{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-04-30","out_of_network":[{"name":"RESIDENTIAL TREATMENT-PSYCHI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1001","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"934272144"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11928.50,"providers":[{"billed_charge":120120.00,"npi":[1043066194]}]}]}]},{"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":"570542729"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1550.00,"providers":[{"billed_charge":1550.00,"npi":[1891795738]}]}]},{"tin":{"type":"ein","value":"873746039"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":958500.00,"providers":[{"billed_charge":4515524.29,"npi":[1053002204]}]}]},{"tin":{"type":"ein","value":"263075304"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9600.00,"providers":[{"billed_charge":27000.00,"npi":[1669638821]}]}]},{"tin":{"type":"ein","value":"472253438"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":699300.00,"providers":[{"billed_charge":3500000.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"842277779"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":31740.00,"providers":[{"billed_charge":115000.00,"npi":[1861045767]}]}]},{"tin":{"type":"ein","value":"931351555"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":105840.00,"providers":[{"billed_charge":540000.00,"npi":[1306522701]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":276558.95,"providers":[{"billed_charge":131573.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":387131.32,"providers":[{"billed_charge":231412.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":13834.12,"providers":[{"billed_charge":13950.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":520364.32,"providers":[{"billed_charge":175056.00,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":45058.51,"providers":[{"billed_charge":22570.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":266948.82,"providers":[{"billed_charge":72252.00,"npi":[1972503910]}]}]}]},{"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":"850988160"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":277.00,"providers":[{"billed_charge":864.00,"npi":[1306621578]}]}]}]},{"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":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":341738.54,"providers":[{"billed_charge":308774.00,"npi":[1891148821]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":20314.94,"providers":[{"billed_charge":67717.40,"npi":[1023046612]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":460963.62,"providers":[{"billed_charge":378798.00,"npi":[1891148821]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":23653.80,"providers":[{"billed_charge":78848.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"203854241"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":300266.17,"providers":[{"billed_charge":613800.00,"npi":[1194826081]}]}]}]},{"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":"576000922"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4116.00,"providers":[{"billed_charge":3150.00,"npi":[1568671030]}]}]},{"tin":{"type":"ein","value":"570542729"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2700.00,"providers":[{"billed_charge":2700.00,"npi":[1891795738]}]}]},{"tin":{"type":"ein","value":"873746039"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":187275.00,"providers":[{"billed_charge":943976.00,"npi":[1053002204]}]}]},{"tin":{"type":"ein","value":"203854241"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":19235.01,"providers":[{"billed_charge":39600.00,"npi":[1194826081]}]}]},{"tin":{"type":"ein","value":"472253438"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":95200.00,"providers":[{"billed_charge":535500.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"931351555"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":43752.00,"providers":[{"billed_charge":289800.00,"npi":[1306522701]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":563088.24,"providers":[{"billed_charge":298296.00,"npi":[1962472860]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":112150.37,"providers":[{"billed_charge":118820.00,"npi":[1417432840]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1.94,"providers":[{"billed_charge":6.40,"npi":[1881647204]}]},{"allowed_amount":3071.58,"providers":[{"billed_charge":3672.41,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":182.63,"providers":[{"billed_charge":608.90,"npi":[1427030774]}]},{"allowed_amount":289.26,"providers":[{"billed_charge":1075.30,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":5613.66,"providers":[{"billed_charge":20263.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":909.98,"providers":[{"billed_charge":3167.26,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6514.00,"providers":[{"billed_charge":246091.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2083.20,"providers":[{"billed_charge":134798.60,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":446.00,"providers":[{"billed_charge":17070.40,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":253.88,"providers":[{"billed_charge":846.25,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":454.50,"providers":[{"billed_charge":1515.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"832550272"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.06,"providers":[{"billed_charge":30.14,"npi":[1942224696]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":404.60,"providers":[{"billed_charge":3959.10,"npi":[1336603646]}]},{"allowed_amount":798.39,"providers":[{"billed_charge":61277.10,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":76.01,"providers":[{"billed_charge":207.75,"npi":[1346297892]}]},{"allowed_amount":17.44,"providers":[{"billed_charge":48.05,"npi":[1346297892]}]},{"allowed_amount":273.27,"providers":[{"billed_charge":748.00,"npi":[1396790325]}]},{"allowed_amount":1032.18,"providers":[{"billed_charge":2869.85,"npi":[1417432840]}]},{"allowed_amount":2481.59,"providers":[{"billed_charge":6792.10,"npi":[1417432840]}]},{"allowed_amount":1587.66,"providers":[{"billed_charge":4324.70,"npi":[1396790325]}]}]}]},{"name":"DRUGS/GENERIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"251","description":"PHARMACY - GENERIC DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":306.64,"providers":[{"billed_charge":830.10,"npi":[1417432840]}]},{"allowed_amount":3.48,"providers":[{"billed_charge":9.60,"npi":[1396790325]}]},{"allowed_amount":396.99,"providers":[{"billed_charge":1090.05,"npi":[1417432840]}]}]}]},{"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":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":581.30,"providers":[{"billed_charge":16916.20,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1235.90,"providers":[{"billed_charge":12934.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1.26,"providers":[{"billed_charge":1523.30,"npi":[1336603646]}]},{"allowed_amount":211.80,"providers":[{"billed_charge":3227.50,"npi":[1336603646]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"43633263"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.20,"providers":[{"billed_charge":2959.27,"npi":[1972503910]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":41188.55,"providers":[{"billed_charge":125427.00,"npi":[1114473212]}]},{"allowed_amount":7764.18,"providers":[{"billed_charge":16870.00,"npi":[1841746948]}]},{"allowed_amount":10929.45,"providers":[{"billed_charge":89206.00,"npi":[1649726738]}]},{"allowed_amount":2978.88,"providers":[{"billed_charge":12526.00,"npi":[1851847974]}]},{"allowed_amount":234811.55,"providers":[{"billed_charge":776074.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":413.24,"providers":[{"billed_charge":876.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":121479.86,"providers":[{"billed_charge":120943.00,"npi":[1962472860]}]},{"allowed_amount":1115.71,"providers":[{"billed_charge":33946.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":683.97,"providers":[{"billed_charge":32175.00,"npi":[1851361778]}]},{"allowed_amount":105320.68,"providers":[{"billed_charge":102404.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17429.31,"providers":[{"billed_charge":17909.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3719.54,"providers":[{"billed_charge":10214.35,"npi":[1396790325]}]},{"allowed_amount":81.48,"providers":[{"billed_charge":280.30,"npi":[1417432840]}]},{"allowed_amount":4614.48,"providers":[{"billed_charge":12652.45,"npi":[1417432840]}]},{"allowed_amount":395.53,"providers":[{"billed_charge":1089.60,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":103658.74,"providers":[{"billed_charge":94765.00,"npi":[1336603646]}]},{"allowed_amount":182.12,"providers":[{"billed_charge":12525.00,"npi":[1336603646]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":618.37,"providers":[{"billed_charge":1680.39,"npi":[1417432840]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20864.84,"providers":[{"billed_charge":57268.12,"npi":[1396790325]}]},{"allowed_amount":72670.26,"providers":[{"billed_charge":198824.21,"npi":[1417432840]}]},{"allowed_amount":4024.36,"providers":[{"billed_charge":10904.10,"npi":[1396790325]}]},{"allowed_amount":295.07,"providers":[{"billed_charge":721.87,"npi":[1417432840]}]},{"allowed_amount":5636.31,"providers":[{"billed_charge":15571.01,"npi":[1417432840]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":32545.42,"providers":[{"billed_charge":1217366.25,"npi":[1649726738]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24921.43,"providers":[{"billed_charge":49561.00,"npi":[1013918960]}]},{"allowed_amount":7299.27,"providers":[{"billed_charge":28393.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":862.06,"providers":[{"billed_charge":2104.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":54.28,"providers":[{"billed_charge":256.00,"npi":[1851846661]}]},{"allowed_amount":5046.96,"providers":[{"billed_charge":15573.00,"npi":[1396207221]}]},{"allowed_amount":74096.99,"providers":[{"billed_charge":195062.00,"npi":[1649726738]}]},{"allowed_amount":63.20,"providers":[{"billed_charge":322.00,"npi":[1841746948]}]},{"allowed_amount":5985.81,"providers":[{"billed_charge":26063.00,"npi":[1649726738]}]},{"allowed_amount":8.83,"providers":[{"billed_charge":308.00,"npi":[1851847974]}]},{"allowed_amount":1455.01,"providers":[{"billed_charge":10780.00,"npi":[1114473212]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2845.66,"providers":[{"billed_charge":41078.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.26,"providers":[{"billed_charge":62.00,"npi":[1851361778]}]},{"allowed_amount":761.38,"providers":[{"billed_charge":46537.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":78.40,"providers":[{"billed_charge":410.63,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":499.90,"providers":[{"billed_charge":6811.00,"npi":[1255645644]}]},{"allowed_amount":281.24,"providers":[{"billed_charge":3141.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560585243"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1660.01,"providers":[{"billed_charge":2812.51,"npi":[1043218944]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2278.32,"providers":[{"billed_charge":5735.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":665.57,"providers":[{"billed_charge":21640.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15.45,"providers":[{"billed_charge":17389.00,"npi":[1972503910]}]},{"allowed_amount":6079.12,"providers":[{"billed_charge":8934.00,"npi":[1972503910]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":929.90,"providers":[{"billed_charge":889682.00,"npi":[1649726738]}]},{"allowed_amount":357.32,"providers":[{"billed_charge":1472.00,"npi":[1720747496]}]},{"allowed_amount":1357.34,"providers":[{"billed_charge":57517.00,"npi":[1114473212]}]},{"allowed_amount":22560.60,"providers":[{"billed_charge":164226.00,"npi":[1649726738]}]},{"allowed_amount":16.92,"providers":[{"billed_charge":4857.00,"npi":[1396207221]}]},{"allowed_amount":783.02,"providers":[{"billed_charge":10415.00,"npi":[1851846661]}]},{"allowed_amount":458.59,"providers":[{"billed_charge":7396.00,"npi":[1841746948]}]},{"allowed_amount":92.11,"providers":[{"billed_charge":9528.00,"npi":[1851847974]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6666.73,"providers":[{"billed_charge":12995.00,"npi":[1881647204]}]},{"allowed_amount":9918.94,"providers":[{"billed_charge":25901.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":503.57,"providers":[{"billed_charge":1872.00,"npi":[1427030774]}]},{"allowed_amount":1178.01,"providers":[{"billed_charge":2840.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"590724459"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":84.58,"providers":[{"billed_charge":6302.00,"npi":[1306938071]}]},{"allowed_amount":698.17,"providers":[{"billed_charge":63502.00,"npi":[1306938071]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":668.82,"providers":[{"billed_charge":356939.00,"npi":[1962472860]}]},{"allowed_amount":13866.00,"providers":[{"billed_charge":338750.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9776.86,"providers":[{"billed_charge":18495.00,"npi":[1740998020]}]},{"allowed_amount":2418.60,"providers":[{"billed_charge":8062.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"42697983"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":263.70,"providers":[{"billed_charge":879.00,"npi":[1023049236]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4293.96,"providers":[{"billed_charge":10378.30,"npi":[1417432840]}]},{"allowed_amount":61445.46,"providers":[{"billed_charge":168221.45,"npi":[1396790325]}]},{"allowed_amount":3375.23,"providers":[{"billed_charge":9888.45,"npi":[1417432840]}]},{"allowed_amount":10240.64,"providers":[{"billed_charge":27921.25,"npi":[1346297892]}]},{"allowed_amount":1403.08,"providers":[{"billed_charge":3862.50,"npi":[1396790325]}]},{"allowed_amount":634.11,"providers":[{"billed_charge":1390.60,"npi":[1396790325]}]},{"allowed_amount":85631.14,"providers":[{"billed_charge":235347.40,"npi":[1417432840]}]},{"allowed_amount":407.67,"providers":[{"billed_charge":1123.05,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":308.66,"providers":[{"billed_charge":335803.00,"npi":[1336603646]}]},{"allowed_amount":3350.30,"providers":[{"billed_charge":131135.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":918.37,"providers":[{"billed_charge":1851.00,"npi":[1063463156]}]},{"allowed_amount":541.55,"providers":[{"billed_charge":2067.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1111.38,"providers":[{"billed_charge":2770.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":399.82,"providers":[{"billed_charge":966.82,"npi":[1427075027]}]},{"allowed_amount":327.56,"providers":[{"billed_charge":894.62,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1603.54,"providers":[{"billed_charge":5363.00,"npi":[1447200233]}]},{"allowed_amount":365.36,"providers":[{"billed_charge":1037.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1004.30,"providers":[{"billed_charge":4584.09,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":57.91,"providers":[{"billed_charge":1451.00,"npi":[1851361778]}]},{"allowed_amount":4145.00,"providers":[{"billed_charge":223698.00,"npi":[1851361778]}]},{"allowed_amount":15.20,"providers":[{"billed_charge":332303.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4765.00,"providers":[{"billed_charge":82288.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7308.85,"providers":[{"billed_charge":27852.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":283.01,"providers":[{"billed_charge":1683.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":115.89,"providers":[{"billed_charge":315.55,"npi":[1811005150]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":48970.54,"providers":[{"billed_charge":164431.00,"npi":[1972503910]}]},{"allowed_amount":220.34,"providers":[{"billed_charge":120047.00,"npi":[1972503910]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2098.87,"providers":[{"billed_charge":18930.00,"npi":[1649726738]}]},{"allowed_amount":551.90,"providers":[{"billed_charge":25936.20,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11.32,"providers":[{"billed_charge":713.00,"npi":[1962472860]}]},{"allowed_amount":81.90,"providers":[{"billed_charge":4288.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":162.60,"providers":[{"billed_charge":8118.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2179.49,"providers":[{"billed_charge":5923.95,"npi":[1417432840]}]},{"allowed_amount":539.42,"providers":[{"billed_charge":1588.45,"npi":[1417432840]}]},{"allowed_amount":213.30,"providers":[{"billed_charge":460.70,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7.47,"providers":[{"billed_charge":1337.00,"npi":[1972503910]}]},{"allowed_amount":4002.35,"providers":[{"billed_charge":20496.50,"npi":[1972503910]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6.47,"providers":[{"billed_charge":1846.00,"npi":[1396207221]}]},{"allowed_amount":15.54,"providers":[{"billed_charge":1512.00,"npi":[1851847974]}]},{"allowed_amount":345.27,"providers":[{"billed_charge":14024.00,"npi":[1114473212]}]},{"allowed_amount":1434.09,"providers":[{"billed_charge":31360.00,"npi":[1649726738]}]},{"allowed_amount":143.98,"providers":[{"billed_charge":2194.00,"npi":[1841746948]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3022.29,"providers":[{"billed_charge":7020.00,"npi":[1881647204]}]},{"allowed_amount":1570.65,"providers":[{"billed_charge":2088.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":32.43,"providers":[{"billed_charge":108.10,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":142.13,"providers":[{"billed_charge":112572.00,"npi":[1962472860]}]},{"allowed_amount":3990.20,"providers":[{"billed_charge":99948.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1431.20,"providers":[{"billed_charge":59737.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1476.90,"providers":[{"billed_charge":1624.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":804.05,"providers":[{"billed_charge":19117.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":747.27,"providers":[{"billed_charge":3622.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1150.96,"providers":[{"billed_charge":3191.10,"npi":[1417432840]}]},{"allowed_amount":15778.37,"providers":[{"billed_charge":43214.75,"npi":[1396790325]}]},{"allowed_amount":21934.68,"providers":[{"billed_charge":60264.15,"npi":[1417432840]}]},{"allowed_amount":2271.45,"providers":[{"billed_charge":6197.35,"npi":[1346297892]}]},{"allowed_amount":1345.02,"providers":[{"billed_charge":3265.30,"npi":[1417432840]}]},{"allowed_amount":501.02,"providers":[{"billed_charge":1372.70,"npi":[1396790325]}]},{"allowed_amount":48.22,"providers":[{"billed_charge":132.85,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":942.60,"providers":[{"billed_charge":28777.00,"npi":[1336603646]}]},{"allowed_amount":162.13,"providers":[{"billed_charge":100070.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5356.42,"providers":[{"billed_charge":21094.00,"npi":[1972503910]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":263.15,"providers":[{"billed_charge":2463.00,"npi":[1851846661]}]},{"allowed_amount":51.86,"providers":[{"billed_charge":357.00,"npi":[1922788728]}]},{"allowed_amount":9892.98,"providers":[{"billed_charge":79796.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":150.38,"providers":[{"billed_charge":216.00,"npi":[1962472860]}]},{"allowed_amount":57754.20,"providers":[{"billed_charge":77743.00,"npi":[1962472860]}]},{"allowed_amount":2150.70,"providers":[{"billed_charge":24875.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":835.25,"providers":[{"billed_charge":21012.00,"npi":[1851361778]}]},{"allowed_amount":27112.68,"providers":[{"billed_charge":36039.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5886.26,"providers":[{"billed_charge":9289.00,"npi":[1255645644]}]},{"allowed_amount":317.00,"providers":[{"billed_charge":1963.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2741.92,"providers":[{"billed_charge":7437.35,"npi":[1346297892]}]},{"allowed_amount":25970.16,"providers":[{"billed_charge":71291.55,"npi":[1417432840]}]},{"allowed_amount":1859.92,"providers":[{"billed_charge":4563.80,"npi":[1417432840]}]},{"allowed_amount":2073.43,"providers":[{"billed_charge":5728.00,"npi":[1417432840]}]},{"allowed_amount":591.49,"providers":[{"billed_charge":1614.80,"npi":[1396790325]}]},{"allowed_amount":24993.90,"providers":[{"billed_charge":68489.10,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":241.10,"providers":[{"billed_charge":5454.00,"npi":[1336603646]}]},{"allowed_amount":293.01,"providers":[{"billed_charge":432.00,"npi":[1336603646]}]},{"allowed_amount":38997.09,"providers":[{"billed_charge":51837.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1978.56,"providers":[{"billed_charge":12093.00,"npi":[1972503910]}]},{"allowed_amount":10846.53,"providers":[{"billed_charge":19375.00,"npi":[1972503910]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":107.22,"providers":[{"billed_charge":3884.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":3.01,"providers":[{"billed_charge":88.00,"npi":[1851361778]}]},{"allowed_amount":113.74,"providers":[{"billed_charge":9288.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":28.47,"providers":[{"billed_charge":94.89,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":99.79,"providers":[{"billed_charge":8696.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":256.00,"providers":[{"billed_charge":1642.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":51.98,"providers":[{"billed_charge":143.20,"npi":[1346297892]}]},{"allowed_amount":885.39,"providers":[{"billed_charge":2413.10,"npi":[1417432840]}]},{"allowed_amount":3539.74,"providers":[{"billed_charge":9696.95,"npi":[1396790325]}]},{"allowed_amount":63.37,"providers":[{"billed_charge":155.70,"npi":[1417432840]}]},{"allowed_amount":5574.95,"providers":[{"billed_charge":15273.25,"npi":[1417432840]}]},{"allowed_amount":183.88,"providers":[{"billed_charge":502.40,"npi":[1396790325]}]},{"allowed_amount":214.91,"providers":[{"billed_charge":589.10,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":278.30,"providers":[{"billed_charge":5183.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":150.23,"providers":[{"billed_charge":2161.00,"npi":[1972503910]}]}]}]},{"name":"PATHOL/CYTOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"311","description":"LABORATORY PATHOLOGICAL - CYTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1058.30,"providers":[{"billed_charge":29961.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":838.26,"providers":[{"billed_charge":2348.00,"npi":[1972503910]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":5216.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":247.23,"providers":[{"billed_charge":668.20,"npi":[1417432840]}]},{"allowed_amount":8648.83,"providers":[{"billed_charge":23505.15,"npi":[1417432840]}]}]}]},{"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":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2543.46,"providers":[{"billed_charge":6066.00,"npi":[1013918960]}]},{"allowed_amount":89.91,"providers":[{"billed_charge":370.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5778.87,"providers":[{"billed_charge":74842.00,"npi":[1649726738]}]},{"allowed_amount":402.88,"providers":[{"billed_charge":270548.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1579.24,"providers":[{"billed_charge":2934.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":983.10,"providers":[{"billed_charge":10775.00,"npi":[1962472860]}]},{"allowed_amount":88.24,"providers":[{"billed_charge":615.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7058.46,"providers":[{"billed_charge":19363.50,"npi":[1417432840]}]},{"allowed_amount":3486.61,"providers":[{"billed_charge":9534.75,"npi":[1396790325]}]},{"allowed_amount":366.93,"providers":[{"billed_charge":792.50,"npi":[1417432840]}]},{"allowed_amount":5536.45,"providers":[{"billed_charge":15200.55,"npi":[1417432840]}]},{"allowed_amount":10304.89,"providers":[{"billed_charge":28096.70,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5536.25,"providers":[{"billed_charge":27022.00,"npi":[1972503910]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":843.18,"providers":[{"billed_charge":5070.00,"npi":[1649726738]}]},{"allowed_amount":52575.22,"providers":[{"billed_charge":175980.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":34666.53,"providers":[{"billed_charge":83831.00,"npi":[1962472860]}]},{"allowed_amount":641.40,"providers":[{"billed_charge":22468.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":95.40,"providers":[{"billed_charge":12566.00,"npi":[1851361778]}]},{"allowed_amount":22333.50,"providers":[{"billed_charge":51024.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1605.97,"providers":[{"billed_charge":4194.00,"npi":[1255645644]}]},{"allowed_amount":125.00,"providers":[{"billed_charge":1700.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10297.25,"providers":[{"billed_charge":28437.30,"npi":[1417432840]}]},{"allowed_amount":503.15,"providers":[{"billed_charge":1377.45,"npi":[1396790325]}]},{"allowed_amount":10938.09,"providers":[{"billed_charge":29988.25,"npi":[1396790325]}]},{"allowed_amount":336.74,"providers":[{"billed_charge":825.10,"npi":[1417432840]}]},{"allowed_amount":334.50,"providers":[{"billed_charge":912.85,"npi":[1346297892]}]},{"allowed_amount":971.04,"providers":[{"billed_charge":2650.80,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":145.70,"providers":[{"billed_charge":4299.00,"npi":[1336603646]}]},{"allowed_amount":25513.38,"providers":[{"billed_charge":62878.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4063.77,"providers":[{"billed_charge":10268.00,"npi":[1972503910]}]},{"allowed_amount":1542.67,"providers":[{"billed_charge":4169.00,"npi":[1972503910]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3815.33,"providers":[{"billed_charge":13529.00,"npi":[1841746948]}]},{"allowed_amount":215748.04,"providers":[{"billed_charge":809182.00,"npi":[1114473212]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":27997.42,"providers":[{"billed_charge":76897.60,"npi":[1396790325]}]},{"allowed_amount":3092.37,"providers":[{"billed_charge":8357.75,"npi":[1417432840]}]},{"allowed_amount":71716.09,"providers":[{"billed_charge":193827.20,"npi":[1417432840]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":683.95,"providers":[{"billed_charge":2188.00,"npi":[1851847974]}]},{"allowed_amount":61431.39,"providers":[{"billed_charge":119342.00,"npi":[1114473212]}]}]}]},{"name":"NUC MED/DX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"341","description":"NUCLEAR MEDICINE - DIAGNOSTIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2175.85,"providers":[{"billed_charge":4061.00,"npi":[1649726738]}]}]}]},{"name":"NUC MED/DX RADIOPHARM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"343","description":"DIAGNOSTIC RADIOPHARMACEUTICALS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21529.06,"providers":[{"billed_charge":89113.07,"npi":[1649726738]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":454.14,"providers":[{"billed_charge":6692.00,"npi":[1649726738]}]},{"allowed_amount":60367.96,"providers":[{"billed_charge":585358.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3639.00,"providers":[{"billed_charge":37518.00,"npi":[1851361778]}]},{"allowed_amount":21219.74,"providers":[{"billed_charge":170374.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17474.84,"providers":[{"billed_charge":139859.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":831.54,"providers":[{"billed_charge":2290.75,"npi":[1396790325]}]},{"allowed_amount":9209.72,"providers":[{"billed_charge":25017.30,"npi":[1417432840]}]},{"allowed_amount":41010.83,"providers":[{"billed_charge":111969.15,"npi":[1417432840]}]},{"allowed_amount":29254.92,"providers":[{"billed_charge":80052.10,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":106.49,"providers":[{"billed_charge":2432.00,"npi":[1336603646]}]},{"allowed_amount":1067.00,"providers":[{"billed_charge":18282.00,"npi":[1336603646]}]},{"allowed_amount":11121.15,"providers":[{"billed_charge":97446.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6468.63,"providers":[{"billed_charge":49762.00,"npi":[1972503910]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":331.72,"providers":[{"billed_charge":9954.00,"npi":[1790264497]}]},{"allowed_amount":103508.94,"providers":[{"billed_charge":1642920.00,"npi":[1649726738]}]},{"allowed_amount":1162.98,"providers":[{"billed_charge":22096.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":56469.31,"providers":[{"billed_charge":496614.00,"npi":[1962472860]}]},{"allowed_amount":6249.00,"providers":[{"billed_charge":109966.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3572.90,"providers":[{"billed_charge":118885.00,"npi":[1851361778]}]},{"allowed_amount":51022.66,"providers":[{"billed_charge":434878.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10039.97,"providers":[{"billed_charge":80329.00,"npi":[1255645644]}]},{"allowed_amount":1553.00,"providers":[{"billed_charge":45756.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":137861.46,"providers":[{"billed_charge":378506.60,"npi":[1417432840]}]},{"allowed_amount":109652.89,"providers":[{"billed_charge":300455.30,"npi":[1396790325]}]},{"allowed_amount":68481.39,"providers":[{"billed_charge":186938.45,"npi":[1417432840]}]},{"allowed_amount":3970.79,"providers":[{"billed_charge":9735.65,"npi":[1417432840]}]},{"allowed_amount":16166.27,"providers":[{"billed_charge":44364.95,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":64575.54,"providers":[{"billed_charge":451520.00,"npi":[1336603646]}]},{"allowed_amount":533.50,"providers":[{"billed_charge":30658.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3950.06,"providers":[{"billed_charge":30314.00,"npi":[1972503910]}]},{"allowed_amount":14634.77,"providers":[{"billed_charge":162697.00,"npi":[1972503910]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":101262.49,"providers":[{"billed_charge":208925.00,"npi":[1649726738]}]},{"allowed_amount":1152820.29,"providers":[{"billed_charge":2851638.04,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12778.65,"providers":[{"billed_charge":15925.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":176415.75,"providers":[{"billed_charge":481021.73,"npi":[1417432840]}]},{"allowed_amount":11757.18,"providers":[{"billed_charge":33705.25,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18182.50,"providers":[{"billed_charge":72234.50,"npi":[1972503910]}]},{"allowed_amount":365611.84,"providers":[{"billed_charge":842921.60,"npi":[1972503910]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":34118.70,"providers":[{"billed_charge":79771.00,"npi":[1649726738]}]},{"allowed_amount":27125.31,"providers":[{"billed_charge":72634.00,"npi":[1629432869]}]},{"allowed_amount":753995.32,"providers":[{"billed_charge":1832585.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":744.68,"providers":[{"billed_charge":2034.10,"npi":[1396790325]}]},{"allowed_amount":46995.72,"providers":[{"billed_charge":128068.30,"npi":[1417432840]}]},{"allowed_amount":753.90,"providers":[{"billed_charge":1628.30,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1619.49,"providers":[{"billed_charge":1496.00,"npi":[1972503910]}]},{"allowed_amount":13270.28,"providers":[{"billed_charge":22455.50,"npi":[1972503910]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1106.77,"providers":[{"billed_charge":2900.00,"npi":[1134675978]}]},{"allowed_amount":251.57,"providers":[{"billed_charge":660.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.46,"providers":[{"billed_charge":24.00,"npi":[1750795183]}]},{"allowed_amount":121.14,"providers":[{"billed_charge":216.00,"npi":[1912986977]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":26.69,"providers":[{"billed_charge":106.61,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81","72","50"],"billing_class":"professional","payments":[{"allowed_amount":84.29,"providers":[{"billed_charge":204.00,"npi":[1234567893]}]},{"allowed_amount":22.00,"providers":[{"billed_charge":22.00,"npi":[1234567893]}]},{"allowed_amount":61.77,"providers":[{"billed_charge":661.32,"npi":[1234567893]}]},{"allowed_amount":3.75,"providers":[{"billed_charge":6.00,"npi":[1234567893]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":170.00,"providers":[{"billed_charge":10705.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":120406.05,"providers":[{"billed_charge":329957.35,"npi":[1417432840]}]},{"allowed_amount":8819.08,"providers":[{"billed_charge":25726.00,"npi":[1417432840]}]}]}]},{"name":"MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"401","description":"OTHER IMAGING SERVICES - MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.70,"providers":[{"billed_charge":32.00,"npi":[1972503910]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19284.27,"providers":[{"billed_charge":194565.00,"npi":[1649726738]}]},{"allowed_amount":98.77,"providers":[{"billed_charge":1040.00,"npi":[1790264497]}]},{"allowed_amount":18698.15,"providers":[{"billed_charge":96485.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2374.09,"providers":[{"billed_charge":33620.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2398.99,"providers":[{"billed_charge":6538.35,"npi":[1396790325]}]},{"allowed_amount":745.84,"providers":[{"billed_charge":2034.40,"npi":[1396790325]}]},{"allowed_amount":8223.76,"providers":[{"billed_charge":22493.15,"npi":[1417432840]}]},{"allowed_amount":7437.21,"providers":[{"billed_charge":20584.55,"npi":[1417432840]}]},{"allowed_amount":1227.35,"providers":[{"billed_charge":3015.60,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1701.13,"providers":[{"billed_charge":27248.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10955.35,"providers":[{"billed_charge":45854.00,"npi":[1972503910]}]},{"allowed_amount":506.12,"providers":[{"billed_charge":4332.00,"npi":[1972503910]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":37.21,"providers":[{"billed_charge":119.00,"npi":[1972503910]}]},{"allowed_amount":7102.62,"providers":[{"billed_charge":11977.00,"npi":[1972503910]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3801.17,"providers":[{"billed_charge":15435.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":532.84,"providers":[{"billed_charge":1451.30,"npi":[1417432840]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10090.22,"providers":[{"billed_charge":42414.00,"npi":[1760963243]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":370.26,"providers":[{"billed_charge":1068.45,"npi":[1396790325]}]},{"allowed_amount":252.76,"providers":[{"billed_charge":745.90,"npi":[1417432840]}]},{"allowed_amount":2372.90,"providers":[{"billed_charge":6650.60,"npi":[1396790325]}]},{"allowed_amount":120.60,"providers":[{"billed_charge":369.15,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14824.16,"providers":[{"billed_charge":43394.00,"npi":[1972503910]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":464.76,"providers":[{"billed_charge":935.00,"npi":[1649726738]}]},{"allowed_amount":2739.25,"providers":[{"billed_charge":6039.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":894.19,"providers":[{"billed_charge":1128.00,"npi":[1972503910]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2962.96,"providers":[{"billed_charge":11137.00,"npi":[1649726738]}]},{"allowed_amount":49.04,"providers":[{"billed_charge":982.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":556.54,"providers":[{"billed_charge":1658.55,"npi":[1396790325]}]},{"allowed_amount":104.93,"providers":[{"billed_charge":315.10,"npi":[1396790325]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":116.39,"providers":[{"billed_charge":388.00,"npi":[1649726738]}]},{"allowed_amount":682.42,"providers":[{"billed_charge":1890.00,"npi":[1649726738]}]}]}]},{"name":"SPEECH PATHOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"440","description":"SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":384.66,"providers":[{"billed_charge":1548.00,"npi":[1649726738]}]}]}]},{"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":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":65598.13,"providers":[{"billed_charge":142307.00,"npi":[1013918960]}]},{"allowed_amount":3202.81,"providers":[{"billed_charge":16181.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1669496.05,"providers":[{"billed_charge":3560990.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7482.18,"providers":[{"billed_charge":21953.00,"npi":[1881647204]}]},{"allowed_amount":36723.91,"providers":[{"billed_charge":57955.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8186.00,"providers":[{"billed_charge":179099.00,"npi":[1962472860]}]},{"allowed_amount":999034.36,"providers":[{"billed_charge":2394532.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"590724459"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":949.78,"providers":[{"billed_charge":1453.00,"npi":[1306938071]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":30828.94,"providers":[{"billed_charge":49028.00,"npi":[1740998020]}]},{"allowed_amount":1553.70,"providers":[{"billed_charge":5179.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":400399.81,"providers":[{"billed_charge":1100318.95,"npi":[1417432840]}]},{"allowed_amount":387550.49,"providers":[{"billed_charge":1060425.95,"npi":[1396790325]}]},{"allowed_amount":2297.70,"providers":[{"billed_charge":5617.85,"npi":[1417432840]}]},{"allowed_amount":58256.12,"providers":[{"billed_charge":159706.10,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3130.60,"providers":[{"billed_charge":114349.00,"npi":[1336603646]}]},{"allowed_amount":629558.23,"providers":[{"billed_charge":1561742.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4350.61,"providers":[{"billed_charge":8896.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1983.45,"providers":[{"billed_charge":3060.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3104.34,"providers":[{"billed_charge":5859.14,"npi":[1427075027]}]},{"allowed_amount":978.60,"providers":[{"billed_charge":3262.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1428.92,"providers":[{"billed_charge":4779.00,"npi":[1447200233]}]},{"allowed_amount":3836.09,"providers":[{"billed_charge":8771.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4486.60,"providers":[{"billed_charge":185131.00,"npi":[1851361778]}]},{"allowed_amount":666286.02,"providers":[{"billed_charge":1616322.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":132160.84,"providers":[{"billed_charge":328591.00,"npi":[1255645644]}]},{"allowed_amount":2548.00,"providers":[{"billed_charge":34507.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"300811171"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2215.02,"providers":[{"billed_charge":6206.30,"npi":[1023435898]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41624.45,"providers":[{"billed_charge":97081.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1503.52,"providers":[{"billed_charge":4692.00,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20325.64,"providers":[{"billed_charge":40281.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4437.08,"providers":[{"billed_charge":9400.60,"npi":[1053358945]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":217972.05,"providers":[{"billed_charge":233819.00,"npi":[1972503910]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1457.56,"providers":[{"billed_charge":2870.00,"npi":[1972503910]}]}]}]},{"name":"CARDIAC CATH LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"481","description":"CARDIOLOGY - CARDIAC CATH LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":217936.62,"providers":[{"billed_charge":555330.00,"npi":[1649726738]}]},{"allowed_amount":92497.82,"providers":[{"billed_charge":141026.00,"npi":[1649726738]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7325.41,"providers":[{"billed_charge":36257.00,"npi":[1649726738]}]},{"allowed_amount":8105.60,"providers":[{"billed_charge":77085.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":1978.00,"providers":[{"billed_charge":48480.00,"npi":[1962472860]}]},{"allowed_amount":535.70,"providers":[{"billed_charge":3890.00,"npi":[1962472860]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":12375.62,"providers":[{"billed_charge":35872.00,"npi":[1871674481]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1282.53,"providers":[{"billed_charge":3656.00,"npi":[1649726738]}]},{"allowed_amount":1184.00,"providers":[{"billed_charge":1920.00,"npi":[1851847974]}]},{"allowed_amount":1685.38,"providers":[{"billed_charge":2247.00,"npi":[1649726738]}]}]}]},{"name":"CHRONIC PAIN CL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"511","description":"CLINIC - CHRONIC PAIN CENTER","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1065.56,"providers":[{"billed_charge":2917.10,"npi":[1417432840]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1976.07,"providers":[{"billed_charge":4202.85,"npi":[1053358945]}]}]}]},{"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":"586076010"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":8706.58,"providers":[{"billed_charge":27477.27,"npi":[1316794639]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1377.04,"providers":[{"billed_charge":11228.00,"npi":[1649726738]}]},{"allowed_amount":1353.09,"providers":[{"billed_charge":27512.00,"npi":[1649726738]}]}]}]},{"name":"MRI-SPINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"612","description":"MRI - SPINAL CORD (INCLUDING SPINE)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2539.45,"providers":[{"billed_charge":36247.00,"npi":[1649726738]}]}]}]},{"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":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1486.94,"providers":[{"billed_charge":4986.40,"npi":[1013918960]}]},{"allowed_amount":2478.38,"providers":[{"billed_charge":10199.10,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6.24,"providers":[{"billed_charge":4478.80,"npi":[1629432869]}]},{"allowed_amount":562826.61,"providers":[{"billed_charge":1974817.90,"npi":[1114473212]}]},{"allowed_amount":8859.41,"providers":[{"billed_charge":99002.10,"npi":[1851847974]}]},{"allowed_amount":5043.84,"providers":[{"billed_charge":88257.50,"npi":[1841746948]}]},{"allowed_amount":20788.66,"providers":[{"billed_charge":455673.00,"npi":[1649726738]}]},{"allowed_amount":15.50,"providers":[{"billed_charge":15268.10,"npi":[1639656713]}]},{"allowed_amount":189669.03,"providers":[{"billed_charge":1052477.31,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1171.27,"providers":[{"billed_charge":3721.10,"npi":[1881647204]}]},{"allowed_amount":7245.27,"providers":[{"billed_charge":62032.45,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":93.13,"providers":[{"billed_charge":310.65,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3299.11,"providers":[{"billed_charge":57412.90,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3911.57,"providers":[{"billed_charge":13038.55,"npi":[1740998020]}]},{"allowed_amount":1889.72,"providers":[{"billed_charge":6298.97,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"850105601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.83,"providers":[{"billed_charge":98.00,"npi":[1215913470]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5933.93,"providers":[{"billed_charge":16338.05,"npi":[1417432840]}]},{"allowed_amount":1231.30,"providers":[{"billed_charge":2942.35,"npi":[1417432840]}]},{"allowed_amount":60.29,"providers":[{"billed_charge":132.80,"npi":[1396790325]}]},{"allowed_amount":11821.53,"providers":[{"billed_charge":32399.35,"npi":[1417432840]}]},{"allowed_amount":6132.90,"providers":[{"billed_charge":16722.45,"npi":[1396790325]}]},{"allowed_amount":777.16,"providers":[{"billed_charge":2140.95,"npi":[1346297892]}]},{"allowed_amount":709.02,"providers":[{"billed_charge":1955.00,"npi":[1346297892]}]},{"allowed_amount":4370.21,"providers":[{"billed_charge":11951.50,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1311.35,"providers":[{"billed_charge":46006.80,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1278.00,"providers":[{"billed_charge":4260.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1269.74,"providers":[{"billed_charge":1597.90,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1270.45,"providers":[{"billed_charge":4249.00,"npi":[1447200233]}]},{"allowed_amount":820.07,"providers":[{"billed_charge":2733.70,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12320.68,"providers":[{"billed_charge":82587.90,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59.98,"providers":[{"billed_charge":9074.40,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":546.60,"providers":[{"billed_charge":1822.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":889.78,"providers":[{"billed_charge":7140.50,"npi":[1376139139]}]},{"allowed_amount":672.13,"providers":[{"billed_charge":5892.65,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":482.40,"providers":[{"billed_charge":1608.00,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4778.31,"providers":[{"billed_charge":55462.00,"npi":[1972503910]}]},{"allowed_amount":219.87,"providers":[{"billed_charge":22115.00,"npi":[1972503910]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":321.99,"providers":[{"billed_charge":1073.30,"npi":[1013918960]}]},{"allowed_amount":713.13,"providers":[{"billed_charge":2306.60,"npi":[1013918960]}]}]}]},{"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":"852020533"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":6240.00,"providers":[{"billed_charge":7808.40,"npi":[1417557950]}]}]}]},{"name":"TRAUMA LEVEL 1","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"681","description":"TRAUMA LEVEL 1","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8556.99,"providers":[{"billed_charge":152614.00,"npi":[1649726738]}]}]}]},{"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":"571049603"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":478.49,"providers":[{"billed_charge":3472.00,"npi":[1669978078]}]},{"allowed_amount":56.57,"providers":[{"billed_charge":496.00,"npi":[1669978078]}]},{"allowed_amount":77.00,"providers":[{"billed_charge":496.00,"npi":[1942610381]}]},{"allowed_amount":37.71,"providers":[{"billed_charge":248.00,"npi":[1669978078]}]},{"allowed_amount":455.30,"providers":[{"billed_charge":3472.00,"npi":[1942610381]}]},{"allowed_amount":113.53,"providers":[{"billed_charge":992.00,"npi":[1942610381]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4162.55,"providers":[{"billed_charge":11772.65,"npi":[1417432840]}]},{"allowed_amount":44717.02,"providers":[{"billed_charge":123146.85,"npi":[1417432840]}]}]}]},{"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":"273818647"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":46.81,"providers":[{"billed_charge":162.00,"npi":[1154385193]}]},{"allowed_amount":187.68,"providers":[{"billed_charge":648.00,"npi":[1154385193]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":23.46,"providers":[{"billed_charge":48.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":16.24,"providers":[{"billed_charge":74.00,"npi":[1427369537]}]},{"allowed_amount":8.09,"providers":[{"billed_charge":37.00,"npi":[1669978078]}]},{"allowed_amount":210.88,"providers":[{"billed_charge":962.00,"npi":[1669978078]}]},{"allowed_amount":97.38,"providers":[{"billed_charge":444.00,"npi":[1942610381]}]},{"allowed_amount":113.68,"providers":[{"billed_charge":518.00,"npi":[1942610381]}]},{"allowed_amount":381.85,"providers":[{"billed_charge":1739.00,"npi":[1942610381]}]},{"allowed_amount":48.66,"providers":[{"billed_charge":222.00,"npi":[1669978078]}]},{"allowed_amount":146.10,"providers":[{"billed_charge":666.00,"npi":[1427369537]}]},{"allowed_amount":40.51,"providers":[{"billed_charge":185.00,"npi":[1427369537]}]}]}]},{"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":"571049603"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":10.03,"providers":[{"billed_charge":44.00,"npi":[1942610381]}]}]}]},{"name":"CT ANGIOGRAPHY CHEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71275","description":"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTR","allowed_amounts":[{"tin":{"type":"ein","value":"571049603"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":203.52,"providers":[{"billed_charge":1200.00,"npi":[1942610381]}]}]}]},{"name":"X-RAY EXAM L-S SPINE 2/3 VWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"72100","description":"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.48,"providers":[{"billed_charge":85.00,"npi":[1134675978]}]}]}]},{"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":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":62.21,"providers":[{"billed_charge":256.00,"npi":[1013918960]}]},{"allowed_amount":2560.00,"providers":[{"billed_charge":3328.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":959.13,"providers":[{"billed_charge":19182.00,"npi":[1649726738]}]},{"allowed_amount":55.31,"providers":[{"billed_charge":3861.00,"npi":[1396207221]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":970.80,"providers":[{"billed_charge":29520.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":249.40,"providers":[{"billed_charge":14478.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":118.76,"providers":[{"billed_charge":395.86,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":163.00,"providers":[{"billed_charge":2656.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18145.18,"providers":[{"billed_charge":49836.35,"npi":[1396790325]}]},{"allowed_amount":577.01,"providers":[{"billed_charge":1724.15,"npi":[1346297892]}]},{"allowed_amount":694.54,"providers":[{"billed_charge":1703.65,"npi":[1417432840]}]},{"allowed_amount":19021.83,"providers":[{"billed_charge":53712.80,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":9244.00,"npi":[1336603646]}]},{"allowed_amount":192.76,"providers":[{"billed_charge":76208.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1520.36,"providers":[{"billed_charge":6578.00,"npi":[1972503910]}]}]}]},{"name":"EEG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"740","description":"EEG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1390.07,"providers":[{"billed_charge":3770.95,"npi":[1417432840]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"571049603"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":2452.20,"providers":[{"billed_charge":16500.00,"npi":[1942610381]}]},{"allowed_amount":244.48,"providers":[{"billed_charge":1650.00,"npi":[1942610381]}]},{"allowed_amount":163.48,"providers":[{"billed_charge":1100.00,"npi":[1427369537]}]},{"allowed_amount":488.96,"providers":[{"billed_charge":3300.00,"npi":[1942610381]}]}]}]},{"name":"GASTR-INTS SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"750","description":"GASTRO-INTESTINAL SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6863.35,"providers":[{"billed_charge":20144.35,"npi":[1417432840]}]},{"allowed_amount":1176.56,"providers":[{"billed_charge":3179.90,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"43633263"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":70692.86,"providers":[{"billed_charge":132038.00,"npi":[1972503910]}]},{"allowed_amount":1392.16,"providers":[{"billed_charge":7335.00,"npi":[1972503910]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7445.48,"providers":[{"billed_charge":26335.00,"npi":[1649726738]}]},{"allowed_amount":308.16,"providers":[{"billed_charge":2321.00,"npi":[1649726738]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":246.00,"providers":[{"billed_charge":6280.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15020.27,"providers":[{"billed_charge":41933.50,"npi":[1417432840]}]},{"allowed_amount":4224.57,"providers":[{"billed_charge":12912.60,"npi":[1417432840]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5844.24,"providers":[{"billed_charge":6666.10,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6253.83,"providers":[{"billed_charge":17500.00,"npi":[1205495884]}]}]}]},{"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":"812719403"},"service_code":["11","15"],"billing_class":"professional","payments":[{"allowed_amount":970.10,"providers":[{"billed_charge":2500.00,"npi":[1497293773]}]},{"allowed_amount":49.05,"providers":[{"billed_charge":125.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":1235.01,"providers":[{"billed_charge":5520.00,"npi":[1205893187]}]},{"allowed_amount":81.51,"providers":[{"billed_charge":360.00,"npi":[1205893187]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":357.59,"providers":[{"billed_charge":476.00,"npi":[1295949220]}]}]}]},{"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":"812719403"},"service_code":["11","15"],"billing_class":"professional","payments":[{"allowed_amount":356.22,"providers":[{"billed_charge":900.00,"npi":[1497293773]}]},{"allowed_amount":2100.60,"providers":[{"billed_charge":5400.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":1536.78,"providers":[{"billed_charge":8640.00,"npi":[1205893187]}]},{"allowed_amount":137.68,"providers":[{"billed_charge":768.00,"npi":[1205893187]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":456.12,"providers":[{"billed_charge":602.00,"npi":[1295949220]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1277.22,"providers":[{"billed_charge":2278.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":22.60,"providers":[{"billed_charge":395.00,"npi":[1851361778]}]}]}]},{"name":"RADIATION PHYSICS CONSULT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77336","description":"CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT PARAMETERS, QUALITY ASSUR","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1954.45,"providers":[{"billed_charge":4429.80,"npi":[1033178330]}]}]}]},{"name":"RADIATION TX MANAGEMENT X5","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77427","description":"RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3468.22,"providers":[{"billed_charge":6837.46,"npi":[1033178330]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":668.05,"providers":[{"billed_charge":1825.05,"npi":[1811005150]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2244.79,"providers":[{"billed_charge":6129.00,"npi":[1811005150]}]}]}]},{"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":"999999999"},"service_code":["81","72"],"billing_class":"professional","payments":[{"allowed_amount":31.42,"providers":[{"billed_charge":460.00,"npi":[1234567893]}]},{"allowed_amount":3.53,"providers":[{"billed_charge":42.24,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3309.32,"providers":[{"billed_charge":9132.60,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2572.77,"providers":[{"billed_charge":7069.30,"npi":[1811005150]}]}]}]},{"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":"844246379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1474.00,"providers":[{"billed_charge":8250.00,"npi":[1821683186]}]},{"allowed_amount":927.28,"providers":[{"billed_charge":5190.00,"npi":[1609451194]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2520.52,"providers":[{"billed_charge":20861.84,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":153.13,"providers":[{"billed_charge":418.15,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":218.73,"providers":[{"billed_charge":612.20,"npi":[1811005150]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"204068094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.76,"providers":[{"billed_charge":120.00,"npi":[1285387084]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":38.20,"providers":[{"billed_charge":200.00,"npi":[1134675978]}]},{"allowed_amount":26.74,"providers":[{"billed_charge":140.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"570604703"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1.13,"providers":[{"billed_charge":9.00,"npi":[1861454977]}]}]},{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7.64,"providers":[{"billed_charge":380.00,"npi":[1376037721]}]}]},{"tin":{"type":"ein","value":"273905550"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1.13,"providers":[{"billed_charge":6.00,"npi":[1194117226]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":565.31,"providers":[{"billed_charge":1544.65,"npi":[1811005150]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"472503725"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":1760.00,"providers":[{"billed_charge":16424.16,"npi":[1578961389]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2553.22,"providers":[{"billed_charge":6972.80,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":426.96,"providers":[{"billed_charge":1175.95,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2182.92,"providers":[{"billed_charge":5960.20,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1073.85,"providers":[{"billed_charge":2928.55,"npi":[1811005150]}]}]}]},{"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":"571122647"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":134.54,"providers":[{"billed_charge":343.00,"npi":[1922460955]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.23,"providers":[{"billed_charge":238.05,"npi":[1811005150]}]}]}]},{"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":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":9.72,"providers":[{"billed_charge":82.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.13,"providers":[{"billed_charge":29.00,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2461.31,"providers":[{"billed_charge":6813.65,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4633.08,"providers":[{"billed_charge":12691.20,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.34,"providers":[{"billed_charge":68.50,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":761.23,"providers":[{"billed_charge":2078.35,"npi":[1811005150]}]}]}]},{"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":11.22,"providers":[{"billed_charge":134.40,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3089.14,"providers":[{"billed_charge":8465.30,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":993.96,"providers":[{"billed_charge":2712.60,"npi":[1811005150]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":26.40,"providers":[{"billed_charge":69.04,"npi":[1134675978]}]},{"allowed_amount":46.20,"providers":[{"billed_charge":120.82,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81","72"],"billing_class":"professional","payments":[{"allowed_amount":11.56,"providers":[{"billed_charge":126.00,"npi":[1234567893]}]},{"allowed_amount":27.29,"providers":[{"billed_charge":299.72,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5332.23,"providers":[{"billed_charge":14699.50,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":917.43,"providers":[{"billed_charge":2528.05,"npi":[1811005150]}]}]}]},{"name":"CCPD/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"851","description":"CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"273836308"},"service_code":["12"],"billing_class":"institutional","payments":[{"allowed_amount":16660.00,"providers":[{"billed_charge":599998.14,"npi":[1649607573]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.48,"providers":[{"billed_charge":403.80,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1030.66,"providers":[{"billed_charge":2829.40,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3545.02,"providers":[{"billed_charge":9748.00,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1681.18,"providers":[{"billed_charge":4637.80,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":182.64,"providers":[{"billed_charge":500.00,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":177.86,"providers":[{"billed_charge":484.20,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":167.56,"providers":[{"billed_charge":459.05,"npi":[1811005150]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":781.79,"providers":[{"billed_charge":2181.30,"npi":[1811005150]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1583.49,"providers":[{"billed_charge":4329.45,"npi":[1811005150]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":255.80,"providers":[{"billed_charge":708.90,"npi":[1811005150]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2840.90,"providers":[{"billed_charge":7941.60,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3616.51,"providers":[{"billed_charge":10016.45,"npi":[1811005150]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":579.30,"providers":[{"billed_charge":1579.60,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":124.76,"providers":[{"billed_charge":340.20,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":201.26,"providers":[{"billed_charge":561.15,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1626.68,"providers":[{"billed_charge":4441.10,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":65.53,"providers":[{"billed_charge":186.10,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4168.71,"providers":[{"billed_charge":11457.30,"npi":[1811005150]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":321.51,"providers":[{"billed_charge":878.05,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":315.84,"providers":[{"billed_charge":865.95,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1984.25,"providers":[{"billed_charge":5465.05,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14454.53,"providers":[{"billed_charge":40125.00,"npi":[1811005150]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":59.75,"providers":[{"billed_charge":100.00,"npi":[1134675978]}]},{"allowed_amount":418.25,"providers":[{"billed_charge":700.00,"npi":[1134675978]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":444.04,"providers":[{"billed_charge":1214.10,"npi":[1811005150]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":105.48,"providers":[{"billed_charge":1120.54,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1108.81,"providers":[{"billed_charge":3260.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4994.10,"providers":[{"billed_charge":13829.45,"npi":[1811005150]}]}]}]},{"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":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":162.86,"providers":[{"billed_charge":224.00,"npi":[1063607646]}]}]}]},{"name":"GARDNER VAG, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87510","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":353.90,"providers":[{"billed_charge":963.45,"npi":[1811005150]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":189.98,"providers":[{"billed_charge":620.00,"npi":[1023098928]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":105.48,"providers":[{"billed_charge":1145.27,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1108.05,"providers":[{"billed_charge":3260.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4965.99,"providers":[{"billed_charge":13734.55,"npi":[1811005150]}]}]}]},{"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":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":690.66,"providers":[{"billed_charge":2120.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3498.94,"providers":[{"billed_charge":9456.65,"npi":[1811005150]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2655.60,"providers":[{"billed_charge":7410.55,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":444.04,"providers":[{"billed_charge":1214.10,"npi":[1811005150]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1024.61,"providers":[{"billed_charge":3010.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":502.77,"providers":[{"billed_charge":1496.80,"npi":[1811005150]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":229.65,"providers":[{"billed_charge":690.00,"npi":[1023098928]}]}]}]},{"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":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":633.15,"providers":[{"billed_charge":3724.20,"npi":[1376037721]}]},{"allowed_amount":42.21,"providers":[{"billed_charge":248.28,"npi":[1467297408]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":24.62,"providers":[{"billed_charge":41.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":189.81,"providers":[{"billed_charge":1350.00,"npi":[1992282297]}]},{"allowed_amount":49.21,"providers":[{"billed_charge":350.00,"npi":[1417407230]}]}]}]},{"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":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":562.72,"providers":[{"billed_charge":4000.00,"npi":[1376037721]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":52.77,"providers":[{"billed_charge":576.00,"npi":[1992282297]}]}]}]},{"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":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14.05,"providers":[{"billed_charge":41.33,"npi":[1376037721]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.45,"providers":[{"billed_charge":406.44,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1835.80,"providers":[{"billed_charge":5742.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11285.82,"providers":[{"billed_charge":30926.95,"npi":[1811005150]}]}]}]},{"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":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":69.92,"providers":[{"billed_charge":588.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"570560638"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":68.93,"providers":[{"billed_charge":580.00,"npi":[1942361688]}]},{"allowed_amount":325.97,"providers":[{"billed_charge":2629.00,"npi":[1942361688]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4754.51,"providers":[{"billed_charge":13086.50,"npi":[1811005150]}]}]}]},{"name":"ELECTRO SHOCK","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"901","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - ELECTROSCHOCK TREATMENT","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3468.76,"providers":[{"billed_charge":9604.00,"npi":[1639656713]}]}]}]},{"name":"IM ADMIN 1ST/ONLY COMPONENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90460","description":"IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, W COUNSELING BY","allowed_amounts":[{"tin":{"type":"ein","value":"576000286"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":663.00,"providers":[{"billed_charge":663.00,"npi":[1477636140]}]}]}]},{"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":"873746039"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3600.00,"providers":[{"billed_charge":19104.00,"npi":[1053002204]}]}]}]},{"name":"PSYCH DIAGNOSTIC EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90791","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["99","12","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":1247.88,"providers":[{"billed_charge":1734.00,"npi":[1831200310]}]},{"allowed_amount":141.03,"providers":[{"billed_charge":204.00,"npi":[1831200310]}]},{"allowed_amount":243.03,"providers":[{"billed_charge":306.00,"npi":[1508811324]}]},{"allowed_amount":7992.87,"providers":[{"billed_charge":11730.00,"npi":[1124135009]}]},{"allowed_amount":1169.82,"providers":[{"billed_charge":1632.00,"npi":[1841374972]}]},{"allowed_amount":486.06,"providers":[{"billed_charge":612.00,"npi":[1841374972]}]},{"allowed_amount":3561.06,"providers":[{"billed_charge":5814.00,"npi":[1508811324]}]},{"allowed_amount":2534.82,"providers":[{"billed_charge":3570.00,"npi":[1609979640]}]},{"allowed_amount":102.00,"providers":[{"billed_charge":102.00,"npi":[1124135009,1609979640]}]},{"allowed_amount":162.88,"providers":[{"billed_charge":612.00,"npi":[1508811324]},{"billed_charge":204.00,"npi":[1508811324,1831200310]}]},{"allowed_amount":264.88,"providers":[{"billed_charge":306.00,"npi":[1841374972]}]},{"allowed_amount":811.56,"providers":[{"billed_charge":1224.00,"npi":[1124135009]}]}]}]},{"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":"300701952"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":155.11,"providers":[{"billed_charge":434.00,"npi":[1972388031]}]}]},{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":4256.16,"providers":[{"billed_charge":4725.00,"npi":[1144780206]}]}]}]},{"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":"576000922"},"service_code":["02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":134.60,"providers":[{"billed_charge":176.00,"npi":[1609979640]}]},{"allowed_amount":271.33,"providers":[{"billed_charge":352.00,"npi":[1124135009,1841374972]}]},{"allowed_amount":1627.98,"providers":[{"billed_charge":2112.00,"npi":[1508811324]}]},{"allowed_amount":405.93,"providers":[{"billed_charge":528.00,"npi":[1508811324]}]},{"allowed_amount":202.61,"providers":[{"billed_charge":264.00,"npi":[1841374972]}]},{"allowed_amount":154.34,"providers":[{"billed_charge":176.00,"npi":[1508811324,1841374972]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":1701.07,"providers":[{"billed_charge":3325.00,"npi":[1508811324]}]},{"allowed_amount":2236.41,"providers":[{"billed_charge":4375.00,"npi":[1124135009]}]},{"allowed_amount":447.89,"providers":[{"billed_charge":875.00,"npi":[1841374972]}]},{"allowed_amount":447.13,"providers":[{"billed_charge":875.00,"npi":[1841374972]}]},{"allowed_amount":1217.96,"providers":[{"billed_charge":2100.00,"npi":[1508811324]}]},{"allowed_amount":1431.12,"providers":[{"billed_charge":2800.00,"npi":[1508811324]}]},{"allowed_amount":811.64,"providers":[{"billed_charge":1400.00,"npi":[1508811324]}]}]}]},{"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":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":262.66,"providers":[{"billed_charge":530.00,"npi":[1609979640]}]},{"allowed_amount":450.33,"providers":[{"billed_charge":795.00,"npi":[1124135009]}]},{"allowed_amount":1984.85,"providers":[{"billed_charge":3975.00,"npi":[1841374972]}]},{"allowed_amount":9779.51,"providers":[{"billed_charge":19610.00,"npi":[1124135009]}]},{"allowed_amount":1323.73,"providers":[{"billed_charge":2650.00,"npi":[1831200310]}]},{"allowed_amount":2251.65,"providers":[{"billed_charge":3975.00,"npi":[1508811324]}]},{"allowed_amount":2511.66,"providers":[{"billed_charge":5035.00,"npi":[1508811324]}]},{"allowed_amount":8997.49,"providers":[{"billed_charge":18020.00,"npi":[1508811324]}]},{"allowed_amount":132.82,"providers":[{"billed_charge":265.00,"npi":[1831200310]}]},{"allowed_amount":131.33,"providers":[{"billed_charge":265.00,"npi":[1124135009]}]},{"allowed_amount":301.68,"providers":[{"billed_charge":530.00,"npi":[1124135009]}]},{"allowed_amount":2640.01,"providers":[{"billed_charge":5300.00,"npi":[1841374972]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1151.14,"providers":[{"billed_charge":1905.00,"npi":[1234567893]}]},{"allowed_amount":427.92,"providers":[{"billed_charge":921.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352528999"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":395.12,"providers":[{"billed_charge":420.00,"npi":[1962447102]}]}]}]},{"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":"831995788"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":242.64,"providers":[{"billed_charge":600.00,"npi":[1053021881]}]}]}]},{"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":"541436102"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":78057.00,"providers":[{"billed_charge":212400.00,"npi":[1902825169]}]}]},{"tin":{"type":"ein","value":"991290907"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":463.48,"providers":[{"billed_charge":5000.00,"npi":[1083479398]}]}]},{"tin":{"type":"ein","value":"811567573"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":24192.00,"providers":[{"billed_charge":154000.00,"npi":[1649715517]}]}]},{"tin":{"type":"ein","value":"873746039"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2310.00,"providers":[{"billed_charge":16038.00,"npi":[1053002204]}]}]},{"tin":{"type":"ein","value":"465287425"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":40920.00,"providers":[{"billed_charge":396782.32,"npi":[1952719189]}]}]}]},{"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":"932779549"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7132.86,"providers":[{"billed_charge":99900.00,"npi":[1023884038]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"203854241"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14955.29,"providers":[{"billed_charge":22050.00,"npi":[1194826081]}]}]}]},{"name":"PSTAY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"919","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - OTHER","allowed_amounts":[{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3648.30,"providers":[{"billed_charge":12162.00,"npi":[1962277343]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6342.50,"providers":[{"billed_charge":45734.00,"npi":[1649726738]}]},{"allowed_amount":1660.82,"providers":[{"billed_charge":9446.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":210.49,"providers":[{"billed_charge":1548.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2323.79,"providers":[{"billed_charge":14123.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1805.82,"providers":[{"billed_charge":4974.70,"npi":[1417432840]}]},{"allowed_amount":8896.82,"providers":[{"billed_charge":24988.50,"npi":[1417432840]}]},{"allowed_amount":633.62,"providers":[{"billed_charge":1745.50,"npi":[1396790325]}]},{"allowed_amount":945.51,"providers":[{"billed_charge":2311.75,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1608.83,"providers":[{"billed_charge":9240.00,"npi":[1336603646]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15043.99,"providers":[{"billed_charge":41486.05,"npi":[1417432840]}]},{"allowed_amount":1270.70,"providers":[{"billed_charge":3526.05,"npi":[1346297892]}]},{"allowed_amount":29.60,"providers":[{"billed_charge":80.00,"npi":[1396790325]}]},{"allowed_amount":192.97,"providers":[{"billed_charge":471.80,"npi":[1417432840]}]},{"allowed_amount":14107.84,"providers":[{"billed_charge":38570.15,"npi":[1396790325]}]}]}]},{"name":"EDUC/TRAINING","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"942","description":"OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10074.62,"providers":[{"billed_charge":15568.00,"npi":[1649726738]}]},{"allowed_amount":88.76,"providers":[{"billed_charge":584.00,"npi":[1649726738]}]}]}]},{"name":"CARDIAC REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"943","description":"OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3324.70,"providers":[{"billed_charge":6448.00,"npi":[1649726738]}]}]}]},{"name":"L-MC2CTD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"948","description":"L-MC2CTD - DESC NOT AVAILABLE","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":490.59,"providers":[{"billed_charge":705.00,"npi":[1649726738]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":557.72,"providers":[{"billed_charge":1896.00,"npi":[1134675978]}]},{"allowed_amount":3.59,"providers":[{"billed_charge":12.00,"npi":[1134675978]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":236.88,"providers":[{"billed_charge":819.00,"npi":[1134675978]}]},{"allowed_amount":227.12,"providers":[{"billed_charge":780.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["99","53"],"billing_class":"professional","payments":[{"allowed_amount":239.36,"providers":[{"billed_charge":450.00,"npi":[1124135009]}]},{"allowed_amount":252.89,"providers":[{"billed_charge":475.00,"npi":[1508811324]}]},{"allowed_amount":240.12,"providers":[{"billed_charge":450.00,"npi":[1841374972]}]},{"allowed_amount":13.15,"providers":[{"billed_charge":25.00,"npi":[1609979640]}]},{"allowed_amount":388.57,"providers":[{"billed_charge":725.00,"npi":[1609979640]}]}]}]},{"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":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":58.56,"providers":[{"billed_charge":250.00,"npi":[1780230680]}]}]}]},{"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":"61651287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":305.23,"providers":[{"billed_charge":1120.00,"npi":[1023047453]}]}]},{"tin":{"type":"ein","value":"203152516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":697.95,"providers":[{"billed_charge":1700.00,"npi":[1134813975]}]}]},{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":339.49,"providers":[{"billed_charge":1020.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":80.70,"providers":[{"billed_charge":282.00,"npi":[1730575168]}]}]},{"tin":{"type":"ein","value":"202312101"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":794.41,"providers":[{"billed_charge":1134.00,"npi":[1578286191]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1903.86,"providers":[{"billed_charge":3859.07,"npi":[1234567893]}]},{"allowed_amount":295.56,"providers":[{"billed_charge":378.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":217.44,"providers":[{"billed_charge":879.21,"npi":[1932922440]}]}]}]},{"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":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":386.24,"providers":[{"billed_charge":1190.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.12,"providers":[{"billed_charge":69.00,"npi":[1730575168]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":405.08,"providers":[{"billed_charge":726.00,"npi":[1234567893]}]}]}]},{"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":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.86,"providers":[{"billed_charge":550.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.18,"providers":[{"billed_charge":138.00,"npi":[1730575168]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":441.54,"providers":[{"billed_charge":1053.10,"npi":[1234567893]}]}]}]},{"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":"822819223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11788.00,"providers":[{"billed_charge":12900.00,"npi":[1417386822]}]}]}]},{"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":"203152516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":363.19,"providers":[{"billed_charge":840.00,"npi":[1134813975]}]}]},{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":450.03,"providers":[{"billed_charge":1275.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":164.63,"providers":[{"billed_charge":495.00,"npi":[1730575168]}]}]},{"tin":{"type":"ein","value":"830770746"},"service_code":["11","99","12"],"billing_class":"professional","payments":[{"allowed_amount":314.94,"providers":[{"billed_charge":600.00,"npi":[1740749985]}]},{"allowed_amount":845.81,"providers":[{"billed_charge":1600.00,"npi":[1740749985]}]},{"allowed_amount":1178.66,"providers":[{"billed_charge":2200.00,"npi":[1740749985]}]}]},{"tin":{"type":"ein","value":"202312101"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":825.15,"providers":[{"billed_charge":1092.00,"npi":[1578286191]}]}]},{"tin":{"type":"ein","value":"474438367"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1273.87,"providers":[{"billed_charge":2600.00,"npi":[1821677782]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2705.40,"providers":[{"billed_charge":3923.42,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":422.28,"providers":[{"billed_charge":1199.86,"npi":[1932922440]}]}]}]},{"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":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":769.06,"providers":[{"billed_charge":855.00,"npi":[1093941346]}]}]}]},{"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":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":128.79,"providers":[{"billed_charge":459.00,"npi":[1376037721]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":90.04,"providers":[{"billed_charge":257.00,"npi":[1134675978]}]},{"allowed_amount":624.16,"providers":[{"billed_charge":1799.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22","19","20"],"billing_class":"professional","payments":[{"allowed_amount":78.28,"providers":[{"billed_charge":237.00,"npi":[1234567893]},{"billed_charge":323.00,"npi":[1234567893]}]},{"allowed_amount":1648.26,"providers":[{"billed_charge":2531.79,"npi":[1234567893]}]},{"allowed_amount":652.79,"providers":[{"billed_charge":1098.00,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":800.26,"providers":[{"billed_charge":2352.00,"npi":[1134675978]}]},{"allowed_amount":397.05,"providers":[{"billed_charge":1176.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","02","20"],"billing_class":"professional","payments":[{"allowed_amount":1054.28,"providers":[{"billed_charge":2640.56,"npi":[1234567893]}]},{"allowed_amount":509.68,"providers":[{"billed_charge":1582.00,"npi":[1234567893]}]},{"allowed_amount":7825.18,"providers":[{"billed_charge":13579.99,"npi":[1234567893]}]},{"allowed_amount":235.73,"providers":[{"billed_charge":774.00,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":114.82,"providers":[{"billed_charge":1008.00,"npi":[1124135009]}]}]}]},{"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":"233044427"},"service_code":["22","52"],"billing_class":"professional","payments":[{"allowed_amount":290.69,"providers":[{"billed_charge":455.00,"npi":[1346709623]}]},{"allowed_amount":41.03,"providers":[{"billed_charge":65.00,"npi":[1346709623]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1378.28,"providers":[{"billed_charge":3363.00,"npi":[1134675978]}]},{"allowed_amount":5492.59,"providers":[{"billed_charge":13452.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"994277174"},"service_code":["02","20","10"],"billing_class":"professional","payments":[{"allowed_amount":321.00,"providers":[{"billed_charge":321.00,"npi":[1700990587]}]},{"allowed_amount":104.60,"providers":[{"billed_charge":195.00,"npi":[1700990587]}]},{"allowed_amount":250.75,"providers":[{"billed_charge":302.00,"npi":[1093744849]}]},{"allowed_amount":2200.20,"providers":[{"billed_charge":3391.00,"npi":[1700990587]}]},{"allowed_amount":837.20,"providers":[{"billed_charge":1208.00,"npi":[1124023510]}]}]},{"tin":{"type":"ein","value":"844246379"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":5925.20,"providers":[{"billed_charge":14000.00,"npi":[1821683186]}]},{"allowed_amount":5731.66,"providers":[{"billed_charge":13625.00,"npi":[1609451194]}]},{"allowed_amount":4025.02,"providers":[{"billed_charge":9500.00,"npi":[1821683186]}]},{"allowed_amount":12755.77,"providers":[{"billed_charge":22000.00,"npi":[1821683186]}]},{"allowed_amount":5059.57,"providers":[{"billed_charge":8750.00,"npi":[1609451194]}]},{"allowed_amount":9314.97,"providers":[{"billed_charge":22125.00,"npi":[1609451194]}]}]},{"tin":{"type":"ein","value":"237085643"},"service_code":["11","50"],"billing_class":"professional","payments":[{"allowed_amount":253.68,"providers":[{"billed_charge":276.00,"npi":[1548344096]}]},{"allowed_amount":169.12,"providers":[{"billed_charge":184.00,"npi":[1548344096]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":878.26,"providers":[{"billed_charge":1291.88,"npi":[1871971648]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","02","72","50","20"],"billing_class":"professional","payments":[{"allowed_amount":3730.97,"providers":[{"billed_charge":7053.46,"npi":[1234567893]}]},{"allowed_amount":605.02,"providers":[{"billed_charge":1297.00,"npi":[1234567893]}]},{"allowed_amount":511.59,"providers":[{"billed_charge":623.00,"npi":[1234567893]}]},{"allowed_amount":72.46,"providers":[{"billed_charge":90.00,"npi":[1234567893]}]},{"allowed_amount":269.38,"providers":[{"billed_charge":955.00,"npi":[1234567893]}]},{"allowed_amount":73.45,"providers":[{"billed_charge":167.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":293.80,"providers":[{"billed_charge":728.00,"npi":[1376037721]}]}]},{"tin":{"type":"ein","value":"570969793"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1277.30,"providers":[{"billed_charge":3225.00,"npi":[1760050512]}]}]},{"tin":{"type":"ein","value":"831995788"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1740.00,"providers":[{"billed_charge":1740.00,"npi":[1164900106]}]}]}]},{"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":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":634.06,"providers":[{"billed_charge":1190.00,"npi":[1508811324]}]},{"allowed_amount":1194.06,"providers":[{"billed_charge":3179.00,"npi":[1841374972]}]},{"allowed_amount":90.58,"providers":[{"billed_charge":132.00,"npi":[1831200310]}]},{"allowed_amount":2106.94,"providers":[{"billed_charge":3967.00,"npi":[1124135009]}]},{"allowed_amount":367.04,"providers":[{"billed_charge":1060.00,"npi":[1609979640]}]},{"allowed_amount":1289.36,"providers":[{"billed_charge":2822.00,"npi":[1831200310]}]},{"allowed_amount":1837.56,"providers":[{"billed_charge":3905.00,"npi":[1841374972]}]},{"allowed_amount":276.46,"providers":[{"billed_charge":626.00,"npi":[1609979640]}]},{"allowed_amount":3308.08,"providers":[{"billed_charge":6477.00,"npi":[1124135009]}]},{"allowed_amount":734.08,"providers":[{"billed_charge":1056.00,"npi":[1508811324]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":133.82,"providers":[{"billed_charge":324.00,"npi":[1750795183]}]},{"allowed_amount":3078.53,"providers":[{"billed_charge":5508.00,"npi":[1912986977]}]},{"allowed_amount":724.36,"providers":[{"billed_charge":1296.00,"npi":[1750795183]}]}]},{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":954.40,"providers":[{"billed_charge":2216.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1430.76,"providers":[{"billed_charge":1784.00,"npi":[1093744849]}]}]},{"tin":{"type":"ein","value":"576000286"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":341.24,"providers":[{"billed_charge":341.24,"npi":[1477636140]}]}]},{"tin":{"type":"ein","value":"570969793"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":4108.14,"providers":[{"billed_charge":9316.00,"npi":[1760050512]}]}]},{"tin":{"type":"ein","value":"570672117"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":825.48,"providers":[{"billed_charge":1960.00,"npi":[1417705310]}]}]},{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":9105.85,"providers":[{"billed_charge":23140.00,"npi":[1134675978]}]},{"allowed_amount":3907.14,"providers":[{"billed_charge":9880.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1013.36,"providers":[{"billed_charge":2176.00,"npi":[1215146352]}]}]},{"tin":{"type":"ein","value":"844246379"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":103.80,"providers":[{"billed_charge":184.00,"npi":[1821683186]}]},{"allowed_amount":79.00,"providers":[{"billed_charge":184.00,"npi":[1821683186]}]},{"allowed_amount":153.98,"providers":[{"billed_charge":368.00,"npi":[1821683186]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2773.08,"providers":[{"billed_charge":6739.20,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22","02","19","72","20"],"billing_class":"professional","payments":[{"allowed_amount":905.36,"providers":[{"billed_charge":1045.00,"npi":[1234567893]}]},{"allowed_amount":1137.91,"providers":[{"billed_charge":3434.00,"npi":[1234567893]}]},{"allowed_amount":7259.18,"providers":[{"billed_charge":14322.83,"npi":[1234567893]}]},{"allowed_amount":837.52,"providers":[{"billed_charge":2156.00,"npi":[1234567893]}]},{"allowed_amount":92.94,"providers":[{"billed_charge":277.00,"npi":[1234567893]}]},{"allowed_amount":1454.99,"providers":[{"billed_charge":3926.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1557.00,"providers":[{"billed_charge":3855.00,"npi":[1376037721]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1122.12,"providers":[{"billed_charge":1848.00,"npi":[1992282297]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6998.79,"providers":[{"billed_charge":10218.00,"npi":[1831452853]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99221","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2888.37,"providers":[{"billed_charge":10115.00,"npi":[1093943466]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":611.88,"providers":[{"billed_charge":780.00,"npi":[1982678660]}]}]},{"tin":{"type":"ein","value":"203854241"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":103.04,"providers":[{"billed_charge":200.00,"npi":[1689349557]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99223","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":689.39,"providers":[{"billed_charge":2143.00,"npi":[1234567893]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1183.66,"providers":[{"billed_charge":2472.00,"npi":[1093943466]}]}]},{"tin":{"type":"ein","value":"300701952"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":3284.30,"providers":[{"billed_charge":12768.00,"npi":[1619078417]}]},{"allowed_amount":4282.17,"providers":[{"billed_charge":16632.00,"npi":[1972388031]}]}]},{"tin":{"type":"ein","value":"471345819"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":660.95,"providers":[{"billed_charge":744.00,"npi":[1497137038]}]}]}]},{"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":"205648616"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":87.93,"providers":[{"billed_charge":144.66,"npi":[1083140230]}]}]},{"tin":{"type":"ein","value":"571124822"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":6213.68,"providers":[{"billed_charge":15840.00,"npi":[1154361723]}]}]},{"tin":{"type":"ein","value":"993250322"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":353.05,"providers":[{"billed_charge":490.00,"npi":[1467958181]}]}]},{"tin":{"type":"ein","value":"300701952"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1677.46,"providers":[{"billed_charge":4704.00,"npi":[1619078417]}]},{"allowed_amount":1315.49,"providers":[{"billed_charge":3724.00,"npi":[1972388031]}]}]},{"tin":{"type":"ein","value":"272812143"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":683.46,"providers":[{"billed_charge":1350.00,"npi":[1821184540]}]}]},{"tin":{"type":"ein","value":"571004971"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1973.79,"providers":[{"billed_charge":2235.00,"npi":[1861440828]}]}]},{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":16399.87,"providers":[{"billed_charge":17700.00,"npi":[1144780206]}]}]},{"tin":{"type":"ein","value":"204086208"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":4236.46,"providers":[{"billed_charge":7705.00,"npi":[1225762933]}]}]},{"tin":{"type":"ein","value":"460881518"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":894.22,"providers":[{"billed_charge":2100.00,"npi":[1700896156]}]}]},{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":708.90,"providers":[{"billed_charge":1080.00,"npi":[1164547071]}]},{"allowed_amount":13286.79,"providers":[{"billed_charge":17160.00,"npi":[1982678660]}]}]},{"tin":{"type":"ein","value":"861770820"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":847.32,"providers":[{"billed_charge":1728.00,"npi":[1063040533]}]},{"allowed_amount":1412.20,"providers":[{"billed_charge":2880.00,"npi":[1831485838]}]},{"allowed_amount":1129.76,"providers":[{"billed_charge":2304.00,"npi":[1760642268]}]},{"allowed_amount":1694.64,"providers":[{"billed_charge":3456.00,"npi":[1578008991]}]}]},{"tin":{"type":"ein","value":"880606916"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":70.61,"providers":[{"billed_charge":175.00,"npi":[1477966828]}]}]},{"tin":{"type":"ein","value":"881714289"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":423.66,"providers":[{"billed_charge":588.00,"npi":[1922503812]}]}]},{"tin":{"type":"ein","value":"472781928"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1694.64,"providers":[{"billed_charge":3360.00,"npi":[1316983729]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","02","21"],"billing_class":"professional","payments":[{"allowed_amount":263.70,"providers":[{"billed_charge":298.00,"npi":[1234567893]}]},{"allowed_amount":6952.10,"providers":[{"billed_charge":12801.96,"npi":[1234567893]}]},{"allowed_amount":135.61,"providers":[{"billed_charge":179.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"570605223"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1119.24,"providers":[{"billed_charge":1650.00,"npi":[1477558740]}]}]},{"tin":{"type":"ein","value":"472527918"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3459.89,"providers":[{"billed_charge":6860.00,"npi":[1760463491]}]}]}]},{"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":"262976526"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1751.12,"providers":[{"billed_charge":2795.00,"npi":[1841671344]}]},{"allowed_amount":3625.19,"providers":[{"billed_charge":6235.00,"npi":[1164951950]}]},{"allowed_amount":3239.62,"providers":[{"billed_charge":5160.00,"npi":[1891923181]}]}]},{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":167.48,"providers":[{"billed_charge":616.00,"npi":[1811561269]}]},{"allowed_amount":1507.32,"providers":[{"billed_charge":5668.00,"npi":[1023636131]}]},{"allowed_amount":4666.79,"providers":[{"billed_charge":17445.00,"npi":[1124086400]}]},{"allowed_amount":2236.96,"providers":[{"billed_charge":13563.00,"npi":[1255307898]}]},{"allowed_amount":1982.58,"providers":[{"billed_charge":7671.00,"npi":[1437653847]}]},{"allowed_amount":277.00,"providers":[{"billed_charge":1294.00,"npi":[1952861536]}]}]},{"tin":{"type":"ein","value":"472781928"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":101.68,"providers":[{"billed_charge":202.00,"npi":[1316983729]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","02","21"],"billing_class":"professional","payments":[{"allowed_amount":2686.42,"providers":[{"billed_charge":10316.12,"npi":[1234567893]}]},{"allowed_amount":113.35,"providers":[{"billed_charge":363.00,"npi":[1234567893]}]},{"allowed_amount":198.36,"providers":[{"billed_charge":224.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"582569828"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1237.34,"providers":[{"billed_charge":5248.32,"npi":[1124682323]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99238","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS","allowed_amounts":[{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2651.00,"providers":[{"billed_charge":3220.00,"npi":[1144780206]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99239","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":532.76,"providers":[{"billed_charge":680.00,"npi":[1982678660]}]}]}]},{"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":"932543044"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":448.40,"providers":[{"billed_charge":11844.00,"npi":[1538466206]}]},{"allowed_amount":368.64,"providers":[{"billed_charge":10404.00,"npi":[1174507578]}]}]},{"tin":{"type":"ein","value":"813642890"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":185.64,"providers":[{"billed_charge":7176.00,"npi":[1932115409]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":656.79,"providers":[{"billed_charge":9567.00,"npi":[1234567893]}]}]}]},{"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":"571004971"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":858.03,"providers":[{"billed_charge":1840.00,"npi":[1578294005]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":11555.15,"providers":[{"billed_charge":33080.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4653.55,"providers":[{"billed_charge":12958.00,"npi":[1417065467]},{"billed_charge":13101.00,"npi":[1740929637]}]},{"allowed_amount":2961.35,"providers":[{"billed_charge":8246.00,"npi":[1457665994]}]},{"allowed_amount":5922.70,"providers":[{"billed_charge":16674.00,"npi":[1366604944,1588244388]}]},{"allowed_amount":7614.90,"providers":[{"billed_charge":21204.00,"npi":[1134357726]}]},{"allowed_amount":3807.45,"providers":[{"billed_charge":10719.00,"npi":[1902485592]}]},{"allowed_amount":10999.30,"providers":[{"billed_charge":30628.00,"npi":[1801271739]},{"billed_charge":30966.00,"npi":[1346732641]}]},{"allowed_amount":423.05,"providers":[{"billed_charge":1191.00,"npi":[1669050589]},{"billed_charge":1198.00,"npi":[1841759628]}]},{"allowed_amount":9307.10,"providers":[{"billed_charge":26202.00,"npi":[1235793621]}]},{"allowed_amount":8884.05,"providers":[{"billed_charge":24738.00,"npi":[1124766134]}]},{"allowed_amount":2115.25,"providers":[{"billed_charge":5955.00,"npi":[1669091633]}]},{"allowed_amount":1692.20,"providers":[{"billed_charge":4725.00,"npi":[1619220589]},{"billed_charge":4751.00,"npi":[1487177895]},{"billed_charge":4712.00,"npi":[1811975550]}]},{"allowed_amount":4230.50,"providers":[{"billed_charge":11910.00,"npi":[1891374435]}]},{"allowed_amount":7191.85,"providers":[{"billed_charge":20026.00,"npi":[1649443607]},{"billed_charge":20336.00,"npi":[1780263780]}]},{"allowed_amount":1269.15,"providers":[{"billed_charge":3917.00,"npi":[1528212982]}]},{"allowed_amount":16498.95,"providers":[{"billed_charge":45942.00,"npi":[1568813327]}]}]},{"tin":{"type":"ein","value":"471345819"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":518.13,"providers":[{"billed_charge":1104.00,"npi":[1093750093]}]}]}]},{"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":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":5663.58,"providers":[{"billed_charge":16447.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1232.78,"providers":[{"billed_charge":3452.00,"npi":[1952842148]}]},{"allowed_amount":3081.95,"providers":[{"billed_charge":8800.00,"npi":[1841759628]},{"billed_charge":8660.00,"npi":[1700121324]}]},{"allowed_amount":616.39,"providers":[{"billed_charge":1726.00,"npi":[1689684920]},{"billed_charge":1423.00,"npi":[1093162596]}]},{"allowed_amount":6780.29,"providers":[{"billed_charge":18986.00,"npi":[1891374435]}]},{"allowed_amount":11095.02,"providers":[{"billed_charge":31284.00,"npi":[1134357726]},{"billed_charge":31068.00,"npi":[1235793621]}]},{"allowed_amount":7396.68,"providers":[{"billed_charge":21386.00,"npi":[1073199808]}]},{"allowed_amount":3698.34,"providers":[{"billed_charge":10378.00,"npi":[1376129254]},{"billed_charge":10356.00,"npi":[1366604944]}]},{"allowed_amount":1849.17,"providers":[{"billed_charge":5178.00,"npi":[1497046411]}]},{"allowed_amount":14793.36,"providers":[{"billed_charge":41712.00,"npi":[1568813327]},{"billed_charge":41424.00,"npi":[1902485592]}]},{"allowed_amount":8629.46,"providers":[{"billed_charge":24164.00,"npi":[1942638564]}]},{"allowed_amount":9862.24,"providers":[{"billed_charge":28538.00,"npi":[1780263780]}]},{"allowed_amount":9245.85,"providers":[{"billed_charge":26070.00,"npi":[1457665994,1417065467]}]},{"allowed_amount":4314.73,"providers":[{"billed_charge":12082.00,"npi":[1669050589,1114017118,1588244388]},{"billed_charge":12142.00,"npi":[1619220589]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":9450.64,"providers":[{"billed_charge":53609.00,"npi":[1124086400]}]},{"allowed_amount":9628.96,"providers":[{"billed_charge":73844.00,"npi":[1255307898]}]}]},{"tin":{"type":"ein","value":"472781928"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":437.68,"providers":[{"billed_charge":870.00,"npi":[1316983729]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":701.94,"providers":[{"billed_charge":2773.00,"npi":[1234567893]}]},{"allowed_amount":751.55,"providers":[{"billed_charge":1770.00,"npi":[1234567893]}]}]}]},{"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":"833973422"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":541.03,"providers":[{"billed_charge":1044.00,"npi":[1942727466]}]},{"allowed_amount":120.60,"providers":[{"billed_charge":232.00,"npi":[1710513072]}]}]}]},{"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":"833973422"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":259.68,"providers":[{"billed_charge":504.00,"npi":[1942727466]}]}]},{"tin":{"type":"ein","value":"832740501"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":374.70,"providers":[{"billed_charge":725.00,"npi":[1396389938]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99310","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"832740501"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":557.75,"providers":[{"billed_charge":1100.00,"npi":[1396389938]}]}]}]},{"name":"PREV VISIT EST AGE 18-39","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99395","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":188.32,"providers":[{"billed_charge":710.00,"npi":[1134675978]}]},{"allowed_amount":4657.82,"providers":[{"billed_charge":17750.00,"npi":[1134675978]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9525.40,"providers":[{"billed_charge":36288.00,"npi":[1134675978]}]}]}]},{"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":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9209.55,"providers":[{"billed_charge":20238.80,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"576000314"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":94.32,"providers":[{"billed_charge":247.80,"npi":[1013900257]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7976.06,"providers":[{"billed_charge":17029.16,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39488.64,"providers":[{"billed_charge":105193.67,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17973.72,"providers":[{"billed_charge":23908.80,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000399"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":567.84,"providers":[{"billed_charge":820.30,"npi":[1891170056]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5962.59,"providers":[{"billed_charge":11245.44,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23286.77,"providers":[{"billed_charge":23297.06,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2514.21,"providers":[{"billed_charge":3580.61,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22601.55,"providers":[{"billed_charge":33401.95,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11107.07,"providers":[{"billed_charge":17474.81,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":87901.26,"providers":[{"billed_charge":315375.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7713.43,"providers":[{"billed_charge":11246.20,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10502.52,"providers":[{"billed_charge":19686.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31828.68,"providers":[{"billed_charge":85635.56,"npi":[1982198289]}]},{"allowed_amount":4306.53,"providers":[{"billed_charge":21532.74,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8898.18,"providers":[{"billed_charge":8985.60,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9656.90,"providers":[{"billed_charge":19994.28,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6566.91,"providers":[{"billed_charge":10723.50,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25960.98,"providers":[{"billed_charge":40147.80,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5529.54,"providers":[{"billed_charge":9106.50,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2434.14,"providers":[{"billed_charge":3778.60,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7906.00,"providers":[{"billed_charge":12975.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1667.42,"providers":[{"billed_charge":2160.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"237099373"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3282.06,"providers":[{"billed_charge":3942.01,"npi":[1487623203]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8619.86,"providers":[{"billed_charge":17004.60,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":56898.28,"providers":[{"billed_charge":94432.50,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8947.80,"providers":[{"billed_charge":20670.30,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25049.50,"providers":[{"billed_charge":32707.20,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"831579694"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1471.71,"providers":[{"billed_charge":1799.60,"npi":[1194200063]}]}]},{"tin":{"type":"ein","value":"576008064"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":62.58,"providers":[{"billed_charge":91.20,"npi":[1417954587]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1486.98,"providers":[{"billed_charge":2126.80,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9716.90,"providers":[{"billed_charge":16168.36,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3994.70,"providers":[{"billed_charge":6319.07,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4316.97,"providers":[{"billed_charge":6574.40,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1652.40,"providers":[{"billed_charge":1652.40,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4721.08,"providers":[{"billed_charge":6770.40,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1534.84,"providers":[{"billed_charge":2891.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9196.27,"providers":[{"billed_charge":12022.25,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13739.48,"providers":[{"billed_charge":62415.40,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":99647.96,"providers":[{"billed_charge":457572.09,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"541533323"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":292.60,"providers":[{"billed_charge":979.60,"npi":[1134124431]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10795.74,"providers":[{"billed_charge":17731.50,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29827.46,"providers":[{"billed_charge":57559.18,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"570963511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":330.78,"providers":[{"billed_charge":513.80,"npi":[1588605299]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2861.32,"providers":[{"billed_charge":3937.50,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":64596.57,"providers":[{"billed_charge":150181.60,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34661.49,"providers":[{"billed_charge":34787.70,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10948.26,"providers":[{"billed_charge":32634.61,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2008.17,"providers":[{"billed_charge":2055.60,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":46727.67,"providers":[{"billed_charge":53028.38,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20832.04,"providers":[{"billed_charge":40299.36,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2050.76,"providers":[{"billed_charge":2269.00,"npi":[1720052723]}]}]}]},{"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":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14564.51,"providers":[{"billed_charge":69000.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1901.52,"providers":[{"billed_charge":14245.87,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2857.27,"providers":[{"billed_charge":28891.85,"npi":[1891782595]}]}]}]},{"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":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6581.16,"providers":[{"billed_charge":7410.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16763.30,"providers":[{"billed_charge":25575.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6092.47,"providers":[{"billed_charge":7596.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25419.32,"providers":[{"billed_charge":37952.50,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8030.51,"providers":[{"billed_charge":22848.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":89659.49,"providers":[{"billed_charge":128983.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26885.39,"providers":[{"billed_charge":40050.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":48996.28,"providers":[{"billed_charge":71050.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":154136.90,"providers":[{"billed_charge":419846.29,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18265.40,"providers":[{"billed_charge":26100.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":102221.22,"providers":[{"billed_charge":110259.57,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5543.73,"providers":[{"billed_charge":6050.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2019.05,"providers":[{"billed_charge":3400.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1015.48,"providers":[{"billed_charge":1336.84,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9044.04,"providers":[{"billed_charge":16650.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33133.62,"providers":[{"billed_charge":52580.58,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":123038.56,"providers":[{"billed_charge":182236.61,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7497.00,"providers":[{"billed_charge":11250.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4807.94,"providers":[{"billed_charge":11900.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7902.40,"providers":[{"billed_charge":8400.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8155.32,"providers":[{"billed_charge":36712.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":247621.35,"providers":[{"billed_charge":966639.45,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15604.82,"providers":[{"billed_charge":16716.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"541533323"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1526.12,"providers":[{"billed_charge":5367.00,"npi":[1134124431]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19527.93,"providers":[{"billed_charge":72525.57,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28135.69,"providers":[{"billed_charge":39200.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1499.40,"providers":[{"billed_charge":5400.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2000.00,"providers":[{"billed_charge":2000.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20816.32,"providers":[{"billed_charge":104081.67,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35172.59,"providers":[{"billed_charge":112894.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17078.45,"providers":[{"billed_charge":24650.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":87760.73,"providers":[{"billed_charge":123100.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15079.32,"providers":[{"billed_charge":28500.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15225.17,"providers":[{"billed_charge":21216.00,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6493.43,"providers":[{"billed_charge":12350.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":47500.00,"providers":[{"billed_charge":47500.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6657.32,"providers":[{"billed_charge":31914.38,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10035.70,"providers":[{"billed_charge":14800.00,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":129773.39,"providers":[{"billed_charge":187775.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29644.84,"providers":[{"billed_charge":59037.94,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6533.12,"providers":[{"billed_charge":8866.00,"npi":[1720052723]}]}]}]},{"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":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":778.52,"providers":[{"billed_charge":3500.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11652.72,"providers":[{"billed_charge":37320.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1050.14,"providers":[{"billed_charge":3200.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"237099373"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":342.65,"providers":[{"billed_charge":550.00,"npi":[1487623203]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16374.20,"providers":[{"billed_charge":55133.55,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29834.93,"providers":[{"billed_charge":141250.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7129.61,"providers":[{"billed_charge":13324.18,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35911.27,"providers":[{"billed_charge":290026.95,"npi":[1891782595]}]}]}]},{"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":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2971.72,"providers":[{"billed_charge":3150.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17487.18,"providers":[{"billed_charge":31775.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26765.72,"providers":[{"billed_charge":31752.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":59417.56,"providers":[{"billed_charge":88311.94,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":56014.08,"providers":[{"billed_charge":98650.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":125020.83,"providers":[{"billed_charge":214627.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32003.85,"providers":[{"billed_charge":33972.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":180413.10,"providers":[{"billed_charge":478344.55,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4953.76,"providers":[{"billed_charge":6140.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11198.39,"providers":[{"billed_charge":14720.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1262.65,"providers":[{"billed_charge":1500.00,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":158503.26,"providers":[{"billed_charge":204090.78,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2984.60,"providers":[{"billed_charge":5250.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8462.77,"providers":[{"billed_charge":9000.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1686.00,"providers":[{"billed_charge":1686.00,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27853.43,"providers":[{"billed_charge":44104.23,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53273.66,"providers":[{"billed_charge":78723.42,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11447.37,"providers":[{"billed_charge":16200.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4418.28,"providers":[{"billed_charge":10800.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16500.00,"providers":[{"billed_charge":16500.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8993.66,"providers":[{"billed_charge":40533.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":114905.85,"providers":[{"billed_charge":457657.10,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":37024.88,"providers":[{"billed_charge":187687.50,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14023.80,"providers":[{"billed_charge":17910.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49126.71,"providers":[{"billed_charge":58000.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8441.07,"providers":[{"billed_charge":27140.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1600.00,"providers":[{"billed_charge":1600.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28217.54,"providers":[{"billed_charge":51448.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26800.00,"providers":[{"billed_charge":26800.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":126739.69,"providers":[{"billed_charge":136400.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24165.78,"providers":[{"billed_charge":42750.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5562.28,"providers":[{"billed_charge":8127.34,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18106.31,"providers":[{"billed_charge":32250.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":45150.00,"providers":[{"billed_charge":45150.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4400.00,"providers":[{"billed_charge":4400.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":205414.15,"providers":[{"billed_charge":217689.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35469.45,"providers":[{"billed_charge":73890.50,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3403.48,"providers":[{"billed_charge":3688.00,"npi":[1720052723]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4301.78,"providers":[{"billed_charge":24756.90,"npi":[1891782595]}]}]}]},{"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":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":200.00,"providers":[{"billed_charge":500.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":680.00,"providers":[{"billed_charge":1700.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2587.20,"providers":[{"billed_charge":6468.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1073.60,"providers":[{"billed_charge":2684.00,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2216.16,"providers":[{"billed_charge":5540.40,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":716.04,"providers":[{"billed_charge":1790.44,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1534.98,"providers":[{"billed_charge":3837.44,"npi":[1649268798]}]}]}]},{"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":6494.96,"providers":[{"billed_charge":24573.76,"npi":[1234567893]}]}]}]},{"name":"Disposable collection and storage bag for breast milk, any size, any type, each","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4287","description":"Disposable collection and storage bag for breast milk, any size, any type, each","allowed_amounts":[{"tin":{"type":"ein","value":"464408166"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":280.80,"providers":[{"billed_charge":936.00,"npi":[1003462581]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":527.04,"providers":[{"billed_charge":637.44,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1625.57,"providers":[{"billed_charge":4500.00,"npi":[1811005150]}]}]}]},{"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":"570650154"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2167.94,"providers":[{"billed_charge":8501.00,"npi":[1194567552]}]}]},{"tin":{"type":"ein","value":"570604703"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":463.20,"providers":[{"billed_charge":1544.00,"npi":[1861454977]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","50"],"billing_class":"professional","payments":[{"allowed_amount":196.88,"providers":[{"billed_charge":772.00,"npi":[1234567893]}]},{"allowed_amount":448.20,"providers":[{"billed_charge":1494.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"571084051"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":857.52,"providers":[{"billed_charge":1588.05,"npi":[1538458864,1003667221]}]},{"allowed_amount":44.11,"providers":[{"billed_charge":176.45,"npi":[1528394574]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":27060.97,"providers":[{"billed_charge":66604.29,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":40329.78,"providers":[{"billed_charge":41568.00,"npi":[1235909367]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":372.07,"providers":[{"billed_charge":954.00,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":2849.70,"providers":[{"billed_charge":2849.70,"npi":[1235909367]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.88,"providers":[{"billed_charge":80.00,"npi":[1750795183]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;6-","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6012","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3847.35,"providers":[{"billed_charge":5052.00,"npi":[1033178330]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;11","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6013","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9564.76,"providers":[{"billed_charge":13860.00,"npi":[1033178330]}]}]}]},{"name":"INTENS MOD TX DEL 1/MX FLDS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6015","description":"INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50854.91,"providers":[{"billed_charge":139878.00,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17968.50,"providers":[{"billed_charge":61100.00,"npi":[1205495884]}]}]}]},{"name":"INTRA-F LOC&TRCK TRGT/PT M E","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6017","description":"INTRA-FRACTION LOCALIZATION AND TRACKING OF TARGET OR PATIENT MOTION DURING DELIVERY OF RADIATION TH","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14083.47,"providers":[{"billed_charge":18777.96,"npi":[1033178330]}]}]}]},{"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":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":48438.00,"providers":[{"billed_charge":121095.00,"npi":[1760671655]}]}]}]},{"name":"ASTV CMTY TX PROGRM PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0040","description":"ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["12","53"],"billing_class":"professional","payments":[{"allowed_amount":87.82,"providers":[{"billed_charge":351.30,"npi":[1508811324]}]},{"allowed_amount":1097.75,"providers":[{"billed_charge":4391.25,"npi":[1508811324]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.64,"providers":[{"billed_charge":16.00,"npi":[1234567893]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":12.22,"providers":[{"billed_charge":650.00,"npi":[1134675978]}]},{"allowed_amount":10.34,"providers":[{"billed_charge":550.00,"npi":[1134675978]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":552.20,"providers":[{"billed_charge":869.31,"npi":[1234567893]}]}]}]},{"name":"SURGICAL BOOT/SHOE EACH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3260","description":"SURGICAL BOOT/SHOE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":150.00,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":227.76,"providers":[{"billed_charge":365.10,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1668.11,"providers":[{"billed_charge":2695.72,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":12320.74,"providers":[{"billed_charge":18762.24,"npi":[1234567893]}]}]}]},{"name":"PART HOSITALIZATN SRVC<24 HR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S0201","description":"PARTIAL HOSPITALIZATION SERVICES, LESS THAN 24 HOURS, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":13770.00,"providers":[{"billed_charge":34425.00,"npi":[1760671655]}]}]}]},{"name":"INTNSVE OP PSYC SVC PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9480","description":"INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":13156.00,"providers":[{"billed_charge":32890.00,"npi":[1760671655]}]}]}]}]}