{"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":"NCNTC R-T FLUOR WND IMG 1ST","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0598T","description":"NONCONTACT R-T FLUOR WND IMG 1ST ANATOMIC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":319.91,"providers":[{"billed_charge":779.88,"npi":[1114399375]}]}]}]},{"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":"833494125"},"service_code":["56","21"],"billing_class":"institutional","payments":[{"allowed_amount":120393.00,"providers":[{"billed_charge":954135.00,"npi":[1609409762]}]},{"allowed_amount":19404.00,"providers":[{"billed_charge":153780.00,"npi":[1609409762]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"640662976"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":596.79,"providers":[{"billed_charge":2199.00,"npi":[1982754974]}]}]},{"tin":{"type":"ein","value":"621519754"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1659.00,"providers":[{"billed_charge":5675.00,"npi":[1083432025]}]},{"allowed_amount":995.40,"providers":[{"billed_charge":3405.00,"npi":[1679174403]}]}]},{"tin":{"type":"ein","value":"646001567"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":699.86,"providers":[{"billed_charge":4480.00,"npi":[1356742894]}]}]}]},{"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":"646001587"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":107952.15,"providers":[{"billed_charge":165074.25,"npi":[1225041809]}]}]}]},{"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":"833494125"},"service_code":["56","21"],"billing_class":"institutional","payments":[{"allowed_amount":5292.00,"providers":[{"billed_charge":47940.00,"npi":[1609409762]}]},{"allowed_amount":16317.00,"providers":[{"billed_charge":147815.00,"npi":[1609409762]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37.09,"providers":[{"billed_charge":123.57,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":632.78,"providers":[{"billed_charge":2940.99,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":236.91,"providers":[{"billed_charge":1265.52,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":546.21,"providers":[{"billed_charge":1820.67,"npi":[1578568481]}]}]}]},{"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":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1165.41,"providers":[{"billed_charge":2650.07,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.23,"providers":[{"billed_charge":80.75,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":467.74,"providers":[{"billed_charge":6311.20,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":852.40,"providers":[{"billed_charge":852.40,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1945.40,"providers":[{"billed_charge":3094.00,"npi":[1558365890]}]},{"allowed_amount":802.12,"providers":[{"billed_charge":3068.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7114.41,"providers":[{"billed_charge":32241.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":370.14,"providers":[{"billed_charge":968.00,"npi":[1932143989]}]},{"allowed_amount":117.99,"providers":[{"billed_charge":306.13,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2778.20,"providers":[{"billed_charge":9057.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3208.80,"providers":[{"billed_charge":6721.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1665.05,"providers":[{"billed_charge":5771.00,"npi":[1578568481]}]}]}]},{"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":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1901.81,"providers":[{"billed_charge":6339.38,"npi":[1144227539]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":293.19,"providers":[{"billed_charge":617.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2332.79,"providers":[{"billed_charge":4261.00,"npi":[1558365890]}]},{"allowed_amount":3.00,"providers":[{"billed_charge":502.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16240.72,"providers":[{"billed_charge":47555.00,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5478.55,"providers":[{"billed_charge":13684.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":277.94,"providers":[{"billed_charge":721.16,"npi":[1932143989]}]},{"allowed_amount":3251.37,"providers":[{"billed_charge":6437.20,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14.37,"providers":[{"billed_charge":189.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":131.41,"providers":[{"billed_charge":991.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2344.18,"providers":[{"billed_charge":6198.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4643.63,"providers":[{"billed_charge":35900.96,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1168.12,"providers":[{"billed_charge":2007.00,"npi":[1811973100]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":32.57,"providers":[{"billed_charge":5594.00,"npi":[1558365890]}]},{"allowed_amount":7128.92,"providers":[{"billed_charge":10836.00,"npi":[1558365890]}]},{"allowed_amount":285.97,"providers":[{"billed_charge":337.00,"npi":[1386709871]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14999.94,"providers":[{"billed_charge":36739.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":161.80,"providers":[{"billed_charge":1019.50,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1597.65,"providers":[{"billed_charge":14726.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9343.89,"providers":[{"billed_charge":24080.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3534.14,"providers":[{"billed_charge":13589.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52.90,"providers":[{"billed_charge":86.00,"npi":[1811973100]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1729.15,"providers":[{"billed_charge":2868.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3176.93,"providers":[{"billed_charge":8836.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":86.73,"providers":[{"billed_charge":1919.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1185.65,"providers":[{"billed_charge":3204.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":462.40,"providers":[{"billed_charge":3700.00,"npi":[1578568481]}]}]}]},{"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":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":272.16,"providers":[{"billed_charge":841.00,"npi":[1912341439]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":312.36,"providers":[{"billed_charge":352.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":804.87,"providers":[{"billed_charge":1270.00,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1439.34,"providers":[{"billed_charge":3498.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2980.52,"providers":[{"billed_charge":9473.00,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2502.69,"providers":[{"billed_charge":15672.00,"npi":[1912341439]}]},{"allowed_amount":98.56,"providers":[{"billed_charge":1225.00,"npi":[1912341439]}]}]}]},{"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":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2258.24,"providers":[{"billed_charge":12064.00,"npi":[1912341439]}]}]}]},{"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":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3564.04,"providers":[{"billed_charge":11039.00,"npi":[1841394418]}]}]}]},{"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":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2434.10,"providers":[{"billed_charge":10071.00,"npi":[1578568481]}]}]}]},{"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":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3580.53,"providers":[{"billed_charge":33923.00,"npi":[1912341439]}]}]}]},{"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":"393714515"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11711.29,"providers":[{"billed_charge":44529.00,"npi":[1346112521]}]},{"allowed_amount":873.69,"providers":[{"billed_charge":6643.00,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16956.45,"providers":[{"billed_charge":184966.00,"npi":[1912341439]}]}]}]},{"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":"471613586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.97,"providers":[{"billed_charge":10.00,"npi":[1922767938]}]}]},{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":190.56,"providers":[{"billed_charge":480.00,"npi":[1114395050]}]},{"allowed_amount":107.41,"providers":[{"billed_charge":230.00,"npi":[1407895725]}]},{"allowed_amount":150.86,"providers":[{"billed_charge":380.00,"npi":[1700557915]}]}]},{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5692.35,"providers":[{"billed_charge":22194.00,"npi":[1942526447]}]}]},{"tin":{"type":"ein","value":"934244735"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":81.12,"providers":[{"billed_charge":280.00,"npi":[1922559772]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.10,"providers":[{"billed_charge":120.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":98.15,"providers":[{"billed_charge":250.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.49,"providers":[{"billed_charge":57.00,"npi":[1255975405]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.16,"providers":[{"billed_charge":192.00,"npi":[1194956755]}]}]},{"tin":{"type":"ein","value":"275099507"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.16,"providers":[{"billed_charge":6.00,"npi":[1518113166]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":35.28,"providers":[{"billed_charge":70.00,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"640362400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.28,"providers":[{"billed_charge":63.00,"npi":[1629365853]}]}]},{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":181.05,"providers":[{"billed_charge":740.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.20,"providers":[{"billed_charge":125.00,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1785.00,"providers":[{"billed_charge":7678.60,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":23.82,"providers":[{"billed_charge":48.00,"npi":[1609323450]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45000.30,"providers":[{"billed_charge":78159.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38028.64,"providers":[{"billed_charge":137570.00,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41127.63,"providers":[{"billed_charge":293437.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":344.67,"providers":[{"billed_charge":1064.50,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2298.25,"providers":[{"billed_charge":3374.78,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":28279.80,"providers":[{"billed_charge":41088.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6320.71,"providers":[{"billed_charge":28145.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29990.93,"providers":[{"billed_charge":45672.00,"npi":[1578568481]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"640732896"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":2519.40,"providers":[{"billed_charge":5116.53,"npi":[1477919603]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":10531.40,"providers":[{"billed_charge":19752.89,"npi":[1234567893]}]}]}]},{"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":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":291.71,"providers":[{"billed_charge":972.33,"npi":[1558365890]}]},{"allowed_amount":7.93,"providers":[{"billed_charge":29.69,"npi":[1386709871]}]},{"allowed_amount":10733.46,"providers":[{"billed_charge":52752.04,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3119.76,"providers":[{"billed_charge":10576.42,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7639.92,"providers":[{"billed_charge":23795.26,"npi":[1912341439]}]},{"allowed_amount":1.34,"providers":[{"billed_charge":154.55,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"646001587"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":141.20,"providers":[{"billed_charge":366.40,"npi":[1932143989]}]},{"allowed_amount":411.44,"providers":[{"billed_charge":2474.30,"npi":[1932143989]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":407.65,"providers":[{"billed_charge":4094.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4026.05,"providers":[{"billed_charge":13420.17,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6432.05,"providers":[{"billed_charge":21616.84,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":124.07,"providers":[{"billed_charge":413.55,"npi":[1811973100]}]}]}]},{"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":"640899562"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":2028.00,"providers":[{"billed_charge":2600.00,"npi":[1518219773]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"640409419"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":75.16,"providers":[{"billed_charge":396.00,"npi":[1497312664]}]}]}]},{"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":"640501324"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":175.41,"providers":[{"billed_charge":770.00,"npi":[1891792842]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":70.00,"npi":[1073775466]}]},{"allowed_amount":47.88,"providers":[{"billed_charge":210.00,"npi":[1891792842]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":35.00,"npi":[1891792842]}]}]},{"tin":{"type":"ein","value":"640409419"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":39.90,"providers":[{"billed_charge":170.00,"npi":[1497312664]}]},{"allowed_amount":87.78,"providers":[{"billed_charge":374.00,"npi":[1497312664]}]}]},{"tin":{"type":"ein","value":"640863698"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":78.60,"providers":[{"billed_charge":350.00,"npi":[1366479115]}]},{"allowed_amount":37.50,"providers":[{"billed_charge":175.00,"npi":[1306993282]}]},{"allowed_amount":52.26,"providers":[{"billed_charge":245.00,"npi":[1366479115]}]},{"allowed_amount":39.90,"providers":[{"billed_charge":175.00,"npi":[1366479115]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":70.00,"npi":[1306993282]}]},{"allowed_amount":29.52,"providers":[{"billed_charge":140.00,"npi":[1306993282]}]}]}]},{"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":"640409419"},"service_code":["22","11","23","21"],"billing_class":"professional","payments":[{"allowed_amount":47.80,"providers":[{"billed_charge":205.00,"npi":[1497312664]}]},{"allowed_amount":19.12,"providers":[{"billed_charge":82.00,"npi":[1497312664]}]},{"allowed_amount":86.04,"providers":[{"billed_charge":369.00,"npi":[1497312664]}]}]}]},{"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":"393714515"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1175.07,"providers":[{"billed_charge":5405.00,"npi":[1346112521]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3140.81,"providers":[{"billed_charge":16965.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":611.22,"providers":[{"billed_charge":1566.00,"npi":[1578568481]}]}]}]},{"name":"X-RAY EXAM KNEE 4 OR MORE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73564","description":"RADIOLOGIC EXAMINATION, KNEE; COMPLETE, 4 OR MORE VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"640507572"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":899.64,"providers":[{"billed_charge":1260.00,"npi":[1912565763]}]}]}]},{"name":"FETAL BIOPHYS PROFIL W/O NST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76819","description":"FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING","allowed_amounts":[{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1198.38,"providers":[{"billed_charge":4275.00,"npi":[1013930122]}]}]}]},{"name":"TRANSVAGINAL US, NON-OB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76830","description":"ULTRASOUND, TRANSVAGINAL","allowed_amounts":[{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.34,"providers":[{"billed_charge":630.00,"npi":[1396306957]}]},{"allowed_amount":915.61,"providers":[{"billed_charge":2310.00,"npi":[1013930122]}]}]}]},{"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":"640501324"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":26.49,"providers":[{"billed_charge":128.00,"npi":[1639666597]}]}]},{"tin":{"type":"ein","value":"412007905"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":239.60,"providers":[{"billed_charge":1108.00,"npi":[1477930162]}]}]},{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2647.59,"providers":[{"billed_charge":8875.00,"npi":[1336187947]}]}]}]},{"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":"412007905"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":309.82,"providers":[{"billed_charge":1408.00,"npi":[1477930162]}]}]},{"tin":{"type":"ein","value":"640501324"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":33.47,"providers":[{"billed_charge":128.00,"npi":[1639666597]}]}]},{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6716.25,"providers":[{"billed_charge":24900.00,"npi":[1336187947]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":464.82,"providers":[{"billed_charge":4382.86,"npi":[1234567893]}]}]}]},{"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":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":29.05,"providers":[{"billed_charge":634.10,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8844.50,"providers":[{"billed_charge":90596.39,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":22.45,"providers":[{"billed_charge":190.00,"npi":[1609323450]}]}]}]},{"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":8013.87,"providers":[{"billed_charge":85839.37,"npi":[1234567893]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.73,"providers":[{"billed_charge":108.00,"npi":[1234567893]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":192.87,"providers":[{"billed_charge":2700.00,"npi":[1234567893]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.52,"providers":[{"billed_charge":537.60,"npi":[1234567893]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE ","allowed_amounts":[{"tin":{"type":"ein","value":"815000928"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1408.37,"providers":[{"billed_charge":2376.00,"npi":[1770367716]}]}]}]},{"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":"421633186"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":528.16,"providers":[{"billed_charge":1264.00,"npi":[1376814533]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1258.20,"providers":[{"billed_charge":6482.45,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS NONAUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81000","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":4.02,"providers":[{"billed_charge":10.00,"npi":[1841076403]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":220.22,"providers":[{"billed_charge":3696.00,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.36,"providers":[{"billed_charge":410.00,"npi":[1114395050]}]},{"allowed_amount":25.92,"providers":[{"billed_charge":270.00,"npi":[1700557915]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3.84,"providers":[{"billed_charge":28.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":2.88,"providers":[{"billed_charge":45.00,"npi":[1730774290]}]},{"allowed_amount":0.96,"providers":[{"billed_charge":15.00,"npi":[1730774290]}]},{"allowed_amount":4.80,"providers":[{"billed_charge":75.00,"npi":[1730774290]}]}]}]},{"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":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":142.23,"providers":[{"billed_charge":858.00,"npi":[1013930122]}]},{"allowed_amount":113.46,"providers":[{"billed_charge":806.00,"npi":[1396306957]}]}]}]},{"name":"NFCT DS BV RNA VAG FLU ALG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81513","description":"NFCT DS BACTERAL VAGINOSIS RNA VAGINAL-FLUID ALG","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6418.80,"providers":[{"billed_charge":32092.20,"npi":[1093753303]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":579.80,"providers":[{"billed_charge":9407.89,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":55.48,"providers":[{"billed_charge":760.00,"npi":[1234567893]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":108.48,"providers":[{"billed_charge":649.23,"npi":[1234567893]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9097.56,"providers":[{"billed_charge":25271.00,"npi":[1234567893]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":161.48,"providers":[{"billed_charge":1890.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.60,"providers":[{"billed_charge":720.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":542.89,"providers":[{"billed_charge":8812.76,"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":2396.87,"providers":[{"billed_charge":31967.73,"npi":[1234567893]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":30.00,"providers":[{"billed_charge":360.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1156.44,"providers":[{"billed_charge":12092.00,"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":1489.59,"providers":[{"billed_charge":17273.44,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1476.26,"providers":[{"billed_charge":19880.31,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":459.80,"providers":[{"billed_charge":4990.95,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":199.92,"providers":[{"billed_charge":2278.80,"npi":[1234567893]}]}]}]},{"name":"HEMOGLOBIN ELECTROPHORESIS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83020","description":"HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F)","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.65,"providers":[{"billed_charge":179.40,"npi":[1942526447]}]}]}]},{"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":"320439952"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":54.81,"providers":[{"billed_charge":204.00,"npi":[1285332064]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":32.04,"providers":[{"billed_charge":221.34,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4890.03,"providers":[{"billed_charge":67140.00,"npi":[1234567893]}]}]}]},{"name":"IMMUNOASSAY QUANT NOS NONAB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83520","description":"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":107.94,"providers":[{"billed_charge":964.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":77.10,"providers":[{"billed_charge":1080.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":875.91,"providers":[{"billed_charge":7643.09,"npi":[1234567893]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1065.03,"providers":[{"billed_charge":8919.40,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":79.22,"providers":[{"billed_charge":971.85,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":489.24,"providers":[{"billed_charge":6804.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF NATRIURETIC PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83880","description":"NATRIURETIC PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":406.41,"providers":[{"billed_charge":3680.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":130.06,"providers":[{"billed_charge":1190.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.78,"providers":[{"billed_charge":174.65,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":300.48,"providers":[{"billed_charge":3200.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":139.52,"providers":[{"billed_charge":1536.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1167.48,"providers":[{"billed_charge":10977.60,"npi":[1234567893]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.59,"providers":[{"billed_charge":201.15,"npi":[1942526447]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":547.68,"providers":[{"billed_charge":5397.90,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1938.87,"providers":[{"billed_charge":20446.24,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":114.33,"providers":[{"billed_charge":1315.75,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":860.72,"providers":[{"billed_charge":15264.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8293.32,"providers":[{"billed_charge":91927.50,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF THYROID (T3 OR T4)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84479","description":"THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":64.02,"providers":[{"billed_charge":766.11,"npi":[1234567893]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":108.46,"providers":[{"billed_charge":1224.00,"npi":[1234567893]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":617.22,"providers":[{"billed_charge":9720.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":144.13,"providers":[{"billed_charge":2110.47,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF C-PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84681","description":"C-PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":65.52,"providers":[{"billed_charge":714.00,"npi":[1234567893]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":88.01,"providers":[{"billed_charge":975.00,"npi":[1234567893]}]}]}]},{"name":"BL SMEAR W/DIFF WBC COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85007","description":"BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EXAMINATION WITH MANUAL DIFFERENTIAL WBC COUNT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8.55,"providers":[{"billed_charge":60.00,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":26.40,"providers":[{"billed_charge":136.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.10,"providers":[{"billed_charge":476.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":15.54,"providers":[{"billed_charge":50.00,"npi":[1841076403]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3839.50,"providers":[{"billed_charge":39430.58,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":250.80,"providers":[{"billed_charge":1292.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12.39,"providers":[{"billed_charge":108.00,"npi":[1194956755]}]}]},{"tin":{"type":"ein","value":"208339281"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":23.31,"providers":[{"billed_charge":75.00,"npi":[1841799616]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":582.00,"providers":[{"billed_charge":6720.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.75,"providers":[{"billed_charge":26.00,"npi":[1255975405]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":34.20,"providers":[{"billed_charge":684.00,"npi":[1234567893]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.23,"providers":[{"billed_charge":276.32,"npi":[1234567893]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":107.36,"providers":[{"billed_charge":2640.00,"npi":[1234567893]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":462.40,"providers":[{"billed_charge":6120.00,"npi":[1234567893]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES (ANA)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86039","description":"ANTINUCLEAR ANTIBODIES (ANA); TITER","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":100.40,"providers":[{"billed_charge":1320.00,"npi":[1234567893]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":172.68,"providers":[{"billed_charge":3532.00,"npi":[1234567893]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.64,"providers":[{"billed_charge":556.80,"npi":[1234567893]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.98,"providers":[{"billed_charge":882.31,"npi":[1234567893]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":556.75,"providers":[{"billed_charge":7484.40,"npi":[1234567893]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":248.90,"providers":[{"billed_charge":3641.92,"npi":[1234567893]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.15,"providers":[{"billed_charge":2219.05,"npi":[1234567893]}]}]}]},{"name":"TB TEST CELL IMMUN MEASURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86480","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":251.01,"providers":[{"billed_charge":2289.60,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":293.76,"providers":[{"billed_charge":5477.12,"npi":[1234567893]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":300.28,"providers":[{"billed_charge":3677.64,"npi":[1234567893]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":475.17,"providers":[{"billed_charge":5777.64,"npi":[1234567893]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":71.60,"providers":[{"billed_charge":1140.00,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":378.78,"providers":[{"billed_charge":5664.00,"npi":[1234567893]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.28,"providers":[{"billed_charge":630.00,"npi":[1234567893]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":498.52,"providers":[{"billed_charge":8220.00,"npi":[1234567893]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14.90,"providers":[{"billed_charge":210.00,"npi":[1234567893]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1187.01,"providers":[{"billed_charge":19620.00,"npi":[1234567893]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":315.09,"providers":[{"billed_charge":2430.00,"npi":[1234567893]}]}]}]},{"name":"SMEAR, GRAM STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87205","description":"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FOR BACTERIA, FUNGI, OR CELL TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1.92,"providers":[{"billed_charge":36.00,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.50,"providers":[{"billed_charge":600.00,"npi":[1234567893]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1918.68,"providers":[{"billed_charge":14868.00,"npi":[1234567893]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":315.42,"providers":[{"billed_charge":1050.00,"npi":[1114701570]}]}]}]},{"name":"SARSCOV & INF VIR A&B AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87428","description":"IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":149.35,"providers":[{"billed_charge":375.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":125.46,"providers":[{"billed_charge":411.00,"npi":[1760353411]}]}]}]},{"name":"STREP A AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87430","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, STREPTOCOCCUS, GROUP A; (EG, ENZYME IMM","allowed_amounts":[{"tin":{"type":"ein","value":"646001350"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":9.25,"providers":[{"billed_charge":35.00,"npi":[1659775732]}]}]}]},{"name":"AG DETECT POLYVAL IA MULT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87451","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE; MULTIPLE STEP METHOD, EACH POLYVALENT A","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":279.07,"providers":[{"billed_charge":2360.00,"npi":[1234567893]}]}]}]},{"name":"CANDIDA, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87480","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":595.32,"providers":[{"billed_charge":4488.00,"npi":[1234567893]}]}]}]},{"name":"Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87494","description":" Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique.","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":272.15,"providers":[{"billed_charge":790.24,"npi":[1093753303]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":81.44,"providers":[{"billed_charge":434.00,"npi":[1043670722]}]}]}]},{"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":351.00,"providers":[{"billed_charge":2105.40,"npi":[1093753303]}]}]}]},{"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":473.85,"providers":[{"billed_charge":2970.00,"npi":[1942526447]}]},{"allowed_amount":4580.55,"providers":[{"billed_charge":28710.00,"npi":[1093753303]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1042.14,"providers":[{"billed_charge":11022.00,"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":666.90,"providers":[{"billed_charge":3753.64,"npi":[1942526447]}]}]}]},{"name":"TRICHOMONAS VAGIN, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87660","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.30,"providers":[{"billed_charge":1020.00,"npi":[1234567893]}]}]}]},{"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":["81"],"billing_class":"professional","payments":[{"allowed_amount":22253.40,"providers":[{"billed_charge":278562.02,"npi":[1093753303]}]},{"allowed_amount":4527.90,"providers":[{"billed_charge":49404.28,"npi":[1942526447]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8813.61,"providers":[{"billed_charge":91896.00,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112.56,"providers":[{"billed_charge":400.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":288.23,"providers":[{"billed_charge":1148.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":246.05,"providers":[{"billed_charge":1435.00,"npi":[1316829252]}]},{"allowed_amount":35.15,"providers":[{"billed_charge":205.00,"npi":[1922695964]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":168.72,"providers":[{"billed_charge":747.84,"npi":[1730774290]}]},{"allowed_amount":421.80,"providers":[{"billed_charge":1869.60,"npi":[1730774290]}]},{"allowed_amount":21.09,"providers":[{"billed_charge":93.48,"npi":[1730774290]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":211.08,"providers":[{"billed_charge":600.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":17.59,"providers":[{"billed_charge":201.00,"npi":[1730774290]}]},{"allowed_amount":123.13,"providers":[{"billed_charge":1407.00,"npi":[1730774290]}]},{"allowed_amount":474.93,"providers":[{"billed_charge":5427.00,"npi":[1730774290]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":140.72,"providers":[{"billed_charge":824.00,"npi":[1316829252]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87812","description":"infectious agent antigen detection of SARS-CoV-2 (COVID-19) and influenza virus types A and B using a single, visually read (direct optical observation) multiplex test","allowed_amounts":[{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":165.30,"providers":[{"billed_charge":800.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":126.60,"providers":[{"billed_charge":480.00,"npi":[1174980478]}]}]}]},{"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":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":35.15,"providers":[{"billed_charge":185.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.95,"providers":[{"billed_charge":570.00,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.66,"providers":[{"billed_charge":550.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":84.36,"providers":[{"billed_charge":408.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":7.03,"providers":[{"billed_charge":31.16,"npi":[1730774290]}]},{"allowed_amount":112.48,"providers":[{"billed_charge":498.56,"npi":[1730774290]}]},{"allowed_amount":49.21,"providers":[{"billed_charge":218.12,"npi":[1730774290]}]}]}]},{"name":"CYTOPATH, C/V, INTERPRET","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88141","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING INTERPRETATION BY PHYSICIAN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":235.68,"providers":[{"billed_charge":1680.00,"npi":[1234567893]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":718.74,"providers":[{"billed_charge":5076.00,"npi":[1942526447]}]},{"allowed_amount":6175.84,"providers":[{"billed_charge":43616.00,"npi":[1093753303]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3614.94,"providers":[{"billed_charge":35636.00,"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.21,"providers":[{"billed_charge":81.00,"npi":[1720405814]}]},{"allowed_amount":36.26,"providers":[{"billed_charge":222.42,"npi":[1598898967]}]}]},{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":34.35,"providers":[{"billed_charge":700.00,"npi":[1861464760]}]}]}]},{"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":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1403.89,"providers":[{"billed_charge":10777.50,"npi":[1598898967]}]},{"allowed_amount":1898.48,"providers":[{"billed_charge":15090.80,"npi":[1720405814]}]},{"allowed_amount":811.76,"providers":[{"billed_charge":6923.00,"npi":[1447331897]}]},{"allowed_amount":63.52,"providers":[{"billed_charge":576.00,"npi":[1104973080]}]},{"allowed_amount":47.64,"providers":[{"billed_charge":432.00,"npi":[1821206962]}]}]},{"tin":{"type":"ein","value":"640867628"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":83.85,"providers":[{"billed_charge":1000.00,"npi":[1164525309]}]},{"allowed_amount":888.85,"providers":[{"billed_charge":10600.00,"npi":[1164525309]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":611.40,"providers":[{"billed_charge":1708.00,"npi":[1659574127]}]}]},{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":4309.89,"providers":[{"billed_charge":43433.00,"npi":[1861464760]}]}]},{"tin":{"type":"ein","value":"640678600"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":41.93,"providers":[{"billed_charge":410.00,"npi":[1790777142]}]},{"allowed_amount":1216.10,"providers":[{"billed_charge":11890.00,"npi":[1790777142]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88307","description":"LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ADRENAL, RESECTION BONE - BIOPSY/CUR","allowed_amounts":[{"tin":{"type":"ein","value":"621695507"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":382.96,"providers":[{"billed_charge":1086.62,"npi":[1598898967]}]}]}]},{"name":"SPECIAL STAINS GROUP 1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88312","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN","allowed_amounts":[{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":755.54,"providers":[{"billed_charge":4662.00,"npi":[1861464760]}]}]}]},{"name":"SPECIAL STAINS GROUP 2","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88313","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT","allowed_amounts":[{"tin":{"type":"ein","value":"640523321"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":307.86,"providers":[{"billed_charge":3192.00,"npi":[1861464760]}]}]}]},{"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":"581666179"},"service_code":["72"],"billing_class":"institutional","payments":[{"allowed_amount":969.00,"providers":[{"billed_charge":5077.70,"npi":[1396439899]}]}]}]},{"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":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10110.00,"providers":[{"billed_charge":196812.00,"npi":[1912670068]}]}]},{"tin":{"type":"ein","value":"800966827"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7220.00,"providers":[{"billed_charge":76000.00,"npi":[1104212794]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1414.56,"providers":[{"billed_charge":2716.00,"npi":[1234567893]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"646008520"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1547.55,"providers":[{"billed_charge":1575.00,"npi":[1326468679]}]}]},{"tin":{"type":"ein","value":"853165427"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":206.36,"providers":[{"billed_charge":680.00,"npi":[1023876166]}]},{"allowed_amount":51.59,"providers":[{"billed_charge":170.00,"npi":[1023876166]}]}]}]},{"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":"874345955"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":329.49,"providers":[{"billed_charge":750.00,"npi":[1396383501]}]}]},{"tin":{"type":"ein","value":"640834532"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":389.12,"providers":[{"billed_charge":480.00,"npi":[1073091963]}]}]},{"tin":{"type":"ein","value":"640662976"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":180.06,"providers":[{"billed_charge":232.00,"npi":[1881258267]}]}]}]},{"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":"384013585"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":100.45,"providers":[{"billed_charge":190.00,"npi":[1306085253]}]},{"allowed_amount":604.70,"providers":[{"billed_charge":950.00,"npi":[1306085253]}]}]},{"tin":{"type":"ein","value":"646029322"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":3613.74,"providers":[{"billed_charge":5480.44,"npi":[1346084092]}]}]},{"tin":{"type":"ein","value":"854131067"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2902.56,"providers":[{"billed_charge":5760.00,"npi":[1912531005]}]}]},{"tin":{"type":"ein","value":"272955562"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":241.63,"providers":[{"billed_charge":380.00,"npi":[1649005265]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":2900.10,"providers":[{"billed_charge":7680.00,"npi":[1811682099]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":6179.00,"providers":[{"billed_charge":12987.00,"npi":[1234567893]}]}]}]},{"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":"923029503"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":27.41,"providers":[{"billed_charge":375.00,"npi":[1619825460]}]}]}]},{"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":"471052932"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25111.80,"providers":[{"billed_charge":198000.00,"npi":[1356703524]}]}]}]},{"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":"833494125"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":78059.42,"providers":[{"billed_charge":631945.00,"npi":[1609409762]}]}]},{"tin":{"type":"ein","value":"461281853"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8505.00,"providers":[{"billed_charge":107865.00,"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":"832176650"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1431.25,"providers":[{"billed_charge":2500.00,"npi":[1538879994]}]}]}]},{"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":"201668701"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":29.52,"providers":[{"billed_charge":266.20,"npi":[1487841847]}]}]},{"tin":{"type":"ein","value":"640682111"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":131.01,"providers":[{"billed_charge":858.00,"npi":[1962507061]}]},{"allowed_amount":285.84,"providers":[{"billed_charge":1872.00,"npi":[1962507061]}]}]}]},{"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":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":218.76,"providers":[{"billed_charge":600.00,"npi":[1629186382]}]}]}]},{"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":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14.52,"providers":[{"billed_charge":40.00,"npi":[1114395050]}]},{"allowed_amount":47.19,"providers":[{"billed_charge":130.00,"npi":[1700557915]}]}]},{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":90.80,"providers":[{"billed_charge":800.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":18.15,"providers":[{"billed_charge":50.00,"npi":[1396306957]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":43.56,"providers":[{"billed_charge":132.00,"npi":[1316829252]}]}]}]},{"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":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":510.84,"providers":[{"billed_charge":1634.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"463878759"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":12.15,"providers":[{"billed_charge":40.00,"npi":[1205528833]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.70,"providers":[{"billed_charge":588.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.35,"providers":[{"billed_charge":245.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":372.59,"providers":[{"billed_charge":945.00,"npi":[1275216467]}]}]},{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":35.40,"providers":[{"billed_charge":135.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":23.76,"providers":[{"billed_charge":70.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"474987773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":229.80,"providers":[{"billed_charge":592.64,"npi":[1497301915]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":55.25,"providers":[{"billed_charge":200.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":179.53,"providers":[{"billed_charge":337.48,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":61.52,"providers":[{"billed_charge":152.00,"npi":[1659775732]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":176.80,"providers":[{"billed_charge":960.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.29,"providers":[{"billed_charge":193.62,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":121.55,"providers":[{"billed_charge":385.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":11.05,"providers":[{"billed_charge":67.00,"npi":[1609323450]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":293.93,"providers":[{"billed_charge":665.00,"npi":[1760353411]}]}]}]},{"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":"455088386"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":311.75,"providers":[{"billed_charge":725.00,"npi":[1629154968]}]}]},{"tin":{"type":"ein","value":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.44,"providers":[{"billed_charge":25.00,"npi":[1750435301]}]}]},{"tin":{"type":"ein","value":"453806985"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":418.74,"providers":[{"billed_charge":1521.00,"npi":[1639822422]}]}]}]},{"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":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":492.24,"providers":[{"billed_charge":882.00,"npi":[1588759955]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":117.20,"providers":[{"billed_charge":320.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"274681891"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":46.88,"providers":[{"billed_charge":200.00,"npi":[1881475911]}]}]},{"tin":{"type":"ein","value":"263078685"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":304.38,"providers":[{"billed_charge":1430.00,"npi":[1477719847]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":163.93,"providers":[{"billed_charge":294.00,"npi":[1871685552]}]}]}]},{"name":"VASOPNEUMATIC DEVICE THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97016","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; VASOPNEUMATIC DEVICES","allowed_amounts":[{"tin":{"type":"ein","value":"203941865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.15,"providers":[{"billed_charge":100.35,"npi":[1134010218]}]}]}]},{"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":"833518366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":216.54,"providers":[{"billed_charge":360.00,"npi":[1215554423]}]}]},{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1608.59,"providers":[{"billed_charge":4940.00,"npi":[1649029547]}]},{"allowed_amount":201.36,"providers":[{"billed_charge":650.00,"npi":[1386529253]}]},{"allowed_amount":121.08,"providers":[{"billed_charge":260.00,"npi":[1376271007]}]},{"allowed_amount":996.03,"providers":[{"billed_charge":3185.00,"npi":[1063397933]}]}]},{"tin":{"type":"ein","value":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":269.92,"providers":[{"billed_charge":400.00,"npi":[1750435301]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":993.94,"providers":[{"billed_charge":7840.00,"npi":[1679982078]}]}]},{"tin":{"type":"ein","value":"274681891"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1097.88,"providers":[{"billed_charge":2915.00,"npi":[1881475911]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":324.82,"providers":[{"billed_charge":675.00,"npi":[1871685552]}]}]},{"tin":{"type":"ein","value":"883757810"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.96,"providers":[{"billed_charge":220.40,"npi":[1104593599]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1687.21,"providers":[{"billed_charge":7565.00,"npi":[1124904172]}]},{"allowed_amount":560.77,"providers":[{"billed_charge":2492.00,"npi":[1295353514]}]},{"allowed_amount":454.05,"providers":[{"billed_charge":2047.00,"npi":[1790506954]}]}]},{"tin":{"type":"ein","value":"640891283"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":54.14,"providers":[{"billed_charge":112.00,"npi":[1487947818]}]}]},{"tin":{"type":"ein","value":"455088386"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":627.85,"providers":[{"billed_charge":1160.00,"npi":[1629154968]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":913.86,"providers":[{"billed_charge":2852.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":634.37,"providers":[{"billed_charge":1600.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.48,"providers":[{"billed_charge":89.00,"npi":[1578452660]}]}]},{"tin":{"type":"ein","value":"203941865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":136.44,"providers":[{"billed_charge":324.84,"npi":[1134010218]}]}]},{"tin":{"type":"ein","value":"271412557"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":359.46,"providers":[{"billed_charge":1020.00,"npi":[1568767242]}]}]}]},{"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":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1169.18,"providers":[{"billed_charge":3185.00,"npi":[1649029547]}]},{"allowed_amount":762.77,"providers":[{"billed_charge":2145.00,"npi":[1063397933]}]},{"allowed_amount":209.58,"providers":[{"billed_charge":585.00,"npi":[1386529253]}]},{"allowed_amount":125.16,"providers":[{"billed_charge":260.00,"npi":[1376271007]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":706.23,"providers":[{"billed_charge":4900.00,"npi":[1679982078]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":372.88,"providers":[{"billed_charge":1190.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1429.60,"providers":[{"billed_charge":6138.00,"npi":[1124904172]}]},{"allowed_amount":562.61,"providers":[{"billed_charge":2475.00,"npi":[1295353514]}]},{"allowed_amount":21.93,"providers":[{"billed_charge":99.00,"npi":[1790506954]}]}]}]},{"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":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":479.60,"providers":[{"billed_charge":3640.00,"npi":[1679982078]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":483.40,"providers":[{"billed_charge":2100.00,"npi":[1295353514]}]},{"allowed_amount":394.28,"providers":[{"billed_charge":1764.00,"npi":[1124904172]}]}]}]},{"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":64350.63,"providers":[{"billed_charge":895500.00,"npi":[1780064949]}]},{"allowed_amount":1868.36,"providers":[{"billed_charge":26000.00,"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":934.18,"providers":[{"billed_charge":13000.00,"npi":[1780064949]}]},{"allowed_amount":10060.40,"providers":[{"billed_charge":140000.00,"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":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1910.67,"providers":[{"billed_charge":4875.00,"npi":[1649029547]}]},{"allowed_amount":278.21,"providers":[{"billed_charge":715.00,"npi":[1386529253]}]},{"allowed_amount":129.96,"providers":[{"billed_charge":260.00,"npi":[1376271007]}]},{"allowed_amount":1025.24,"providers":[{"billed_charge":2600.00,"npi":[1063397933]}]}]},{"tin":{"type":"ein","value":"640903379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":177.74,"providers":[{"billed_charge":469.00,"npi":[1356378871]}]}]},{"tin":{"type":"ein","value":"640887209"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1314.44,"providers":[{"billed_charge":8550.00,"npi":[1679982078]}]}]},{"tin":{"type":"ein","value":"274681891"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.80,"providers":[{"billed_charge":275.00,"npi":[1881475911]}]}]},{"tin":{"type":"ein","value":"201677707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1177.23,"providers":[{"billed_charge":3220.00,"npi":[1790449932]}]}]},{"tin":{"type":"ein","value":"883757810"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":51.52,"providers":[{"billed_charge":136.40,"npi":[1104593599]}]}]},{"tin":{"type":"ein","value":"464053647"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":206.12,"providers":[{"billed_charge":856.00,"npi":[1790506954]}]},{"allowed_amount":515.24,"providers":[{"billed_charge":2140.00,"npi":[1124904172]}]},{"allowed_amount":612.80,"providers":[{"billed_charge":2568.00,"npi":[1295353514]}]}]},{"tin":{"type":"ein","value":"203941865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":360.64,"providers":[{"billed_charge":772.80,"npi":[1134010218]}]}]},{"tin":{"type":"ein","value":"932831546"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.56,"providers":[{"billed_charge":450.00,"npi":[1811870900]}]}]}]},{"name":"RMVL DEVITAL TIS 20 CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97597","description":"DEBRIDEMENT (EG, HIGH PRESSURE WATERJET W/WOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT W SCISSORS, SCAL","allowed_amounts":[{"tin":{"type":"ein","value":"300852649"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":79.00,"providers":[{"billed_charge":640.00,"npi":[1548885759]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"640931880"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":689.04,"providers":[{"billed_charge":880.00,"npi":[1881781631]}]}]}]},{"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":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":505.50,"providers":[{"billed_charge":705.00,"npi":[1588759955]}]}]},{"tin":{"type":"ein","value":"455088386"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":977.30,"providers":[{"billed_charge":1450.00,"npi":[1629154968]}]}]},{"tin":{"type":"ein","value":"271878561"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1491.57,"providers":[{"billed_charge":1980.00,"npi":[1750435301]}]}]},{"tin":{"type":"ein","value":"263078685"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":875.08,"providers":[{"billed_charge":1690.00,"npi":[1477719847]}]}]},{"tin":{"type":"ein","value":"453806985"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1177.82,"providers":[{"billed_charge":2100.00,"npi":[1639822422]}]}]},{"tin":{"type":"ein","value":"640943837"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":289.84,"providers":[{"billed_charge":400.00,"npi":[1871685552]}]}]},{"tin":{"type":"ein","value":"640931880"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":135.87,"providers":[{"billed_charge":150.00,"npi":[1881781631]}]}]}]},{"name":"CHIROPRACTIC MANJ 5 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98942","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"464657769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1318.33,"providers":[{"billed_charge":2100.00,"npi":[1083042170]}]}]},{"tin":{"type":"ein","value":"200338259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":219.35,"providers":[{"billed_charge":310.00,"npi":[1588759955]}]}]}]},{"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":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.17,"providers":[{"billed_charge":35.00,"npi":[1659775732]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":27.56,"providers":[{"billed_charge":200.00,"npi":[1730774290]}]}]}]},{"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":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2784.60,"providers":[{"billed_charge":3000.00,"npi":[1093344699]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["72","20"],"billing_class":"professional","payments":[{"allowed_amount":835.38,"providers":[{"billed_charge":1858.80,"npi":[1730774290]}]},{"allowed_amount":417.69,"providers":[{"billed_charge":929.40,"npi":[1730774290]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"811097331"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":193.80,"providers":[{"billed_charge":250.00,"npi":[1285205740]}]}]}]},{"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":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2979.60,"providers":[{"billed_charge":5066.00,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"208339281"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":7925.76,"providers":[{"billed_charge":7955.00,"npi":[1841799616]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":651.77,"providers":[{"billed_charge":1025.00,"npi":[1194956755]}]}]},{"tin":{"type":"ein","value":"923527145"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":641.97,"providers":[{"billed_charge":990.00,"npi":[1619211992]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":372.44,"providers":[{"billed_charge":675.44,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"510466372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":558.66,"providers":[{"billed_charge":900.00,"npi":[1316750045]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":163.86,"providers":[{"billed_charge":332.00,"npi":[1619165560]}]},{"allowed_amount":385.56,"providers":[{"billed_charge":664.00,"npi":[1225326093,1598865362]}]},{"allowed_amount":2602.53,"providers":[{"billed_charge":4482.00,"npi":[1659775732]}]}]},{"tin":{"type":"ein","value":"461561484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3419.82,"providers":[{"billed_charge":5965.00,"npi":[1568089977]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":1336.50,"providers":[{"billed_charge":3102.00,"npi":[1477135267]}]},{"allowed_amount":590.87,"providers":[{"billed_charge":987.00,"npi":[1679219588]}]},{"allowed_amount":60.75,"providers":[{"billed_charge":141.00,"npi":[1679219588]}]}]},{"tin":{"type":"ein","value":"824404269"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":27648.00,"providers":[{"billed_charge":30000.00,"npi":[1841076403]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2079.85,"providers":[{"billed_charge":3273.28,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1117.35,"providers":[{"billed_charge":2505.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"471613586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":891.96,"providers":[{"billed_charge":1560.00,"npi":[1922767938]}]}]},{"tin":{"type":"ein","value":"640829371"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":788.67,"providers":[{"billed_charge":1962.00,"npi":[1295296408]}]}]},{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1415.31,"providers":[{"billed_charge":1558.00,"npi":[1114395050]}]}]},{"tin":{"type":"ein","value":"202695060"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1323.56,"providers":[{"billed_charge":1890.00,"npi":[1427113000]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1713.27,"providers":[{"billed_charge":3887.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"831597932"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":230.90,"providers":[{"billed_charge":260.00,"npi":[1659846129]}]}]},{"tin":{"type":"ein","value":"640650533"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":701.04,"providers":[{"billed_charge":960.00,"npi":[1538178777]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":876.30,"providers":[{"billed_charge":1150.00,"npi":[1013930122]}]}]},{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":891.00,"providers":[{"billed_charge":1560.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"815000928"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":187.44,"providers":[{"billed_charge":660.00,"npi":[1770367716]}]},{"allowed_amount":3128.58,"providers":[{"billed_charge":6930.00,"npi":[1770367716]}]}]},{"tin":{"type":"ein","value":"461590861"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":328.62,"providers":[{"billed_charge":474.00,"npi":[1548754211]}]},{"allowed_amount":206.76,"providers":[{"billed_charge":474.00,"npi":[1548754211]}]}]},{"tin":{"type":"ein","value":"640394192"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":670.41,"providers":[{"billed_charge":1237.50,"npi":[1801372685]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1265.37,"providers":[{"billed_charge":2176.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["22","02"],"billing_class":"professional","payments":[{"allowed_amount":308.82,"providers":[{"billed_charge":900.00,"npi":[1164083747]}]},{"allowed_amount":1286.75,"providers":[{"billed_charge":3750.00,"npi":[1164083747]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1348.22,"providers":[{"billed_charge":1526.00,"npi":[1376004150]}]},{"allowed_amount":1563.33,"providers":[{"billed_charge":2289.00,"npi":[1609323450]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":576.00,"providers":[{"billed_charge":576.00,"npi":[1760353411]}]}]}]},{"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":"320439952"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10314.65,"providers":[{"billed_charge":20783.00,"npi":[1285332064]}]},{"allowed_amount":4674.12,"providers":[{"billed_charge":9132.00,"npi":[1043974678]}]}]},{"tin":{"type":"ein","value":"640507572"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7520.24,"providers":[{"billed_charge":9880.00,"npi":[1427591627]}]},{"allowed_amount":1190.98,"providers":[{"billed_charge":1330.00,"npi":[1912565763]}]}]},{"tin":{"type":"ein","value":"923029503"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1981.91,"providers":[{"billed_charge":8050.00,"npi":[1194393603]}]},{"allowed_amount":664.60,"providers":[{"billed_charge":1750.00,"npi":[1194393603]}]}]},{"tin":{"type":"ein","value":"640834532"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":625.52,"providers":[{"billed_charge":743.28,"npi":[1073091963]}]}]},{"tin":{"type":"ein","value":"923893466"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":312.76,"providers":[{"billed_charge":400.00,"npi":[1902815566]}]}]},{"tin":{"type":"ein","value":"831851747"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":531.70,"providers":[{"billed_charge":1000.00,"npi":[1598521213]}]}]},{"tin":{"type":"ein","value":"851351435"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3402.88,"providers":[{"billed_charge":5770.56,"npi":[1114701570]}]}]},{"tin":{"type":"ein","value":"640586958"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3440.36,"providers":[{"billed_charge":4488.00,"npi":[1598382640]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":5435.12,"providers":[{"billed_charge":6050.00,"npi":[1275216467]}]}]},{"tin":{"type":"ein","value":"640937314"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":425.36,"providers":[{"billed_charge":600.00,"npi":[1033643432]}]}]},{"tin":{"type":"ein","value":"640655662"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":795.68,"providers":[{"billed_charge":1164.00,"npi":[1194956755]}]}]},{"tin":{"type":"ein","value":"813504372"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":15147.08,"providers":[{"billed_charge":27410.16,"npi":[1811221401]}]},{"allowed_amount":597.88,"providers":[{"billed_charge":1683.08,"npi":[1811221401]}]}]},{"tin":{"type":"ein","value":"640574599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.67,"providers":[{"billed_charge":300.00,"npi":[1093344699]}]}]},{"tin":{"type":"ein","value":"510466372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":265.84,"providers":[{"billed_charge":400.00,"npi":[1316750045]}]},{"allowed_amount":664.60,"providers":[{"billed_charge":1000.00,"npi":[1518521145]}]}]},{"tin":{"type":"ein","value":"646001350"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1238.49,"providers":[{"billed_charge":1359.00,"npi":[1629186382]}]}]},{"tin":{"type":"ein","value":"640662976"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":113.54,"providers":[{"billed_charge":168.00,"npi":[1881258267]}]}]},{"tin":{"type":"ein","value":"461561484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11059.36,"providers":[{"billed_charge":19760.00,"npi":[1568089977]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":376.89,"providers":[{"billed_charge":612.00,"npi":[1679219588]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":811.00,"providers":[{"billed_charge":991.00,"npi":[1316524838]}]},{"allowed_amount":12434.00,"providers":[{"billed_charge":12651.00,"npi":[1497765705]}]},{"allowed_amount":3241.00,"providers":[{"billed_charge":3241.00,"npi":[1316524838]}]}]},{"tin":{"type":"ein","value":"272255038"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1407.42,"providers":[{"billed_charge":2221.74,"npi":[1306211164]}]}]},{"tin":{"type":"ein","value":"821078593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6112.55,"providers":[{"billed_charge":12650.00,"npi":[1295187789]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":316.27,"providers":[{"billed_charge":337.00,"npi":[1234567893]}]},{"allowed_amount":1220.49,"providers":[{"billed_charge":2718.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":4996.56,"providers":[{"billed_charge":11139.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"834721464"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":3587.07,"providers":[{"billed_charge":7695.00,"npi":[1588141725]}]}]},{"tin":{"type":"ein","value":"471613586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":744.38,"providers":[{"billed_charge":1190.00,"npi":[1922767938]}]}]},{"tin":{"type":"ein","value":"630995963"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":992.00,"providers":[{"billed_charge":992.00,"npi":[1407895725]}]},{"allowed_amount":1169.74,"providers":[{"billed_charge":1364.00,"npi":[1700557915]}]}]},{"tin":{"type":"ein","value":"640914383"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":425.36,"providers":[{"billed_charge":829.52,"npi":[1386485100]}]}]},{"tin":{"type":"ein","value":"874345955"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4357.10,"providers":[{"billed_charge":8200.00,"npi":[1396383501]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":2764.84,"providers":[{"billed_charge":6214.00,"npi":[1336981836]}]},{"allowed_amount":1622.00,"providers":[{"billed_charge":4780.00,"npi":[1154827079]}]},{"allowed_amount":243.30,"providers":[{"billed_charge":717.00,"npi":[1154827079]}]}]},{"tin":{"type":"ein","value":"934244735"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":30400.00,"providers":[{"billed_charge":30400.00,"npi":[1922559772]}]}]},{"tin":{"type":"ein","value":"463878759"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1871.52,"providers":[{"billed_charge":2832.00,"npi":[1023847506]}]},{"allowed_amount":1988.49,"providers":[{"billed_charge":3009.00,"npi":[1205528833]}]}]},{"tin":{"type":"ein","value":"720993441"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2929.61,"providers":[{"billed_charge":3420.00,"npi":[1174346613]}]}]},{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1595.10,"providers":[{"billed_charge":2250.00,"npi":[1255975405]}]},{"allowed_amount":106.34,"providers":[{"billed_charge":150.00,"npi":[1396306957]}]},{"allowed_amount":375.30,"providers":[{"billed_charge":450.00,"npi":[1013930122]}]}]},{"tin":{"type":"ein","value":"841927794"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":375.30,"providers":[{"billed_charge":975.57,"npi":[1578183802]}]}]},{"tin":{"type":"ein","value":"273156796"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":974.05,"providers":[{"billed_charge":974.05,"npi":[1326511031]}]}]},{"tin":{"type":"ein","value":"822818022"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":319.02,"providers":[{"billed_charge":918.00,"npi":[1922695964]}]},{"allowed_amount":1169.74,"providers":[{"billed_charge":3366.00,"npi":[1316829252]}]}]},{"tin":{"type":"ein","value":"862363267"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":849.30,"providers":[{"billed_charge":1896.00,"npi":[1639824543]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":319.02,"providers":[{"billed_charge":525.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"421633186"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2126.72,"providers":[{"billed_charge":2944.00,"npi":[1376814533]}]}]},{"tin":{"type":"ein","value":"646010232"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.92,"providers":[{"billed_charge":175.00,"npi":[1497444285]}]},{"allowed_amount":350.00,"providers":[{"billed_charge":350.00,"npi":[1881753986]}]},{"allowed_amount":1675.52,"providers":[{"billed_charge":1750.00,"npi":[1427673532]}]}]},{"tin":{"type":"ein","value":"815000928"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":7118.92,"providers":[{"billed_charge":11220.00,"npi":[1770367716]}]},{"allowed_amount":413.14,"providers":[{"billed_charge":1077.10,"npi":[1770367716]}]}]},{"tin":{"type":"ein","value":"461590861"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1563.80,"providers":[{"billed_charge":1680.00,"npi":[1548754211]}]},{"allowed_amount":405.52,"providers":[{"billed_charge":672.00,"npi":[1548754211]}]}]},{"tin":{"type":"ein","value":"640362400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1125.90,"providers":[{"billed_charge":1212.00,"npi":[1629365853]}]}]},{"tin":{"type":"ein","value":"640770155"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":106.34,"providers":[{"billed_charge":168.00,"npi":[1609323450]}]},{"allowed_amount":961.44,"providers":[{"billed_charge":1176.00,"npi":[1376004150]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1260.00,"providers":[{"billed_charge":1260.00,"npi":[1760353411]}]}]},{"tin":{"type":"ein","value":"455454264"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":212.68,"providers":[{"billed_charge":405.68,"npi":[1730774290]}]},{"allowed_amount":1807.78,"providers":[{"billed_charge":3448.28,"npi":[1730774290]}]},{"allowed_amount":4997.98,"providers":[{"billed_charge":9533.48,"npi":[1730774290]}]}]}]},{"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":"646001350"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":132.30,"providers":[{"billed_charge":332.00,"npi":[1588623532]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"436457002"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":149.64,"providers":[{"billed_charge":384.00,"npi":[1104024769]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["02","21"],"billing_class":"professional","payments":[{"allowed_amount":236.28,"providers":[{"billed_charge":450.00,"npi":[1992371330]}]},{"allowed_amount":78.76,"providers":[{"billed_charge":150.00,"npi":[1992371330,1164104543]}]},{"allowed_amount":393.80,"providers":[{"billed_charge":750.00,"npi":[1164104543]}]}]},{"tin":{"type":"ein","value":"880747037"},"service_code":["02","21"],"billing_class":"professional","payments":[{"allowed_amount":39.38,"providers":[{"billed_charge":75.00,"npi":[1346069960]}]},{"allowed_amount":694.95,"providers":[{"billed_charge":1125.00,"npi":[1609960889]}]},{"allowed_amount":1158.25,"providers":[{"billed_charge":1875.00,"npi":[1609960889]}]},{"allowed_amount":2874.74,"providers":[{"billed_charge":5475.00,"npi":[1346069960]}]}]}]},{"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":"640507572"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":919.00,"providers":[{"billed_charge":1250.00,"npi":[1679925408]}]},{"allowed_amount":91.90,"providers":[{"billed_charge":125.00,"npi":[1457849333]}]},{"allowed_amount":183.80,"providers":[{"billed_charge":250.00,"npi":[1679925408]}]}]},{"tin":{"type":"ein","value":"55823824"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":69.32,"providers":[{"billed_charge":177.00,"npi":[1679517411]}]}]},{"tin":{"type":"ein","value":"810904111"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1476.41,"providers":[{"billed_charge":4600.00,"npi":[1386725570]}]}]},{"tin":{"type":"ein","value":"932472974"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":418.92,"providers":[{"billed_charge":728.00,"npi":[1114214038]}]}]},{"tin":{"type":"ein","value":"824421335"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":966.70,"providers":[{"billed_charge":1988.00,"npi":[1003043043]}]}]},{"tin":{"type":"ein","value":"646008520"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":168.93,"providers":[{"billed_charge":193.00,"npi":[1568036184]}]},{"allowed_amount":2533.95,"providers":[{"billed_charge":2895.00,"npi":[1568036184]}]}]},{"tin":{"type":"ein","value":"621519754"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":258.45,"providers":[{"billed_charge":630.00,"npi":[1891590816]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":86.65,"providers":[{"billed_charge":138.00,"npi":[1598382640]}]},{"allowed_amount":1646.35,"providers":[{"billed_charge":2622.00,"npi":[1598382640]}]}]},{"tin":{"type":"ein","value":"721512476"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":366.71,"providers":[{"billed_charge":400.00,"npi":[1821044025]}]}]},{"tin":{"type":"ein","value":"640735747"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":84.47,"providers":[{"billed_charge":115.00,"npi":[1275820847]}]},{"allowed_amount":337.88,"providers":[{"billed_charge":460.00,"npi":[1326335902]}]}]}]},{"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":"932472974"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1429.02,"providers":[{"billed_charge":2405.00,"npi":[1417481896]}]}]},{"tin":{"type":"ein","value":"621650432"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1309.24,"providers":[{"billed_charge":3190.00,"npi":[1386778199]}]}]},{"tin":{"type":"ein","value":"824421335"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":711.69,"providers":[{"billed_charge":1246.00,"npi":[1003043043]}]}]},{"tin":{"type":"ein","value":"450573649"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":100.38,"providers":[{"billed_charge":100.38,"npi":[1235234808]}]}]},{"tin":{"type":"ein","value":"640735747"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1152.36,"providers":[{"billed_charge":1395.00,"npi":[1275820847]}]},{"allowed_amount":753.74,"providers":[{"billed_charge":1085.00,"npi":[1457345456]}]},{"allowed_amount":1024.32,"providers":[{"billed_charge":1240.00,"npi":[1326335902]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"646001549"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":581.28,"providers":[{"billed_charge":964.04,"npi":[1255946018]}]},{"allowed_amount":415.20,"providers":[{"billed_charge":688.60,"npi":[1124117171]}]}]},{"tin":{"type":"ein","value":"646008276"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1719.25,"providers":[{"billed_charge":1989.50,"npi":[1043396591]}]}]},{"tin":{"type":"ein","value":"640911702"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1794.00,"providers":[{"billed_charge":3000.00,"npi":[1609416544]}]}]}]},{"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":"646001549"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":395.91,"providers":[{"billed_charge":638.03,"npi":[1255946018]}]}]},{"tin":{"type":"ein","value":"842925284"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1131.00,"providers":[{"billed_charge":8972.00,"npi":[1730709627]}]}]},{"tin":{"type":"ein","value":"646001528"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1820.40,"providers":[{"billed_charge":2460.00,"npi":[1972728590]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2544.36,"providers":[{"billed_charge":6978.00,"npi":[1699290460,1831076751]}]},{"allowed_amount":3816.54,"providers":[{"billed_charge":10467.00,"npi":[1225547185]}]}]},{"tin":{"type":"ein","value":"811218105"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4184.70,"providers":[{"billed_charge":33199.00,"npi":[1033797550]}]}]},{"tin":{"type":"ein","value":"263453190"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2120.30,"providers":[{"billed_charge":6165.00,"npi":[1013943752,1609815000]}]}]},{"tin":{"type":"ein","value":"646000400"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1526.80,"providers":[{"billed_charge":4740.00,"npi":[1710096615]}]}]},{"tin":{"type":"ein","value":"934108863"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1583.40,"providers":[{"billed_charge":12618.00,"npi":[1639581739]}]},{"allowed_amount":113.10,"providers":[{"billed_charge":892.00,"npi":[1679981120]}]}]}]},{"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":"842925284"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1148.98,"providers":[{"billed_charge":9155.00,"npi":[1730709627]}]}]},{"tin":{"type":"ein","value":"475129962"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1148.98,"providers":[{"billed_charge":9083.00,"npi":[1457094948]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1236.06,"providers":[{"billed_charge":3458.00,"npi":[1124078944]}]}]},{"tin":{"type":"ein","value":"263453190"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1236.06,"providers":[{"billed_charge":3512.00,"npi":[1609815000]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"811665429"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":708.24,"providers":[{"billed_charge":1092.00,"npi":[1083488043]}]}]}]},{"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":"811665429"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":733.00,"providers":[{"billed_charge":1220.00,"npi":[1902454317]}]},{"allowed_amount":73.30,"providers":[{"billed_charge":122.00,"npi":[1902454317]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"800885134"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.90,"providers":[{"billed_charge":60.00,"npi":[1013930122]}]},{"allowed_amount":254.20,"providers":[{"billed_charge":600.00,"npi":[1396306957]}]}]}]},{"name":"CARE MGMT SVC BHVL HLTH COND","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99484","description":"CARE MANAGEMENT SERVICES FOR BEHAVIORAL HEALTH CONDITIONS, AT LEAST 20 MINUTES OF CLINICAL STAFF TIM","allowed_amounts":[{"tin":{"type":"ein","value":"815000928"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":364.08,"providers":[{"billed_charge":576.00,"npi":[1770367716]}]}]}]},{"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":"721275309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10935.32,"providers":[{"billed_charge":10935.32,"npi":[1619071941]}]}]},{"tin":{"type":"ein","value":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":110826.59,"providers":[{"billed_charge":199100.00,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":90712.12,"providers":[{"billed_charge":635170.44,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9031.45,"providers":[{"billed_charge":7021.00,"npi":[1528596814]}]},{"allowed_amount":9276.37,"providers":[{"billed_charge":7211.40,"npi":[1760831630]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":45299.62,"providers":[{"billed_charge":37386.43,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"646001540"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30459.65,"providers":[{"billed_charge":29763.00,"npi":[1629058094]}]}]},{"tin":{"type":"ein","value":"640868008"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":118963.07,"providers":[{"billed_charge":91033.28,"npi":[1770533176]}]}]},{"tin":{"type":"ein","value":"640466231"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":143877.04,"providers":[{"billed_charge":242214.00,"npi":[1003829375]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":86057.39,"providers":[{"billed_charge":120571.72,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":490795.57,"providers":[{"billed_charge":708350.50,"npi":[1932821063]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"640868008"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7222.88,"providers":[{"billed_charge":6614.75,"npi":[1770533176]}]}]}]},{"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":"721275309"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53334.92,"providers":[{"billed_charge":53334.92,"npi":[1619071941]}]}]},{"tin":{"type":"ein","value":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":119080.52,"providers":[{"billed_charge":178835.00,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":113973.26,"providers":[{"billed_charge":1261301.14,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6535.12,"providers":[{"billed_charge":4958.11,"npi":[1528596814]}]},{"allowed_amount":21239.14,"providers":[{"billed_charge":17415.02,"npi":[1760831630]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":111599.04,"providers":[{"billed_charge":111367.20,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"646001540"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":62083.64,"providers":[{"billed_charge":60800.00,"npi":[1629058094]}]}]},{"tin":{"type":"ein","value":"640868008"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":195618.72,"providers":[{"billed_charge":138616.99,"npi":[1770533176]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":166921.19,"providers":[{"billed_charge":233281.00,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"640466231"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":183763.44,"providers":[{"billed_charge":308800.00,"npi":[1003829375]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":877981.44,"providers":[{"billed_charge":1101595.00,"npi":[1932821063]}]}]}]},{"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":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1483.86,"providers":[{"billed_charge":24192.14,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"43171173"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13785.84,"providers":[{"billed_charge":13785.84,"npi":[1366492910]}]}]},{"tin":{"type":"ein","value":"640466231"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5403.12,"providers":[{"billed_charge":8000.00,"npi":[1003829375]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":71228.16,"providers":[{"billed_charge":101480.00,"npi":[1932821063]}]}]}]},{"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":"760796521"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10989.44,"providers":[{"billed_charge":19140.00,"npi":[1316047392]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16958.50,"providers":[{"billed_charge":268998.43,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"640466231"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":77599.27,"providers":[{"billed_charge":136350.00,"npi":[1003829375]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18204.62,"providers":[{"billed_charge":29389.00,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":287497.40,"providers":[{"billed_charge":374840.00,"npi":[1932821063]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"872889138"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":66000.00,"providers":[{"billed_charge":66000.00,"npi":[1932821063]}]}]}]},{"name":"SPLY ALW NONIMPL CGM 1 MO SP=1 UOS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4239","description":"SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":13937.28,"providers":[{"billed_charge":40991.76,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"640616376"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3070.32,"providers":[{"billed_charge":6600.00,"npi":[1467415414]}]}]},{"tin":{"type":"ein","value":"640936379"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1449.69,"providers":[{"billed_charge":3805.00,"npi":[1811708019]}]},{"allowed_amount":157.57,"providers":[{"billed_charge":325.00,"npi":[1245936681]}]}]}]},{"name":"FQHC VISIT ESTABLISHED PATIE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0467","description":"FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"640829371"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1352.40,"providers":[{"billed_charge":4508.00,"npi":[1295296408]}]}]}]},{"name":"ALCOHL&/RX SRVC; INTENSV OP;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0015","description":"ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"923029503"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":55104.63,"providers":[{"billed_charge":222500.00,"npi":[1619825460]}]},{"allowed_amount":141250.00,"providers":[{"billed_charge":565000.00,"npi":[1124635354]}]}]}]},{"name":"INJ CEFTRIAXONE SODM PER 250","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0696","description":"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.46,"providers":[{"billed_charge":104.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.95,"providers":[{"billed_charge":50.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":10.72,"providers":[{"billed_charge":210.00,"npi":[1275216467]}]}]}]},{"name":"Injection, methylprednisolone acetate, 1 mg","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1010","description":"Injection, methylprednisolone acetate, 1 mg ","allowed_amounts":[{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.80,"providers":[{"billed_charge":240.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":36.38,"providers":[{"billed_charge":360.00,"npi":[1760353411]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"640790547"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":0.37,"providers":[{"billed_charge":20.00,"npi":[1770885121]}]}]},{"tin":{"type":"ein","value":"640907721"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.11,"providers":[{"billed_charge":54.00,"npi":[1023687910]}]}]},{"tin":{"type":"ein","value":"883800094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.66,"providers":[{"billed_charge":144.00,"npi":[1336981836]}]}]},{"tin":{"type":"ein","value":"462950767"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.15,"providers":[{"billed_charge":69.00,"npi":[1861277964]}]}]},{"tin":{"type":"ein","value":"204193593"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.11,"providers":[{"billed_charge":24.00,"npi":[1043670722]}]}]},{"tin":{"type":"ein","value":"852620842"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1.12,"providers":[{"billed_charge":54.00,"npi":[1174980478]}]}]},{"tin":{"type":"ein","value":"640787918"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.07,"providers":[{"billed_charge":88.00,"npi":[1760353411]}]}]},{"tin":{"type":"ein","value":"822133878"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":9.17,"providers":[{"billed_charge":245.00,"npi":[1275216467]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"813504372"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.48,"providers":[{"billed_charge":12.48,"npi":[1811221401]}]}]}]},{"name":"LOCM 300-399 MG/ML I CONC PE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"Q9967","description":"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML","allowed_amounts":[{"tin":{"type":"ein","value":"200289504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":94.95,"providers":[{"billed_charge":952.50,"npi":[1336187947]}]}]}]},{"name":"GLBAL FEE URGNT CARE CENTERS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9083","description":"GLOBAL FEE URGENT CARE CENTERS","allowed_amounts":[{"tin":{"type":"ein","value":"640914383"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":10000.00,"providers":[{"billed_charge":11050.00,"npi":[1013524495]}]}]}]}]}