{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-06-27","out_of_network":[{"name":"Under Proprietary Laboratory Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"0449U","description":"Under Proprietary Laboratory Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"811082020"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31022.96,"providers":[{"billed_charge":124091.84,"npi":[1598314437]}]}]}]},{"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":"934025601"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":16933.00,"providers":[{"billed_charge":233050.00,"npi":[1780452565]}]}]}]},{"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":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":940228.35,"providers":[{"billed_charge":845364.41,"npi":[1831116441]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31059.54,"providers":[{"billed_charge":85392.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":540561.57,"providers":[{"billed_charge":273460.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":344082.05,"providers":[{"billed_charge":166980.00,"npi":[1053356352]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381369611"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":62691.33,"providers":[{"billed_charge":69239.00,"npi":[1982685384]}]}]}]},{"name":"MED-SUR-GY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"121","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"382383119"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":363235.38,"providers":[{"billed_charge":162448.00,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":338525.18,"providers":[{"billed_charge":151316.00,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":85486.30,"providers":[{"billed_charge":26226.00,"npi":[1376564088]}]}]}]},{"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":"382409580"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":763157.09,"providers":[{"billed_charge":861000.00,"npi":[1053342220]}]}]},{"tin":{"type":"ein","value":"43232990"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":506948.60,"providers":[{"billed_charge":1004400.00,"npi":[1144381245]}]}]}]},{"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":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":86704.89,"providers":[{"billed_charge":107521.98,"npi":[1831116441]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.41,"providers":[{"billed_charge":84.23,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":129.41,"providers":[{"billed_charge":508.85,"npi":[1790706901]}]},{"allowed_amount":13115.33,"providers":[{"billed_charge":76689.30,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":789.59,"providers":[{"billed_charge":121256.58,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.79,"providers":[{"billed_charge":35.10,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":771.68,"providers":[{"billed_charge":6559.10,"npi":[1982685384]}]},{"allowed_amount":17599.80,"providers":[{"billed_charge":142823.54,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"390816845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":430.88,"providers":[{"billed_charge":1436.82,"npi":[1003831132]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":100.86,"providers":[{"billed_charge":440.10,"npi":[1962508259]}]},{"allowed_amount":10.33,"providers":[{"billed_charge":45.06,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":84.99,"providers":[{"billed_charge":179.29,"npi":[1295803377]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":862.80,"providers":[{"billed_charge":3331.00,"npi":[1790706901]}]}]}]},{"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":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1985.38,"providers":[{"billed_charge":15292.86,"npi":[1982685384]}]},{"allowed_amount":579.05,"providers":[{"billed_charge":4111.80,"npi":[1982685384]}]}]}]},{"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":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":746.14,"providers":[{"billed_charge":12783.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":76868.12,"providers":[{"billed_charge":279079.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2902.52,"providers":[{"billed_charge":4664.00,"npi":[1831132133]}]},{"allowed_amount":149.36,"providers":[{"billed_charge":128.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":958.38,"providers":[{"billed_charge":12363.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2364.46,"providers":[{"billed_charge":10316.18,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":581.28,"providers":[{"billed_charge":1038.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4190.80,"providers":[{"billed_charge":23563.70,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27839.92,"providers":[{"billed_charge":149685.40,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39466.20,"providers":[{"billed_charge":120244.50,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":696.24,"providers":[{"billed_charge":9677.00,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1628.80,"providers":[{"billed_charge":7188.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3409.96,"providers":[{"billed_charge":8513.92,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5210.00,"providers":[{"billed_charge":10986.95,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10048.61,"providers":[{"billed_charge":46931.00,"npi":[1790706901]}]},{"allowed_amount":28272.71,"providers":[{"billed_charge":81752.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1576.08,"providers":[{"billed_charge":23842.40,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":40431.56,"providers":[{"billed_charge":170441.00,"npi":[1780658443]}]},{"allowed_amount":67.13,"providers":[{"billed_charge":242.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1366.52,"providers":[{"billed_charge":4723.00,"npi":[1841245594]}]},{"allowed_amount":505.02,"providers":[{"billed_charge":4040.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5288.97,"providers":[{"billed_charge":8080.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4556.66,"providers":[{"billed_charge":13272.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3136.32,"providers":[{"billed_charge":27031.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60274.75,"providers":[{"billed_charge":103411.60,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16510.58,"providers":[{"billed_charge":45020.80,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12604.89,"providers":[{"billed_charge":36322.21,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12178.46,"providers":[{"billed_charge":22025.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12915.81,"providers":[{"billed_charge":42527.00,"npi":[1992761985]}]}]}]},{"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":"381369611"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":86.50,"providers":[{"billed_charge":408.70,"npi":[1982685384]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12.00,"providers":[{"billed_charge":285.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.93,"providers":[{"billed_charge":5199.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":316.34,"providers":[{"billed_charge":1073.00,"npi":[1790706901]}]},{"allowed_amount":60.66,"providers":[{"billed_charge":499.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":565.61,"providers":[{"billed_charge":1034.12,"npi":[1831116441]}]},{"allowed_amount":115.71,"providers":[{"billed_charge":9428.45,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":528.68,"providers":[{"billed_charge":8678.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1493.30,"providers":[{"billed_charge":3001.00,"npi":[1841245594]}]},{"allowed_amount":6.98,"providers":[{"billed_charge":24.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1348.57,"providers":[{"billed_charge":5929.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1908.44,"providers":[{"billed_charge":4992.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":498.45,"providers":[{"billed_charge":2174.45,"npi":[1962508259]}]},{"allowed_amount":10.74,"providers":[{"billed_charge":46.83,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":34.66,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":31.42,"providers":[{"billed_charge":71.31,"npi":[1083644579]}]},{"allowed_amount":139.02,"providers":[{"billed_charge":6195.60,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":79.52,"providers":[{"billed_charge":142.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":32.43,"providers":[{"billed_charge":3777.80,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":197.09,"providers":[{"billed_charge":577.20,"npi":[1982685384]}]},{"allowed_amount":90.51,"providers":[{"billed_charge":264.20,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19.86,"providers":[{"billed_charge":415.70,"npi":[1346275856]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":230.36,"providers":[{"billed_charge":4904.85,"npi":[1871672618]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":64.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15645.35,"providers":[{"billed_charge":60501.37,"npi":[1790706901]}]},{"allowed_amount":13881.13,"providers":[{"billed_charge":53254.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":260.03,"providers":[{"billed_charge":55582.33,"npi":[1831116441]}]},{"allowed_amount":408.47,"providers":[{"billed_charge":1974.63,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8.46,"providers":[{"billed_charge":102.00,"npi":[1780658443]}]},{"allowed_amount":121.95,"providers":[{"billed_charge":89302.59,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":983.92,"providers":[{"billed_charge":2397.00,"npi":[1841245594]}]},{"allowed_amount":3357.68,"providers":[{"billed_charge":8177.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":277.32,"providers":[{"billed_charge":116516.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":360.59,"providers":[{"billed_charge":2282.00,"npi":[1831132133]}]},{"allowed_amount":40.18,"providers":[{"billed_charge":7720.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.90,"providers":[{"billed_charge":7667.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19.63,"providers":[{"billed_charge":605.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":839.35,"providers":[{"billed_charge":130962.40,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["22","19"],"billing_class":"institutional","payments":[{"allowed_amount":571.74,"providers":[{"billed_charge":2508.60,"npi":[1619923919]}]},{"allowed_amount":176.83,"providers":[{"billed_charge":744.75,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":17.70,"providers":[{"billed_charge":58496.04,"npi":[1306227764]}]},{"allowed_amount":78.64,"providers":[{"billed_charge":1020.52,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":113.90,"providers":[{"billed_charge":496.86,"npi":[1962508259]}]},{"allowed_amount":2630.02,"providers":[{"billed_charge":11474.61,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":90.12,"providers":[{"billed_charge":695.12,"npi":[1083644579]}]},{"allowed_amount":296.97,"providers":[{"billed_charge":32964.46,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3897.04,"providers":[{"billed_charge":6959.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"344428256"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":381.00,"providers":[{"billed_charge":1270.00,"npi":[1407854771]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.61,"providers":[{"billed_charge":15959.90,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10.96,"providers":[{"billed_charge":71.90,"npi":[1902894512]}]},{"allowed_amount":1036.85,"providers":[{"billed_charge":102646.60,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381976271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.86,"providers":[{"billed_charge":2283.00,"npi":[1528031226]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":231.38,"providers":[{"billed_charge":72679.80,"npi":[1316938327]}]},{"allowed_amount":482.35,"providers":[{"billed_charge":71559.85,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8065.90,"providers":[{"billed_charge":33537.70,"npi":[1982685384]}]},{"allowed_amount":3656.64,"providers":[{"billed_charge":26314.10,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":35.37,"providers":[{"billed_charge":7537.74,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":189.39,"providers":[{"billed_charge":7475.55,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3386.04,"providers":[{"billed_charge":7140.55,"npi":[1295803377]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.41,"providers":[{"billed_charge":954.44,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":39.03,"providers":[{"billed_charge":2603.74,"npi":[1831116441]}]},{"allowed_amount":249.92,"providers":[{"billed_charge":1792.87,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":12.95,"providers":[{"billed_charge":62.00,"npi":[1780658443]}]},{"allowed_amount":102.30,"providers":[{"billed_charge":1183.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12.94,"providers":[{"billed_charge":1305.20,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":158.28,"providers":[{"billed_charge":1243.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":40.23,"providers":[{"billed_charge":226.50,"npi":[1982685384]}]},{"allowed_amount":161.10,"providers":[{"billed_charge":848.20,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.24,"providers":[{"billed_charge":245.88,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":46.35,"providers":[{"billed_charge":193.00,"npi":[1831132133]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":33.95,"providers":[{"billed_charge":1358.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3342.83,"providers":[{"billed_charge":14536.00,"npi":[1790706901]}]},{"allowed_amount":2613.30,"providers":[{"billed_charge":10916.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":91.20,"providers":[{"billed_charge":413.00,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1084.07,"providers":[{"billed_charge":1838.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":18.24,"providers":[{"billed_charge":559.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":584.46,"providers":[{"billed_charge":2549.91,"npi":[1962508259]}]},{"allowed_amount":11.27,"providers":[{"billed_charge":49.18,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7.77,"providers":[{"billed_charge":150.00,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6.47,"providers":[{"billed_charge":140.07,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":259.28,"providers":[{"billed_charge":463.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.82,"providers":[{"billed_charge":21470.10,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":241.34,"providers":[{"billed_charge":22713.70,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1790.70,"providers":[{"billed_charge":7206.00,"npi":[1982685384]}]},{"allowed_amount":1073.31,"providers":[{"billed_charge":7242.20,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":412.84,"providers":[{"billed_charge":870.60,"npi":[1295803377]}]}]}]},{"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":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":106.00,"providers":[{"billed_charge":1538.00,"npi":[1871672618]}]},{"allowed_amount":141.32,"providers":[{"billed_charge":1339.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3588.86,"providers":[{"billed_charge":13388.92,"npi":[1790706901]}]},{"allowed_amount":2885.35,"providers":[{"billed_charge":10529.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5685.65,"providers":[{"billed_charge":10376.62,"npi":[1831116441]}]},{"allowed_amount":7916.03,"providers":[{"billed_charge":29795.98,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51.31,"providers":[{"billed_charge":375.00,"npi":[1780658443]}]},{"allowed_amount":7291.55,"providers":[{"billed_charge":29251.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":20098.77,"providers":[{"billed_charge":74715.00,"npi":[1053356352]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":508.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":641.85,"providers":[{"billed_charge":2089.00,"npi":[1831132133]}]},{"allowed_amount":138.40,"providers":[{"billed_charge":839.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":427.90,"providers":[{"billed_charge":2117.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.95,"providers":[{"billed_charge":1612.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":596.68,"providers":[{"billed_charge":2074.00,"npi":[1811097223]}]},{"allowed_amount":5424.81,"providers":[{"billed_charge":48555.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16618.89,"providers":[{"billed_charge":71047.60,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1462.43,"providers":[{"billed_charge":19615.19,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1920.27,"providers":[{"billed_charge":8378.38,"npi":[1962508259]}]},{"allowed_amount":172.98,"providers":[{"billed_charge":754.70,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":220.44,"providers":[{"billed_charge":446.19,"npi":[1083644579]}]},{"allowed_amount":6212.36,"providers":[{"billed_charge":17668.17,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":384.85,"providers":[{"billed_charge":475.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8012.69,"providers":[{"billed_charge":81823.30,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10121.49,"providers":[{"billed_charge":29897.10,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1925.55,"providers":[{"billed_charge":5469.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":427.89,"providers":[{"billed_charge":6889.32,"npi":[1073588711]}]},{"allowed_amount":51.31,"providers":[{"billed_charge":307.86,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2918.75,"providers":[{"billed_charge":9041.60,"npi":[1982685384]}]},{"allowed_amount":454.30,"providers":[{"billed_charge":9099.80,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2956.47,"providers":[{"billed_charge":7055.23,"npi":[1346275856]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":254.90,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":221.89,"providers":[{"billed_charge":467.90,"npi":[1295803377]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3.17,"providers":[{"billed_charge":20.81,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":42.00,"providers":[{"billed_charge":71.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":117.10,"providers":[{"billed_charge":456.00,"npi":[1790706901]}]},{"allowed_amount":230.84,"providers":[{"billed_charge":1318.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4.50,"providers":[{"billed_charge":42.44,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":35.47,"providers":[{"billed_charge":3117.90,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":72.06,"providers":[{"billed_charge":372.40,"npi":[1982685384]}]},{"allowed_amount":162.44,"providers":[{"billed_charge":1167.50,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":103.91,"providers":[{"billed_charge":453.42,"npi":[1962508259]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5522.86,"providers":[{"billed_charge":4729.00,"npi":[1053356352]}]}]}]},{"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":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":86.27,"providers":[{"billed_charge":1138.29,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1916.21,"providers":[{"billed_charge":5236.00,"npi":[1790706901]}]},{"allowed_amount":828.50,"providers":[{"billed_charge":2150.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":657.65,"providers":[{"billed_charge":2480.95,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":85.85,"providers":[{"billed_charge":12360.00,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"386108110"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":172.54,"providers":[{"billed_charge":1359.00,"npi":[1063471639]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":93.78,"providers":[{"billed_charge":800.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2733.45,"providers":[{"billed_charge":10808.20,"npi":[1982685384]}]},{"allowed_amount":2062.80,"providers":[{"billed_charge":6259.00,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":216.32,"providers":[{"billed_charge":1230.00,"npi":[1811097223]}]},{"allowed_amount":2637.10,"providers":[{"billed_charge":22717.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":71.79,"providers":[{"billed_charge":313.20,"npi":[1962508259]}]},{"allowed_amount":995.24,"providers":[{"billed_charge":4342.18,"npi":[1962508259]}]}]}]},{"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":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1178.48,"providers":[{"billed_charge":5646.00,"npi":[1790706901]}]},{"allowed_amount":2622.68,"providers":[{"billed_charge":6173.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":172.54,"providers":[{"billed_charge":607.38,"npi":[1831116441]}]},{"allowed_amount":9370.63,"providers":[{"billed_charge":31877.92,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6215.94,"providers":[{"billed_charge":17376.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10149.85,"providers":[{"billed_charge":29378.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10856.15,"providers":[{"billed_charge":19483.80,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2717.61,"providers":[{"billed_charge":8354.90,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":69.60,"providers":[{"billed_charge":303.69,"npi":[1962508259]}]},{"allowed_amount":1059.88,"providers":[{"billed_charge":4624.34,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6947.54,"providers":[{"billed_charge":17274.52,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2241.37,"providers":[{"billed_charge":3420.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5450.01,"providers":[{"billed_charge":13539.50,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7363.40,"providers":[{"billed_charge":21616.10,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":260.06,"providers":[{"billed_charge":690.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":509.39,"providers":[{"billed_charge":1658.29,"npi":[1346275856]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3693.00,"providers":[{"billed_charge":43324.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1133.32,"providers":[{"billed_charge":8241.20,"npi":[1831116441]}]},{"allowed_amount":5981.06,"providers":[{"billed_charge":53646.52,"npi":[1831116441]}]}]}]},{"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":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2407.87,"providers":[{"billed_charge":21446.94,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9259.75,"providers":[{"billed_charge":38711.00,"npi":[1790706901]}]},{"allowed_amount":6556.41,"providers":[{"billed_charge":23819.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2621.16,"providers":[{"billed_charge":39270.56,"npi":[1831116441]}]},{"allowed_amount":208.38,"providers":[{"billed_charge":3028.28,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5438.68,"providers":[{"billed_charge":97225.50,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6486.39,"providers":[{"billed_charge":66765.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9640.06,"providers":[{"billed_charge":133192.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6089.34,"providers":[{"billed_charge":61529.30,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10483.15,"providers":[{"billed_charge":76589.20,"npi":[1376564088]}]}]}]},{"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":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":174.42,"providers":[{"billed_charge":4190.78,"npi":[1083644579]}]},{"allowed_amount":10037.32,"providers":[{"billed_charge":108684.34,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":35599.19,"providers":[{"billed_charge":166785.00,"npi":[1790706901]}]},{"allowed_amount":23105.15,"providers":[{"billed_charge":127959.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1333.45,"providers":[{"billed_charge":13524.14,"npi":[1831116441]}]},{"allowed_amount":11985.92,"providers":[{"billed_charge":153759.83,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":351.00,"providers":[{"billed_charge":5820.00,"npi":[1780658443]}]},{"allowed_amount":10960.37,"providers":[{"billed_charge":237098.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12030.07,"providers":[{"billed_charge":213824.20,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":14225.23,"providers":[{"billed_charge":335673.00,"npi":[1053356352]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":6529.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11325.86,"providers":[{"billed_charge":79486.60,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1590.16,"providers":[{"billed_charge":31954.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8998.94,"providers":[{"billed_charge":23083.10,"npi":[1982685384]}]},{"allowed_amount":219.32,"providers":[{"billed_charge":3376.70,"npi":[1982685384]}]},{"allowed_amount":4198.12,"providers":[{"billed_charge":26198.30,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":181.07,"providers":[{"billed_charge":2183.00,"npi":[1811097223]}]},{"allowed_amount":6673.67,"providers":[{"billed_charge":94981.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":21825.38,"providers":[{"billed_charge":218980.10,"npi":[1376564088]}]},{"allowed_amount":236.83,"providers":[{"billed_charge":2083.70,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4205.30,"providers":[{"billed_charge":65264.47,"npi":[1306227764]}]}]}]},{"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":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7331.97,"providers":[{"billed_charge":15225.83,"npi":[1831116441]}]},{"allowed_amount":2787.95,"providers":[{"billed_charge":2074.72,"npi":[1831116441]}]}]}]},{"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":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":172.71,"providers":[{"billed_charge":190.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":155.00,"providers":[{"billed_charge":155.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.53,"providers":[{"billed_charge":340.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":172.71,"providers":[{"billed_charge":285.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"383593303"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":130.02,"providers":[{"billed_charge":176.00,"npi":[1669035366]}]}]},{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.58,"providers":[{"billed_charge":45.00,"npi":[1144990938]}]}]},{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":175.04,"providers":[{"billed_charge":320.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":290.88,"providers":[{"billed_charge":640.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9928.41,"providers":[{"billed_charge":13662.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":36.36,"providers":[{"billed_charge":60.00,"npi":[1629459904]}]},{"allowed_amount":290.62,"providers":[{"billed_charge":480.00,"npi":[1346693413]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":38.65,"providers":[{"billed_charge":50.00,"npi":[1245982909]}]},{"allowed_amount":46.38,"providers":[{"billed_charge":60.00,"npi":[1629753223]}]},{"allowed_amount":54.11,"providers":[{"billed_charge":70.00,"npi":[1154032670]}]}]}]},{"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":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":104.19,"providers":[{"billed_charge":918.71,"npi":[1083644579]}]},{"allowed_amount":1861.12,"providers":[{"billed_charge":13609.83,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1098.78,"providers":[{"billed_charge":4505.00,"npi":[1790706901]}]},{"allowed_amount":1367.90,"providers":[{"billed_charge":6451.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2389.95,"providers":[{"billed_charge":17056.71,"npi":[1831116441]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":785.96,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1095.71,"providers":[{"billed_charge":8077.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1385.70,"providers":[{"billed_charge":15969.20,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1085.34,"providers":[{"billed_charge":19974.10,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":208.38,"providers":[{"billed_charge":2169.00,"npi":[1053356352]}]},{"allowed_amount":2344.35,"providers":[{"billed_charge":30731.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":312.58,"providers":[{"billed_charge":2444.80,"npi":[1376564088]}]}]}]},{"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":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":346.22,"providers":[{"billed_charge":1668.77,"npi":[1831116441]}]}]}]},{"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":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":94.06,"providers":[{"billed_charge":257.50,"npi":[1831116441]}]}]}]},{"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":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96.42,"providers":[{"billed_charge":279.25,"npi":[1831116441]}]}]}]},{"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":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22806.43,"providers":[{"billed_charge":27377.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":429739.01,"providers":[{"billed_charge":882073.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18027.54,"providers":[{"billed_charge":24745.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12618.18,"providers":[{"billed_charge":18485.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":46947.95,"providers":[{"billed_charge":204833.24,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381358208"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2526.90,"providers":[{"billed_charge":13065.75,"npi":[1063414233]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3100.72,"providers":[{"billed_charge":5537.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23281.78,"providers":[{"billed_charge":53627.00,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":206387.49,"providers":[{"billed_charge":484272.30,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":331394.77,"providers":[{"billed_charge":298747.00,"npi":[1316938327]}]},{"allowed_amount":329.38,"providers":[{"billed_charge":106915.80,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":105987.57,"providers":[{"billed_charge":188035.60,"npi":[1982685384]}]},{"allowed_amount":20440.64,"providers":[{"billed_charge":117962.50,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10668.78,"providers":[{"billed_charge":33257.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":89476.45,"providers":[{"billed_charge":177020.26,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19267.84,"providers":[{"billed_charge":40632.60,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":116802.75,"providers":[{"billed_charge":263092.00,"npi":[1790706901]}]},{"allowed_amount":24777.50,"providers":[{"billed_charge":88313.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":360995.22,"providers":[{"billed_charge":798769.11,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":261301.32,"providers":[{"billed_charge":488302.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":569.20,"providers":[{"billed_charge":1956.00,"npi":[1841245594]}]},{"allowed_amount":4139.93,"providers":[{"billed_charge":7356.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36205.18,"providers":[{"billed_charge":63559.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11419.97,"providers":[{"billed_charge":24481.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":451039.30,"providers":[{"billed_charge":662923.00,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":93310.71,"providers":[{"billed_charge":273794.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":99884.23,"providers":[{"billed_charge":285472.81,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":284903.17,"providers":[{"billed_charge":517180.83,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":74199.77,"providers":[{"billed_charge":183657.00,"npi":[1407877723]}]},{"allowed_amount":939.00,"providers":[{"billed_charge":80992.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12134.40,"providers":[{"billed_charge":24501.00,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"386108110"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6094.44,"providers":[{"billed_charge":13634.00,"npi":[1063471639]}]}]},{"tin":{"type":"ein","value":"381976271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4163.50,"providers":[{"billed_charge":8883.10,"npi":[1528031226]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":50644.79,"providers":[{"billed_charge":121196.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10934.86,"providers":[{"billed_charge":22706.00,"npi":[1972564730]}]}]},{"tin":{"type":"ein","value":"381362830"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1680.10,"providers":[{"billed_charge":4332.00,"npi":[1952307852]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":551.91,"providers":[{"billed_charge":1326.00,"npi":[1871672618]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1966.94,"providers":[{"billed_charge":34998.00,"npi":[1053356352]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381738615"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2.30,"providers":[{"billed_charge":2.30,"npi":[1497750608]}]}]}]},{"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":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.17,"providers":[{"billed_charge":2841.84,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31.14,"providers":[{"billed_charge":103.75,"npi":[1497859649]}]},{"allowed_amount":1221.02,"providers":[{"billed_charge":5263.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":885.93,"providers":[{"billed_charge":23034.55,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":973.70,"providers":[{"billed_charge":5256.35,"npi":[1831132133]}]},{"allowed_amount":645.18,"providers":[{"billed_charge":3024.60,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.06,"providers":[{"billed_charge":2559.82,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":62.86,"providers":[{"billed_charge":274.19,"npi":[1962508259]}]},{"allowed_amount":2014.11,"providers":[{"billed_charge":8787.11,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"42516906"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":514.16,"providers":[{"billed_charge":249005.94,"npi":[1699275487]}]},{"allowed_amount":177.56,"providers":[{"billed_charge":266382.42,"npi":[1871608612]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":47.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14.61,"providers":[{"billed_charge":2474.31,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":150.25,"providers":[{"billed_charge":14833.69,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":135.09,"providers":[{"billed_charge":25035.10,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6349.11,"providers":[{"billed_charge":32748.50,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5992.11,"providers":[{"billed_charge":21042.24,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3137.10,"providers":[{"billed_charge":6615.66,"npi":[1295803377]}]},{"allowed_amount":12913.65,"providers":[{"billed_charge":27232.58,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2872.21,"providers":[{"billed_charge":10393.85,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":33575.87,"providers":[{"billed_charge":176435.72,"npi":[1831116441]}]},{"allowed_amount":2318.23,"providers":[{"billed_charge":42615.73,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6077.60,"providers":[{"billed_charge":28686.00,"npi":[1780658443]}]},{"allowed_amount":9304.92,"providers":[{"billed_charge":46121.15,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":137.76,"providers":[{"billed_charge":659.45,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.38,"providers":[{"billed_charge":1152.50,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19.91,"providers":[{"billed_charge":956.50,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11049.10,"providers":[{"billed_charge":48383.36,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8490.62,"providers":[{"billed_charge":17266.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":80.82,"providers":[{"billed_charge":31576.27,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1123.08,"providers":[{"billed_charge":25420.19,"npi":[1083644579]}]},{"allowed_amount":2500.58,"providers":[{"billed_charge":24336.12,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.75,"providers":[{"billed_charge":87.25,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2523.33,"providers":[{"billed_charge":5102.39,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"386108110"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.76,"providers":[{"billed_charge":323.00,"npi":[1063471639]}]}]},{"tin":{"type":"ein","value":"381976271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3460.26,"providers":[{"billed_charge":9075.89,"npi":[1528031226]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":61.20,"providers":[{"billed_charge":3211.30,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.50,"providers":[{"billed_charge":248.00,"npi":[1972564730]}]}]}]},{"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":"341788398"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":6981.00,"providers":[{"billed_charge":6981.00,"npi":[1114627890]}]}]}]},{"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":"381859770"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":39.69,"providers":[{"billed_charge":115.00,"npi":[1104260603,1326422528]}]},{"allowed_amount":635.86,"providers":[{"billed_charge":1840.00,"npi":[1326422528]}]},{"allowed_amount":158.76,"providers":[{"billed_charge":460.00,"npi":[1104260603]}]},{"allowed_amount":515.97,"providers":[{"billed_charge":1495.00,"npi":[1104260603]}]}]}]},{"name":"MRI BRAIN STEM W/O & W/DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70553","description":"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FO","allowed_amounts":[{"tin":{"type":"ein","value":"381859770"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":215.34,"providers":[{"billed_charge":636.00,"npi":[1104260603]}]},{"allowed_amount":107.67,"providers":[{"billed_charge":318.00,"npi":[1104260603]}]}]}]},{"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":"934891173"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.95,"providers":[{"billed_charge":25.00,"npi":[1265457485]}]},{"allowed_amount":103.04,"providers":[{"billed_charge":200.00,"npi":[1265457485]}]}]},{"tin":{"type":"ein","value":"203696992"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":52.73,"providers":[{"billed_charge":234.00,"npi":[1881670594]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":8.26,"providers":[{"billed_charge":21.00,"npi":[1659687408]}]},{"allowed_amount":16.38,"providers":[{"billed_charge":42.00,"npi":[1518157478]}]},{"allowed_amount":107.18,"providers":[{"billed_charge":273.00,"npi":[1518157478]}]},{"allowed_amount":41.30,"providers":[{"billed_charge":105.00,"npi":[1659687408]}]},{"allowed_amount":173.46,"providers":[{"billed_charge":441.00,"npi":[1518157478]}]},{"allowed_amount":115.64,"providers":[{"billed_charge":294.00,"npi":[1659687408]}]}]},{"tin":{"type":"ein","value":"382492131"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":37.17,"providers":[{"billed_charge":81.00,"npi":[1336137264]}]},{"allowed_amount":12.39,"providers":[{"billed_charge":27.00,"npi":[1336137264]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":12.95,"providers":[{"billed_charge":24.00,"npi":[1013171941]}]}]}]},{"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":"381894009"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":20.48,"providers":[{"billed_charge":52.00,"npi":[1811275266]}]},{"allowed_amount":31.02,"providers":[{"billed_charge":78.00,"npi":[1811275266]}]},{"allowed_amount":10.24,"providers":[{"billed_charge":26.00,"npi":[1942648662]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":9.85,"providers":[{"billed_charge":21.00,"npi":[1659687408]}]},{"allowed_amount":68.95,"providers":[{"billed_charge":147.00,"npi":[1659687408]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":98.43,"providers":[{"billed_charge":270.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":15.36,"providers":[{"billed_charge":28.00,"npi":[1013171941]}]}]}]},{"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":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1429.70,"providers":[{"billed_charge":4503.00,"npi":[1790706901]}]},{"allowed_amount":2999.40,"providers":[{"billed_charge":10428.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":342.86,"providers":[{"billed_charge":9864.00,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":58.20,"providers":[{"billed_charge":213.80,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":620.88,"providers":[{"billed_charge":2825.00,"npi":[1982685384]}]},{"allowed_amount":737.80,"providers":[{"billed_charge":2034.00,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":796.30,"providers":[{"billed_charge":3474.14,"npi":[1962508259]}]}]}]},{"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":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":175.96,"providers":[{"billed_charge":552.00,"npi":[1083644579]}]},{"allowed_amount":309.65,"providers":[{"billed_charge":3647.57,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6798.31,"providers":[{"billed_charge":28328.32,"npi":[1831116441]}]},{"allowed_amount":615.05,"providers":[{"billed_charge":1189.15,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":488.03,"providers":[{"billed_charge":2819.00,"npi":[1972564730]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13104.50,"providers":[{"billed_charge":42793.00,"npi":[1811097223]}]}]}]},{"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":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":364.54,"providers":[{"billed_charge":1098.00,"npi":[1790706901]}]},{"allowed_amount":2891.40,"providers":[{"billed_charge":9638.00,"npi":[1790706901]}]}]}]},{"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":"382286062"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1433.52,"providers":[{"billed_charge":2544.00,"npi":[1033110549]}]}]},{"tin":{"type":"ein","value":"880602985"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":412.21,"providers":[{"billed_charge":1760.00,"npi":[1548279763]}]},{"allowed_amount":351.39,"providers":[{"billed_charge":1430.00,"npi":[1548279763]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":563.49,"providers":[{"billed_charge":700.00,"npi":[1396769378]}]},{"allowed_amount":366.93,"providers":[{"billed_charge":455.00,"npi":[1598887457]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":380.07,"providers":[{"billed_charge":837.00,"npi":[1982774469]}]}]}]},{"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":"382286062"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1820.91,"providers":[{"billed_charge":3922.00,"npi":[1033110549]}]}]},{"tin":{"type":"ein","value":"880602985"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":583.95,"providers":[{"billed_charge":2312.00,"npi":[1548279763]}]},{"allowed_amount":412.20,"providers":[{"billed_charge":1632.00,"npi":[1548279763]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":438.67,"providers":[{"billed_charge":1625.00,"npi":[1598887457]}]},{"allowed_amount":717.62,"providers":[{"billed_charge":2500.00,"npi":[1396769378]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":483.48,"providers":[{"billed_charge":945.00,"npi":[1982774469]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":731.16,"providers":[{"billed_charge":2447.20,"npi":[1053314146]}]}]}]},{"name":"ELECTROLYTE PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80051","description":"ELECTROLYTE PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CARBON DIOXIDE (BICARBONATE) (82374) CHLORI","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.72,"providers":[{"billed_charge":96.40,"npi":[1932414463]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2769.64,"providers":[{"billed_charge":8351.44,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18083.00,"providers":[{"billed_charge":64151.12,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4123.65,"providers":[{"billed_charge":6775.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":22758.75,"providers":[{"billed_charge":76339.58,"npi":[1053314146]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":104.10,"providers":[{"billed_charge":480.00,"npi":[1053314146]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6781.80,"providers":[{"billed_charge":23005.63,"npi":[1053314146]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":183.12,"providers":[{"billed_charge":918.00,"npi":[1053314146]}]}]}]},{"name":"OBSTETRIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80081","description":"OBSTETRIC PANEL (INCLUDES HIV TESTING)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":299.45,"providers":[{"billed_charge":1165.00,"npi":[1053314146]}]}]}]},{"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":"813667937"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":75.60,"providers":[{"billed_charge":150.00,"npi":[1538422548]}]}]},{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":289.80,"providers":[{"billed_charge":460.00,"npi":[1265503031]}]}]}]},{"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":"474715923"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":12024.09,"providers":[{"billed_charge":38700.00,"npi":[1144606542]}]},{"allowed_amount":559.26,"providers":[{"billed_charge":1800.00,"npi":[1144606542]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21375.30,"providers":[{"billed_charge":42960.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":130.56,"providers":[{"billed_charge":212.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1153.16,"providers":[{"billed_charge":6798.00,"npi":[1053314146]}]}]}]},{"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":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.48,"providers":[{"billed_charge":11.00,"npi":[1982697454]}]},{"allowed_amount":52.20,"providers":[{"billed_charge":165.00,"npi":[1558354159]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":5.92,"providers":[{"billed_charge":20.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":20.72,"providers":[{"billed_charge":70.00,"npi":[1245936012]}]}]}]},{"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":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":247.50,"providers":[{"billed_charge":4620.00,"npi":[1114330974]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":766.29,"providers":[{"billed_charge":3738.00,"npi":[1114330974]}]}]}]},{"name":"FETAL CHRMOML ANEUPLOIDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI","allowed_amounts":[{"tin":{"type":"ein","value":"811082020"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":50856.35,"providers":[{"billed_charge":209497.80,"npi":[1598314437]}]}]}]},{"name":"ASSAY OF SERUM ALBUMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82040","description":"ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":522.72,"providers":[{"billed_charge":1848.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":130.57,"providers":[{"billed_charge":315.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1746.36,"providers":[{"billed_charge":6796.80,"npi":[1053314146]}]}]}]},{"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":"42516906"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":8347.25,"providers":[{"billed_charge":247296.00,"npi":[1871608612]}]},{"allowed_amount":11631.02,"providers":[{"billed_charge":344448.00,"npi":[1699275487]}]}]},{"tin":{"type":"ein","value":"900754081"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":11496.74,"providers":[{"billed_charge":273792.00,"npi":[1417055542]}]}]},{"tin":{"type":"ein","value":"364525442"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":5871.73,"providers":[{"billed_charge":176640.00,"npi":[1407897465]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":202.02,"providers":[{"billed_charge":702.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82247","description":"BILIRUBIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":534.66,"providers":[{"billed_charge":1862.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":301.50,"providers":[{"billed_charge":1041.02,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4860.00,"providers":[{"billed_charge":4860.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27658.24,"providers":[{"billed_charge":93179.20,"npi":[1053314146]}]}]}]},{"name":"CARCINOEMBRYONIC ANTIGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82378","description":"CARCINOEMBRYONIC ANTIGEN (CEA)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.51,"providers":[{"billed_charge":162.00,"npi":[1053314146]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":312.96,"providers":[{"billed_charge":1104.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":302.18,"providers":[{"billed_charge":1102.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82565","description":"CREATININE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":99.20,"providers":[{"billed_charge":162.40,"npi":[1932414463]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":132.00,"providers":[{"billed_charge":171.60,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1009.92,"providers":[{"billed_charge":1583.40,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1401.84,"providers":[{"billed_charge":1670.40,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10419.84,"providers":[{"billed_charge":38730.16,"npi":[1053314146]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":977.90,"providers":[{"billed_charge":3465.00,"npi":[1053314146]}]}]}]},{"name":"VIT D 1 25-DIHYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82652","description":"VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5852.00,"providers":[{"billed_charge":18240.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":391.16,"providers":[{"billed_charge":462.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2793.75,"providers":[{"billed_charge":9750.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":246.40,"providers":[{"billed_charge":275.80,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3357.20,"providers":[{"billed_charge":11704.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2481.36,"providers":[{"billed_charge":8811.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":312.48,"providers":[{"billed_charge":1188.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":131.88,"providers":[{"billed_charge":462.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":213.12,"providers":[{"billed_charge":740.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.02,"providers":[{"billed_charge":102.10,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2006.10,"providers":[{"billed_charge":6999.20,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":95.68,"providers":[{"billed_charge":116.10,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1704.30,"providers":[{"billed_charge":5959.20,"npi":[1053314146]}]}]}]},{"name":"H PYLORI (C-13), BREATH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83013","description":"HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":646.68,"providers":[{"billed_charge":2208.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":226.60,"providers":[{"billed_charge":1100.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3207.79,"providers":[{"billed_charge":4294.40,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14615.37,"providers":[{"billed_charge":60057.82,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":246.78,"providers":[{"billed_charge":1350.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":100.44,"providers":[{"billed_charge":111.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2274.02,"providers":[{"billed_charge":10462.54,"npi":[1053314146]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.50,"providers":[{"billed_charge":18.50,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1922.25,"providers":[{"billed_charge":6561.60,"npi":[1053314146]}]}]}]},{"name":"LACTATE (LD) (LDH) ENZYME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83615","description":"LACTATE DEHYDROGENASE (LD), (LDH);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":86.94,"providers":[{"billed_charge":306.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":325.09,"providers":[{"billed_charge":1239.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2010.00,"providers":[{"billed_charge":7449.40,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF NATRIURETIC PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83880","description":"NATRIURETIC PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":376.92,"providers":[{"billed_charge":1160.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2410.46,"providers":[{"billed_charge":8421.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY ALKALINE PHOSPHATASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84075","description":"PHOSPHATASE, ALKALINE;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":571.35,"providers":[{"billed_charge":1932.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":758.00,"providers":[{"billed_charge":2400.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":271.18,"providers":[{"billed_charge":286.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":717.67,"providers":[{"billed_charge":2580.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1968.50,"providers":[{"billed_charge":7874.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":182.50,"providers":[{"billed_charge":182.50,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6428.27,"providers":[{"billed_charge":17432.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84154","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":544.27,"providers":[{"billed_charge":1850.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84155","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":435.12,"providers":[{"billed_charge":1628.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":111.72,"providers":[{"billed_charge":451.20,"npi":[1053314146]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":214.75,"providers":[{"billed_charge":1625.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2763.42,"providers":[{"billed_charge":7930.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5905.90,"providers":[{"billed_charge":20505.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":495.00,"providers":[{"billed_charge":1786.87,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":768.11,"providers":[{"billed_charge":1011.45,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7328.30,"providers":[{"billed_charge":40489.02,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4339.28,"providers":[{"billed_charge":5220.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27148.80,"providers":[{"billed_charge":96724.80,"npi":[1053314146]}]}]}]},{"name":"TRANSFERASE (AST) (SGOT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84450","description":"TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":749.34,"providers":[{"billed_charge":2534.00,"npi":[1053314146]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84460","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":763.20,"providers":[{"billed_charge":2514.40,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.05,"providers":[{"billed_charge":170.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2914.38,"providers":[{"billed_charge":10280.00,"npi":[1053314146]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2154.45,"providers":[{"billed_charge":7569.88,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF UREA NITROGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84520","description":"UREA NITROGEN; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":77.76,"providers":[{"billed_charge":96.40,"npi":[1932414463]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2197.34,"providers":[{"billed_charge":8498.00,"npi":[1053314146]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1577.24,"providers":[{"billed_charge":3265.05,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2295.90,"providers":[{"billed_charge":2348.40,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11849.10,"providers":[{"billed_charge":47510.54,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":215.77,"providers":[{"billed_charge":269.10,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1149.96,"providers":[{"billed_charge":2880.80,"npi":[1053314146]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.28,"providers":[{"billed_charge":197.20,"npi":[1053314146]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":113.19,"providers":[{"billed_charge":521.60,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":341.28,"providers":[{"billed_charge":1733.60,"npi":[1053314146]}]}]}]},{"name":"THROMBOPLASTIN TIME, PARTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85730","description":"THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33.67,"providers":[{"billed_charge":145.20,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":541.52,"providers":[{"billed_charge":2502.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":273.24,"providers":[{"billed_charge":990.00,"npi":[1053314146]}]}]}]},{"name":"C-REACTIVE PROTEIN, HS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86141","description":"C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":279.72,"providers":[{"billed_charge":999.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":82.88,"providers":[{"billed_charge":400.00,"npi":[1053314146]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":593.46,"providers":[{"billed_charge":1836.00,"npi":[1053314146]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6210.87,"providers":[{"billed_charge":18051.60,"npi":[1053314146]}]}]}]},{"name":"IMMUNOFIX E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86334","description":"IMMUNOFIXATION ELECTROPHORESIS; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":142.96,"providers":[{"billed_charge":800.00,"npi":[1053314146]}]}]}]},{"name":"T CELL, ABSOLUTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86361","description":"T CELLS; ABSOLUTE CD4 COUNT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":171.36,"providers":[{"billed_charge":400.00,"npi":[1053314146]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":744.96,"providers":[{"billed_charge":2544.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":167.98,"providers":[{"billed_charge":592.00,"npi":[1053314146]}]}]}]},{"name":"TB AG RESPONSE T-CELL SUSP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86481","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":640.00,"providers":[{"billed_charge":1600.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":34.20,"providers":[{"billed_charge":360.00,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":886.20,"providers":[{"billed_charge":3084.19,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1346.76,"providers":[{"billed_charge":4749.35,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":588.04,"providers":[{"billed_charge":2412.05,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":695.79,"providers":[{"billed_charge":3210.74,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":495.50,"providers":[{"billed_charge":1700.00,"npi":[1053314146]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":184.16,"providers":[{"billed_charge":640.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1022.12,"providers":[{"billed_charge":1564.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2965.20,"providers":[{"billed_charge":8383.24,"npi":[1053314146]}]}]}]},{"name":"VARICELLA-ZOSTER ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86787","description":"ANTIBODY; VARICELLA-ZOSTER","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":339.90,"providers":[{"billed_charge":1254.00,"npi":[1053314146]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":649.23,"providers":[{"billed_charge":2550.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":811.20,"providers":[{"billed_charge":1440.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3117.66,"providers":[{"billed_charge":10888.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.68,"providers":[{"billed_charge":720.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":26.29,"providers":[{"billed_charge":110.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33.46,"providers":[{"billed_charge":140.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.60,"providers":[{"billed_charge":420.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":452.27,"providers":[{"billed_charge":2100.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1944.46,"providers":[{"billed_charge":9006.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":271.96,"providers":[{"billed_charge":406.25,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1151.66,"providers":[{"billed_charge":5340.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":325.24,"providers":[{"billed_charge":1410.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":773.48,"providers":[{"billed_charge":804.75,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":462.56,"providers":[{"billed_charge":1680.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1615.09,"providers":[{"billed_charge":4828.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6066.90,"providers":[{"billed_charge":16352.08,"npi":[1053314146]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"874116721"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":231.48,"providers":[{"billed_charge":700.00,"npi":[1376287169]}]}]},{"tin":{"type":"ein","value":"861738064"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":53.01,"providers":[{"billed_charge":150.00,"npi":[1760070635]}]},{"allowed_amount":133.41,"providers":[{"billed_charge":400.00,"npi":[1194266957]}]}]},{"tin":{"type":"ein","value":"922410744"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":151.08,"providers":[{"billed_charge":777.60,"npi":[1548904808]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":141.32,"providers":[{"billed_charge":340.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"872462330"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":141.36,"providers":[{"billed_charge":691.20,"npi":[1508072687]}]},{"allowed_amount":123.69,"providers":[{"billed_charge":604.80,"npi":[1982803540]}]},{"allowed_amount":35.34,"providers":[{"billed_charge":172.80,"npi":[1902024383]}]}]}]},{"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":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":239.00,"providers":[{"billed_charge":400.00,"npi":[1245936012]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":192.00,"providers":[{"billed_charge":192.00,"npi":[1932414463]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":210.96,"providers":[{"billed_charge":2340.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3143.84,"providers":[{"billed_charge":5600.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1824.80,"providers":[{"billed_charge":1824.80,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1183.72,"providers":[{"billed_charge":13130.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7494.69,"providers":[{"billed_charge":26660.00,"npi":[1053314146]}]}]}]},{"name":"GARDNER VAG, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87511","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":260.00,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1405.07,"providers":[{"billed_charge":4303.60,"npi":[1053314146]}]}]}]},{"name":"HIV-1 QUANT&REVRSE TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87536","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION, INCLUDES REVERSE TRA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1906.24,"providers":[{"billed_charge":4900.00,"npi":[1053314146]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":691.48,"providers":[{"billed_charge":7670.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":140.35,"providers":[{"billed_charge":400.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1824.80,"providers":[{"billed_charge":1824.80,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1183.72,"providers":[{"billed_charge":13130.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7466.62,"providers":[{"billed_charge":26560.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":665.00,"providers":[{"billed_charge":1330.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.88,"providers":[{"billed_charge":680.00,"npi":[1234567893]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5840.64,"providers":[{"billed_charge":10400.00,"npi":[1053314146]}]}]}]},{"name":"SARS-COV-2 COVID-19 AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87635","description":"Infectious agent detection by nucleic acid (DNA or RNA); (SARS-CoV-2) [COVID-19], amplified probe te","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.98,"providers":[{"billed_charge":597.00,"npi":[1144606542]}]}]}]},{"name":"SARSCOV2&INF A&B&RSV AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87637","description":"IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":427.92,"providers":[{"billed_charge":1500.00,"npi":[1144606542]}]},{"allowed_amount":7274.64,"providers":[{"billed_charge":25500.00,"npi":[1144606542]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1483.30,"providers":[{"billed_charge":4550.00,"npi":[1053314146]}]}]}]},{"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":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":501.82,"providers":[{"billed_charge":1003.64,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4435.06,"providers":[{"billed_charge":15760.00,"npi":[1053314146]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1066.45,"providers":[{"billed_charge":12105.40,"npi":[1234567893]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1684.80,"providers":[{"billed_charge":2960.00,"npi":[1053314146]}]}]}]},{"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":"821936174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":98.49,"providers":[{"billed_charge":210.00,"npi":[1194231597]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":347.55,"providers":[{"billed_charge":1260.00,"npi":[1114330974]}]}]}]},{"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":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":49.59,"providers":[{"billed_charge":180.00,"npi":[1114330974]}]}]}]},{"name":"CYTOPATH C/V THIN LAYER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88142","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2562.06,"providers":[{"billed_charge":3234.00,"npi":[1932414463]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":106.68,"providers":[{"billed_charge":900.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4556.06,"providers":[{"billed_charge":15836.00,"npi":[1053314146]}]}]}]},{"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":"261926383"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":17.55,"providers":[{"billed_charge":185.00,"npi":[1003868969]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":88.76,"providers":[{"billed_charge":800.00,"npi":[1234567893]}]},{"allowed_amount":54.18,"providers":[{"billed_charge":160.00,"npi":[1234567893]}]},{"allowed_amount":52.64,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":852.19,"providers":[{"billed_charge":2480.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":123.48,"providers":[{"billed_charge":366.00,"npi":[1659574127]}]}]},{"tin":{"type":"ein","value":"381857764"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":613.29,"providers":[{"billed_charge":1800.00,"npi":[1902914062]}]},{"allowed_amount":257.01,"providers":[{"billed_charge":750.00,"npi":[1558650283]}]}]},{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":579.56,"providers":[{"billed_charge":11011.80,"npi":[1326393307]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":241.20,"providers":[{"billed_charge":546.00,"npi":[1396368734]}]}]}]},{"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":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":951.25,"providers":[{"billed_charge":1940.00,"npi":[1679117063]}]}]}]},{"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":"382009364"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":203.13,"providers":[{"billed_charge":270.00,"npi":[1558303958]}]},{"allowed_amount":231.85,"providers":[{"billed_charge":270.00,"npi":[1558303958]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":945.76,"providers":[{"billed_charge":1820.00,"npi":[1831338441]}]}]},{"tin":{"type":"ein","value":"382406558"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":51.34,"providers":[{"billed_charge":85.00,"npi":[1215541545]}]},{"allowed_amount":58.20,"providers":[{"billed_charge":85.00,"npi":[1215541545]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1463.61,"providers":[{"billed_charge":5200.00,"npi":[1043507833]}]},{"allowed_amount":950.64,"providers":[{"billed_charge":3450.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2894.40,"providers":[{"billed_charge":6600.00,"npi":[1447323829]}]},{"allowed_amount":518.56,"providers":[{"billed_charge":1050.00,"npi":[1447323829]}]}]}]},{"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":"273742440"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":737.20,"providers":[{"billed_charge":799.76,"npi":[1033203161]}]},{"allowed_amount":1599.52,"providers":[{"billed_charge":1599.52,"npi":[1033203161]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":208.32,"providers":[{"billed_charge":520.00,"npi":[1669538211,1467802744]}]},{"allowed_amount":1666.56,"providers":[{"billed_charge":4160.00,"npi":[1497889927]}]},{"allowed_amount":620.97,"providers":[{"billed_charge":1560.00,"npi":[1912103268]}]},{"allowed_amount":416.64,"providers":[{"billed_charge":1040.00,"npi":[1275092348]}]},{"allowed_amount":2602.06,"providers":[{"billed_charge":6500.00,"npi":[1831338441]}]},{"allowed_amount":831.34,"providers":[{"billed_charge":2080.00,"npi":[1831513886]}]},{"allowed_amount":1041.60,"providers":[{"billed_charge":2600.00,"npi":[1417605833]}]}]},{"tin":{"type":"ein","value":"831910484"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":92.15,"providers":[{"billed_charge":167.88,"npi":[1629416169]}]},{"allowed_amount":1052.30,"providers":[{"billed_charge":1678.80,"npi":[1629416169]}]}]}]},{"name":"PSYTX W PT W E/M 45 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90836","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3470.88,"providers":[{"billed_charge":4900.00,"npi":[1255372058]}]}]}]},{"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":"474714944"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2185.12,"providers":[{"billed_charge":3200.00,"npi":[1811331481]}]}]},{"tin":{"type":"ein","value":"825510340"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":245.82,"providers":[{"billed_charge":660.00,"npi":[1114403136]}]},{"allowed_amount":655.27,"providers":[{"billed_charge":1540.00,"npi":[1114403136]}]}]},{"tin":{"type":"ein","value":"382363235"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":273.14,"providers":[{"billed_charge":429.00,"npi":[1750393690]}]},{"allowed_amount":156.02,"providers":[{"billed_charge":214.50,"npi":[1750393690]}]}]},{"tin":{"type":"ein","value":"814957518"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":200.56,"providers":[{"billed_charge":360.00,"npi":[1205058344]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":400.26,"providers":[{"billed_charge":420.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"20779408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":702.12,"providers":[{"billed_charge":1140.00,"npi":[1639760663]}]}]},{"tin":{"type":"ein","value":"382776209"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":200.58,"providers":[{"billed_charge":490.00,"npi":[1629263140]}]},{"allowed_amount":1053.18,"providers":[{"billed_charge":2205.00,"npi":[1740458538]}]},{"allowed_amount":237.87,"providers":[{"billed_charge":490.00,"npi":[1740458538]}]},{"allowed_amount":455.07,"providers":[{"billed_charge":735.00,"npi":[1629263140]}]}]},{"tin":{"type":"ein","value":"821510432"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":702.12,"providers":[{"billed_charge":1050.00,"npi":[1992169460]}]},{"allowed_amount":204.86,"providers":[{"billed_charge":350.00,"npi":[1992169460]}]},{"allowed_amount":578.17,"providers":[{"billed_charge":875.00,"npi":[1992169460]}]}]},{"tin":{"type":"ein","value":"822225208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":377.19,"providers":[{"billed_charge":525.00,"npi":[1396054920]}]}]},{"tin":{"type":"ein","value":"883690599"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1407.92,"providers":[{"billed_charge":1600.00,"npi":[1861694424]}]},{"allowed_amount":100.00,"providers":[{"billed_charge":100.00,"npi":[1861694424]}]}]},{"tin":{"type":"ein","value":"863656058"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2615.16,"providers":[{"billed_charge":6400.00,"npi":[1003278631]}]},{"allowed_amount":540.78,"providers":[{"billed_charge":1200.00,"npi":[1003278631]}]},{"allowed_amount":638.32,"providers":[{"billed_charge":1600.00,"npi":[1437765336]}]},{"allowed_amount":1117.31,"providers":[{"billed_charge":2400.00,"npi":[1437765336]}]}]},{"tin":{"type":"ein","value":"833919424"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":80.23,"providers":[{"billed_charge":185.00,"npi":[1720771900]}]}]},{"tin":{"type":"ein","value":"472970145"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":546.28,"providers":[{"billed_charge":1000.00,"npi":[1396913497]}]},{"allowed_amount":5458.83,"providers":[{"billed_charge":8750.00,"npi":[1396913497]}]}]},{"tin":{"type":"ein","value":"853424902"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":4363.20,"providers":[{"billed_charge":7200.00,"npi":[1508241787]}]},{"allowed_amount":6820.47,"providers":[{"billed_charge":11250.00,"npi":[1154652865]}]},{"allowed_amount":425.05,"providers":[{"billed_charge":750.00,"npi":[1508241787]}]},{"allowed_amount":80.23,"providers":[{"billed_charge":150.00,"npi":[1508241787]}]}]},{"tin":{"type":"ein","value":"383579022"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":234.04,"providers":[{"billed_charge":500.00,"npi":[1215502265]}]},{"allowed_amount":1024.30,"providers":[{"billed_charge":2500.00,"npi":[1215502265]}]}]},{"tin":{"type":"ein","value":"453029406"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":307.29,"providers":[{"billed_charge":525.00,"npi":[1457514366]}]}]},{"tin":{"type":"ein","value":"454675306"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":200.56,"providers":[{"billed_charge":500.00,"npi":[1093049561]}]},{"allowed_amount":4262.72,"providers":[{"billed_charge":8000.00,"npi":[1487021978]}]},{"allowed_amount":151.69,"providers":[{"billed_charge":250.00,"npi":[1487021978]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1637.71,"providers":[{"billed_charge":3576.00,"npi":[1447323829]}]},{"allowed_amount":1246.29,"providers":[{"billed_charge":2384.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1386.44,"providers":[{"billed_charge":2973.00,"npi":[1497889927]}]}]},{"tin":{"type":"ein","value":"460974303"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":300.84,"providers":[{"billed_charge":600.00,"npi":[1366672370]}]}]},{"tin":{"type":"ein","value":"471173250"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2260.51,"providers":[{"billed_charge":3705.00,"npi":[1558916270]}]}]},{"tin":{"type":"ein","value":"460642468"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":468.08,"providers":[{"billed_charge":700.00,"npi":[1326455320]}]}]},{"tin":{"type":"ein","value":"831910484"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":136.57,"providers":[{"billed_charge":250.78,"npi":[1629416169]}]},{"allowed_amount":1402.31,"providers":[{"billed_charge":2257.02,"npi":[1629416169]}]}]},{"tin":{"type":"ein","value":"831389809"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":187.22,"providers":[{"billed_charge":450.00,"npi":[1427534098]}]}]}]},{"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":"386088382"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":145.32,"providers":[{"billed_charge":630.00,"npi":[1972037844]}]}]}]},{"name":"DIALYSIS PROCEDURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90999","description":"UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"852368872"},"service_code":["65"],"billing_class":"professional","payments":[{"allowed_amount":80041.50,"providers":[{"billed_charge":200103.75,"npi":[1437413168]}]}]}]},{"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":1323.00,"providers":[{"billed_charge":3600.00,"npi":[1902825169]}]}]},{"tin":{"type":"ein","value":"320478538"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6210.27,"providers":[{"billed_charge":108000.00,"npi":[1346747235]}]}]}]},{"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":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1184.16,"providers":[{"billed_charge":6636.07,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1225.86,"providers":[{"billed_charge":6659.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":763.31,"providers":[{"billed_charge":4183.20,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":511.54,"providers":[{"billed_charge":3033.00,"npi":[1053356352]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"465322251"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":248.34,"providers":[{"billed_charge":930.00,"npi":[1982834826]}]},{"allowed_amount":143.64,"providers":[{"billed_charge":540.00,"npi":[1982834826]}]}]},{"tin":{"type":"ein","value":"382027689"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":30.60,"providers":[{"billed_charge":108.00,"npi":[1770549099]}]},{"allowed_amount":53.77,"providers":[{"billed_charge":189.00,"npi":[1134625502]}]},{"allowed_amount":45.76,"providers":[{"billed_charge":162.00,"npi":[1770549099]}]},{"allowed_amount":15.30,"providers":[{"billed_charge":54.00,"npi":[1134625502]}]},{"allowed_amount":7.65,"providers":[{"billed_charge":27.00,"npi":[1770549099,1134625502]}]}]},{"tin":{"type":"ein","value":"270391924"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":11.97,"providers":[{"billed_charge":15.00,"npi":[1831267376]}]}]},{"tin":{"type":"ein","value":"381359063"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":99.80,"providers":[{"billed_charge":640.00,"npi":[1992990089]}]},{"allowed_amount":89.82,"providers":[{"billed_charge":576.00,"npi":[1992990089]}]},{"allowed_amount":19.96,"providers":[{"billed_charge":128.00,"npi":[1992990089]}]}]},{"tin":{"type":"ein","value":"383322109"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":99.80,"providers":[{"billed_charge":590.00,"npi":[1477599587,1124077953]}]},{"allowed_amount":23.94,"providers":[{"billed_charge":118.00,"npi":[1386680494]}]},{"allowed_amount":130.04,"providers":[{"billed_charge":767.00,"npi":[1619310885]}]},{"allowed_amount":120.36,"providers":[{"billed_charge":708.00,"npi":[1619310885]}]},{"allowed_amount":39.92,"providers":[{"billed_charge":236.00,"npi":[1346774981]}]},{"allowed_amount":29.94,"providers":[{"billed_charge":177.00,"npi":[1346774981]}]},{"allowed_amount":67.83,"providers":[{"billed_charge":472.00,"npi":[1386680494]}]},{"allowed_amount":239.82,"providers":[{"billed_charge":1416.00,"npi":[1124077953]}]},{"allowed_amount":119.76,"providers":[{"billed_charge":708.00,"npi":[1477599587]}]}]},{"tin":{"type":"ein","value":"382791823"},"service_code":["22","19","21"],"billing_class":"professional","payments":[{"allowed_amount":207.96,"providers":[{"billed_charge":702.00,"npi":[1164816476]}]},{"allowed_amount":160.56,"providers":[{"billed_charge":540.00,"npi":[1164816476]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":54.00,"npi":[1164816476]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":491.13,"providers":[{"billed_charge":1348.90,"npi":[1275915092]}]},{"allowed_amount":48.60,"providers":[{"billed_charge":131.60,"npi":[1962889402]}]},{"allowed_amount":39.90,"providers":[{"billed_charge":164.50,"npi":[1275915092]}]},{"allowed_amount":63.84,"providers":[{"billed_charge":197.40,"npi":[1275915092]}]},{"allowed_amount":19.95,"providers":[{"billed_charge":65.80,"npi":[1962889402]}]},{"allowed_amount":167.58,"providers":[{"billed_charge":460.60,"npi":[1962889402]}]}]},{"tin":{"type":"ein","value":"383316559"},"service_code":["22","23","51","21"],"billing_class":"professional","payments":[{"allowed_amount":23.94,"providers":[{"billed_charge":84.00,"npi":[1356318398]}]},{"allowed_amount":40.38,"providers":[{"billed_charge":140.00,"npi":[1073924189]}]},{"allowed_amount":40.14,"providers":[{"billed_charge":140.00,"npi":[1003883539]}]},{"allowed_amount":39.90,"providers":[{"billed_charge":140.00,"npi":[1003883539,1720221542]}]},{"allowed_amount":47.88,"providers":[{"billed_charge":168.00,"npi":[1356318398]}]},{"allowed_amount":64.32,"providers":[{"billed_charge":224.00,"npi":[1003883539]}]},{"allowed_amount":16.20,"providers":[{"billed_charge":56.00,"npi":[1720221542]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":28.00,"npi":[1003883539,1356318398,1073924189]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":304.35,"providers":[{"billed_charge":779.00,"npi":[1234567893]}]},{"allowed_amount":70.83,"providers":[{"billed_charge":207.00,"npi":[1234567893]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":28.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":71.82,"providers":[{"billed_charge":197.40,"npi":[1588657076]}]},{"allowed_amount":35.91,"providers":[{"billed_charge":98.70,"npi":[1104266881]}]},{"allowed_amount":252.45,"providers":[{"billed_charge":690.90,"npi":[1104266881]}]},{"allowed_amount":31.92,"providers":[{"billed_charge":98.70,"npi":[1588657076]}]},{"allowed_amount":215.82,"providers":[{"billed_charge":592.20,"npi":[1588657076]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":32.90,"npi":[1104266881]}]}]},{"tin":{"type":"ein","value":"386006309"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":39.90,"providers":[{"billed_charge":375.00,"npi":[1073698809]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":150.00,"npi":[1073698809]}]},{"allowed_amount":87.78,"providers":[{"billed_charge":825.00,"npi":[1073698809]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"270391924"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":58.09,"providers":[{"billed_charge":150.00,"npi":[1831267376]}]},{"allowed_amount":1194.48,"providers":[{"billed_charge":1800.00,"npi":[1831267376]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"382319009"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":156.87,"providers":[{"billed_charge":312.00,"npi":[1215955422]}]}]}]},{"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":"382719621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":131.60,"providers":[{"billed_charge":336.00,"npi":[1578727335]}]}]},{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":33.40,"providers":[{"billed_charge":64.00,"npi":[1144990938]}]},{"allowed_amount":49.40,"providers":[{"billed_charge":96.00,"npi":[1164898722]}]},{"allowed_amount":119.90,"providers":[{"billed_charge":216.00,"npi":[1649520784]}]}]}]},{"name":"HLTH BHV ASSMT/REASSESSMENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96156","description":"HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","allowed_amounts":[{"tin":{"type":"ein","value":"883690599"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":85.99,"providers":[{"billed_charge":105.00,"npi":[1861694424]}]},{"allowed_amount":217.61,"providers":[{"billed_charge":220.00,"npi":[1861694424]}]}]}]},{"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":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":98.28,"providers":[{"billed_charge":140.70,"npi":[1538106059]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2012.10,"providers":[{"billed_charge":4410.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":11.93,"providers":[{"billed_charge":56.88,"npi":[1669243135]}]},{"allowed_amount":119.30,"providers":[{"billed_charge":568.80,"npi":[1457065930]}]},{"allowed_amount":293.88,"providers":[{"billed_charge":1365.12,"npi":[1669243135]}]}]}]},{"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":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.84,"providers":[{"billed_charge":152.00,"npi":[1063844769]}]},{"allowed_amount":24.92,"providers":[{"billed_charge":76.00,"npi":[1275599979]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":199.39,"providers":[{"billed_charge":1232.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":909.91,"providers":[{"billed_charge":8760.00,"npi":[1326274168]}]},{"allowed_amount":24.92,"providers":[{"billed_charge":240.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.76,"providers":[{"billed_charge":240.00,"npi":[1861792186]}]},{"allowed_amount":857.60,"providers":[{"billed_charge":2580.00,"npi":[1942704572]}]}]}]},{"name":"ELECTRICAL STIMULATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97032","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":272.37,"providers":[{"billed_charge":1785.00,"npi":[1477969533]}]}]}]},{"name":"ULTRASOUND THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97035","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":63.30,"providers":[{"billed_charge":275.00,"npi":[1164642302]}]}]}]},{"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":"364877508"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":513.92,"providers":[{"billed_charge":2400.00,"npi":[1295004141]}]}]},{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":612.06,"providers":[{"billed_charge":2760.00,"npi":[1477969533]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":597.54,"providers":[{"billed_charge":2185.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.76,"providers":[{"billed_charge":92.64,"npi":[1821541566]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":389.74,"providers":[{"billed_charge":1725.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"562474213"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":275.22,"providers":[{"billed_charge":352.00,"npi":[1831142488]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3569.46,"providers":[{"billed_charge":16440.00,"npi":[1326274168]}]},{"allowed_amount":103.94,"providers":[{"billed_charge":480.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":544.68,"providers":[{"billed_charge":1365.00,"npi":[1538993217]}]},{"allowed_amount":389.75,"providers":[{"billed_charge":975.00,"npi":[1073089991]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":389.73,"providers":[{"billed_charge":1245.00,"npi":[1609678499]}]},{"allowed_amount":348.25,"providers":[{"billed_charge":1162.00,"npi":[1669964243]}]},{"allowed_amount":80.84,"providers":[{"billed_charge":249.00,"npi":[1376271007]}]},{"allowed_amount":2247.55,"providers":[{"billed_charge":7138.00,"npi":[1962062273]}]},{"allowed_amount":311.79,"providers":[{"billed_charge":996.00,"npi":[1376352732]}]}]},{"tin":{"type":"ein","value":"810719772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":268.49,"providers":[{"billed_charge":850.00,"npi":[1063722676]}]}]},{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":274.25,"providers":[{"billed_charge":550.00,"npi":[1164642302]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2866.35,"providers":[{"billed_charge":8964.00,"npi":[1184811747]}]},{"allowed_amount":340.66,"providers":[{"billed_charge":1079.00,"npi":[1760062905]}]},{"allowed_amount":129.92,"providers":[{"billed_charge":415.00,"npi":[1275599979]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2497.35,"providers":[{"billed_charge":7800.00,"npi":[1942704572]}]},{"allowed_amount":166.30,"providers":[{"billed_charge":520.00,"npi":[1861792186]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":792.20,"providers":[{"billed_charge":3800.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":190.53,"providers":[{"billed_charge":700.00,"npi":[1619673209,1205582673]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":753.46,"providers":[{"billed_charge":3480.00,"npi":[1730566621]}]}]},{"tin":{"type":"ein","value":"571188400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":447.47,"providers":[{"billed_charge":850.00,"npi":[1326219312]}]}]}]},{"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":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1614.06,"providers":[{"billed_charge":5184.00,"npi":[1184811747]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2542.15,"providers":[{"billed_charge":7150.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":320.87,"providers":[{"billed_charge":1300.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2655.00,"providers":[{"billed_charge":10920.00,"npi":[1326274168]}]},{"allowed_amount":57.76,"providers":[{"billed_charge":240.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":157.24,"providers":[{"billed_charge":325.00,"npi":[1073089991]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":484.55,"providers":[{"billed_charge":1536.00,"npi":[1609678499]}]},{"allowed_amount":27.63,"providers":[{"billed_charge":96.00,"npi":[1669964243]}]},{"allowed_amount":754.09,"providers":[{"billed_charge":2496.00,"npi":[1376352732]}]},{"allowed_amount":1017.22,"providers":[{"billed_charge":3360.00,"npi":[1962062273]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1184.08,"providers":[{"billed_charge":5125.00,"npi":[1730566621]}]}]}]},{"name":"GAIT TRAINING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97116","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)","allowed_amounts":[{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.94,"providers":[{"billed_charge":360.00,"npi":[1326274168]}]}]}]},{"name":"MASSAGE THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97124","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE A","allowed_amounts":[{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":562.62,"providers":[{"billed_charge":1900.00,"npi":[1477969533]}]}]}]},{"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":"364877508"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":157.04,"providers":[{"billed_charge":800.00,"npi":[1295004141]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":441.56,"providers":[{"billed_charge":1440.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.65,"providers":[{"billed_charge":525.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"562474213"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":245.01,"providers":[{"billed_charge":328.80,"npi":[1831142488]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":269.86,"providers":[{"billed_charge":715.00,"npi":[1073089991]}]},{"allowed_amount":215.73,"providers":[{"billed_charge":585.00,"npi":[1538993217]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.06,"providers":[{"billed_charge":240.00,"npi":[1609450956]}]},{"allowed_amount":1768.22,"providers":[{"billed_charge":8640.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":294.38,"providers":[{"billed_charge":912.00,"npi":[1962062273]}]},{"allowed_amount":98.13,"providers":[{"billed_charge":304.00,"npi":[1376352732]}]}]},{"tin":{"type":"ein","value":"382820107"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":61.34,"providers":[{"billed_charge":170.00,"npi":[1770605842]}]}]},{"tin":{"type":"ein","value":"810719772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.32,"providers":[{"billed_charge":375.00,"npi":[1063722676]}]}]},{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.65,"providers":[{"billed_charge":275.00,"npi":[1164642302]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1103.11,"providers":[{"billed_charge":3420.00,"npi":[1184811747]}]},{"allowed_amount":24.53,"providers":[{"billed_charge":76.00,"npi":[1275599979]}]},{"allowed_amount":49.06,"providers":[{"billed_charge":152.00,"npi":[1457690786]}]},{"allowed_amount":517.86,"providers":[{"billed_charge":1596.00,"npi":[1962940494]}]},{"allowed_amount":98.12,"providers":[{"billed_charge":304.00,"npi":[1063844769]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2021.75,"providers":[{"billed_charge":6180.00,"npi":[1942704572]}]},{"allowed_amount":157.04,"providers":[{"billed_charge":480.00,"npi":[1861792186]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":507.05,"providers":[{"billed_charge":2000.00,"npi":[1619673209]}]},{"allowed_amount":343.48,"providers":[{"billed_charge":1400.00,"npi":[1205582673]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":235.56,"providers":[{"billed_charge":1200.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.60,"providers":[{"billed_charge":330.00,"npi":[1730566621]}]}]}]},{"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":"461228277"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":25341.97,"providers":[{"billed_charge":25341.97,"npi":[1902506306]}]},{"allowed_amount":30757.70,"providers":[{"billed_charge":30757.70,"npi":[1043750904]}]},{"allowed_amount":14650.13,"providers":[{"billed_charge":14650.13,"npi":[1770133456]}]},{"allowed_amount":15713.71,"providers":[{"billed_charge":15960.97,"npi":[1902506306]}]},{"allowed_amount":7638.01,"providers":[{"billed_charge":7666.88,"npi":[1891278487]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"461228277"},"service_code":["11","12","02"],"billing_class":"professional","payments":[{"allowed_amount":6045.28,"providers":[{"billed_charge":7669.74,"npi":[1902506306]}]},{"allowed_amount":705.74,"providers":[{"billed_charge":871.50,"npi":[1902506306]}]},{"allowed_amount":2005.81,"providers":[{"billed_charge":2640.35,"npi":[1770133456]}]},{"allowed_amount":136.76,"providers":[{"billed_charge":180.00,"npi":[1891278487]}]},{"allowed_amount":5428.37,"providers":[{"billed_charge":7070.53,"npi":[1043750904]}]},{"allowed_amount":840.57,"providers":[{"billed_charge":970.37,"npi":[1902506306]}]}]}]},{"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":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1095.16,"providers":[{"billed_charge":2970.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":276.80,"providers":[{"billed_charge":840.00,"npi":[1962940494]}]},{"allowed_amount":650.48,"providers":[{"billed_charge":1995.00,"npi":[1184811747]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.40,"providers":[{"billed_charge":500.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.40,"providers":[{"billed_charge":375.00,"npi":[1861792186]}]},{"allowed_amount":3210.55,"providers":[{"billed_charge":8775.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2688.52,"providers":[{"billed_charge":9480.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":256.73,"providers":[{"billed_charge":840.00,"npi":[1669964243]}]},{"allowed_amount":134.94,"providers":[{"billed_charge":420.00,"npi":[1609678499]}]},{"allowed_amount":1058.76,"providers":[{"billed_charge":3360.00,"npi":[1376352732]}]},{"allowed_amount":1297.50,"providers":[{"billed_charge":4095.00,"npi":[1962062273]}]}]},{"tin":{"type":"ein","value":"571188400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":103.80,"providers":[{"billed_charge":150.00,"npi":[1326219312]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1415.14,"providers":[{"billed_charge":5375.00,"npi":[1730566621]}]}]}]},{"name":"SELF CARE MNGMENT TRAINING","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97535","description":"SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING,","allowed_amounts":[{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":86.55,"providers":[{"billed_charge":276.00,"npi":[1376352732]}]}]}]},{"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":"462479137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":92.58,"providers":[{"billed_charge":150.00,"npi":[1710321005]}]}]},{"tin":{"type":"ein","value":"382133559"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":578.70,"providers":[{"billed_charge":1053.75,"npi":[1851451637]}]}]},{"tin":{"type":"ein","value":"205182636"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.20,"providers":[{"billed_charge":60.00,"npi":[1255447306]}]}]}]},{"name":"CHIROPRACTIC MANJ 5 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98942","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"611507069"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":548.68,"providers":[{"billed_charge":649.00,"npi":[1992845598]}]}]}]},{"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":"923375687"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":112.15,"providers":[{"billed_charge":349.00,"npi":[1366718454]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":448.60,"providers":[{"billed_charge":680.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"842071867"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":190.66,"providers":[{"billed_charge":814.00,"npi":[1780347377]}]},{"allowed_amount":95.33,"providers":[{"billed_charge":407.00,"npi":[1013167162]}]}]},{"tin":{"type":"ein","value":"842580415"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1525.28,"providers":[{"billed_charge":3020.00,"npi":[1275863102]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":8867.68,"providers":[{"billed_charge":19750.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"872673604"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":224.30,"providers":[{"billed_charge":710.00,"npi":[1003987694]}]}]}]},{"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":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":12957.66,"providers":[{"billed_charge":19250.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"821784717"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":114.36,"providers":[{"billed_charge":565.00,"npi":[1891478889]}]}]}]},{"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":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":45.32,"providers":[{"billed_charge":100.00,"npi":[1295227460]}]}]}]},{"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":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":55.79,"providers":[{"billed_charge":60.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":140.24,"providers":[{"billed_charge":400.00,"npi":[1295227460]}]},{"allowed_amount":111.58,"providers":[{"billed_charge":200.00,"npi":[1295227460]}]}]}]},{"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":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":907.90,"providers":[{"billed_charge":990.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":679.14,"providers":[{"billed_charge":2904.00,"npi":[1285231662]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":540.19,"providers":[{"billed_charge":1848.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"842580415"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1821.71,"providers":[{"billed_charge":3895.00,"npi":[1275863102]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":72.79,"providers":[{"billed_charge":141.00,"npi":[1407475494]}]}]},{"tin":{"type":"ein","value":"465695978"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":274.35,"providers":[{"billed_charge":792.00,"npi":[1770312514]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50","10"],"billing_class":"professional","payments":[{"allowed_amount":65.91,"providers":[{"billed_charge":234.69,"npi":[1538212485]}]},{"allowed_amount":453.95,"providers":[{"billed_charge":1173.45,"npi":[1558554998]}]},{"allowed_amount":1271.06,"providers":[{"billed_charge":3285.66,"npi":[1538212485]}]},{"allowed_amount":3268.44,"providers":[{"billed_charge":8448.84,"npi":[1396368734]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":13176.43,"providers":[{"billed_charge":21750.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","02","20"],"billing_class":"professional","payments":[{"allowed_amount":1944.85,"providers":[{"billed_charge":9126.00,"npi":[1669243135]}]},{"allowed_amount":56.02,"providers":[{"billed_charge":365.04,"npi":[1457065930]}]},{"allowed_amount":2577.81,"providers":[{"billed_charge":12046.32,"npi":[1457065930]}]},{"allowed_amount":154.34,"providers":[{"billed_charge":730.08,"npi":[1669243135,1457065930]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1327.49,"providers":[{"billed_charge":4165.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"383593303"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":655.68,"providers":[{"billed_charge":1359.00,"npi":[1669035366]}]}]},{"tin":{"type":"ein","value":"842847032"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":509.53,"providers":[{"billed_charge":700.00,"npi":[1770303083]}]}]},{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1271.06,"providers":[{"billed_charge":1518.30,"npi":[1265503031]}]}]},{"tin":{"type":"ein","value":"464805855"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":635.53,"providers":[{"billed_charge":749.00,"npi":[1780137927]}]}]},{"tin":{"type":"ein","value":"933109432"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":272.37,"providers":[{"billed_charge":817.11,"npi":[1932761467]}]}]},{"tin":{"type":"ein","value":"383251354"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3252.88,"providers":[{"billed_charge":3990.00,"npi":[1093339145]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1003.21,"providers":[{"billed_charge":2362.42,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"386004868"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":181.58,"providers":[{"billed_charge":869.46,"npi":[1538106059]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":617.36,"providers":[{"billed_charge":1488.96,"npi":[1154032670]}]},{"allowed_amount":2006.42,"providers":[{"billed_charge":4839.12,"npi":[1245982909]}]},{"allowed_amount":926.04,"providers":[{"billed_charge":2233.44,"npi":[1629753223]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":913.84,"providers":[{"billed_charge":1150.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":7263.20,"providers":[{"billed_charge":12000.00,"npi":[1295227460]}]},{"allowed_amount":593.19,"providers":[{"billed_charge":1350.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"383584702"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":428.15,"providers":[{"billed_charge":600.00,"npi":[1215021472]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1715.25,"providers":[{"billed_charge":4160.00,"npi":[1447323829]}]},{"allowed_amount":363.16,"providers":[{"billed_charge":640.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"863366964"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":289.34,"providers":[{"billed_charge":670.00,"npi":[1699199125]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1273.04,"providers":[{"billed_charge":1680.00,"npi":[1346693413]}]}]}]},{"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":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1024.32,"providers":[{"billed_charge":1120.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1044.84,"providers":[{"billed_charge":4488.00,"npi":[1952016941,1285231662]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1980.97,"providers":[{"billed_charge":6732.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"382009364"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1445.44,"providers":[{"billed_charge":1816.00,"npi":[1558303958]}]}]},{"tin":{"type":"ein","value":"813667937"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":776.80,"providers":[{"billed_charge":1520.00,"npi":[1538422548]}]},{"allowed_amount":10379.70,"providers":[{"billed_charge":15390.00,"npi":[1538422548]}]}]},{"tin":{"type":"ein","value":"465695978"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1145.93,"providers":[{"billed_charge":3740.00,"npi":[1770312514]}]},{"allowed_amount":345.70,"providers":[{"billed_charge":1122.00,"npi":[1659085033]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":3075.78,"providers":[{"billed_charge":5524.32,"npi":[1558554998]}]},{"allowed_amount":4225.32,"providers":[{"billed_charge":7595.94,"npi":[1396368734]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":15378.90,"providers":[{"billed_charge":24000.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"823482082"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1720.57,"providers":[{"billed_charge":4725.00,"npi":[1871195727]}]}]},{"tin":{"type":"ein","value":"821784717"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":174.14,"providers":[{"billed_charge":748.00,"npi":[1891478889]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":3809.05,"providers":[{"billed_charge":18020.80,"npi":[1669243135]}]},{"allowed_amount":326.49,"providers":[{"billed_charge":1544.64,"npi":[1457065930]}]},{"allowed_amount":108.83,"providers":[{"billed_charge":514.88,"npi":[1669243135]}]}]},{"tin":{"type":"ein","value":"382027689"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":369.00,"providers":[{"billed_charge":896.00,"npi":[1689682551]}]},{"allowed_amount":553.50,"providers":[{"billed_charge":1344.00,"npi":[1548421167]}]}]},{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":2393.66,"providers":[{"billed_charge":6350.00,"npi":[1043507833]}]},{"allowed_amount":1733.34,"providers":[{"billed_charge":4700.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1508.12,"providers":[{"billed_charge":3224.00,"npi":[1942891353]}]},{"allowed_amount":1376.98,"providers":[{"billed_charge":2962.00,"npi":[1629640479]}]},{"allowed_amount":751.08,"providers":[{"billed_charge":1612.00,"npi":[1679117063]}]}]},{"tin":{"type":"ein","value":"472743108"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":613.64,"providers":[{"billed_charge":900.00,"npi":[1114493384]}]}]},{"tin":{"type":"ein","value":"382719621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3072.96,"providers":[{"billed_charge":4272.00,"npi":[1578727335]}]}]},{"tin":{"type":"ein","value":"320415553"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":672.19,"providers":[{"billed_charge":1188.00,"npi":[1366994816]}]}]},{"tin":{"type":"ein","value":"382692114"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2432.76,"providers":[{"billed_charge":3325.00,"npi":[1083807176]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":761.81,"providers":[{"billed_charge":1793.92,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"861531584"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":256.08,"providers":[{"billed_charge":526.00,"npi":[1619545845]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":870.64,"providers":[{"billed_charge":2112.96,"npi":[1154032670]}]},{"allowed_amount":1850.11,"providers":[{"billed_charge":4490.04,"npi":[1629753223]}]},{"allowed_amount":2198.63,"providers":[{"billed_charge":5282.40,"npi":[1245982909]}]}]},{"tin":{"type":"ein","value":"832004627"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1664.52,"providers":[{"billed_charge":2275.00,"npi":[1255772604]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":9989.94,"providers":[{"billed_charge":12870.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2176.68,"providers":[{"billed_charge":3400.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":128.04,"providers":[{"billed_charge":190.00,"npi":[1447323829]}]},{"allowed_amount":97.10,"providers":[{"billed_charge":190.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":3841.20,"providers":[{"billed_charge":4500.00,"npi":[1346693413]}]},{"allowed_amount":1155.18,"providers":[{"billed_charge":1350.00,"npi":[1629459904]}]},{"allowed_amount":97.10,"providers":[{"billed_charge":150.00,"npi":[1346693413]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"462781294"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":366.57,"providers":[{"billed_charge":600.00,"npi":[1093423824]}]}]}]},{"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":"382081222"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":1955.90,"providers":[{"billed_charge":2020.00,"npi":[1972584191]}]},{"allowed_amount":195.59,"providers":[{"billed_charge":202.00,"npi":[1972584191]}]}]}]},{"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":"991552518"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3387.45,"providers":[{"billed_charge":6672.90,"npi":[1306191853]}]}]}]},{"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":"220966774"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":514.64,"providers":[{"billed_charge":595.00,"npi":[1669576906]}]}]},{"tin":{"type":"ein","value":"853978891"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4290.00,"providers":[{"billed_charge":4290.00,"npi":[1417156332]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":786.19,"providers":[{"billed_charge":1207.00,"npi":[1730157173]}]}]},{"tin":{"type":"ein","value":"270723388"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":664.64,"providers":[{"billed_charge":675.00,"npi":[1528321809]}]}]},{"tin":{"type":"ein","value":"843331851"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":588.16,"providers":[{"billed_charge":600.00,"npi":[1871611251]}]}]},{"tin":{"type":"ein","value":"364827394"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":649.78,"providers":[{"billed_charge":1200.00,"npi":[1841955846]}]}]}]},{"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":"453204159"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":578.59,"providers":[{"billed_charge":1887.36,"npi":[1912677048]}]}]},{"tin":{"type":"ein","value":"263366822"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":79.22,"providers":[{"billed_charge":500.00,"npi":[1205932159]}]}]},{"tin":{"type":"ein","value":"382789107"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1090.73,"providers":[{"billed_charge":2016.00,"npi":[1508521105]}]}]},{"tin":{"type":"ein","value":"386173147"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":575.00,"providers":[{"billed_charge":575.00,"npi":[1104104520]}]}]},{"tin":{"type":"ein","value":"451068969"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1800.00,"providers":[{"billed_charge":1800.00,"npi":[1265559488]}]}]},{"tin":{"type":"ein","value":"382262467"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":118.83,"providers":[{"billed_charge":125.00,"npi":[1386657427]}]}]},{"tin":{"type":"ein","value":"680655441"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":630.00,"providers":[{"billed_charge":630.00,"npi":[1003921891]}]}]},{"tin":{"type":"ein","value":"833394001"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2974.99,"providers":[{"billed_charge":8200.00,"npi":[1447554654]}]}]},{"tin":{"type":"ein","value":"382027689"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":376.10,"providers":[{"billed_charge":1140.00,"npi":[1548421167]}]}]},{"tin":{"type":"ein","value":"200760613"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":6535.65,"providers":[{"billed_charge":6600.00,"npi":[1316938061]}]}]},{"tin":{"type":"ein","value":"161634286"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":237.66,"providers":[{"billed_charge":300.00,"npi":[1376616615]}]}]},{"tin":{"type":"ein","value":"743107704"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":100.00,"providers":[{"billed_charge":100.00,"npi":[1588651897]}]}]},{"tin":{"type":"ein","value":"383536668"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":8580.00,"providers":[{"billed_charge":8580.00,"npi":[1184661670]}]}]},{"tin":{"type":"ein","value":"20764814"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":285.21,"providers":[{"billed_charge":285.21,"npi":[1518951672]}]}]},{"tin":{"type":"ein","value":"383481310"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":100.00,"providers":[{"billed_charge":100.00,"npi":[1841272259]}]},{"allowed_amount":1600.00,"providers":[{"billed_charge":1600.00,"npi":[1841272259]}]}]},{"tin":{"type":"ein","value":"464805855"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":872.83,"providers":[{"billed_charge":1243.00,"npi":[1780137927]}]}]},{"tin":{"type":"ein","value":"262719426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":871.42,"providers":[{"billed_charge":1320.00,"npi":[1043237951]}]}]},{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3419.18,"providers":[{"billed_charge":4350.00,"npi":[1255372058]}]}]},{"tin":{"type":"ein","value":"382550047"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":396.10,"providers":[{"billed_charge":625.00,"npi":[1447875976]}]}]},{"tin":{"type":"ein","value":"383614942"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1663.62,"providers":[{"billed_charge":1680.00,"npi":[1770568198]}]}]},{"tin":{"type":"ein","value":"752398395"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4765.92,"providers":[{"billed_charge":5000.00,"npi":[1124029335]}]}]},{"tin":{"type":"ein","value":"853366098"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":356.49,"providers":[{"billed_charge":632.44,"npi":[1629432786]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":475.32,"providers":[{"billed_charge":1368.00,"npi":[1487722914]}]}]},{"tin":{"type":"ein","value":"822784244"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":823.92,"providers":[{"billed_charge":1272.00,"npi":[1679764997]}]}]},{"tin":{"type":"ein","value":"43754400"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1454.01,"providers":[{"billed_charge":2940.00,"npi":[1194103390]}]}]},{"tin":{"type":"ein","value":"990777079"},"service_code":["02","51"],"billing_class":"professional","payments":[{"allowed_amount":95.91,"providers":[{"billed_charge":395.10,"npi":[1386756740]}]},{"allowed_amount":75.22,"providers":[{"billed_charge":395.10,"npi":[1619381316]}]}]},{"tin":{"type":"ein","value":"203232712"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":630.00,"providers":[{"billed_charge":630.00,"npi":[1699874677]}]}]},{"tin":{"type":"ein","value":"375088693"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5390.00,"providers":[{"billed_charge":5390.00,"npi":[1417064502]}]}]},{"tin":{"type":"ein","value":"814043627"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":475.32,"providers":[{"billed_charge":700.00,"npi":[1821239302]}]}]},{"tin":{"type":"ein","value":"823744003"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":189.22,"providers":[{"billed_charge":220.00,"npi":[1740661982]}]}]},{"tin":{"type":"ein","value":"80660230"},"service_code":["51","21"],"billing_class":"professional","payments":[{"allowed_amount":3329.36,"providers":[{"billed_charge":3500.00,"npi":[1972585248]}]},{"allowed_amount":675.49,"providers":[{"billed_charge":1000.00,"npi":[1972585248]}]}]},{"tin":{"type":"ein","value":"834605197"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":316.88,"providers":[{"billed_charge":360.00,"npi":[1730854605]}]}]},{"tin":{"type":"ein","value":"161768956"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":90.00,"npi":[1205834470]}]},{"allowed_amount":799.22,"providers":[{"billed_charge":810.00,"npi":[1205834470]}]}]},{"tin":{"type":"ein","value":"851540000"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":553.85,"providers":[{"billed_charge":1404.00,"npi":[1033745310]}]}]},{"tin":{"type":"ein","value":"991552518"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":237.66,"providers":[{"billed_charge":467.34,"npi":[1306191853]}]},{"allowed_amount":3445.10,"providers":[{"billed_charge":7010.10,"npi":[1306191853]}]}]},{"tin":{"type":"ein","value":"382407635"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1800.00,"providers":[{"billed_charge":1800.00,"npi":[1902970619]}]}]}]},{"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":"383276498"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2469.81,"providers":[{"billed_charge":3285.00,"npi":[1871949925]}]}]},{"tin":{"type":"ein","value":"383189890"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":112.08,"providers":[{"billed_charge":150.00,"npi":[1629503024]}]}]},{"tin":{"type":"ein","value":"382201764"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":352.83,"providers":[{"billed_charge":540.00,"npi":[1831274786]}]}]},{"tin":{"type":"ein","value":"814048754"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":117.61,"providers":[{"billed_charge":195.00,"npi":[1972573061]}]}]},{"tin":{"type":"ein","value":"205326061"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2100.00,"providers":[{"billed_charge":2100.00,"npi":[1912941477]}]}]},{"tin":{"type":"ein","value":"900977152"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":99.97,"providers":[{"billed_charge":400.00,"npi":[1780226613]}]}]},{"tin":{"type":"ein","value":"834368857"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5970.10,"providers":[{"billed_charge":6075.50,"npi":[1689962136]}]}]},{"tin":{"type":"ein","value":"382550047"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5292.45,"providers":[{"billed_charge":8300.00,"npi":[1922673342]}]}]},{"tin":{"type":"ein","value":"991552518"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":176.42,"providers":[{"billed_charge":351.51,"npi":[1306191853]}]},{"allowed_amount":10181.63,"providers":[{"billed_charge":21793.62,"npi":[1306191853]}]}]}]},{"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":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1406.73,"providers":[{"billed_charge":7488.00,"npi":[1619910106]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":863.52,"providers":[{"billed_charge":3948.00,"npi":[1972562171]}]}]}]},{"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":"611442402"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":744.05,"providers":[{"billed_charge":3988.00,"npi":[1952977357]}]}]},{"tin":{"type":"ein","value":"381914446"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":116.43,"providers":[{"billed_charge":717.00,"npi":[1568663185]}]}]},{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":369.58,"providers":[{"billed_charge":1938.00,"npi":[1326089848,1265926018,1437680121,1235716986]}]},{"allowed_amount":1263.11,"providers":[{"billed_charge":6783.00,"npi":[1124327366]}]},{"allowed_amount":184.79,"providers":[{"billed_charge":969.00,"npi":[1255540894,1295964773,1194216101]}]},{"allowed_amount":554.37,"providers":[{"billed_charge":2907.00,"npi":[1346251816,1659505378,1073896346,1740544915]}]},{"allowed_amount":923.95,"providers":[{"billed_charge":4845.00,"npi":[1982991824,1215977343,1578050340,1396235685,1801245618]}]},{"allowed_amount":1108.74,"providers":[{"billed_charge":5814.00,"npi":[1679198972]}]},{"allowed_amount":559.26,"providers":[{"billed_charge":2907.00,"npi":[1275093114]}]},{"allowed_amount":1113.63,"providers":[{"billed_charge":5814.00,"npi":[1447660212]}]},{"allowed_amount":15541.92,"providers":[{"billed_charge":81396.00,"npi":[1619910106]}]},{"allowed_amount":4809.43,"providers":[{"billed_charge":25194.00,"npi":[1124642095]}]},{"allowed_amount":744.05,"providers":[{"billed_charge":3876.00,"npi":[1811348691]}]},{"allowed_amount":3695.80,"providers":[{"billed_charge":19380.00,"npi":[1306056106]}]},{"allowed_amount":3520.79,"providers":[{"billed_charge":18411.00,"npi":[1245646868]}]},{"allowed_amount":739.16,"providers":[{"billed_charge":3876.00,"npi":[1346816774,1518913557]}]},{"allowed_amount":2950.76,"providers":[{"billed_charge":15504.00,"npi":[1710079074]}]},{"allowed_amount":2771.85,"providers":[{"billed_charge":14535.00,"npi":[1669748091]}]},{"allowed_amount":3146.32,"providers":[{"billed_charge":16473.00,"npi":[1164862561]}]},{"allowed_amount":13883.70,"providers":[{"billed_charge":72675.00,"npi":[1255373130]}]},{"allowed_amount":523.95,"providers":[{"billed_charge":2907.00,"npi":[1811334386]}]},{"allowed_amount":3316.08,"providers":[{"billed_charge":17442.00,"npi":[1417306184]}]},{"allowed_amount":1857.68,"providers":[{"billed_charge":9690.00,"npi":[1700824968]}]},{"allowed_amount":174.65,"providers":[{"billed_charge":969.00,"npi":[1669791760]}]},{"allowed_amount":2037.58,"providers":[{"billed_charge":10659.00,"npi":[1407029564]}]},{"allowed_amount":2786.52,"providers":[{"billed_charge":14535.00,"npi":[1699902239]}]},{"allowed_amount":5743.16,"providers":[{"billed_charge":30039.00,"npi":[1497800767]}]},{"allowed_amount":1663.11,"providers":[{"billed_charge":8721.00,"npi":[1033670724]}]},{"allowed_amount":2596.84,"providers":[{"billed_charge":13566.00,"npi":[1588874374]}]},{"allowed_amount":1293.53,"providers":[{"billed_charge":6783.00,"npi":[1740696400,1144516352,1275196669,1215135553]}]},{"allowed_amount":2032.69,"providers":[{"billed_charge":10659.00,"npi":[1245404896]}]},{"allowed_amount":2222.37,"providers":[{"billed_charge":11628.00,"npi":[1568774008]}]},{"allowed_amount":3511.01,"providers":[{"billed_charge":18411.00,"npi":[1487886685]}]},{"allowed_amount":4540.90,"providers":[{"billed_charge":25194.00,"npi":[1326088030]}]},{"allowed_amount":1025.58,"providers":[{"billed_charge":5814.00,"npi":[1386096964]}]},{"allowed_amount":3700.69,"providers":[{"billed_charge":19380.00,"npi":[1619916178]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["23","53"],"billing_class":"professional","payments":[{"allowed_amount":104.71,"providers":[{"billed_charge":401.00,"npi":[1164052395]}]},{"allowed_amount":440.58,"providers":[{"billed_charge":1604.00,"npi":[1619419553]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3575.77,"providers":[{"billed_charge":18183.00,"npi":[1306883541]}]},{"allowed_amount":369.58,"providers":[{"billed_charge":1254.00,"npi":[1366688442]}]},{"allowed_amount":4081.57,"providers":[{"billed_charge":20691.00,"npi":[1093378507]}]},{"allowed_amount":862.33,"providers":[{"billed_charge":4389.00,"npi":[1689849002,1811330467]}]},{"allowed_amount":985.52,"providers":[{"billed_charge":5016.00,"npi":[1700827490]}]},{"allowed_amount":3822.15,"providers":[{"billed_charge":19437.00,"npi":[1245209410]}]},{"allowed_amount":1355.09,"providers":[{"billed_charge":6897.00,"npi":[1528379997]}]},{"allowed_amount":1108.71,"providers":[{"billed_charge":5643.00,"npi":[1063783181]}]},{"allowed_amount":3329.39,"providers":[{"billed_charge":16929.00,"npi":[1154553964]}]},{"allowed_amount":4434.84,"providers":[{"billed_charge":22572.00,"npi":[1427255835]}]},{"allowed_amount":123.19,"providers":[{"billed_charge":627.00,"npi":[1083827612,1790359792,1619997160,1720547045,1710948914,1497714265]}]},{"allowed_amount":3585.55,"providers":[{"billed_charge":18183.00,"npi":[1063767457]}]},{"allowed_amount":2222.37,"providers":[{"billed_charge":7524.00,"npi":[1679829667]}]},{"allowed_amount":3326.22,"providers":[{"billed_charge":11286.00,"npi":[1003875287]}]},{"allowed_amount":2590.25,"providers":[{"billed_charge":13167.00,"npi":[1023373503]}]},{"allowed_amount":492.76,"providers":[{"billed_charge":2508.00,"npi":[1558894378,1922462183]}]},{"allowed_amount":2467.06,"providers":[{"billed_charge":12540.00,"npi":[1588985923,1083633887]}]},{"allowed_amount":1601.47,"providers":[{"billed_charge":8151.00,"npi":[1598040677,1740592294]}]},{"allowed_amount":2347.13,"providers":[{"billed_charge":11913.00,"npi":[1245686831]}]},{"allowed_amount":6775.45,"providers":[{"billed_charge":34485.00,"npi":[1972562171]}]},{"allowed_amount":1727.92,"providers":[{"billed_charge":8778.00,"npi":[1508204587]}]},{"allowed_amount":2217.48,"providers":[{"billed_charge":7524.00,"npi":[1104863349]}]},{"allowed_amount":2340.61,"providers":[{"billed_charge":11913.00,"npi":[1922628676]}]}]},{"tin":{"type":"ein","value":"811230538"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":184.79,"providers":[{"billed_charge":816.00,"npi":[1407066095]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":5063.74,"providers":[{"billed_charge":12540.00,"npi":[1598028003]}]},{"allowed_amount":920.68,"providers":[{"billed_charge":2280.00,"npi":[1114330974]}]},{"allowed_amount":6905.10,"providers":[{"billed_charge":17100.00,"npi":[1104137025]}]},{"allowed_amount":4143.06,"providers":[{"billed_charge":10260.00,"npi":[1396819900]}]}]},{"tin":{"type":"ein","value":"843515632"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3322.97,"providers":[{"billed_charge":29099.00,"npi":[1134185051]}]},{"allowed_amount":1397.20,"providers":[{"billed_charge":12272.00,"npi":[1700883204]}]},{"allowed_amount":174.65,"providers":[{"billed_charge":1534.00,"npi":[1518587591]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":10442.79,"providers":[{"billed_charge":50509.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"382988086"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8874.81,"providers":[{"billed_charge":21408.00,"npi":[1861873390]}]},{"allowed_amount":7795.41,"providers":[{"billed_charge":18732.00,"npi":[1487183984]}]},{"allowed_amount":2052.25,"providers":[{"billed_charge":4906.00,"npi":[1497923221]}]},{"allowed_amount":6102.96,"providers":[{"billed_charge":14718.00,"npi":[1588289003]}]},{"allowed_amount":5927.95,"providers":[{"billed_charge":14272.00,"npi":[1861832552]}]},{"allowed_amount":184.79,"providers":[{"billed_charge":446.00,"npi":[1053524017]}]},{"allowed_amount":2956.64,"providers":[{"billed_charge":7136.00,"npi":[1356733489]}]},{"allowed_amount":9434.07,"providers":[{"billed_charge":22746.00,"npi":[1730292343]}]}]},{"tin":{"type":"ein","value":"873710985"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1113.63,"providers":[{"billed_charge":7464.00,"npi":[1508313313]}]},{"allowed_amount":739.16,"providers":[{"billed_charge":4976.00,"npi":[1609823921]}]},{"allowed_amount":2037.58,"providers":[{"billed_charge":13684.00,"npi":[1619048329]}]},{"allowed_amount":184.79,"providers":[{"billed_charge":1244.00,"npi":[1336458249]}]},{"allowed_amount":554.37,"providers":[{"billed_charge":3732.00,"npi":[1013964337]}]},{"allowed_amount":2371.85,"providers":[{"billed_charge":16172.00,"npi":[1467554949]}]},{"allowed_amount":2416.94,"providers":[{"billed_charge":16172.00,"npi":[1114986734]}]}]}]},{"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":"611442402"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1341.55,"providers":[{"billed_charge":7355.00,"npi":[1225234354]}]}]},{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":4227.00,"npi":[1841811072,1255373130,1215558317,1790700292]}]},{"allowed_amount":506.94,"providers":[{"billed_charge":2818.00,"npi":[1962468090,1467434357]}]},{"allowed_amount":1341.55,"providers":[{"billed_charge":7045.00,"npi":[1124642095]}]},{"allowed_amount":2916.89,"providers":[{"billed_charge":15499.00,"npi":[1710079074]}]},{"allowed_amount":2421.24,"providers":[{"billed_charge":12681.00,"npi":[1033796297,1578121703,1346538766]}]},{"allowed_amount":4292.96,"providers":[{"billed_charge":22544.00,"npi":[1306056106]}]},{"allowed_amount":1609.86,"providers":[{"billed_charge":8454.00,"npi":[1124327366,1346251816,1154618254,1669748091]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":2818.00,"npi":[1659505378,1770740946]}]},{"allowed_amount":2564.38,"providers":[{"billed_charge":14090.00,"npi":[1811334386]}]},{"allowed_amount":1891.07,"providers":[{"billed_charge":9863.00,"npi":[1982991824]}]},{"allowed_amount":1878.17,"providers":[{"billed_charge":9863.00,"npi":[1255540894,1568774008]}]},{"allowed_amount":1073.24,"providers":[{"billed_charge":5636.00,"npi":[1407029564]}]},{"allowed_amount":2600.75,"providers":[{"billed_charge":14090.00,"npi":[1184245383]}]},{"allowed_amount":1354.45,"providers":[{"billed_charge":7045.00,"npi":[1235579467]}]},{"allowed_amount":3756.34,"providers":[{"billed_charge":19726.00,"npi":[1417306184,1992325542]}]},{"allowed_amount":3226.17,"providers":[{"billed_charge":16908.00,"npi":[1801245618]}]},{"allowed_amount":7532.03,"providers":[{"billed_charge":39452.00,"npi":[1619916178]}]},{"allowed_amount":3219.72,"providers":[{"billed_charge":16908.00,"npi":[1619910106]}]},{"allowed_amount":2281.23,"providers":[{"billed_charge":12681.00,"npi":[1407177884]}]},{"allowed_amount":543.07,"providers":[{"billed_charge":2818.00,"npi":[1992123715]}]},{"allowed_amount":2683.10,"providers":[{"billed_charge":14090.00,"npi":[1245404896,1740544915]}]},{"allowed_amount":5902.82,"providers":[{"billed_charge":30998.00,"npi":[1487886685]}]},{"allowed_amount":1348.00,"providers":[{"billed_charge":7045.00,"npi":[1275196669]}]},{"allowed_amount":3548.58,"providers":[{"billed_charge":19726.00,"npi":[1598250946]}]},{"allowed_amount":760.41,"providers":[{"billed_charge":4227.00,"npi":[1588015879,1982832861]}]},{"allowed_amount":4799.90,"providers":[{"billed_charge":25362.00,"npi":[1396235685]}]},{"allowed_amount":253.47,"providers":[{"billed_charge":1409.00,"npi":[1043621931,1487866976]}]},{"allowed_amount":2414.79,"providers":[{"billed_charge":12681.00,"npi":[1144631292,1215135553]}]},{"allowed_amount":4842.48,"providers":[{"billed_charge":25362.00,"npi":[1215977343]}]},{"allowed_amount":3762.79,"providers":[{"billed_charge":19726.00,"npi":[1346816774,1740696400,1588874374]}]},{"allowed_amount":1262.51,"providers":[{"billed_charge":7045.00,"npi":[1669791760]}]},{"allowed_amount":3488.03,"providers":[{"billed_charge":18317.00,"npi":[1700824968]}]},{"allowed_amount":3149.30,"providers":[{"billed_charge":16908.00,"npi":[1679198972]}]},{"allowed_amount":5366.20,"providers":[{"billed_charge":28180.00,"npi":[1144516352]}]},{"allowed_amount":9946.82,"providers":[{"billed_charge":52133.00,"npi":[1497800767]}]},{"allowed_amount":248.63,"providers":[{"billed_charge":1409.00,"npi":[1184151631]}]},{"allowed_amount":268.31,"providers":[{"billed_charge":1409.00,"npi":[1194216101,1922362185,1326616863,1447660212]}]},{"allowed_amount":6439.44,"providers":[{"billed_charge":33816.00,"npi":[1073896346]}]}]},{"tin":{"type":"ein","value":"844478409"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":253.47,"providers":[{"billed_charge":844.00,"npi":[1104127760]}]},{"allowed_amount":195.95,"providers":[{"billed_charge":844.00,"npi":[1316443054]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3577.40,"providers":[{"billed_charge":18440.00,"npi":[1700827490]}]},{"allowed_amount":178.87,"providers":[{"billed_charge":922.00,"npi":[1427255835]}]},{"allowed_amount":2146.44,"providers":[{"billed_charge":11064.00,"npi":[1972562171]}]},{"allowed_amount":2150.74,"providers":[{"billed_charge":11064.00,"npi":[1093378507]}]},{"allowed_amount":2504.18,"providers":[{"billed_charge":12908.00,"npi":[1811330467]}]},{"allowed_amount":1073.22,"providers":[{"billed_charge":5532.00,"npi":[1558894378]}]},{"allowed_amount":1609.83,"providers":[{"billed_charge":8298.00,"npi":[1528379997]}]},{"allowed_amount":1967.57,"providers":[{"billed_charge":10142.00,"npi":[1598040677]}]},{"allowed_amount":1788.70,"providers":[{"billed_charge":9220.00,"npi":[1063783181,1154553964]}]},{"allowed_amount":715.48,"providers":[{"billed_charge":3688.00,"npi":[1740592294]}]},{"allowed_amount":1077.52,"providers":[{"billed_charge":5532.00,"npi":[1245686831,1790359792]}]},{"allowed_amount":894.35,"providers":[{"billed_charge":4610.00,"npi":[1063767457,1720510209]}]},{"allowed_amount":1430.96,"providers":[{"billed_charge":7376.00,"npi":[1023373503]}]},{"allowed_amount":1793.00,"providers":[{"billed_charge":9220.00,"npi":[1427444843]}]},{"allowed_amount":357.74,"providers":[{"billed_charge":1844.00,"npi":[1689849002,1083827612,1245209410,1508204587]}]}]},{"tin":{"type":"ein","value":"811230538"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":3606.00,"npi":[1376807784]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":2404.00,"npi":[1154761245]}]},{"allowed_amount":3219.72,"providers":[{"billed_charge":14424.00,"npi":[1407066095]}]}]},{"tin":{"type":"ein","value":"382962430"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":536.61,"providers":[{"billed_charge":4764.00,"npi":[1841827599]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":12141.00,"providers":[{"billed_charge":30096.00,"npi":[1114330974,1598028003]}]},{"allowed_amount":16862.50,"providers":[{"billed_charge":41800.00,"npi":[1104137025]}]},{"allowed_amount":8768.50,"providers":[{"billed_charge":21736.00,"npi":[1750901443]}]},{"allowed_amount":10792.00,"providers":[{"billed_charge":26752.00,"npi":[1396819900]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":9016.72,"providers":[{"billed_charge":45178.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"382988086"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":506.94,"providers":[{"billed_charge":1368.00,"npi":[1407080286]}]},{"allowed_amount":1348.00,"providers":[{"billed_charge":3420.00,"npi":[1487183984]}]}]},{"tin":{"type":"ein","value":"873710985"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":5406.00,"npi":[1467554949]}]},{"allowed_amount":506.94,"providers":[{"billed_charge":3604.00,"npi":[1255521423,1437500949]}]},{"allowed_amount":811.38,"providers":[{"billed_charge":5406.00,"npi":[1336458249]}]},{"allowed_amount":2702.45,"providers":[{"billed_charge":18020.00,"npi":[1245218734]}]},{"allowed_amount":2683.10,"providers":[{"billed_charge":18020.00,"npi":[1609823921]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":3604.00,"npi":[1114986734]}]},{"allowed_amount":1878.17,"providers":[{"billed_charge":12614.00,"npi":[1821451642]}]}]}]},{"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":"383433632"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2593.02,"providers":[{"billed_charge":5400.00,"npi":[1134575798]}]}]}]},{"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":"272480925"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1764.22,"providers":[{"billed_charge":3120.00,"npi":[1790940526]}]}]},{"tin":{"type":"ein","value":"454894232"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":62.40,"providers":[{"billed_charge":200.00,"npi":[1437207271]}]}]},{"tin":{"type":"ein","value":"874406123"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":436.80,"providers":[{"billed_charge":875.00,"npi":[1851855845]}]}]},{"tin":{"type":"ein","value":"834368857"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1276.06,"providers":[{"billed_charge":2450.00,"npi":[1033803127]}]},{"allowed_amount":787.87,"providers":[{"billed_charge":1430.00,"npi":[1033803127]}]}]}]},{"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":"205326061"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":536.93,"providers":[{"billed_charge":725.00,"npi":[1912941477]}]}]}]},{"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":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1043.73,"providers":[{"billed_charge":2214.00,"npi":[1649520784]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":673.53,"providers":[{"billed_charge":1650.00,"npi":[1558354159]}]},{"allowed_amount":81.64,"providers":[{"billed_charge":200.00,"npi":[1982697454]}]}]}]},{"name":"CHRON CARE MGMT SRVC 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99490","description":"CHRONIC CARE MANAGEMENT SERVICES, AT LEAST 20 MINUTES OF CLINICAL STAFF TIME DIRECTED BY A PHYSICIAN","allowed_amounts":[{"tin":{"type":"ein","value":"271484025"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2623.18,"providers":[{"billed_charge":3895.00,"npi":[1548211592]}]}]}]},{"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":"20753921"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3526.85,"providers":[{"billed_charge":4649.15,"npi":[1215982749]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":111734.01,"providers":[{"billed_charge":163062.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382415274"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":51.81,"providers":[{"billed_charge":160.95,"npi":[1528071115]}]}]},{"tin":{"type":"ein","value":"386004653"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27.72,"providers":[{"billed_charge":37.50,"npi":[1386670933]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2819.83,"providers":[{"billed_charge":3296.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386004676"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1589.46,"providers":[{"billed_charge":1740.00,"npi":[1487722682]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3409.86,"providers":[{"billed_charge":3717.00,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":95675.18,"providers":[{"billed_charge":249746.85,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"386008155"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2250.99,"providers":[{"billed_charge":2873.50,"npi":[1669416947]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22632.64,"providers":[{"billed_charge":40261.50,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3713.45,"providers":[{"billed_charge":7375.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26900.39,"providers":[{"billed_charge":35424.90,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"386006334"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54.90,"providers":[{"billed_charge":72.60,"npi":[1538568902]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":541.35,"providers":[{"billed_charge":1719.50,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15563.22,"providers":[{"billed_charge":17858.94,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30339.22,"providers":[{"billed_charge":91236.80,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"386031668"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":817.36,"providers":[{"billed_charge":854.00,"npi":[1730119504]}]}]},{"tin":{"type":"ein","value":"381712300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":739.91,"providers":[{"billed_charge":905.85,"npi":[1811010416]}]}]},{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":52845.60,"providers":[{"billed_charge":118471.85,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2499.87,"providers":[{"billed_charge":3244.50,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"386006926"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":168.90,"providers":[{"billed_charge":552.50,"npi":[1790724656]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2631.57,"providers":[{"billed_charge":2886.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16396.38,"providers":[{"billed_charge":21614.61,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4789.88,"providers":[{"billed_charge":9359.40,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9203.76,"providers":[{"billed_charge":15370.93,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11234.34,"providers":[{"billed_charge":11241.45,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"386004685"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":137.26,"providers":[{"billed_charge":140.00,"npi":[1104864271]}]}]},{"tin":{"type":"ein","value":"382285796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2470.52,"providers":[{"billed_charge":4410.00,"npi":[1689621047]}]}]},{"tin":{"type":"ein","value":"382094795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":507.84,"providers":[{"billed_charge":1248.72,"npi":[1780688721]}]}]},{"tin":{"type":"ein","value":"386006902"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54.27,"providers":[{"billed_charge":76.00,"npi":[1740221688]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12211.42,"providers":[{"billed_charge":16100.50,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386006306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1797.08,"providers":[{"billed_charge":2475.70,"npi":[1982644241]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13073.48,"providers":[{"billed_charge":20803.20,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"381869375"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1710.05,"providers":[{"billed_charge":1948.80,"npi":[1669618989]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11566.33,"providers":[{"billed_charge":15124.60,"npi":[1699863704]}]}]}]},{"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":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11146.50,"providers":[{"billed_charge":26400.00,"npi":[1124056296]}]}]}]},{"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":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":59900.40,"providers":[{"billed_charge":175300.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":803.04,"providers":[{"billed_charge":850.00,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"20753921"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6083.76,"providers":[{"billed_charge":8496.00,"npi":[1215982749]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":303128.34,"providers":[{"billed_charge":567000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16791.65,"providers":[{"billed_charge":17850.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":57745.17,"providers":[{"billed_charge":80935.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2312.26,"providers":[{"billed_charge":7082.60,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9868.29,"providers":[{"billed_charge":13110.20,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18371.53,"providers":[{"billed_charge":18400.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":60648.47,"providers":[{"billed_charge":146160.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21293.16,"providers":[{"billed_charge":31556.00,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386008155"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1600.00,"providers":[{"billed_charge":1600.00,"npi":[1669416947]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":193319.16,"providers":[{"billed_charge":242923.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10725.56,"providers":[{"billed_charge":11200.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10383.06,"providers":[{"billed_charge":26650.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42470.11,"providers":[{"billed_charge":56082.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":73747.77,"providers":[{"billed_charge":79055.00,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":125161.32,"providers":[{"billed_charge":359874.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"381869375"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6575.00,"providers":[{"billed_charge":6575.00,"npi":[1669618989]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21663.26,"providers":[{"billed_charge":26950.00,"npi":[1699863704]}]}]}]},{"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":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":119406.32,"providers":[{"billed_charge":198100.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1267.98,"providers":[{"billed_charge":2556.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2535.96,"providers":[{"billed_charge":15033.60,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":118930.86,"providers":[{"billed_charge":502930.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3794.04,"providers":[{"billed_charge":7600.00,"npi":[1699863704]}]}]}]},{"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":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":558897.01,"providers":[{"billed_charge":1055845.50,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20271.64,"providers":[{"billed_charge":22500.00,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"386006926"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1208.30,"providers":[{"billed_charge":3675.00,"npi":[1790724656]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42516.39,"providers":[{"billed_charge":59850.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5410.00,"providers":[{"billed_charge":5600.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3829.84,"providers":[{"billed_charge":5544.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1896.25,"providers":[{"billed_charge":3984.80,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":37143.20,"providers":[{"billed_charge":55511.54,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":99450.00,"providers":[{"billed_charge":99450.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31900.00,"providers":[{"billed_charge":31900.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386004676"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15500.00,"providers":[{"billed_charge":15500.00,"npi":[1487722682]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39600.00,"providers":[{"billed_charge":39600.00,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":150855.30,"providers":[{"billed_charge":199240.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":640.40,"providers":[{"billed_charge":995.00,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386006306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9467.50,"providers":[{"billed_charge":10500.00,"npi":[1982644241]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26467.32,"providers":[{"billed_charge":27675.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26326.17,"providers":[{"billed_charge":61050.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":716.64,"providers":[{"billed_charge":1830.00,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14845.78,"providers":[{"billed_charge":20240.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":229602.34,"providers":[{"billed_charge":667150.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"386031668"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2455.00,"providers":[{"billed_charge":2455.00,"npi":[1730119504]}]}]},{"tin":{"type":"ein","value":"381712300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3250.00,"providers":[{"billed_charge":3250.00,"npi":[1811010416]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38435.23,"providers":[{"billed_charge":48100.00,"npi":[1699863704]}]}]}]},{"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":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5494.56,"providers":[{"billed_charge":10000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22292.10,"providers":[{"billed_charge":125750.00,"npi":[1720046188]}]}]}]},{"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":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":44800.00,"providers":[{"billed_charge":112000.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":666.00,"providers":[{"billed_charge":1665.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1620.00,"providers":[{"billed_charge":4050.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2840.00,"providers":[{"billed_charge":7100.00,"npi":[1720046188]}]}]}]},{"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":1406.58,"providers":[{"billed_charge":7650.00,"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":2059.20,"providers":[{"billed_charge":6864.00,"npi":[1003462581]}]}]}]},{"name":"GLOVES NON-STERILE PER 100","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4927","description":"GLOVES, NONSTERILE, PER 100","allowed_amounts":[{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.48,"providers":[{"billed_charge":40.00,"npi":[1174969877]}]}]}]},{"name":"BREAST PUMP ELECTRIC ANY TYP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0603","description":"BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"464408166"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":75.03,"providers":[{"billed_charge":400.00,"npi":[1003462581]}]}]}]},{"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":"382009364"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1650.00,"providers":[{"billed_charge":4125.00,"npi":[1558303958]}]}]}]},{"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":"382027689"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":182.86,"providers":[{"billed_charge":300.00,"npi":[1689682551]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.92,"providers":[{"billed_charge":100.00,"npi":[1346693413]}]}]}]},{"name":"PROLNG OF/OP E&M BYND RT;EA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2212","description":"PROLONG OFC/OP E&M BYND REQ TIME; EA ADD 15 M","allowed_amounts":[{"tin":{"type":"ein","value":"462781294"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":173.54,"providers":[{"billed_charge":400.00,"npi":[1093423824]}]}]}]},{"name":"COORD CARE FEE PHYS OVRSIGHT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G9008","description":"COORDINATED CARE FEE, PHYSICIAN COORDINATED CARE OVERSIGHT SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":496.80,"providers":[{"billed_charge":1242.00,"npi":[1265503031]}]}]}]},{"name":"INJ CEFTRIAXONE SODM PER 250","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0696","description":"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":0.90,"providers":[{"billed_charge":60.00,"npi":[1114330974]}]}]}]},{"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":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2.74,"providers":[{"billed_charge":840.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":0.18,"providers":[{"billed_charge":2.88,"npi":[1669243135]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":57.22,"providers":[{"billed_charge":4950.00,"npi":[1114330974]}]}]}]},{"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":2294.10,"providers":[{"billed_charge":3685.44,"npi":[1234567893]}]}]}]}]}