{"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":"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":"470379836"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":165282.48,"providers":[{"billed_charge":87922.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":645946.88,"providers":[{"billed_charge":168596.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":150694.50,"providers":[{"billed_charge":50783.00,"npi":[1912085184]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":203563.60,"providers":[{"billed_charge":209326.00,"npi":[1396969499]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":585891.93,"providers":[{"billed_charge":223328.00,"npi":[1508941097]}]}]}]},{"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":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":559834.24,"providers":[{"billed_charge":215516.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":112494.92,"providers":[{"billed_charge":52626.00,"npi":[1912085184]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":305.34,"providers":[{"billed_charge":642.50,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":306.85,"providers":[{"billed_charge":1022.70,"npi":[1962594622]}]},{"allowed_amount":9503.92,"providers":[{"billed_charge":26112.65,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28.39,"providers":[{"billed_charge":11230.45,"npi":[1508941097]}]},{"allowed_amount":378.19,"providers":[{"billed_charge":1260.70,"npi":[1265517759]}]},{"allowed_amount":127.90,"providers":[{"billed_charge":580277.65,"npi":[1508941097]}]},{"allowed_amount":2009.92,"providers":[{"billed_charge":25754.50,"npi":[1265517759]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1246.68,"providers":[{"billed_charge":182822.95,"npi":[1912085184]}]}]}]},{"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":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6553.56,"providers":[{"billed_charge":17863.45,"npi":[1962594622]}]},{"allowed_amount":2106.24,"providers":[{"billed_charge":5787.20,"npi":[1962594622]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23.56,"providers":[{"billed_charge":64.72,"npi":[1962594622]}]},{"allowed_amount":1383.45,"providers":[{"billed_charge":4085.47,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470399853"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1737.41,"providers":[{"billed_charge":3126.00,"npi":[1568547032]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2736.15,"providers":[{"billed_charge":283642.00,"npi":[1336155738]}]},{"allowed_amount":690.88,"providers":[{"billed_charge":1648.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":357.00,"providers":[{"billed_charge":357.00,"npi":[1396969499]}]},{"allowed_amount":13685.51,"providers":[{"billed_charge":57941.00,"npi":[1265517759]}]},{"allowed_amount":18043.93,"providers":[{"billed_charge":86689.00,"npi":[1265517759]}]},{"allowed_amount":860.97,"providers":[{"billed_charge":3568.60,"npi":[1508941097]}]},{"allowed_amount":9758.73,"providers":[{"billed_charge":661416.23,"npi":[1508941097]}]},{"allowed_amount":1077.27,"providers":[{"billed_charge":1175865.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1681.57,"providers":[{"billed_charge":80229.00,"npi":[1982675955]}]},{"allowed_amount":109.44,"providers":[{"billed_charge":343.03,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":235.12,"providers":[{"billed_charge":510681.50,"npi":[1912085184]}]},{"allowed_amount":3368.72,"providers":[{"billed_charge":387165.00,"npi":[1912085184]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":26.97,"providers":[{"billed_charge":29.00,"npi":[1093802688]}]},{"allowed_amount":167.40,"providers":[{"billed_charge":180.00,"npi":[1093802688]}]},{"allowed_amount":566.37,"providers":[{"billed_charge":609.00,"npi":[1093802688]}]}]},{"tin":{"type":"ein","value":"630997281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71.32,"providers":[{"billed_charge":647.00,"npi":[1780648352]}]}]},{"tin":{"type":"ein","value":"470443636"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9795.38,"providers":[{"billed_charge":20609.00,"npi":[1528016995]}]},{"allowed_amount":396.68,"providers":[{"billed_charge":834.64,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":645.12,"providers":[{"billed_charge":92608.00,"npi":[1215006101]}]},{"allowed_amount":1680.71,"providers":[{"billed_charge":158576.00,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"440577118"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2119.76,"providers":[{"billed_charge":4532.72,"npi":[1093740128]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5006.58,"providers":[{"billed_charge":134091.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"362604009"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1113.97,"providers":[{"billed_charge":3895.00,"npi":[1588713440]}]},{"allowed_amount":2810.81,"providers":[{"billed_charge":6056.00,"npi":[1588713440]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2606.06,"providers":[{"billed_charge":5415.53,"npi":[1962594622]}]},{"allowed_amount":3899.92,"providers":[{"billed_charge":10714.81,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4929.00,"providers":[{"billed_charge":5300.00,"npi":[1093802688]}]},{"allowed_amount":2192.01,"providers":[{"billed_charge":2357.00,"npi":[1093802688]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":671.19,"providers":[{"billed_charge":1844.44,"npi":[1962594622]}]},{"allowed_amount":621.92,"providers":[{"billed_charge":1460.50,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":736.56,"providers":[{"billed_charge":792.00,"npi":[1093802688]}]},{"allowed_amount":230.64,"providers":[{"billed_charge":248.00,"npi":[1093802688]}]}]}]},{"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":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":445.96,"providers":[{"billed_charge":2492.00,"npi":[1215006101]}]},{"allowed_amount":3448.04,"providers":[{"billed_charge":20520.00,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1996.57,"providers":[{"billed_charge":20818.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3551.52,"providers":[{"billed_charge":43124.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22987.28,"providers":[{"billed_charge":123600.00,"npi":[1508941097]}]},{"allowed_amount":383.20,"providers":[{"billed_charge":3790.00,"npi":[1265517759]}]},{"allowed_amount":2449.74,"providers":[{"billed_charge":3657.00,"npi":[1265517759]}]},{"allowed_amount":167.58,"providers":[{"billed_charge":79586.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2044.63,"providers":[{"billed_charge":18483.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4250.85,"providers":[{"billed_charge":46539.00,"npi":[1912085184]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6906.02,"providers":[{"billed_charge":23287.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":50229.97,"providers":[{"billed_charge":48805.00,"npi":[1508941097]}]}]}]},{"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":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":660.09,"providers":[{"billed_charge":7505.00,"npi":[1649355132]}]},{"allowed_amount":382.97,"providers":[{"billed_charge":1604.00,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2481.06,"providers":[{"billed_charge":28575.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4438.69,"providers":[{"billed_charge":53002.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26437.92,"providers":[{"billed_charge":154406.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":519.21,"providers":[{"billed_charge":5449.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4539.30,"providers":[{"billed_charge":67031.00,"npi":[1912085184]}]},{"allowed_amount":381.75,"providers":[{"billed_charge":20060.00,"npi":[1912085184]}]},{"allowed_amount":424.05,"providers":[{"billed_charge":2594.00,"npi":[1912085184]}]}]}]},{"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":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5060.08,"providers":[{"billed_charge":70015.00,"npi":[1649355132]}]},{"allowed_amount":4455.82,"providers":[{"billed_charge":50051.00,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9975.58,"providers":[{"billed_charge":127357.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8962.60,"providers":[{"billed_charge":171253.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2506.32,"providers":[{"billed_charge":7292.00,"npi":[1265517759]}]},{"allowed_amount":1087.80,"providers":[{"billed_charge":259757.00,"npi":[1508941097]}]},{"allowed_amount":1424.87,"providers":[{"billed_charge":16710.00,"npi":[1508941097]}]},{"allowed_amount":50801.94,"providers":[{"billed_charge":581897.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5297.71,"providers":[{"billed_charge":70419.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2102.48,"providers":[{"billed_charge":94850.00,"npi":[1912085184]}]},{"allowed_amount":11081.19,"providers":[{"billed_charge":175325.00,"npi":[1912085184]}]},{"allowed_amount":348.04,"providers":[{"billed_charge":4440.00,"npi":[1912085184]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3497.00,"providers":[{"billed_charge":3497.00,"npi":[1710176367]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.10,"providers":[{"billed_charge":20.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":89.98,"providers":[{"billed_charge":175.00,"npi":[1699115394]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":307.90,"providers":[{"billed_charge":7192.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2976.80,"providers":[{"billed_charge":28717.00,"npi":[1508941097]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":52.92,"providers":[{"billed_charge":243773.00,"npi":[1508941097]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":130.68,"providers":[{"billed_charge":338.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":51.94,"providers":[{"billed_charge":8974.00,"npi":[1508941097]}]},{"allowed_amount":163.14,"providers":[{"billed_charge":212.00,"npi":[1508941097]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":191.82,"providers":[{"billed_charge":364.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":168.40,"providers":[{"billed_charge":219.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.59,"providers":[{"billed_charge":219.00,"npi":[1912085184]}]}]}]},{"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":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18341.79,"providers":[{"billed_charge":38590.00,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":67772.61,"providers":[{"billed_charge":200947.00,"npi":[1215006101]}]},{"allowed_amount":91852.63,"providers":[{"billed_charge":352460.00,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60205.48,"providers":[{"billed_charge":227608.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":887.30,"providers":[{"billed_charge":2437.62,"npi":[1962594622]}]},{"allowed_amount":12491.86,"providers":[{"billed_charge":26677.96,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":138287.58,"providers":[{"billed_charge":409797.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":69240.19,"providers":[{"billed_charge":131874.00,"npi":[1265517759]}]},{"allowed_amount":569736.10,"providers":[{"billed_charge":1717516.00,"npi":[1508941097]}]},{"allowed_amount":2007.72,"providers":[{"billed_charge":370891.00,"npi":[1508941097]}]},{"allowed_amount":8823.86,"providers":[{"billed_charge":30131.00,"npi":[1265517759]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":109744.14,"providers":[{"billed_charge":320600.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":189582.91,"providers":[{"billed_charge":934437.00,"npi":[1912085184]}]},{"allowed_amount":1248.16,"providers":[{"billed_charge":203184.00,"npi":[1912085184]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":151.01,"providers":[{"billed_charge":5004.00,"npi":[1336155738]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379755"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10883.26,"providers":[{"billed_charge":43641.00,"npi":[1336184019]}]}]}]},{"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":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2881.61,"providers":[{"billed_charge":6162.50,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5519.48,"providers":[{"billed_charge":41773.65,"npi":[1649355132]}]},{"allowed_amount":30.05,"providers":[{"billed_charge":19835.50,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":138.78,"providers":[{"billed_charge":31587.10,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1636.18,"providers":[{"billed_charge":5453.65,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.60,"providers":[{"billed_charge":66554.30,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23379.07,"providers":[{"billed_charge":187382.86,"npi":[1508941097]}]},{"allowed_amount":1491.33,"providers":[{"billed_charge":4848.30,"npi":[1265517759]}]},{"allowed_amount":3436.89,"providers":[{"billed_charge":11418.00,"npi":[1265517759]}]},{"allowed_amount":125.69,"providers":[{"billed_charge":79976.28,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":221.66,"providers":[{"billed_charge":31464.85,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":368.13,"providers":[{"billed_charge":40324.05,"npi":[1912085184]}]},{"allowed_amount":59.10,"providers":[{"billed_charge":71939.05,"npi":[1912085184]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":56.73,"providers":[{"billed_charge":61.00,"npi":[1093802688]}]}]}]},{"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":"470385129"},"service_code":["11","23","21"],"billing_class":"professional","payments":[{"allowed_amount":31.48,"providers":[{"billed_charge":71.49,"npi":[1396974069]}]},{"allowed_amount":24.00,"providers":[{"billed_charge":47.66,"npi":[1396974069]}]},{"allowed_amount":43.32,"providers":[{"billed_charge":95.32,"npi":[1396974069]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":22.34,"providers":[{"billed_charge":44.00,"npi":[1598116360]}]},{"allowed_amount":60.80,"providers":[{"billed_charge":110.00,"npi":[1598116360]}]},{"allowed_amount":86.40,"providers":[{"billed_charge":132.00,"npi":[1598116360]}]}]}]},{"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":"470385129"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":14.39,"providers":[{"billed_charge":28.57,"npi":[1396974069]}]}]}]},{"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":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":895.44,"providers":[{"billed_charge":2285.00,"npi":[1265517759]}]},{"allowed_amount":242.07,"providers":[{"billed_charge":66265.00,"npi":[1508941097]}]},{"allowed_amount":870.13,"providers":[{"billed_charge":3656.00,"npi":[1265517759]}]},{"allowed_amount":111.97,"providers":[{"billed_charge":54383.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":134.12,"providers":[{"billed_charge":14624.00,"npi":[1912085184]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":267.18,"providers":[{"billed_charge":4723.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5179.10,"providers":[{"billed_charge":11804.00,"npi":[1508941097]}]}]}]},{"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":"470385129"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":753.49,"providers":[{"billed_charge":1640.52,"npi":[1154687549]}]},{"allowed_amount":378.67,"providers":[{"billed_charge":781.20,"npi":[1154687549]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":94.42,"providers":[{"billed_charge":195.00,"npi":[1598116360]}]}]}]},{"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":"470385129"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":530.32,"providers":[{"billed_charge":1090.54,"npi":[1154687549]}]},{"allowed_amount":924.44,"providers":[{"billed_charge":1982.80,"npi":[1154687549]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":332.80,"providers":[{"billed_charge":465.00,"npi":[1598116360]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.08,"providers":[{"billed_charge":64.00,"npi":[1710176367]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25168.00,"providers":[{"billed_charge":31460.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2535.00,"providers":[{"billed_charge":6000.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4862.34,"providers":[{"billed_charge":12707.27,"npi":[1710176367]}]}]}]},{"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":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.40,"providers":[{"billed_charge":120.00,"npi":[1679530505]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":36.00,"providers":[{"billed_charge":126.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":92.50,"providers":[{"billed_charge":231.60,"npi":[1710176367]}]}]}]},{"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":"391884072"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":21494.00,"providers":[{"billed_charge":194304.00,"npi":[1609981448]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2841.60,"providers":[{"billed_charge":6900.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":149.22,"providers":[{"billed_charge":698.04,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":410.21,"providers":[{"billed_charge":918.96,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1832.70,"providers":[{"billed_charge":4347.23,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1243.17,"providers":[{"billed_charge":2827.49,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":951.36,"providers":[{"billed_charge":2176.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2859.36,"providers":[{"billed_charge":8318.64,"npi":[1710176367]}]}]},{"tin":{"type":"ein","value":"271700281"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.75,"providers":[{"billed_charge":2.75,"npi":[1043894199]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":527.85,"providers":[{"billed_charge":1179.55,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":726.96,"providers":[{"billed_charge":1632.96,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.16,"providers":[{"billed_charge":125.46,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":66.76,"providers":[{"billed_charge":152.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1529.84,"providers":[{"billed_charge":3536.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":173.85,"providers":[{"billed_charge":547.72,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2230.20,"providers":[{"billed_charge":5046.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":966.81,"providers":[{"billed_charge":2776.48,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1236.48,"providers":[{"billed_charge":2990.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1111.10,"providers":[{"billed_charge":4150.84,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":981.97,"providers":[{"billed_charge":2377.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":310.50,"providers":[{"billed_charge":900.00,"npi":[1710176367]}]}]}]},{"name":"RBC SED RATE, NONAUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85651","description":"SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":40.98,"providers":[{"billed_charge":92.46,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":116.06,"providers":[{"billed_charge":1260.81,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":419.04,"providers":[{"billed_charge":1011.51,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":381.24,"providers":[{"billed_charge":683.28,"npi":[1710176367]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":178.22,"providers":[{"billed_charge":410.56,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":68.49,"providers":[{"billed_charge":180.00,"npi":[1710176367]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16.53,"providers":[{"billed_charge":38.00,"npi":[1710176367]}]}]}]},{"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":11.72,"providers":[{"billed_charge":130.00,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":164.08,"providers":[{"billed_charge":1740.00,"npi":[1234567893]}]}]}]},{"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":199.24,"providers":[{"billed_charge":2114.48,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":164.08,"providers":[{"billed_charge":1820.00,"npi":[1234567893]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2189.46,"providers":[{"billed_charge":5148.00,"npi":[1710176367]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":70.32,"providers":[{"billed_charge":1020.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.72,"providers":[{"billed_charge":130.00,"npi":[1234567893]}]}]}]},{"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":450.00,"providers":[{"billed_charge":3978.35,"npi":[1234567893]}]}]}]},{"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":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2593.60,"providers":[{"billed_charge":6800.00,"npi":[1710176367]}]}]}]},{"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":168.91,"providers":[{"billed_charge":1425.00,"npi":[1234567893]}]}]}]},{"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":"470549869"},"service_code":["22","81","21"],"billing_class":"professional","payments":[{"allowed_amount":50.76,"providers":[{"billed_charge":312.00,"npi":[1437209350]}]},{"allowed_amount":719.21,"providers":[{"billed_charge":4356.00,"npi":[1437209350]}]},{"allowed_amount":1694.96,"providers":[{"billed_charge":10400.00,"npi":[1437209350]}]}]}]},{"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":"391901298"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":66.70,"providers":[{"billed_charge":175.00,"npi":[1811777907]}]}]},{"tin":{"type":"ein","value":"270631628"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":151.64,"providers":[{"billed_charge":500.00,"npi":[1275314429]}]}]},{"tin":{"type":"ein","value":"833296621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":301.56,"providers":[{"billed_charge":800.00,"npi":[1225133044]}]}]}]},{"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":"813456428"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":101.01,"providers":[{"billed_charge":250.00,"npi":[1366053969]}]},{"allowed_amount":2323.23,"providers":[{"billed_charge":5750.00,"npi":[1366053969]}]}]},{"tin":{"type":"ein","value":"476000611"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":4950.01,"providers":[{"billed_charge":8120.00,"npi":[1689129025]}]},{"allowed_amount":1536.21,"providers":[{"billed_charge":2520.00,"npi":[1770854895]}]}]},{"tin":{"type":"ein","value":"853644816"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1010.10,"providers":[{"billed_charge":1900.00,"npi":[1639947476]}]},{"allowed_amount":808.08,"providers":[{"billed_charge":1520.00,"npi":[1639947476]}]}]},{"tin":{"type":"ein","value":"931462174"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2687.39,"providers":[{"billed_charge":5400.00,"npi":[1376131706]}]}]},{"tin":{"type":"ein","value":"873262015"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":561.15,"providers":[{"billed_charge":1150.00,"npi":[1952183527]}]},{"allowed_amount":558.60,"providers":[{"billed_charge":1150.00,"npi":[1689428815]}]},{"allowed_amount":2352.49,"providers":[{"billed_charge":4830.00,"npi":[1952183527]}]},{"allowed_amount":112.23,"providers":[{"billed_charge":230.00,"npi":[1689428815]}]}]},{"tin":{"type":"ein","value":"421629846"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":830.56,"providers":[{"billed_charge":1428.00,"npi":[1598820912]}]}]},{"tin":{"type":"ein","value":"820710193"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":8362.96,"providers":[{"billed_charge":17100.00,"npi":[1790065670]}]},{"allowed_amount":336.69,"providers":[{"billed_charge":675.00,"npi":[1790065670]}]}]},{"tin":{"type":"ein","value":"470529089"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":710.40,"providers":[{"billed_charge":900.00,"npi":[1639809239]}]}]},{"tin":{"type":"ein","value":"881187757"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":561.15,"providers":[{"billed_charge":625.00,"npi":[1689284374]}]}]},{"tin":{"type":"ein","value":"470814384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1122.40,"providers":[{"billed_charge":1500.00,"npi":[1316486210]}]}]}]},{"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":"470390618"},"service_code":["99","11"],"billing_class":"professional","payments":[{"allowed_amount":18.33,"providers":[{"billed_charge":80.00,"npi":[1356068746]}]},{"allowed_amount":128.31,"providers":[{"billed_charge":560.00,"npi":[1356068746]}]}]}]},{"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":"650101421"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7125.00,"providers":[{"billed_charge":50608.00,"npi":[1801227046]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":360.60,"providers":[{"billed_charge":10752.00,"npi":[1912085184]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":470.25,"providers":[{"billed_charge":1590.00,"npi":[1508941097]}]}]}]},{"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":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2863.74,"providers":[{"billed_charge":20154.00,"npi":[1508941097]}]}]}]},{"name":"ELECTROCARDIOGRAM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93000","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.60,"providers":[{"billed_charge":280.00,"npi":[1679530505]}]}]}]},{"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":"470765154"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":14.76,"providers":[{"billed_charge":46.00,"npi":[1164490140]}]},{"allowed_amount":44.28,"providers":[{"billed_charge":138.00,"npi":[1740664911]}]},{"allowed_amount":15.44,"providers":[{"billed_charge":46.00,"npi":[1891137758]}]},{"allowed_amount":12.64,"providers":[{"billed_charge":23.00,"npi":[1598984965]}]},{"allowed_amount":103.36,"providers":[{"billed_charge":184.00,"npi":[1316973381]}]},{"allowed_amount":7.38,"providers":[{"billed_charge":23.00,"npi":[1740664911]}]},{"allowed_amount":232.56,"providers":[{"billed_charge":414.00,"npi":[1164490140]}]},{"allowed_amount":8.52,"providers":[{"billed_charge":23.00,"npi":[1891137758]}]},{"allowed_amount":90.44,"providers":[{"billed_charge":161.00,"npi":[1164490140]}]},{"allowed_amount":12.92,"providers":[{"billed_charge":23.00,"npi":[1164475729,1316973381,1811075773]}]},{"allowed_amount":38.20,"providers":[{"billed_charge":69.00,"npi":[1164475729]}]},{"allowed_amount":25.56,"providers":[{"billed_charge":46.00,"npi":[1598984965]}]},{"allowed_amount":194.88,"providers":[{"billed_charge":345.00,"npi":[1811075773]}]},{"allowed_amount":73.80,"providers":[{"billed_charge":230.00,"npi":[1740664911]}]}]},{"tin":{"type":"ein","value":"823898488"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":177.12,"providers":[{"billed_charge":552.00,"npi":[1114128261]}]},{"allowed_amount":7.38,"providers":[{"billed_charge":23.00,"npi":[1114128261]}]},{"allowed_amount":22.14,"providers":[{"billed_charge":69.00,"npi":[1366549933]}]},{"allowed_amount":66.42,"providers":[{"billed_charge":207.00,"npi":[1366549933]}]}]}]},{"name":"RHYTHM ECG REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93042","description":"RHYTHM ECG, 1-3 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":21.50,"providers":[{"billed_charge":98.00,"npi":[1386174449]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"900286511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":54.10,"providers":[{"billed_charge":150.00,"npi":[1336182773]}]}]}]},{"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":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":404.69,"providers":[{"billed_charge":875.00,"npi":[1194509075]}]},{"allowed_amount":1836.54,"providers":[{"billed_charge":3975.00,"npi":[1245849215]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":86.70,"providers":[{"billed_charge":145.00,"npi":[1295453496]}]}]},{"tin":{"type":"ein","value":"470845219"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":150.28,"providers":[{"billed_charge":247.00,"npi":[1245952274]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":57.90,"providers":[{"billed_charge":100.00,"npi":[1234567893]}]}]}]},{"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":"273017327"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":118.40,"providers":[{"billed_charge":450.00,"npi":[1013399179]}]}]},{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":98.68,"providers":[{"billed_charge":235.00,"npi":[1518563816]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":406.43,"providers":[{"billed_charge":926.40,"npi":[1811057664]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":489.95,"providers":[{"billed_charge":1072.00,"npi":[1295453496]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":29.60,"providers":[{"billed_charge":84.00,"npi":[1164098869]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":219.66,"providers":[{"billed_charge":500.00,"npi":[1518563816]}]}]},{"tin":{"type":"ein","value":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10010.18,"providers":[{"billed_charge":19035.00,"npi":[1245849215]}]},{"allowed_amount":926.58,"providers":[{"billed_charge":1845.00,"npi":[1194509075]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":252.37,"providers":[{"billed_charge":539.00,"npi":[1295453496]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":1432.69,"providers":[{"billed_charge":4085.00,"npi":[1164098869]}]},{"allowed_amount":32.95,"providers":[{"billed_charge":95.00,"npi":[1164098869]}]}]}]},{"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":"844570495"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":34957.45,"providers":[{"billed_charge":157212.16,"npi":[1497486823]}]}]}]},{"name":"GRP ADAPT BHV TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97154","description":"GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"844570495"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":329.13,"providers":[{"billed_charge":10867.20,"npi":[1497486823]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":518.34,"providers":[{"billed_charge":1176.00,"npi":[1518563816]}]}]},{"tin":{"type":"ein","value":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1246.99,"providers":[{"billed_charge":2205.00,"npi":[1245849215]}]},{"allowed_amount":2184.45,"providers":[{"billed_charge":3870.00,"npi":[1194509075]}]}]},{"tin":{"type":"ein","value":"201970309"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":444.73,"providers":[{"billed_charge":765.00,"npi":[1770552531]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1044.44,"providers":[{"billed_charge":1730.00,"npi":[1316673700]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1771.34,"providers":[{"billed_charge":5640.00,"npi":[1164098869]}]}]}]},{"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":"470868784"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":620.10,"providers":[{"billed_charge":1070.00,"npi":[1114171998]}]}]},{"tin":{"type":"ein","value":"201970309"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":377.90,"providers":[{"billed_charge":605.00,"npi":[1770552531]}]}]},{"tin":{"type":"ein","value":"454832680"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":344.10,"providers":[{"billed_charge":500.00,"npi":[1245484872]}]}]},{"tin":{"type":"ein","value":"911781681"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2516.88,"providers":[{"billed_charge":3400.00,"npi":[1467535062]}]}]},{"tin":{"type":"ein","value":"874821653"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3270.39,"providers":[{"billed_charge":5890.00,"npi":[1093427874]}]}]},{"tin":{"type":"ein","value":"834285049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":481.74,"providers":[{"billed_charge":868.00,"npi":[1982428678]}]}]},{"tin":{"type":"ein","value":"470845219"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1238.76,"providers":[{"billed_charge":2160.00,"npi":[1245952274]}]}]},{"tin":{"type":"ein","value":"852260473"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":309.69,"providers":[{"billed_charge":675.00,"npi":[1487948378]}]}]},{"tin":{"type":"ein","value":"812700983"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.05,"providers":[{"billed_charge":325.00,"npi":[1083035869]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":70.01,"providers":[{"billed_charge":120.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"900286511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":666.18,"providers":[{"billed_charge":990.00,"npi":[1336182773]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"874821653"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":634.54,"providers":[{"billed_charge":1239.00,"npi":[1093427874]}]}]}]},{"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":"470666715"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":218.10,"providers":[{"billed_charge":468.65,"npi":[1376153197]}]}]}]},{"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":"883950938"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":353.10,"providers":[{"billed_charge":760.00,"npi":[1588343917]}]}]},{"tin":{"type":"ein","value":"470421272"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":840.35,"providers":[{"billed_charge":959.00,"npi":[1851378434]}]}]},{"tin":{"type":"ein","value":"470553173"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1016.88,"providers":[{"billed_charge":1713.50,"npi":[1114705217]}]}]},{"tin":{"type":"ein","value":"470388012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":398.76,"providers":[{"billed_charge":640.00,"npi":[1124137039]}]}]},{"tin":{"type":"ein","value":"452808338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5315.26,"providers":[{"billed_charge":19200.00,"npi":[1093752883]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":437.49,"providers":[{"billed_charge":570.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":448.62,"providers":[{"billed_charge":498.00,"npi":[1699115394]}]}]},{"tin":{"type":"ein","value":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1163.12,"providers":[{"billed_charge":2968.40,"npi":[1679530505]}]}]},{"tin":{"type":"ein","value":"470538792"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":747.72,"providers":[{"billed_charge":1171.30,"npi":[1255914040]}]}]},{"tin":{"type":"ein","value":"462459722"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3743.36,"providers":[{"billed_charge":6750.00,"npi":[1801006325]}]},{"allowed_amount":166.16,"providers":[{"billed_charge":300.00,"npi":[1801006325]}]}]},{"tin":{"type":"ein","value":"470375220"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":638.31,"providers":[{"billed_charge":870.00,"npi":[1093852972]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","72","20","10"],"billing_class":"professional","payments":[{"allowed_amount":166.80,"providers":[{"billed_charge":460.00,"npi":[1234567893]}]},{"allowed_amount":273.55,"providers":[{"billed_charge":505.00,"npi":[1234567893]}]},{"allowed_amount":100.00,"providers":[{"billed_charge":364.00,"npi":[1234567893]}]},{"allowed_amount":406.89,"providers":[{"billed_charge":587.22,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"470532605"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1186.36,"providers":[{"billed_charge":2170.00,"npi":[1659969426]}]}]},{"tin":{"type":"ein","value":"470750886"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":498.48,"providers":[{"billed_charge":1002.00,"npi":[1023571197]}]}]}]},{"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":"470421272"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1521.18,"providers":[{"billed_charge":1800.00,"npi":[1851378434]}]}]},{"tin":{"type":"ein","value":"834455142"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3273.62,"providers":[{"billed_charge":3304.00,"npi":[1386274520]}]},{"allowed_amount":230.34,"providers":[{"billed_charge":236.00,"npi":[1386274520]}]}]},{"tin":{"type":"ein","value":"452808338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":467.88,"providers":[{"billed_charge":1440.00,"npi":[1093752883]}]}]},{"tin":{"type":"ein","value":"271700281"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1887.63,"providers":[{"billed_charge":3686.00,"npi":[1043894199]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1866.60,"providers":[{"billed_charge":2430.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":631.65,"providers":[{"billed_charge":678.00,"npi":[1699115394]}]}]},{"tin":{"type":"ein","value":"271191270"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1093.73,"providers":[{"billed_charge":2200.00,"npi":[1851642466]}]}]},{"tin":{"type":"ein","value":"470662290"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":167.58,"providers":[{"billed_charge":274.00,"npi":[1699081208]}]}]},{"tin":{"type":"ein","value":"462459722"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":350.91,"providers":[{"billed_charge":750.00,"npi":[1427498120]}]},{"allowed_amount":3503.70,"providers":[{"billed_charge":7500.00,"npi":[1427498120]}]},{"allowed_amount":587.85,"providers":[{"billed_charge":1250.00,"npi":[1013688530]}]},{"allowed_amount":116.97,"providers":[{"billed_charge":250.00,"npi":[1013688530,1801006325]}]},{"allowed_amount":6086.46,"providers":[{"billed_charge":13000.00,"npi":[1801006325]}]}]},{"tin":{"type":"ein","value":"470583290"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2316.05,"providers":[{"billed_charge":2475.00,"npi":[1174567572]}]},{"allowed_amount":2863.52,"providers":[{"billed_charge":3600.00,"npi":[1073066304]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":777.17,"providers":[{"billed_charge":1249.43,"npi":[1234567893]}]},{"allowed_amount":1010.38,"providers":[{"billed_charge":2136.00,"npi":[1234567893]}]},{"allowed_amount":998.60,"providers":[{"billed_charge":1534.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"873486516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1388.89,"providers":[{"billed_charge":1778.00,"npi":[1417290560]}]}]},{"tin":{"type":"ein","value":"833424514"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4159.43,"providers":[{"billed_charge":4556.00,"npi":[1679823967]}]}]},{"tin":{"type":"ein","value":"451775323"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":116.97,"providers":[{"billed_charge":290.00,"npi":[1285104513]}]}]}]},{"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":"470765154"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":54.15,"providers":[{"billed_charge":200.00,"npi":[1114446028]}]},{"allowed_amount":222.98,"providers":[{"billed_charge":400.00,"npi":[1518490135]}]},{"allowed_amount":3254.46,"providers":[{"billed_charge":10200.00,"npi":[1568759207]}]},{"allowed_amount":334.47,"providers":[{"billed_charge":600.00,"npi":[1194285908]}]},{"allowed_amount":2424.43,"providers":[{"billed_charge":7600.00,"npi":[1528053006]}]},{"allowed_amount":1084.53,"providers":[{"billed_charge":4000.00,"npi":[1629063920]}]},{"allowed_amount":443.34,"providers":[{"billed_charge":800.00,"npi":[1013570266]}]}]}]},{"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":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":645.34,"providers":[{"billed_charge":3392.00,"npi":[1558833277]}]},{"allowed_amount":379.36,"providers":[{"billed_charge":1696.00,"npi":[1902259633]}]},{"allowed_amount":1138.08,"providers":[{"billed_charge":5088.00,"npi":[1386174449]}]},{"allowed_amount":161.23,"providers":[{"billed_charge":848.00,"npi":[1043969223]}]}]},{"tin":{"type":"ein","value":"911769718"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":641.10,"providers":[{"billed_charge":2968.00,"npi":[1790452977]}]}]},{"tin":{"type":"ein","value":"470765154"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":759.22,"providers":[{"billed_charge":1356.00,"npi":[1568099786]}]},{"allowed_amount":379.36,"providers":[{"billed_charge":678.00,"npi":[1013570266]}]},{"allowed_amount":1200.84,"providers":[{"billed_charge":3729.00,"npi":[1568759207]}]},{"allowed_amount":758.73,"providers":[{"billed_charge":2373.00,"npi":[1528053006]}]}]}]},{"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":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1635.27,"providers":[{"billed_charge":8603.00,"npi":[1043969223]}]},{"allowed_amount":5215.38,"providers":[{"billed_charge":23351.00,"npi":[1386174449]}]},{"allowed_amount":1649.04,"providers":[{"billed_charge":7374.00,"npi":[1902259633]}]},{"allowed_amount":233.61,"providers":[{"billed_charge":1229.00,"npi":[1558833277]}]}]}]},{"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":"476006099"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":72.70,"providers":[{"billed_charge":187.20,"npi":[1154584639]}]}]},{"tin":{"type":"ein","value":"476006293"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":207.00,"providers":[{"billed_charge":207.00,"npi":[1730183369]}]}]},{"tin":{"type":"ein","value":"332332868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3978.28,"providers":[{"billed_charge":20613.60,"npi":[1295542520]}]}]},{"tin":{"type":"ein","value":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9196.55,"providers":[{"billed_charge":20240.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006205"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":363.50,"providers":[{"billed_charge":1014.00,"npi":[1093748212]}]}]},{"tin":{"type":"ein","value":"476006092"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3610.00,"providers":[{"billed_charge":3610.00,"npi":[1649203720]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18627.20,"providers":[{"billed_charge":25621.38,"npi":[1477588101]}]}]}]},{"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":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":69923.64,"providers":[{"billed_charge":165822.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":161350.14,"providers":[{"billed_charge":218488.30,"npi":[1477588101]}]}]}]},{"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":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":74788.61,"providers":[{"billed_charge":168623.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38362.80,"providers":[{"billed_charge":51870.00,"npi":[1477588101]}]}]}]},{"name":"INFUS SET EXT INSULIN PUMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4230","description":"INFUSION SET FOR EXTERNAL INSULIN PUMP, NONNEEDLE CANNULA TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"383271174"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":99.00,"providers":[{"billed_charge":280.00,"npi":[1417941774]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3012.67,"providers":[{"billed_charge":11430.38,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7071.85,"providers":[{"billed_charge":31479.64,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7910.14,"providers":[{"billed_charge":23888.78,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2179.72,"providers":[{"billed_charge":7315.96,"npi":[1234567893]}]}]}]},{"name":"PILLW NASL CANNULA TYPE INTF","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7033","description":"PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":200.64,"providers":[{"billed_charge":1465.47,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":99.00,"providers":[{"billed_charge":99.00,"npi":[1234567893]}]},{"allowed_amount":1658.53,"providers":[{"billed_charge":9782.26,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":1633.36,"providers":[{"billed_charge":6112.04,"npi":[1234567893]}]},{"allowed_amount":35.00,"providers":[{"billed_charge":35.00,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":743.00,"providers":[{"billed_charge":3196.59,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1373.34,"providers":[{"billed_charge":6489.36,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":316.42,"providers":[{"billed_charge":1489.90,"npi":[1234567893]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2630.45,"providers":[{"billed_charge":11306.61,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"470490912"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":82.23,"providers":[{"billed_charge":120.40,"npi":[1265628259]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6611.75,"providers":[{"billed_charge":20265.80,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":67.70,"providers":[{"billed_charge":507.30,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"470737313"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":94.93,"providers":[{"billed_charge":200.00,"npi":[1376885921]}]}]},{"tin":{"type":"ein","value":"470490912"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1044.23,"providers":[{"billed_charge":2122.20,"npi":[1265628259]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7812.99,"providers":[{"billed_charge":32002.40,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":15958.97,"providers":[{"billed_charge":85048.26,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1065.86,"providers":[{"billed_charge":6180.00,"npi":[1234567893]}]}]}]},{"name":"NEG PRSS WND TX PUMP STATN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E2402","description":"NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":56544.00,"providers":[{"billed_charge":149294.20,"npi":[1234567893]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":40831.89,"providers":[{"billed_charge":43876.48,"npi":[1234567893]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":1289.23,"providers":[{"billed_charge":1384.14,"npi":[1234567893]}]}]}]},{"name":"BHVAL HLTH; LNG-TERM RES PER","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0019","description":"BEHAVIORAL HEALTH; LONG-TERM RESIDENTIAL (NONMEDICAL, NONACUTE CARE IN A RESIDENTIAL TREATMENT PROGR","allowed_amounts":[{"tin":{"type":"ein","value":"814879982"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":210.00,"providers":[{"billed_charge":700.00,"npi":[1679948335]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6323.20,"providers":[{"billed_charge":15808.00,"npi":[1234567893]}]}]}]},{"name":"MULTISYS THERAPY JUVS PER 15","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H2033","description":"MULTISYSTEMIC THERAPY FOR JUVENILES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"391901298"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":3279.66,"providers":[{"billed_charge":11160.00,"npi":[1548912025]}]}]}]},{"name":"NRS CARE HOM; REGISTERED NUR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9123","description":"NURSING CARE, IN THE HOME; BY REGISTERED NURSE, PER HOUR (USE FOR GENERAL NURSING CARE ONLY, NOT TO","allowed_amounts":[{"tin":{"type":"ein","value":"521590951"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2200.00,"providers":[{"billed_charge":4060.00,"npi":[1932202439]}]}]}]},{"name":"NRS CARE THE HOME LPN PER HR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9124","description":"NURSING CARE, IN THE HOME; BY LICENSED PRACTICAL NURSE, PER HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"521590951"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":940.00,"providers":[{"billed_charge":1440.00,"npi":[1932202439]}]}]}]}]}