{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-07-28","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"921890639"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":219380.49,"providers":[{"billed_charge":2640000.00,"npi":[1437846656]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"330751869"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":404656.18,"providers":[{"billed_charge":590210.75,"npi":[1114971660]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"465204199"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38605.27,"providers":[{"billed_charge":104441.62,"npi":[1790656676]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"872129116"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":3145.24,"providers":[{"billed_charge":34000.00,"npi":[1225774409]}]}]}]},{"name":"PSTAY/WARD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"154","description":"ROOM AND BOARD - WARD -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"883269656"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":11794.65,"providers":[{"billed_charge":82500.00,"npi":[1710727896]}]}]}]},{"name":"REHAB/WARD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"158","description":"ROOM AND BOARD - WARD -REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"932390418"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":1572.62,"providers":[{"billed_charge":15890.00,"npi":[1386326478]}]}]}]},{"name":"DRAIN/INJ JOINT/BURSA W/US","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"20611","description":"ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJ JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIA","allowed_amounts":[{"tin":{"type":"ein","value":"931950904"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1995.13,"providers":[{"billed_charge":4208.88,"npi":[1902289226]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"956002748"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":616.72,"providers":[{"billed_charge":1389.00,"npi":[1558410217]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"956000930"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":332.50,"providers":[{"billed_charge":795.52,"npi":[1821159195]}]}]}]},{"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":"951643327"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":648.18,"providers":[{"billed_charge":982.10,"npi":[1518951300]}]}]}]},{"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":"956000930"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":299.16,"providers":[{"billed_charge":715.60,"npi":[1821159195]}]}]}]},{"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":"330751869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":53330.53,"providers":[{"billed_charge":130383.25,"npi":[1114971660]}]}]}]},{"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":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9497.98,"providers":[{"billed_charge":304.82,"npi":[1689608150]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"946036494"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8354.80,"providers":[{"billed_charge":32880.00,"npi":[1710918545]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12492.21,"providers":[{"billed_charge":13529.00,"npi":[1689608150]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21957.93,"providers":[{"billed_charge":5437.60,"npi":[1689608150]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"951644600"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1097.83,"providers":[{"billed_charge":7493.30,"npi":[1639172372]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1839.76,"providers":[{"billed_charge":3931.00,"npi":[1689608150]}]}]}]},{"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":"952226406"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1214.49,"providers":[{"billed_charge":4327.00,"npi":[1689608150]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"330751869"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":98.12,"providers":[{"billed_charge":954.50,"npi":[1114971660]}]}]}]},{"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":"951644600"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8.38,"providers":[{"billed_charge":8.38,"npi":[1639172372]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"851644866"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1006.35,"providers":[{"billed_charge":4090.80,"npi":[1013514199]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":34473.20,"providers":[{"billed_charge":11978.00,"npi":[1689608150]}]}]}]},{"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":"951644600"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6484.69,"providers":[{"billed_charge":11568.96,"npi":[1639172372]}]}]}]},{"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":"956000930"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1631.57,"providers":[{"billed_charge":3903.29,"npi":[1821159195]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":37788.02,"providers":[{"billed_charge":50443.00,"npi":[1689608150]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"851644866"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15382.19,"providers":[{"billed_charge":84497.00,"npi":[1417554528]}]}]}]},{"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":"952226406"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3829.43,"providers":[{"billed_charge":8328.00,"npi":[1689608150]}]}]}]},{"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":"330751869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145445.01,"providers":[{"billed_charge":315602.25,"npi":[1114971660]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"330751869"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":18535.95,"providers":[{"billed_charge":261426.83,"npi":[1114971660]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"851644866"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":13117.18,"providers":[{"billed_charge":55846.50,"npi":[1013514199]}]}]}]},{"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":"237064656"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":289.00,"providers":[{"billed_charge":289.00,"npi":[1083636294]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":16475.64,"providers":[{"billed_charge":70528.00,"npi":[1689608150]}]}]}]},{"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":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2052.08,"providers":[{"billed_charge":1484.00,"npi":[1689608150]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"831960549"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":148.56,"providers":[{"billed_charge":343.56,"npi":[1124596382]}]}]}]},{"name":"EGD DIAGNOSTIC BRUSH WASH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"43235","description":"ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY ","allowed_amounts":[{"tin":{"type":"ein","value":"954722860"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":1971.13,"providers":[{"billed_charge":10500.00,"npi":[1679650675]}]}]}]},{"name":"EGD BIOPSY SINGLE/MULTIPLE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"43239","description":"ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE","allowed_amounts":[{"tin":{"type":"ein","value":"455335276"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":2082.71,"providers":[{"billed_charge":3187.50,"npi":[1316926678]}]}]}]},{"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":"201645949"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":28991.84,"providers":[{"billed_charge":67673.57,"npi":[1942269725]}]}]}]},{"name":"DIAGNOSTIC COLONOSCOPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"45378","description":"COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN ","allowed_amounts":[{"tin":{"type":"ein","value":"954722860"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":5893.45,"providers":[{"billed_charge":20300.00,"npi":[1679650675]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"464144489"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":6250.51,"providers":[{"billed_charge":50986.00,"npi":[1275951196]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"851644866"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19670.16,"providers":[{"billed_charge":28587.50,"npi":[1417554528]}]}]}]},{"name":"SKILLED NURSE/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"551","description":"SKILLED NURSING - VISIT CHARGE","allowed_amounts":[{"tin":{"type":"ein","value":"830750832"},"service_code":["12"],"billing_class":"institutional","payments":[{"allowed_amount":320.00,"providers":[{"billed_charge":320.00,"npi":[1104305036]}]}]}]},{"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":"851634852"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":838.86,"providers":[{"billed_charge":8160.00,"npi":[1033716147]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"951934652"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":9483.00,"providers":[{"billed_charge":17920.00,"npi":[1760487987]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"952226406"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3386.79,"providers":[{"billed_charge":46139.00,"npi":[1689608150]}]}]}]},{"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":"863087969"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":67.50,"providers":[{"billed_charge":90.00,"npi":[1982090783]}]}]}]},{"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":"200797926"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":996.00,"providers":[{"billed_charge":3465.00,"npi":[1134150071]}]}]}]},{"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":"951816017"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":571.93,"providers":[{"billed_charge":6000.00,"npi":[1831188275]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"330751869"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1756.30,"providers":[{"billed_charge":58656.00,"npi":[1114971660]}]}]}]},{"name":"ULTRASOUND BREAST COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76641","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"954747393"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":45.71,"providers":[{"billed_charge":201.00,"npi":[1386893006]}]}]}]},{"name":"US EXAM, ABDOM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76700","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE","allowed_amounts":[{"tin":{"type":"ein","value":"200797926"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3322.22,"providers":[{"billed_charge":13728.00,"npi":[1134150071]}]}]}]},{"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":"834721282"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":671.70,"providers":[{"billed_charge":3195.00,"npi":[1073855607]}]}]}]},{"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":"834721282"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":800.85,"providers":[{"billed_charge":4740.00,"npi":[1073855607]}]}]}]},{"name":"DXA BONE DENSITY, AXIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77080","description":"DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP","allowed_amounts":[{"tin":{"type":"ein","value":"954747393"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":498.16,"providers":[{"billed_charge":3276.00,"npi":[1982660387]}]}]}]},{"name":"GUIDANCE FOR RADIAJ TX DLVR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77387","description":"GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR DELIVERY OF RADIATION TREATMENT DELIVERY, INCLUDES IN","allowed_amounts":[{"tin":{"type":"ein","value":"330906421"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":3546.77,"providers":[{"billed_charge":5044.00,"npi":[1790049591]}]}]}]},{"name":"RADIATION TREATMENT DELIVERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77407","description":"RADIATION TREATMENT DELIVERY, =>1 MEV; INTERMEDIATE","allowed_amounts":[{"tin":{"type":"ein","value":"461346640"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14350.40,"providers":[{"billed_charge":47965.44,"npi":[1730354929]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"954457756"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":24.55,"providers":[{"billed_charge":30.00,"npi":[1477794808]}]}]}]},{"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":"952584668"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":17.68,"providers":[{"billed_charge":139.64,"npi":[1316905235]}]}]}]},{"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":"455080644"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":80.34,"providers":[{"billed_charge":246.00,"npi":[1861413023]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"371420589"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":707.60,"providers":[{"billed_charge":10260.00,"npi":[1043352586]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"843172409"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":37218.50,"providers":[{"billed_charge":2503546.40,"npi":[1003437500]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"954457756"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":10.45,"providers":[{"billed_charge":11.00,"npi":[1477794808]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"465459135"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":335.82,"providers":[{"billed_charge":1450.00,"npi":[1174757553]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"954524103"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.25,"providers":[{"billed_charge":207.90,"npi":[1548225428]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"465459135"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":249.68,"providers":[{"billed_charge":700.00,"npi":[1174757553]}]}]}]},{"name":"ULTRASOUND BREAST COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"954747393"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":242.91,"providers":[{"billed_charge":742.00,"npi":[1386893006]}]}]}]},{"name":"ASSAY OF APOLIPOPROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82172","description":"APOLIPOPROTEIN, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"330488938"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":84.36,"providers":[{"billed_charge":600.00,"npi":[1346467354]}]}]}]},{"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":"330488938"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":177.60,"providers":[{"billed_charge":600.00,"npi":[1346467354]}]}]}]},{"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":"455080644"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.24,"providers":[{"billed_charge":138.00,"npi":[1861413023]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"954524103"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":73.50,"providers":[{"billed_charge":247.50,"npi":[1548225428]}]}]}]},{"name":"HEMOGLOBIN CHROMOTOGRAPHY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83021","description":"HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY (EG, A2, S, C, AND/OR F)","allowed_amounts":[{"tin":{"type":"ein","value":"330488938"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":72.24,"providers":[{"billed_charge":240.00,"npi":[1346467354]}]}]}]},{"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":"952833205"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":271.88,"providers":[{"billed_charge":652.22,"npi":[1477711521]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"954457756"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":24.24,"providers":[{"billed_charge":46.00,"npi":[1477794808]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"954524103"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":103.24,"providers":[{"billed_charge":550.00,"npi":[1548225428]}]}]}]},{"name":"BH/INTENS OP/PSYCH","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"84439","description":"INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"813390299"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14625.00,"providers":[{"billed_charge":28860.00,"npi":[1598348294]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"954457756"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":16.80,"providers":[{"billed_charge":61.00,"npi":[1477794808]}]}]}]},{"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":"954457756"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":756.27,"providers":[{"billed_charge":1568.00,"npi":[1477794808]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"954457756"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":14.13,"providers":[{"billed_charge":23.00,"npi":[1477794808]}]}]}]},{"name":"CCPD/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"851","description":"CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"270514415"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":17372.00,"providers":[{"billed_charge":146635.52,"npi":[1609020403]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"952833205"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.62,"providers":[{"billed_charge":62.93,"npi":[1477711521]}]}]}]},{"name":"INFLUENZA A/B AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87400","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, INFLUENZA, A OR B, EACH; (EG, ENZYME IM","allowed_amounts":[{"tin":{"type":"ein","value":"465459135"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":70.65,"providers":[{"billed_charge":750.00,"npi":[1174757553]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4895.07,"providers":[{"billed_charge":9474.30,"npi":[1790470763]}]}]}]},{"name":"CHYLMD PNEUM, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87486","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"621433252"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":500.03,"providers":[{"billed_charge":982.52,"npi":[1104631415]}]}]}]},{"name":"GARDNER VAG, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87511","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":263.17,"providers":[{"billed_charge":491.26,"npi":[1790470763]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":263.18,"providers":[{"billed_charge":491.26,"npi":[1790470763]}]}]}]},{"name":"M.TUBERCULO, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87556","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOBACTERIA TUBERCULOSIS, AMPLIFIED PROBE ","allowed_amounts":[{"tin":{"type":"ein","value":"853163633"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":791.92,"providers":[{"billed_charge":6368.62,"npi":[1063011898]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1193.05,"providers":[{"billed_charge":2315.94,"npi":[1790470763]}]}]}]},{"name":"M.PNEUMON, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87581","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3430.04,"providers":[{"billed_charge":6807.46,"npi":[1790470763]}]}]}]},{"name":"RESP VIRUS 3-5 TARGETS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87631","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ","allowed_amounts":[{"tin":{"type":"ein","value":"621433252"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2745.63,"providers":[{"billed_charge":5419.94,"npi":[1104631415]}]}]}]},{"name":"SARS-COV-2 COVID-19 AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87635","description":"Infectious agent detection by nucleic acid (DNA or RNA); (SARS-CoV-2) [COVID-19], amplified probe te","allowed_amounts":[{"tin":{"type":"ein","value":"862686429"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1359.72,"providers":[{"billed_charge":2602.86,"npi":[1912655614]}]}]}]},{"name":"SARSCOV2 & INF A&B AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87636","description":"IADNA SARSCOV2& INF A&B MULT AMPLIFIED PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"208785833"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":158.54,"providers":[{"billed_charge":190.91,"npi":[1275601478]}]}]}]},{"name":"SARSCOV2&INF A&B&RSV AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87637","description":"IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"334198695"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7274.13,"providers":[{"billed_charge":8160.00,"npi":[1528953239]}]}]}]},{"name":"STAPH A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87640","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1807.12,"providers":[{"billed_charge":3509.00,"npi":[1790470763]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"334777680"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":105.27,"providers":[{"billed_charge":126.33,"npi":[1558150078]}]}]}]},{"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":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1938.71,"providers":[{"billed_charge":3789.72,"npi":[1790470763]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"921249599"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1693.07,"providers":[{"billed_charge":3228.28,"npi":[1790470763]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"454298417"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":130.59,"providers":[{"billed_charge":287.00,"npi":[1255957205]}]}]}]},{"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":"330855183"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1813.01,"providers":[{"billed_charge":5518.00,"npi":[1326234204]}]}]}]},{"name":"PSTAY TREATMENT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"900","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"946036494"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3346.32,"providers":[{"billed_charge":13356.80,"npi":[1710918545]}]}]}]},{"name":"BH/INTENS OP/PSYCH","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"905","description":"INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"994587611"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21436.45,"providers":[{"billed_charge":207000.00,"npi":[1336961853]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"851501226"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7156.25,"providers":[{"billed_charge":100000.00,"npi":[1730706979]}]}]}]},{"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":"831064292"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5138.30,"providers":[{"billed_charge":12600.00,"npi":[1699935080]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"825283810"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":233.75,"providers":[{"billed_charge":400.00,"npi":[1356838429]}]}]}]},{"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":"542844958"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9808.70,"providers":[{"billed_charge":14850.00,"npi":[1003831504]}]}]}]},{"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":"995021743"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1173.96,"providers":[{"billed_charge":172800.00,"npi":[1649666470]}]}]}]},{"name":"PSTAY/REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"911","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"873864005"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":138750.00,"providers":[{"billed_charge":165000.00,"npi":[1922716646]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"923242581"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4235.64,"providers":[{"billed_charge":39000.00,"npi":[1528759032]}]}]}]},{"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":"861713640"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14639.04,"providers":[{"billed_charge":126000.00,"npi":[1376232728]}]}]}]},{"name":"PSTAY/INDIV RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"914","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - INDIVIDUAL THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"884143640"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":44594.91,"providers":[{"billed_charge":80800.00,"npi":[1003522483]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"990964419"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":178695.64,"providers":[{"billed_charge":2567299.96,"npi":[1902692767]}]}]}]},{"name":"EYE EXAM NEW PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92004","description":"OPHTHALMOLOGICAL SERVICES: MEDICAL EXAMINATION AND EVALUATION W INITIATION OF DIAGNOSTIC AND TRTMNT ","allowed_amounts":[{"tin":{"type":"ein","value":"462280074"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":660.23,"providers":[{"billed_charge":1050.00,"npi":[1700109501]}]}]}]},{"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":"825388333"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":167.11,"providers":[{"billed_charge":550.00,"npi":[1407165434]}]}]}]},{"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":"900020280"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":25.82,"providers":[{"billed_charge":136.56,"npi":[1235186347]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"825388333"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1391.98,"providers":[{"billed_charge":2450.00,"npi":[1407165434]}]}]}]},{"name":"MYOCRD STRAIN IMG SPCKL TRCK","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93356","description":"MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH","allowed_amounts":[{"tin":{"type":"ein","value":"825388333"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":263.51,"providers":[{"billed_charge":700.00,"npi":[1407165434]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"330751869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":648.12,"providers":[{"billed_charge":2437.00,"npi":[1114971660]}]}]}]},{"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":"271860106"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":416.81,"providers":[{"billed_charge":1450.00,"npi":[1841220621]}]}]}]},{"name":"EEG, AWAKE AND DROWSY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95816","description":"ELECTROENCEPHALOGRAM (EEG); INCLUDING RECORDING AWAKE AND DROWSY","allowed_amounts":[{"tin":{"type":"ein","value":"860795502"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13090.18,"providers":[{"billed_charge":21401.00,"npi":[1477876753]}]}]}]},{"name":"DEVEL TST PHYS/QHP 1ST HR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96112","description":"DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"860795502"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4709.13,"providers":[{"billed_charge":14050.00,"npi":[1477876753]}]}]}]},{"name":"DEVEL TST PHYS/QHP EA ADDL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96113","description":"DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"860795502"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4780.96,"providers":[{"billed_charge":31300.00,"npi":[1477876753]}]}]}]},{"name":"PT-FOCUSED HLTH RISK ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96160","description":"ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WI","allowed_amounts":[{"tin":{"type":"ein","value":"820823237"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":53.40,"providers":[{"billed_charge":71.20,"npi":[1235450834]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"454298417"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":158.70,"providers":[{"billed_charge":1000.00,"npi":[1255957205]}]}]}]},{"name":"REFILL/MAINT, PORTABLE PUMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96521","description":"REFILLING AND MAINTENANCE OF PORTABLE PUMP","allowed_amounts":[{"tin":{"type":"ein","value":"208413999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":781.50,"providers":[{"billed_charge":1000.00,"npi":[1184661571]}]}]}]},{"name":"PHOTOCHEMOTHERAPY WITH UV-B","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96910","description":"PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM AND ULTRAVIOLET B","allowed_amounts":[{"tin":{"type":"ein","value":"461078275"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":541.64,"providers":[{"billed_charge":813.48,"npi":[1205015211]}]}]}]},{"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":"200506793"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":336.00,"providers":[{"billed_charge":480.00,"npi":[1417981507]}]}]}]},{"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":"813587136"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2302.14,"providers":[{"billed_charge":15628.80,"npi":[1427699487]}]}]}]},{"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":"813587136"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":436.59,"providers":[{"billed_charge":2323.20,"npi":[1427699487]}]}]}]},{"name":"Brief Synchronous Communication Technology Evaluation and Management Service","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98016","description":"a brief synchronous communication technology evaluation and management service","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14.47,"providers":[{"billed_charge":26.43,"npi":[1811993454]}]}]}]},{"name":"SPECIMEN HANDLING OFFICE-LAB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99000","description":"HANDLING AND/OR CONVEYANCE OF SPECIMEN FOR TRANSFER FROM THE OFFICE TO A LABORATORY","allowed_amounts":[{"tin":{"type":"ein","value":"465459135"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":597.68,"providers":[{"billed_charge":850.00,"npi":[1174757553]}]}]}]},{"name":"MED SERV EVE/WKEND/HOLIDAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99051","description":"SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOU","allowed_amounts":[{"tin":{"type":"ein","value":"208785833"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":592.34,"providers":[{"billed_charge":2700.00,"npi":[1275601478]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"454298417"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":5917.95,"providers":[{"billed_charge":16400.00,"npi":[1255957205]}]}]}]},{"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":"452751949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1119.70,"providers":[{"billed_charge":2760.00,"npi":[1821030057]}]}]}]},{"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":"814698474"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1702.50,"providers":[{"billed_charge":2270.00,"npi":[1861565285]}]}]}]},{"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":"451486258"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5934.84,"providers":[{"billed_charge":22563.12,"npi":[1053467720]}]}]}]},{"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":"465058879"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":273.74,"providers":[{"billed_charge":330.00,"npi":[1083610703]}]}]}]},{"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":"472513872"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5473.21,"providers":[{"billed_charge":8200.00,"npi":[1417123332]}]}]}]},{"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":"330905995"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":846.84,"providers":[{"billed_charge":1610.00,"npi":[1699087908]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE ","allowed_amounts":[{"tin":{"type":"ein","value":"813991713"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1213.02,"providers":[{"billed_charge":1650.00,"npi":[1073527099]}]}]}]},{"name":"BEHAV CHNG SMOKING 3-10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99406","description":"SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":12.84,"providers":[{"billed_charge":21.96,"npi":[1811993454]}]}]}]},{"name":"Under Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99418","description":"Under Prolonged Service With or Without Direct Patient Contact on the Date of an Evaluation and Management Service","allowed_amounts":[{"tin":{"type":"ein","value":"562616409"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2520.00,"providers":[{"billed_charge":2520.00,"npi":[1417008772]}]}]}]},{"name":"SELF-MEAS BP PT EDUCAJ/TRAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99473","description":"SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION","allowed_amounts":[{"tin":{"type":"ein","value":"820823237"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":243.00,"providers":[{"billed_charge":324.00,"npi":[1235450834]}]}]}]},{"name":"ADVNCD CARE PLAN 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99497","description":"ADV CARE PLANNING INCL THE EXPLANATION AND DISCUSSION OF ADV DIRECTIVES SUCH AS STANDARD FORMS (W CO","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":836.96,"providers":[{"billed_charge":2400.00,"npi":[1811993454]}]}]}]},{"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":"952426613"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":838.00,"providers":[{"billed_charge":838.00,"npi":[1689608994]}]}]}]},{"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":"330285453"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":74577.96,"providers":[{"billed_charge":74577.96,"npi":[1639131436]}]}]}]},{"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":"330285453"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":44786.57,"providers":[{"billed_charge":44786.57,"npi":[1639131436]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":67.16,"providers":[{"billed_charge":138.40,"npi":[1902863202]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":346.25,"providers":[{"billed_charge":711.82,"npi":[1902863202]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":196.29,"providers":[{"billed_charge":644.74,"npi":[1902863202]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":186.12,"providers":[{"billed_charge":483.70,"npi":[1902863202]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":975.75,"providers":[{"billed_charge":4350.00,"npi":[1902863202]}]}]}]},{"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":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2172.56,"providers":[{"billed_charge":8180.92,"npi":[1902863202]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"954021787"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1100.82,"providers":[{"billed_charge":7035.00,"npi":[1902863202]}]}]}]},{"name":"Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0316","description":"Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (","allowed_amounts":[{"tin":{"type":"ein","value":"562616409"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":989.75,"providers":[{"billed_charge":2600.00,"npi":[1417008772]}]}]}]},{"name":"ANL ALCHL MISUSE SCREN 15MIM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0442","description":"ANNUAL ALCOHOL MISUSE SCREENING, 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":184.57,"providers":[{"billed_charge":417.72,"npi":[1811993454]}]}]}]},{"name":"ANL DEPRSSION SCREENG 15 MIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0444","description":"ANNUAL DEPRESSION SCREENING, 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14.57,"providers":[{"billed_charge":29.63,"npi":[1811993454]}]}]}]},{"name":"ANN F2F INT BEHV TX CV DZ IN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0446","description":"ANNUAL, FACE-TO-FACE INTENSIVE BEHAVIORAL THERAPY FOR CARDIOVASCULAR DISEASE, INDIVIDUAL, 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":303.64,"providers":[{"billed_charge":493.90,"npi":[1811993454]}]}]}]},{"name":"FCE-FCE BEHAVRL CNSL OBESITY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0447","description":"FACE-TO-FACE BEHAVIORAL COUNSELING FOR OBESITY, 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"810600022"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":56.72,"providers":[{"billed_charge":93.92,"npi":[1811993454]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 1-7","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0480","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"823146637"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3778.56,"providers":[{"billed_charge":21836.08,"npi":[1861994600]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 8-1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0481","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"813115799"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":782.95,"providers":[{"billed_charge":8904.50,"npi":[1306381694]}]}]}]},{"name":"MOD SED SVC PRV SM PHYS PER","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0500","description":"MODERATE SEDATION SERVICES PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONA","allowed_amounts":[{"tin":{"type":"ein","value":"852562583"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":44.95,"providers":[{"billed_charge":1900.00,"npi":[1891053187]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"462568903"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":564.32,"providers":[{"billed_charge":1884.00,"npi":[1679956809]}]}]}]},{"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":"810600022"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":27.21,"providers":[{"billed_charge":53.10,"npi":[1811993454]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"330652655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":51.28,"providers":[{"billed_charge":992.00,"npi":[1033452727]}]}]}]},{"name":"ALCOHOL &/OR DRUG SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0049","description":"ALCOHOL AND/OR DRUG SCREENING","allowed_amounts":[{"tin":{"type":"ein","value":"820823237"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":231.48,"providers":[{"billed_charge":308.52,"npi":[1235450834]}]}]}]},{"name":"BEHAVIORL HLTH DAY TX PER HR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H2012","description":"BEHAVIORAL HEALTH DAY TREATMENT, PER HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"883178042"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2038.05,"providers":[{"billed_charge":87325.00,"npi":[1558073072]}]}]}]},{"name":"INJLEVOCARNITINE PER 1 G","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1955","description":"INJECTION, LEVOCARNITINE, PER 1 G","allowed_amounts":[{"tin":{"type":"ein","value":"680250542"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":231.98,"providers":[{"billed_charge":461.80,"npi":[1619084829]}]}]}]},{"name":"INJ TRIAMCINOLON ACETONID NO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J3301","description":"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG","allowed_amounts":[{"tin":{"type":"ein","value":"931950904"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.38,"providers":[{"billed_charge":390.50,"npi":[1902289226]}]}]}]},{"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":"843172409"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":342.79,"providers":[{"billed_charge":1018.15,"npi":[1003437500]}]}]}]},{"name":"TRAVL 1 WAY NEC LAB SPEC; TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"P9604","description":"TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F","allowed_amounts":[{"tin":{"type":"ein","value":"843045583"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15.30,"providers":[{"billed_charge":30.00,"npi":[1508499393]}]}]}]},{"name":"SERVICES PROV AN URGENT CARE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9088","description":"SERVICES PROVIDED IN AN URGENT CARE CENTER (LIST IN ADDITION TO CODE FOR SERVICE)","allowed_amounts":[{"tin":{"type":"ein","value":"208785833"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":687.78,"providers":[{"billed_charge":900.00,"npi":[1275601478]}]}]}]}]}