" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 2972.89, "providers": [{ "billed_charge": 6900.00, "npi": [1790485621] } ] }, { "allowed_amount": 1986.18, "providers": [{ "billed_charge": 6300.00, "npi": [1790485621] } ] }, { "allowed_amount": 1300.67, "providers": [{ "billed_charge": 3150.00, "npi": [1023538378] } ] }, { "allowed_amount": 1532.95, "providers": [{ "billed_charge": 5250.00, "npi": [1023538378] } ] } ] }, { "tin": { "type": "ein", "value": "463900147" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2480.32, "providers": [{ "billed_charge": 4025.00, "npi": [1063248128] } ] } ] }, { "tin": { "type": "ein", "value": "486084911" }, "service_code": ["11", "22"], "billing_class": "professional", "payments": [{ "allowed_amount": 508.26, "providers": [{ "billed_charge": 1620.00, "npi": [1154345478] } ] }, { "allowed_amount": 666.10, "providers": [{ "billed_charge": 1050.00, "npi": [1154345478] } ] } ] }, { "tin": { "type": "ein", "value": "481159633" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 905.87, "providers": [{ "billed_charge": 1288.00, "npi": [1801577275] } ] } ] }, { "tin": { "type": "ein", "value": "431899877" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 380.94, "providers": [{ "billed_charge": 600.00, "npi": [1851687313] } ] } ] }, { "tin": { "type": "ein", "value": "481005740" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4107.92, "providers": [{ "billed_charge": 5270.00, "npi": [1356005557] } ] } ] }, { "tin": { "type": "ein", "value": "205949265" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1725.44, "providers": [{ "billed_charge": 3636.48, "npi": [1437410446] } ] } ] }, { "tin": { "type": "ein", "value": "480886411" }, "service_code": ["11", "02", "53", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 646.60, "providers": [{ "billed_charge": 1400.00, "npi": [1174045439] } ] }, { "allowed_amount": 64.66, "providers": [{ "billed_charge": 140.00, "npi": [1174045439] } ] }, { "allowed_amount": 1047.36, "providers": [{ "billed_charge": 1680.00, "npi": [1174045439] } ] } ] }, { "tin": { "type": "ein", "value": "480970362" }, "service_code": ["11", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1901.80, "providers": [{ "billed_charge": 2860.00, "npi": [1083144539] } ] }, { "allowed_amount": 256.70, "providers": [{ "billed_charge": 286.00, "npi": [1083144539] } ] } ] }, { "tin": { "type": "ein", "value": "480698542" }, "service_code": ["72"], "billing_class": "professional", "payments": [{ "allowed_amount": 266.44, "providers": [{ "billed_charge": 530.00, "npi": [1720350580] } ] } ] }, { "tin": { "type": "ein", "value": "480993446" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1531.82, "providers": [{ "billed_charge": 2464.00, "npi": [1942065628] } ] }, { "allowed_amount": 8650.88, "providers": [{ "billed_charge": 13888.00, "npi": [1851181275] } ] }, { "allowed_amount": 1402.00, "providers": [{ "billed_charge": 2240.00, "npi": [1124741707] } ] }, { "allowed_amount": 659.76, "providers": [{ "billed_charge": 896.00, "npi": [1710400411] } ] } ] }, { "tin": { "type": "ein", "value": "480642318" }, "service_code": ["11", "02", "10"], "billing_class": "professional", "payments": [{ "allowed_amount": 1097.28, "providers": [{ "billed_charge": 2576.00, "npi": [1902403413] } ] }, { "allowed_amount": 215.68, "providers": [{ "billed_charge": 322.00, "npi": [1285894709] } ] }, { "allowed_amount": 1077.53, "providers": [{ "billed_charge": 1610.00, "npi": [1902403413] } ] }, { "allowed_amount": 68.58, "providers": [{ "billed_charge": 161.00, "npi": [1902403413] } ] }, { "allowed_amount": 685.80, "providers": [{ "billed_charge": 1610.00, "npi": [1285894709] } ] } ] } ] }, { "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": "480678906" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2562.99, "providers": [{ "billed_charge": 4419.00, "npi": [1982206835] } ] } ] } ] }, { "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": "274185968" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 1037.58, "providers": [{ "billed_charge": 6061.00, "npi": [1356051676] } ] } ] }, { "tin": { "type": "ein", "value": "480728186" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 1523.27, "providers": [{ "billed_charge": 6400.00, "npi": [1720476559] } ] } ] } ] }, { "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": "274185968" }, "service_code": ["61", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 2730.06, "providers": [{ "billed_charge": 11980.00, "npi": [1902899834] } ] }, { "allowed_amount": 604.89, "providers": [{ "billed_charge": 2628.00, "npi": [1790097400] } ] } ] }, { "tin": { "type": "ein", "value": "462385484" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1949.09, "providers": [{ "billed_charge": 6525.00, "npi": [1124054580] } ] }, { "allowed_amount": 873.73, "providers": [{ "billed_charge": 2925.00, "npi": [1659785483] } ] }, { "allowed_amount": 4105.06, "providers": [{ "billed_charge": 13725.00, "npi": [1114238466] } ] } ] }, { "tin": { "type": "ein", "value": "871247257" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 865.74, "providers": [{ "billed_charge": 2250.00, "npi": [1942988159] } ] }, { "allowed_amount": 175.83, "providers": [{ "billed_charge": 450.00, "npi": [1487298188] } ] } ] }, { "tin": { "type": "ein", "value": "204099493" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 70.07, "providers": [{ "billed_charge": 144.00, "npi": [1851748289] } ] } ] }, { "tin": { "type": "ein", "value": "271371893" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1275.29, "providers": [{ "billed_charge": 9500.00, "npi": [1609060953] } ] } ] }, { "tin": { "type": "ein", "value": "480728186" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 5012.89, "providers": [{ "billed_charge": 26400.00, "npi": [1720476559] } ] } ] }, { "tin": { "type": "ein", "value": "475317446" }, "service_code": ["51"], "billing_class": "professional", "payments": [{ "allowed_amount": 3667.50, "providers": [{ "billed_charge": 9618.90, "npi": [1437213998] } ] }, { "allowed_amount": 2037.50, "providers": [{ "billed_charge": 5331.33, "npi": [1629364807] } ] } ] }, { "tin": { "type": "ein", "value": "481172106" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 600.91, "providers": [{ "billed_charge": 1449.00, "npi": [1043878036] } ] } ] }, { "tin": { "type": "ein", "value": "814396737" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 201.63, "providers": [{ "billed_charge": 1743.00, "npi": [1609031442] } ] } ] }, { "tin": { "type": "ein", "value": "800677957" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 417.40, "providers": [{ "billed_charge": 640.00, "npi": [1851886055] } ] } ] } ] }, { "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": "462385484" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1732.47, "providers": [{ "billed_charge": 5525.00, "npi": [1659785483] } ] }, { "allowed_amount": 2445.84, "providers": [{ "billed_charge": 7800.00, "npi": [1114238466] } ] }, { "allowed_amount": 2961.92, "providers": [{ "billed_charge": 9425.00, "npi": [1124054580] } ] } ] }, { "tin": { "type": "ein", "value": "871247257" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 433.15, "providers": [{ "billed_charge": 1075.00, "npi": [1487298188] } ] } ] }, { "tin": { "type": "ein", "value": "271371893" }, "service_code": ["22", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1750.43, "providers": [{ "billed_charge": 12206.00, "npi": [1245979152] } ] }, { "allowed_amount": 1739.00, "providers": [{ "billed_charge": 12206.00, "npi": [1831829852] } ] }, { "allowed_amount": 6069.03, "providers": [{ "billed_charge": 42362.00, "npi": [1134797590] } ] }, { "allowed_amount": 812.72, "providers": [{ "billed_charge": 5744.00, "npi": [1609060953] } ] }, { "allowed_amount": 203.82, "providers": [{ "billed_charge": 1436.00, "npi": [1831829852] } ] } ] }, { "tin": { "type": "ein", "value": "462414983" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 1555.03, "providers": [{ "billed_charge": 4620.24, "npi": [1497986525] } ] } ] }, { "tin": { "type": "ein", "value": "814396737" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 305.73, "providers": [{ "billed_charge": 2490.00, "npi": [1750886990] } ] } ] } ] }, { "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": "473718543" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1131.18, "providers": [{ "billed_charge": 11368.00, "npi": [1134801236] } ] }, { "allowed_amount": 471.24, "providers": [{ "billed_charge": 4722.00, "npi": [1366155699] } ] }, { "allowed_amount": 188.19, "providers": [{ "billed_charge": 1836.00, "npi": [1518650407] } ] }, { "allowed_amount": 1979.82, "providers": [{ "billed_charge": 19938.00, "npi": [1447298690] } ] }, { "allowed_amount": 1509.60, "providers": [{ "billed_charge": 15392.00, "npi": [1184462186] } ] }, { "allowed_amount": 1697.79, "providers": [{ "billed_charge": 17228.00, "npi": [1831075415] } ] } ] } ] }, { "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": "473718543" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 1780.29, "providers": [{ "billed_charge": 18137.00, "npi": [1831075415] } ] }, { "allowed_amount": 1049.92, "providers": [{ "billed_charge": 6946.00, "npi": [1649912619] } ] }, { "allowed_amount": 4929.54, "providers": [{ "billed_charge": 50166.00, "npi": [1134801236] } ] }, { "allowed_amount": 1233.99, "providers": [{ "billed_charge": 12735.00, "npi": [1518650407] } ] }, { "allowed_amount": 2602.95, "providers": [{ "billed_charge": 26627.00, "npi": [1184462186] } ] } ] }, { "tin": { "type": "ein", "value": "480778482" }, "service_code": ["23"], "billing_class": "professional", "payments": [{ "allowed_amount": 3374.41, "providers": [{ "billed_charge": 30534.00, "npi": [1174262026] } ] }, { "allowed_amount": 803.15, "providers": [{ "billed_charge": 7270.00, "npi": [1659001378] } ] }, { "allowed_amount": 161.31, "providers": [{ "billed_charge": 1454.00, "npi": [1821738667] } ] }, { "allowed_amount": 1128.53, "providers": [{ "billed_charge": 10178.00, "npi": [1053059550] } ] } ] } ] }, { "name": "CRITICAL CARE, FIRST HOUR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99291", "description": "CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "481163756" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 432.96, "providers": [{ "billed_charge": 1680.00, "npi": [1992227649] } ] } ] }, { "tin": { "type": "ein", "value": "800677957" }, "service_code": ["21"], "billing_class": "professional", "payments": [{ "allowed_amount": 3469.44, "providers": [{ "billed_charge": 5844.00, "npi": [1851886055] } ] } ] } ] }, { "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": "820827332" }, "service_code": ["31", "32"], "billing_class": "professional", "payments": [{ "allowed_amount": 3284.50, "providers": [{ "billed_charge": 13320.00, "npi": [1730109554] } ] }, { "allowed_amount": 1283.38, "providers": [{ "billed_charge": 5180.00, "npi": [1487128591] } ] }, { "allowed_amount": 2222.08, "providers": [{ "billed_charge": 10360.00, "npi": [1730109554] } ] }, { "allowed_amount": 358.87, "providers": [{ "billed_charge": 1480.00, "npi": [1417262734] } ] }, { "allowed_amount": 163.22, "providers": [{ "billed_charge": 740.00, "npi": [1417262734, 1487128591] } ] } ] } ] }, { "name": "HOME VISIT EST PATIENT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "99349", "description": "HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "862695676" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4080.00, "providers": [{ "billed_charge": 4080.00, "npi": [1518258029] } ] } ] } ] }, { "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": "486035405" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2187.32, "providers": [{ "billed_charge": 5066.00, "npi": [1679554943] } ] } ] }, { "tin": { "type": "ein", "value": "486042132" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2224.02, "providers": [{ "billed_charge": 4999.50, "npi": [1730274143] } ] } ] }, { "tin": { "type": "ein", "value": "486000798" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 41424.46, "providers": [{ "billed_charge": 96850.70, "npi": [1215075411] } ] } ] }, { "tin": { "type": "ein", "value": "953743718" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 24292.38, "providers": [{ "billed_charge": 29177.16, "npi": [1104830850] } ] }, { "allowed_amount": 2567.22, "providers": [{ "billed_charge": 9406.34, "npi": [1306871215] } ] } ] }, { "tin": { "type": "ein", "value": "486017228" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 455.08, "providers": [{ "billed_charge": 1124.80, "npi": [1568443893] } ] } ] }, { "tin": { "type": "ein", "value": "486034067" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 4059.02, "providers": [{ "billed_charge": 9118.65, "npi": [1972606580] } ] } ] }, { "tin": { "type": "ein", "value": "486099245" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3797.10, "providers": [{ "billed_charge": 11980.48, "npi": [1770581340] } ] } ] }, { "tin": { "type": "ein", "value": "486033520" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 763.35, "providers": [{ "billed_charge": 1600.20, "npi": [1437153038] } ] } ] }, { "tin": { "type": "ein", "value": "481194075" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 5112.31, "providers": [{ "billed_charge": 10549.50, "npi": [1639157555] } ] } ] }, { "tin": { "type": "ein", "value": "446000201" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 378.04, "providers": [{ "billed_charge": 520.00, "npi": [1730419227] } ] } ] } ] }, { "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": "486042132" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2021.40, "providers": [{ "billed_charge": 3625.00, "npi": [1730274143] } ] } ] }, { "tin": { "type": "ein", "value": "486000798" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 256624.35, "providers": [{ "billed_charge": 556958.84, "npi": [1215075411] } ] } ] }, { "tin": { "type": "ein", "value": "953743718" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 47498.33, "providers": [{ "billed_charge": 48437.40, "npi": [1104830850] } ] } ] }, { "tin": { "type": "ein", "value": "486099245" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 2829.96, "providers": [{ "billed_charge": 8296.75, "npi": [1770581340] } ] } ] }, { "tin": { "type": "ein", "value": "486034067" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 7751.60, "providers": [{ "billed_charge": 15319.00, "npi": [1972606580] } ] } ] }, { "tin": { "type": "ein", "value": "481194075" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 9208.05, "providers": [{ "billed_charge": 20125.00, "npi": [1639157555] } ] } ] } ] }, { "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": "486000798" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 3371.36, "providers": [{ "billed_charge": 6080.00, "npi": [1215075411] } ] } ] } ] }, { "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": "486000798" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 123730.38, "providers": [{ "billed_charge": 298723.19, "npi": [1215075411] } ] } ] }, { "tin": { "type": "ein", "value": "953743718" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 6430.76, "providers": [{ "billed_charge": 6430.76, "npi": [1104830850] } ] } ] }, { "tin": { "type": "ein", "value": "486017228" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 340.45, "providers": [{ "billed_charge": 650.00, "npi": [1568443893] } ] } ] }, { "tin": { "type": "ein", "value": "486034067" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 652.76, "providers": [{ "billed_charge": 1290.00, "npi": [1972606580] } ] } ] }, { "tin": { "type": "ein", "value": "481194075" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 15508.44, "providers": [{ "billed_charge": 40250.00, "npi": [1639157555] } ] } ] }, { "tin": { "type": "ein", "value": "486033520" }, "service_code": ["41"], "billing_class": "professional", "payments": [{ "allowed_amount": 337.14, "providers": [{ "billed_charge": 762.00, "npi": [1437153038] } ] } ] } ] }, { "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": "481221623" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 698.99, "providers": [{ "billed_charge": 1750.00, "npi": [1285525261] } ] } ] } ] }, { "name": "COLL V BLD VP/URN SMP CATH I", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0471", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE OR URINE SAMPLE BY CATHETERIZATION FROM AN INDIVIDUAL IN ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812244474" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.43, "providers": [{ "billed_charge": 194.94, "npi": [1558717827] } ] } ] } ] }, { "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": 293.83, "providers": [{ "billed_charge": 405.00, "npi": [1508351693] } ] } ] } ] }, { "name": "VISIT CPLX INHERENT E&M ASSO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2211", "description": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "821720770" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.42, "providers": [{ "billed_charge": 60.00, "npi": [1285379164] } ] }, { "allowed_amount": 494.25, "providers": [{ "billed_charge": 1080.00, "npi": [1285379164] } ] } ] } ] }, { "name": "MENTAL HLTH PART HOSP TX <24", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0035", "description": "MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841595162" }, "service_code": ["52"], "billing_class": "professional", "payments": [{ "allowed_amount": 17550.00, "providers": [{ "billed_charge": 70200.00, "npi": [1194031070] } ] } ] } ] }, { "name": "TRAVL 1 WAY NEC LAB SPEC; AC", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "P9603", "description": "TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F", "allowed_amounts": [{ "tin": { "type": "ein", "value": "812244474" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.74, "providers": [{ "billed_charge": 84.00, "npi": [1558717827] } ] } ] } ] }, { "name": "TELEHEALTH ORIG SITE FACILIT", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "Q3014", "description": "TELEHEALTH ORIGINATING SITE FACILITY FEE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "481193556" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 266.54, "providers": [{ "billed_charge": 869.00, "npi": [1952112930] } ] } ] } ] }, { "name": "HOME INFUS TX IMMUOTHAPY; PE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9338", "description": "HOME INFUSION THERAPY, IMMUNOTHERAPY, ADMINISTRATIVE SERVICES, PROFESSIONAL PHARMACY SERVICES, CARE ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 160.00, "providers": [{ "billed_charge": 1600.00, "npi": [1234567893] } ] } ] } ] }, { "name": "INTNSVE OP PSYC SVC PER DIEM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "S9480", "description": "INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "841595162" }, "service_code": ["52"], "billing_class": "professional", "payments": [{ "allowed_amount": 2200.00, "providers": [{ "billed_charge": 8800.00, "npi": [1194031070] } ] } ] } ] } ] }