{"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":11861.72,"providers":[{"billed_charge":51096.64,"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":"570542729"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31600.00,"providers":[{"billed_charge":31883.33,"npi":[1891795738]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":35352.00,"providers":[{"billed_charge":32971.00,"npi":[1861496234]}]}]},{"tin":{"type":"ein","value":"873746039"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":135750.00,"providers":[{"billed_charge":674424.00,"npi":[1053002204]}]}]},{"tin":{"type":"ein","value":"472253438"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":543200.00,"providers":[{"billed_charge":2716000.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"263075304"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":58560.00,"providers":[{"billed_charge":164700.00,"npi":[1669638821]}]}]},{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11900.00,"providers":[{"billed_charge":37800.00,"npi":[1033697099]}]}]},{"tin":{"type":"ein","value":"842277779"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":16560.00,"providers":[{"billed_charge":60000.00,"npi":[1861045767]}]}]},{"tin":{"type":"ein","value":"931351555"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1764.00,"providers":[{"billed_charge":9000.00,"npi":[1306522701]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":223183.14,"providers":[{"billed_charge":113313.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":574222.41,"providers":[{"billed_charge":229971.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":50635.59,"providers":[{"billed_charge":16275.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":129595.44,"providers":[{"billed_charge":76752.00,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":40193.63,"providers":[{"billed_charge":11625.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":280926.88,"providers":[{"billed_charge":53767.00,"npi":[1326043548]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"850988160"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1177.25,"providers":[{"billed_charge":3668.00,"npi":[1306621578]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":147196.50,"providers":[{"billed_charge":128112.00,"npi":[1891148821]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":409547.41,"providers":[{"billed_charge":322818.00,"npi":[1891148821]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":188543.72,"providers":[{"billed_charge":633256.00,"npi":[1033120837]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"472253438"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":76000.01,"providers":[{"billed_charge":432000.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":35150.00,"providers":[{"billed_charge":148000.00,"npi":[1033697099]}]}]}]},{"name":"ANESTH, LENS SURGERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"142","description":"ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":813.74,"providers":[{"billed_charge":5125.00,"npi":[1234567893]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":547877.16,"providers":[{"billed_charge":515169.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":158493.40,"providers":[{"billed_charge":128279.00,"npi":[1851361778]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":26694.69,"providers":[{"billed_charge":8112.00,"npi":[1417432840]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":474.90,"providers":[{"billed_charge":555.70,"npi":[1881647204]}]},{"allowed_amount":2.31,"providers":[{"billed_charge":7.60,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":436.34,"providers":[{"billed_charge":1622.05,"npi":[1427030774]}]},{"allowed_amount":133.72,"providers":[{"billed_charge":445.65,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6091.00,"providers":[{"billed_charge":240444.90,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45.17,"providers":[{"billed_charge":150.55,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"832550272"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.73,"providers":[{"billed_charge":72.40,"npi":[1942224696]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":89.70,"providers":[{"billed_charge":246.50,"npi":[1346297892]}]},{"allowed_amount":895.56,"providers":[{"billed_charge":2509.35,"npi":[1417432840]}]},{"allowed_amount":295.43,"providers":[{"billed_charge":814.85,"npi":[1396790325]}]},{"allowed_amount":1820.85,"providers":[{"billed_charge":5008.85,"npi":[1417432840]}]},{"allowed_amount":1001.65,"providers":[{"billed_charge":2753.75,"npi":[1396790325]}]},{"allowed_amount":19.71,"providers":[{"billed_charge":54.30,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.84,"providers":[{"billed_charge":4047.90,"npi":[1336603646]}]},{"allowed_amount":598.39,"providers":[{"billed_charge":60893.10,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2577.89,"providers":[{"billed_charge":6322.00,"npi":[1427055821]}]},{"allowed_amount":320.70,"providers":[{"billed_charge":1069.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11910.16,"providers":[{"billed_charge":39300.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1732.20,"providers":[{"billed_charge":118912.20,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1417.87,"providers":[{"billed_charge":24113.70,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.73,"providers":[{"billed_charge":5.75,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2133.60,"providers":[{"billed_charge":7112.00,"npi":[1962277343]}]}]}]},{"name":"DRUGS/GENERIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"251","description":"PHARMACY - GENERIC DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":306.87,"providers":[{"billed_charge":845.40,"npi":[1417432840]}]},{"allowed_amount":23.41,"providers":[{"billed_charge":64.50,"npi":[1396790325]}]},{"allowed_amount":598.33,"providers":[{"billed_charge":1647.80,"npi":[1417432840]}]},{"allowed_amount":28.80,"providers":[{"billed_charge":79.35,"npi":[1396790325]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":142.09,"providers":[{"billed_charge":15373.70,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":328.90,"providers":[{"billed_charge":12059.40,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.26,"providers":[{"billed_charge":1455.50,"npi":[1336603646]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":223342.78,"providers":[{"billed_charge":835787.00,"npi":[1649726738]}]},{"allowed_amount":4871.48,"providers":[{"billed_charge":11051.00,"npi":[1841746948]}]},{"allowed_amount":1387.76,"providers":[{"billed_charge":7696.00,"npi":[1851847974]}]},{"allowed_amount":45461.52,"providers":[{"billed_charge":139334.00,"npi":[1114473212]}]},{"allowed_amount":14233.90,"providers":[{"billed_charge":107540.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1542.51,"providers":[{"billed_charge":4148.76,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":139770.84,"providers":[{"billed_charge":124538.00,"npi":[1962472860]}]},{"allowed_amount":819.01,"providers":[{"billed_charge":32807.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":683.97,"providers":[{"billed_charge":27433.00,"npi":[1851361778]}]},{"allowed_amount":111001.69,"providers":[{"billed_charge":102601.00,"npi":[1851361778]}]},{"allowed_amount":280.76,"providers":[{"billed_charge":518.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19206.64,"providers":[{"billed_charge":17734.00,"npi":[1255645644]}]},{"allowed_amount":439.00,"providers":[{"billed_charge":10815.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4491.03,"providers":[{"billed_charge":12386.80,"npi":[1417432840]}]},{"allowed_amount":22.21,"providers":[{"billed_charge":54.30,"npi":[1417432840]}]},{"allowed_amount":3103.80,"providers":[{"billed_charge":8598.80,"npi":[1396790325]}]},{"allowed_amount":467.19,"providers":[{"billed_charge":1287.00,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":120367.12,"providers":[{"billed_charge":100729.00,"npi":[1336603646]}]},{"allowed_amount":182.12,"providers":[{"billed_charge":16008.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":45751.96,"providers":[{"billed_charge":147387.00,"npi":[1326043548]}]},{"allowed_amount":1531.51,"providers":[{"billed_charge":3878.00,"npi":[1326043548]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":234.04,"providers":[{"billed_charge":640.22,"npi":[1417432840]}]},{"allowed_amount":28.31,"providers":[{"billed_charge":77.99,"npi":[1417432840]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4957.05,"providers":[{"billed_charge":13585.34,"npi":[1396790325]}]},{"allowed_amount":92379.00,"providers":[{"billed_charge":254967.71,"npi":[1417432840]}]},{"allowed_amount":259.86,"providers":[{"billed_charge":5659.88,"npi":[1417432840]}]},{"allowed_amount":5436.98,"providers":[{"billed_charge":15063.50,"npi":[1417432840]}]},{"allowed_amount":20487.70,"providers":[{"billed_charge":56438.45,"npi":[1396790325]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":33001.93,"providers":[{"billed_charge":1517819.28,"npi":[1649726738]}]},{"allowed_amount":1631.16,"providers":[{"billed_charge":74701.84,"npi":[1649726738]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":29725.30,"providers":[{"billed_charge":55471.00,"npi":[1013918960]}]},{"allowed_amount":12535.09,"providers":[{"billed_charge":47824.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3000.15,"providers":[{"billed_charge":4433.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":392.00,"npi":[1851847974]}]},{"allowed_amount":48.81,"providers":[{"billed_charge":84.00,"npi":[1841746948]}]},{"allowed_amount":66647.40,"providers":[{"billed_charge":183960.00,"npi":[1649726738]}]},{"allowed_amount":6026.83,"providers":[{"billed_charge":25935.00,"npi":[1649726738]}]},{"allowed_amount":3053.23,"providers":[{"billed_charge":10631.00,"npi":[1396207221]}]},{"allowed_amount":2276.91,"providers":[{"billed_charge":15819.00,"npi":[1114473212]}]},{"allowed_amount":281.52,"providers":[{"billed_charge":1140.00,"npi":[1851846661]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":463.98,"providers":[{"billed_charge":48523.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2588.66,"providers":[{"billed_charge":64682.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":523.30,"providers":[{"billed_charge":11559.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":181.20,"providers":[{"billed_charge":24004.00,"npi":[1336603646]}]},{"allowed_amount":3.00,"providers":[{"billed_charge":32.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1406.68,"providers":[{"billed_charge":3939.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":13786.74,"providers":[{"billed_charge":29984.00,"npi":[1326043548]}]},{"allowed_amount":187.08,"providers":[{"billed_charge":2389.00,"npi":[1326043548]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1233.96,"providers":[{"billed_charge":936970.00,"npi":[1649726738]}]},{"allowed_amount":1004.84,"providers":[{"billed_charge":6078.00,"npi":[1720747496]}]},{"allowed_amount":21410.82,"providers":[{"billed_charge":156738.00,"npi":[1649726738]}]},{"allowed_amount":1647.05,"providers":[{"billed_charge":20039.00,"npi":[1851846661]}]},{"allowed_amount":1616.90,"providers":[{"billed_charge":63131.00,"npi":[1114473212]}]},{"allowed_amount":16.92,"providers":[{"billed_charge":1408.00,"npi":[1396207221]}]},{"allowed_amount":71.32,"providers":[{"billed_charge":10593.00,"npi":[1851847974]}]},{"allowed_amount":758.85,"providers":[{"billed_charge":9329.00,"npi":[1841746948]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1616.51,"providers":[{"billed_charge":6520.00,"npi":[1881647204]}]},{"allowed_amount":9724.57,"providers":[{"billed_charge":18549.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":562.48,"providers":[{"billed_charge":2091.00,"npi":[1427030774]}]},{"allowed_amount":371.38,"providers":[{"billed_charge":1001.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":600.06,"providers":[{"billed_charge":381899.00,"npi":[1962472860]}]},{"allowed_amount":12333.00,"providers":[{"billed_charge":408588.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7736.81,"providers":[{"billed_charge":14003.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":298.57,"providers":[{"billed_charge":367757.00,"npi":[1336603646]}]},{"allowed_amount":3062.30,"providers":[{"billed_charge":128319.00,"npi":[1336603646]}]},{"allowed_amount":37.41,"providers":[{"billed_charge":875.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3873.32,"providers":[{"billed_charge":10880.35,"npi":[1417432840]}]},{"allowed_amount":240.05,"providers":[{"billed_charge":661.30,"npi":[1346297892]}]},{"allowed_amount":1922.18,"providers":[{"billed_charge":11475.45,"npi":[1417432840]}]},{"allowed_amount":101.65,"providers":[{"billed_charge":223.90,"npi":[1346297892]}]},{"allowed_amount":79431.19,"providers":[{"billed_charge":219729.50,"npi":[1417432840]}]},{"allowed_amount":58881.23,"providers":[{"billed_charge":162258.25,"npi":[1396790325]}]},{"allowed_amount":7819.10,"providers":[{"billed_charge":21485.35,"npi":[1346297892]}]},{"allowed_amount":1688.04,"providers":[{"billed_charge":3718.15,"npi":[1396790325]}]},{"allowed_amount":2059.86,"providers":[{"billed_charge":5762.40,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":69.88,"providers":[{"billed_charge":2827.00,"npi":[1326043548]}]},{"allowed_amount":58.21,"providers":[{"billed_charge":194003.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":891.96,"providers":[{"billed_charge":2377.00,"npi":[1427055821]}]},{"allowed_amount":1624.15,"providers":[{"billed_charge":3774.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":861.17,"providers":[{"billed_charge":2151.18,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":471.42,"providers":[{"billed_charge":1559.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":10018.10,"providers":[{"billed_charge":22297.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4749.50,"providers":[{"billed_charge":234246.00,"npi":[1851361778]}]},{"allowed_amount":15.20,"providers":[{"billed_charge":329657.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4765.00,"providers":[{"billed_charge":87153.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"541848065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":491.70,"providers":[{"billed_charge":1585.00,"npi":[1437175734]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9228.52,"providers":[{"billed_charge":33243.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"562084959"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30.00,"providers":[{"billed_charge":100.00,"npi":[1144247982]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":108.57,"providers":[{"billed_charge":1250.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":154.40,"providers":[{"billed_charge":846.00,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"756004221"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1019.34,"providers":[{"billed_charge":5422.00,"npi":[1932123247]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1380.31,"providers":[{"billed_charge":14985.00,"npi":[1649726738]}]},{"allowed_amount":527.13,"providers":[{"billed_charge":26806.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":416.20,"providers":[{"billed_charge":14785.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":594.90,"providers":[{"billed_charge":9518.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":148.22,"providers":[{"billed_charge":509.90,"npi":[1417432840]}]},{"allowed_amount":1150.82,"providers":[{"billed_charge":3170.30,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11.32,"providers":[{"billed_charge":1973.00,"npi":[1336603646]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15.54,"providers":[{"billed_charge":252.00,"npi":[1851846661]}]},{"allowed_amount":416.99,"providers":[{"billed_charge":17097.00,"npi":[1114473212]}]},{"allowed_amount":1307.77,"providers":[{"billed_charge":31637.00,"npi":[1649726738]}]},{"allowed_amount":74.38,"providers":[{"billed_charge":1604.00,"npi":[1841746948]}]},{"allowed_amount":7.77,"providers":[{"billed_charge":1584.00,"npi":[1396207221]},{"billed_charge":1953.00,"npi":[1851847974]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1348.05,"providers":[{"billed_charge":5436.00,"npi":[1881647204]}]},{"allowed_amount":1820.26,"providers":[{"billed_charge":2137.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1106.88,"providers":[{"billed_charge":3031.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":671.60,"providers":[{"billed_charge":60915.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":142.13,"providers":[{"billed_charge":118766.00,"npi":[1962472860]}]},{"allowed_amount":3114.60,"providers":[{"billed_charge":122762.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1186.05,"providers":[{"billed_charge":19201.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":954.12,"providers":[{"billed_charge":1182.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1137.78,"providers":[{"billed_charge":3942.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19482.65,"providers":[{"billed_charge":53878.80,"npi":[1417432840]}]},{"allowed_amount":1748.30,"providers":[{"billed_charge":4803.90,"npi":[1346297892]}]},{"allowed_amount":232.99,"providers":[{"billed_charge":513.20,"npi":[1396790325,1346297892]}]},{"allowed_amount":14580.86,"providers":[{"billed_charge":40177.60,"npi":[1396790325]}]},{"allowed_amount":644.30,"providers":[{"billed_charge":1828.45,"npi":[1396790325]}]},{"allowed_amount":1381.06,"providers":[{"billed_charge":3877.60,"npi":[1417432840]}]},{"allowed_amount":444.79,"providers":[{"billed_charge":2374.05,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":820.60,"providers":[{"billed_charge":30819.00,"npi":[1336603646]}]},{"allowed_amount":8.63,"providers":[{"billed_charge":228.00,"npi":[1336603646]}]},{"allowed_amount":162.13,"providers":[{"billed_charge":102499.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15.36,"providers":[{"billed_charge":1234.00,"npi":[1326043548]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8555.36,"providers":[{"billed_charge":88896.00,"npi":[1649726738]}]},{"allowed_amount":91.84,"providers":[{"billed_charge":143877.00,"npi":[1649726738]}]},{"allowed_amount":180.68,"providers":[{"billed_charge":884.00,"npi":[1922788728]}]},{"allowed_amount":764.95,"providers":[{"billed_charge":4436.00,"npi":[1851846661]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":55130.31,"providers":[{"billed_charge":78964.00,"npi":[1962472860]}]},{"allowed_amount":150.38,"providers":[{"billed_charge":216.00,"npi":[1962472860]}]},{"allowed_amount":2150.70,"providers":[{"billed_charge":24471.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":835.25,"providers":[{"billed_charge":18218.00,"npi":[1851361778]}]},{"allowed_amount":25808.74,"providers":[{"billed_charge":33648.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3158.18,"providers":[{"billed_charge":6188.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":335.05,"providers":[{"billed_charge":738.00,"npi":[1396790325]}]},{"allowed_amount":1152.66,"providers":[{"billed_charge":3161.65,"npi":[1346297892]}]},{"allowed_amount":369.88,"providers":[{"billed_charge":1018.95,"npi":[1396790325]}]},{"allowed_amount":23144.89,"providers":[{"billed_charge":63680.25,"npi":[1396790325]}]},{"allowed_amount":1570.05,"providers":[{"billed_charge":4421.85,"npi":[1417432840]}]},{"allowed_amount":500.19,"providers":[{"billed_charge":2182.10,"npi":[1417432840]}]},{"allowed_amount":22850.30,"providers":[{"billed_charge":63216.75,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":126.10,"providers":[{"billed_charge":8367.00,"npi":[1336603646]}]},{"allowed_amount":34608.29,"providers":[{"billed_charge":50088.00,"npi":[1336603646]}]},{"allowed_amount":293.01,"providers":[{"billed_charge":432.00,"npi":[1336603646]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":93.61,"providers":[{"billed_charge":3028.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":128.39,"providers":[{"billed_charge":10156.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":113.74,"providers":[{"billed_charge":6829.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":299.26,"providers":[{"billed_charge":838.95,"npi":[1396790325]}]},{"allowed_amount":51.98,"providers":[{"billed_charge":143.20,"npi":[1346297892]}]},{"allowed_amount":624.27,"providers":[{"billed_charge":1717.15,"npi":[1417432840]}]},{"allowed_amount":3325.86,"providers":[{"billed_charge":9146.45,"npi":[1396790325]}]},{"allowed_amount":110.56,"providers":[{"billed_charge":304.60,"npi":[1346297892]}]},{"allowed_amount":33.01,"providers":[{"billed_charge":80.70,"npi":[1417432840]}]},{"allowed_amount":5269.99,"providers":[{"billed_charge":14550.50,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":19.38,"providers":[{"billed_charge":4219.00,"npi":[1336603646]}]},{"allowed_amount":3.52,"providers":[{"billed_charge":226.00,"npi":[1336603646]}]}]}]},{"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":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":89.05,"providers":[{"billed_charge":213368.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/CYTOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"311","description":"LABORATORY PATHOLOGICAL - CYTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1607.17,"providers":[{"billed_charge":35924.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":6914.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1977.87,"providers":[{"billed_charge":5448.70,"npi":[1417432840]}]},{"allowed_amount":158.96,"providers":[{"billed_charge":437.90,"npi":[1417432840]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":469.38,"providers":[{"billed_charge":1110.00,"npi":[1013918960]}]},{"allowed_amount":4213.30,"providers":[{"billed_charge":8738.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6903.12,"providers":[{"billed_charge":77690.00,"npi":[1649726738]}]},{"allowed_amount":402.88,"providers":[{"billed_charge":272436.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":110.86,"providers":[{"billed_charge":447.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":983.10,"providers":[{"billed_charge":14101.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8627.56,"providers":[{"billed_charge":23736.60,"npi":[1396790325]}]},{"allowed_amount":3718.70,"providers":[{"billed_charge":10327.75,"npi":[1417432840]}]},{"allowed_amount":3443.01,"providers":[{"billed_charge":9551.40,"npi":[1396790325]}]},{"allowed_amount":4071.75,"providers":[{"billed_charge":11278.05,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7377.39,"providers":[{"billed_charge":34088.00,"npi":[1326043548]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51610.96,"providers":[{"billed_charge":173625.00,"npi":[1649726738]}]},{"allowed_amount":434.05,"providers":[{"billed_charge":7155.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":95.40,"providers":[{"billed_charge":15027.00,"npi":[1851361778]}]},{"allowed_amount":19577.15,"providers":[{"billed_charge":43900.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37747.87,"providers":[{"billed_charge":88449.00,"npi":[1962472860]}]},{"allowed_amount":644.40,"providers":[{"billed_charge":28035.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1729.92,"providers":[{"billed_charge":4172.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":145.70,"providers":[{"billed_charge":6687.00,"npi":[1336603646]}]},{"allowed_amount":21032.11,"providers":[{"billed_charge":50659.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10725.07,"providers":[{"billed_charge":29582.15,"npi":[1396790325]}]},{"allowed_amount":472.93,"providers":[{"billed_charge":1302.85,"npi":[1417432840]}]},{"allowed_amount":475.66,"providers":[{"billed_charge":1393.80,"npi":[1396790325]}]},{"allowed_amount":7642.29,"providers":[{"billed_charge":21199.50,"npi":[1417432840]}]},{"allowed_amount":190.02,"providers":[{"billed_charge":1211.90,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":13722.15,"providers":[{"billed_charge":41725.00,"npi":[1326043548]}]},{"allowed_amount":442.65,"providers":[{"billed_charge":1765.00,"npi":[1326043548]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":214163.50,"providers":[{"billed_charge":796196.00,"npi":[1114473212]}]},{"allowed_amount":5562.50,"providers":[{"billed_charge":16228.00,"npi":[1841746948]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":51047.98,"providers":[{"billed_charge":140628.00,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":57434.64,"providers":[{"billed_charge":187013.00,"npi":[1326043548]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1875.55,"providers":[{"billed_charge":6395.00,"npi":[1851847974]}]},{"allowed_amount":70460.58,"providers":[{"billed_charge":136412.00,"npi":[1114473212]}]}]}]},{"name":"NUC MED/DX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"341","description":"NUCLEAR MEDICINE - DIAGNOSTIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2175.85,"providers":[{"billed_charge":5555.00,"npi":[1649726738]}]}]}]},{"name":"NUC MED/DX RADIOPHARM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"343","description":"DIAGNOSTIC RADIOPHARMACEUTICALS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1065.23,"providers":[{"billed_charge":48670.03,"npi":[1649726738]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":66317.42,"providers":[{"billed_charge":684763.00,"npi":[1649726738]}]},{"allowed_amount":580.84,"providers":[{"billed_charge":7563.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2941.00,"providers":[{"billed_charge":20567.00,"npi":[1851361778]}]},{"allowed_amount":20403.75,"providers":[{"billed_charge":154987.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19469.22,"providers":[{"billed_charge":158911.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3630.72,"providers":[{"billed_charge":10002.00,"npi":[1417432840]}]},{"allowed_amount":21017.61,"providers":[{"billed_charge":57852.60,"npi":[1396790325]}]},{"allowed_amount":31839.46,"providers":[{"billed_charge":88061.05,"npi":[1417432840]}]},{"allowed_amount":2075.92,"providers":[{"billed_charge":7613.40,"npi":[1417432840]}]},{"allowed_amount":1210.24,"providers":[{"billed_charge":3334.00,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15277.86,"providers":[{"billed_charge":130244.00,"npi":[1336603646]}]},{"allowed_amount":1067.00,"providers":[{"billed_charge":13052.00,"npi":[1336603646]}]},{"allowed_amount":98.30,"providers":[{"billed_charge":2505.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":298.32,"providers":[{"billed_charge":2885.00,"npi":[1326043548]}]},{"allowed_amount":16816.47,"providers":[{"billed_charge":128493.00,"npi":[1326043548]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":95941.72,"providers":[{"billed_charge":1583918.00,"npi":[1649726738]}]},{"allowed_amount":1747.15,"providers":[{"billed_charge":33263.00,"npi":[1649726738]}]},{"allowed_amount":1783.20,"providers":[{"billed_charge":23412.00,"npi":[1790264497]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":237.94,"providers":[{"billed_charge":4244.00,"npi":[1962472860]}]},{"allowed_amount":63707.12,"providers":[{"billed_charge":530966.00,"npi":[1962472860]}]},{"allowed_amount":4250.00,"providers":[{"billed_charge":151253.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2727.90,"providers":[{"billed_charge":122492.00,"npi":[1851361778]}]},{"allowed_amount":53733.23,"providers":[{"billed_charge":447772.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3106.00,"providers":[{"billed_charge":41724.00,"npi":[1255645644]}]},{"allowed_amount":10250.35,"providers":[{"billed_charge":86799.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":62254.80,"providers":[{"billed_charge":435932.00,"npi":[1336603646]}]},{"allowed_amount":553.58,"providers":[{"billed_charge":8488.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":46247.91,"providers":[{"billed_charge":128288.35,"npi":[1417432840]}]},{"allowed_amount":13425.68,"providers":[{"billed_charge":36985.30,"npi":[1396790325]}]},{"allowed_amount":1713.08,"providers":[{"billed_charge":4188.45,"npi":[1417432840]}]},{"allowed_amount":95856.90,"providers":[{"billed_charge":263732.10,"npi":[1396790325]}]},{"allowed_amount":135582.27,"providers":[{"billed_charge":375178.25,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3219.06,"providers":[{"billed_charge":32518.00,"npi":[1326043548]}]},{"allowed_amount":28044.02,"providers":[{"billed_charge":423442.00,"npi":[1326043548]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":145960.91,"providers":[{"billed_charge":327243.00,"npi":[1649726738]}]},{"allowed_amount":1165611.04,"providers":[{"billed_charge":2937057.06,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5095.00,"providers":[{"billed_charge":61646.00,"npi":[1851361778]}]},{"allowed_amount":12888.23,"providers":[{"billed_charge":13842.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10660.43,"providers":[{"billed_charge":16150.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":105315.80,"providers":[{"billed_charge":289236.81,"npi":[1417432840]}]},{"allowed_amount":1432.27,"providers":[{"billed_charge":3945.65,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":66597.14,"providers":[{"billed_charge":154626.00,"npi":[1326043548]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":829119.96,"providers":[{"billed_charge":2044578.00,"npi":[1649726738]}]},{"allowed_amount":17951.83,"providers":[{"billed_charge":53275.00,"npi":[1629432869]}]},{"allowed_amount":20574.31,"providers":[{"billed_charge":40397.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1634.75,"providers":[{"billed_charge":4503.45,"npi":[1417432840]}]},{"allowed_amount":33886.34,"providers":[{"billed_charge":93050.30,"npi":[1417432840]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":339.90,"providers":[{"billed_charge":880.00,"npi":[1134675978]}]},{"allowed_amount":1344.14,"providers":[{"billed_charge":3480.00,"npi":[1134675978]}]},{"allowed_amount":23.19,"providers":[{"billed_charge":60.00,"npi":[1720899875]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":161.52,"providers":[{"billed_charge":288.00,"npi":[1235152349]}]},{"allowed_amount":201.90,"providers":[{"billed_charge":360.00,"npi":[1750795183]}]},{"allowed_amount":524.94,"providers":[{"billed_charge":936.00,"npi":[1912986977]}]},{"allowed_amount":80.76,"providers":[{"billed_charge":144.00,"npi":[1477991479]}]},{"allowed_amount":53.84,"providers":[{"billed_charge":96.00,"npi":[1952982563]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":49.86,"providers":[{"billed_charge":144.00,"npi":[1447313630]}]},{"allowed_amount":199.44,"providers":[{"billed_charge":576.00,"npi":[1336423599]}]},{"allowed_amount":254.02,"providers":[{"billed_charge":624.00,"npi":[1194037853]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":92.53,"providers":[{"billed_charge":365.52,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":8.31,"providers":[{"billed_charge":24.00,"npi":[1234567893]}]},{"allowed_amount":68.30,"providers":[{"billed_charge":729.88,"npi":[1234567893]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":419.00,"providers":[{"billed_charge":7321.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":53036.84,"providers":[{"billed_charge":145727.10,"npi":[1417432840]}]},{"allowed_amount":8797.93,"providers":[{"billed_charge":25668.85,"npi":[1417432840]}]}]}]},{"name":"MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"401","description":"OTHER IMAGING SERVICES - MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":679.93,"providers":[{"billed_charge":2379.00,"npi":[1326043548]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19078.46,"providers":[{"billed_charge":188773.00,"npi":[1649726738]}]},{"allowed_amount":12576.28,"providers":[{"billed_charge":82578.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":400.00,"providers":[{"billed_charge":4582.00,"npi":[1962472860]}]},{"allowed_amount":234.90,"providers":[{"billed_charge":2380.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2704.97,"providers":[{"billed_charge":38185.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1381.79,"providers":[{"billed_charge":3789.00,"npi":[1396790325]}]},{"allowed_amount":7080.84,"providers":[{"billed_charge":19833.20,"npi":[1417432840]}]},{"allowed_amount":1407.19,"providers":[{"billed_charge":3876.60,"npi":[1396790325]}]},{"allowed_amount":7912.33,"providers":[{"billed_charge":21739.70,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2537.12,"providers":[{"billed_charge":28971.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3970.16,"providers":[{"billed_charge":23347.00,"npi":[1326043548]}]},{"allowed_amount":1960.10,"providers":[{"billed_charge":14628.00,"npi":[1326043548]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6665.80,"providers":[{"billed_charge":19531.00,"npi":[1326043548]}]}]}]},{"name":"PET SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"404","description":"POSITION EMISSION TOMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9724.12,"providers":[{"billed_charge":23120.00,"npi":[1649726738]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4189.75,"providers":[{"billed_charge":21080.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":664.60,"providers":[{"billed_charge":27588.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1043.64,"providers":[{"billed_charge":5956.00,"npi":[1326043548]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4903.43,"providers":[{"billed_charge":20702.00,"npi":[1760963243]}]},{"allowed_amount":42.33,"providers":[{"billed_charge":2045.00,"npi":[1649726738]}]},{"allowed_amount":2300.79,"providers":[{"billed_charge":9905.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":170.06,"providers":[{"billed_charge":520.55,"npi":[1396790325]}]},{"allowed_amount":68.06,"providers":[{"billed_charge":166.40,"npi":[1417432840]}]},{"allowed_amount":236.30,"providers":[{"billed_charge":723.30,"npi":[1417432840]}]},{"allowed_amount":198.47,"providers":[{"billed_charge":584.95,"npi":[1396790325]}]},{"allowed_amount":313.48,"providers":[{"billed_charge":941.05,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9859.31,"providers":[{"billed_charge":40249.00,"npi":[1326043548]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3538.91,"providers":[{"billed_charge":7640.00,"npi":[1649726738]}]},{"allowed_amount":1574.56,"providers":[{"billed_charge":3373.00,"npi":[1649726738]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":140.73,"providers":[{"billed_charge":852.00,"npi":[1326043548]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1717.99,"providers":[{"billed_charge":4838.00,"npi":[1649726738]}]},{"allowed_amount":341.39,"providers":[{"billed_charge":1058.00,"npi":[1649726738]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3097.38,"providers":[{"billed_charge":5016.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8890.73,"providers":[{"billed_charge":30920.00,"npi":[1013918960]}]},{"allowed_amount":67572.97,"providers":[{"billed_charge":135826.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1493025.50,"providers":[{"billed_charge":3493706.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3959.74,"providers":[{"billed_charge":15970.00,"npi":[1881647204]}]},{"allowed_amount":38936.29,"providers":[{"billed_charge":56782.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6853.00,"providers":[{"billed_charge":192325.00,"npi":[1962472860]}]},{"allowed_amount":1030484.95,"providers":[{"billed_charge":2443151.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30901.37,"providers":[{"billed_charge":48660.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":671578.00,"providers":[{"billed_charge":1621478.00,"npi":[1336603646]}]},{"allowed_amount":2411.60,"providers":[{"billed_charge":115285.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":338440.48,"providers":[{"billed_charge":936933.20,"npi":[1417432840]}]},{"allowed_amount":346263.34,"providers":[{"billed_charge":953891.30,"npi":[1396790325]}]},{"allowed_amount":2297.70,"providers":[{"billed_charge":5617.85,"npi":[1417432840]}]},{"allowed_amount":48118.05,"providers":[{"billed_charge":132198.30,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1717.50,"providers":[{"billed_charge":5725.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":335113.99,"providers":[{"billed_charge":873415.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2158.00,"providers":[{"billed_charge":3320.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4226.02,"providers":[{"billed_charge":8119.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":20956.64,"providers":[{"billed_charge":53146.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4486.60,"providers":[{"billed_charge":184884.00,"npi":[1851361778]}]},{"allowed_amount":629444.86,"providers":[{"billed_charge":1531374.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":144775.72,"providers":[{"billed_charge":339174.00,"npi":[1255645644]}]},{"allowed_amount":1274.00,"providers":[{"billed_charge":46006.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":67616.43,"providers":[{"billed_charge":151074.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8535.82,"providers":[{"billed_charge":28574.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4711.68,"providers":[{"billed_charge":15263.50,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8868.75,"providers":[{"billed_charge":18733.85,"npi":[1053358945]}]}]}]},{"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":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1043.64,"providers":[{"billed_charge":3914.00,"npi":[1326043548]}]}]}]},{"name":"CARDIAC CATH LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"481","description":"CARDIOLOGY - CARDIAC CATH LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51609.71,"providers":[{"billed_charge":92297.00,"npi":[1649726738]}]},{"allowed_amount":197754.73,"providers":[{"billed_charge":548286.00,"npi":[1649726738]}]}]}]},{"name":"STRESS TEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"482","description":"CARDIOLOGY - STRESS TEST","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":519.01,"providers":[{"billed_charge":1439.00,"npi":[1649726738]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4539.77,"providers":[{"billed_charge":91287.00,"npi":[1649726738]}]},{"allowed_amount":10689.44,"providers":[{"billed_charge":49686.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":454.70,"providers":[{"billed_charge":15169.00,"npi":[1962472860]}]},{"allowed_amount":2967.70,"providers":[{"billed_charge":75138.00,"npi":[1962472860]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":5723.31,"providers":[{"billed_charge":16829.00,"npi":[1871674481]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1489.54,"providers":[{"billed_charge":1904.00,"npi":[1649726738]}]},{"allowed_amount":1679.86,"providers":[{"billed_charge":2688.00,"npi":[1851847974]}]}]}]},{"name":"CHRONIC PAIN CL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"511","description":"CLINIC - CHRONIC PAIN CENTER","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":535.74,"providers":[{"billed_charge":1475.85,"npi":[1417432840]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1965.40,"providers":[{"billed_charge":4260.05,"npi":[1053358945]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"586076010"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":7345.89,"providers":[{"billed_charge":22338.72,"npi":[1316794639]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1424.75,"providers":[{"billed_charge":24820.00,"npi":[1649726738]}]},{"allowed_amount":402.88,"providers":[{"billed_charge":3480.00,"npi":[1649726738]}]}]}]},{"name":"MRI-SPINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"612","description":"MRI - SPINAL CORD (INCLUDING SPINE)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":595.23,"providers":[{"billed_charge":11229.00,"npi":[1649726738]}]}]}]},{"name":"MAGNETIC RESONANCE TECHNOLOG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"614","description":"MAGNETIC RESONANCE TECHNOLOGY - MRI -OTHER","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4390.22,"providers":[{"billed_charge":30136.00,"npi":[1649726738]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7042.15,"providers":[{"billed_charge":83686.50,"npi":[1013918960]}]},{"allowed_amount":2645.36,"providers":[{"billed_charge":8861.90,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":40737.51,"providers":[{"billed_charge":224215.70,"npi":[1851847974]}]},{"allowed_amount":365187.81,"providers":[{"billed_charge":1497566.81,"npi":[1649726738]}]},{"allowed_amount":46.08,"providers":[{"billed_charge":21806.00,"npi":[1639656713]}]},{"allowed_amount":18881.62,"providers":[{"billed_charge":474416.90,"npi":[1649726738]}]},{"allowed_amount":61722.31,"providers":[{"billed_charge":169126.30,"npi":[1841746948]}]},{"allowed_amount":4.16,"providers":[{"billed_charge":3142.80,"npi":[1629432869]}]},{"allowed_amount":914992.82,"providers":[{"billed_charge":2824842.10,"npi":[1114473212]}]},{"allowed_amount":29.10,"providers":[{"billed_charge":481.10,"npi":[1922788728]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5589.70,"providers":[{"billed_charge":22543.75,"npi":[1881647204]}]},{"allowed_amount":2402.92,"providers":[{"billed_charge":8009.70,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":152.95,"providers":[{"billed_charge":510.05,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9391.93,"providers":[{"billed_charge":70320.66,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1534.80,"providers":[{"billed_charge":5115.93,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"850105601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36.56,"providers":[{"billed_charge":106.00,"npi":[1215913470]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7036.05,"providers":[{"billed_charge":19464.60,"npi":[1417432840]}]},{"allowed_amount":120.56,"providers":[{"billed_charge":398.30,"npi":[1396790325]}]},{"allowed_amount":11159.55,"providers":[{"billed_charge":31002.00,"npi":[1417432840]}]},{"allowed_amount":269.18,"providers":[{"billed_charge":2286.80,"npi":[1417432840]}]},{"allowed_amount":4597.92,"providers":[{"billed_charge":12667.45,"npi":[1396790325]}]},{"allowed_amount":782.32,"providers":[{"billed_charge":2154.20,"npi":[1346297892]}]},{"allowed_amount":3740.91,"providers":[{"billed_charge":10349.30,"npi":[1396790325]}]},{"allowed_amount":849.18,"providers":[{"billed_charge":2339.35,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":111.91,"providers":[{"billed_charge":863.80,"npi":[1336603646]}]},{"allowed_amount":1480.40,"providers":[{"billed_charge":48927.90,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":23069.26,"providers":[{"billed_charge":80499.10,"npi":[1326043548]}]},{"allowed_amount":5054.05,"providers":[{"billed_charge":90847.50,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2830.69,"providers":[{"billed_charge":12637.00,"npi":[1427055821]}]},{"allowed_amount":725.70,"providers":[{"billed_charge":2419.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":149.17,"providers":[{"billed_charge":894.47,"npi":[1427075027]}]},{"allowed_amount":49.77,"providers":[{"billed_charge":166.77,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":670.64,"providers":[{"billed_charge":2235.60,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12205.04,"providers":[{"billed_charge":70414.78,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":99.31,"providers":[{"billed_charge":9031.30,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":417.45,"providers":[{"billed_charge":1391.50,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":889.78,"providers":[{"billed_charge":6932.15,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1113.00,"providers":[{"billed_charge":3710.00,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"582296052"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21246.94,"providers":[{"billed_charge":58534.20,"npi":[1033889795]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1208.76,"providers":[{"billed_charge":4384.10,"npi":[1013918960]}]},{"allowed_amount":578.85,"providers":[{"billed_charge":1929.50,"npi":[1013918960]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"450699531"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":900.00,"providers":[{"billed_charge":900.00,"npi":[1205915188]}]}]}]},{"name":"TRAUMA LEVEL 1","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"681","description":"TRAUMA LEVEL 1","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6615.99,"providers":[{"billed_charge":107447.00,"npi":[1649726738]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"571049603"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":358.26,"providers":[{"billed_charge":2728.00,"npi":[1942610381]}]},{"allowed_amount":188.56,"providers":[{"billed_charge":1488.00,"npi":[1669978078]}]},{"allowed_amount":414.83,"providers":[{"billed_charge":3224.00,"npi":[1669978078]}]},{"allowed_amount":18.86,"providers":[{"billed_charge":248.00,"npi":[1942610381]}]},{"allowed_amount":37.72,"providers":[{"billed_charge":496.00,"npi":[1942610381]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":33765.90,"providers":[{"billed_charge":92884.40,"npi":[1417432840]}]},{"allowed_amount":3641.03,"providers":[{"billed_charge":9978.65,"npi":[1417432840]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"273818647"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":109.48,"providers":[{"billed_charge":378.00,"npi":[1154385193]}]},{"allowed_amount":78.20,"providers":[{"billed_charge":270.00,"npi":[1154385193]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":8.15,"providers":[{"billed_charge":37.00,"npi":[1669978078]}]},{"allowed_amount":32.60,"providers":[{"billed_charge":148.00,"npi":[1427369537,1417940818]}]},{"allowed_amount":97.62,"providers":[{"billed_charge":444.00,"npi":[1942610381]}]},{"allowed_amount":431.59,"providers":[{"billed_charge":1961.00,"npi":[1942610381]}]},{"allowed_amount":105.89,"providers":[{"billed_charge":481.00,"npi":[1942610381]}]},{"allowed_amount":8.09,"providers":[{"billed_charge":37.00,"npi":[1417940818]}]},{"allowed_amount":146.70,"providers":[{"billed_charge":666.00,"npi":[1669978078]}]},{"allowed_amount":16.30,"providers":[{"billed_charge":74.00,"npi":[1417940818]}]},{"allowed_amount":105.95,"providers":[{"billed_charge":481.00,"npi":[1427369537]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4192.00,"providers":[{"billed_charge":5888.00,"npi":[1013918960]}]},{"allowed_amount":473.06,"providers":[{"billed_charge":1024.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":495.00,"providers":[{"billed_charge":17742.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":605.08,"providers":[{"billed_charge":730.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":249.40,"providers":[{"billed_charge":13779.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":560.80,"providers":[{"billed_charge":29463.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":7586.00,"npi":[1336603646]}]},{"allowed_amount":192.76,"providers":[{"billed_charge":85759.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17948.29,"providers":[{"billed_charge":50430.85,"npi":[1417432840]}]},{"allowed_amount":15139.45,"providers":[{"billed_charge":41830.60,"npi":[1396790325]}]},{"allowed_amount":237.85,"providers":[{"billed_charge":581.55,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":398.16,"providers":[{"billed_charge":3432.00,"npi":[1326043548]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"571049603"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":324.00,"providers":[{"billed_charge":2200.00,"npi":[1942610381]}]},{"allowed_amount":81.00,"providers":[{"billed_charge":550.00,"npi":[1427369537]}]},{"allowed_amount":162.00,"providers":[{"billed_charge":1100.00,"npi":[1427369537]}]},{"allowed_amount":2186.84,"providers":[{"billed_charge":14850.00,"npi":[1942610381]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7566.44,"providers":[{"billed_charge":24892.00,"npi":[1649726738]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":627.10,"providers":[{"billed_charge":5680.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6037.60,"providers":[{"billed_charge":17977.05,"npi":[1417432840]}]},{"allowed_amount":21878.63,"providers":[{"billed_charge":61357.95,"npi":[1417432840]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1569.69,"providers":[{"billed_charge":1569.69,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9303.33,"providers":[{"billed_charge":26250.00,"npi":[1205495884]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":914.51,"providers":[{"billed_charge":2375.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":53.40,"providers":[{"billed_charge":240.00,"npi":[1205893187]}]},{"allowed_amount":1411.80,"providers":[{"billed_charge":6360.00,"npi":[1205893187]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":51.95,"providers":[{"billed_charge":68.00,"npi":[1295949220]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":2210.16,"providers":[{"billed_charge":5700.00,"npi":[1497293773]}]}]},{"tin":{"type":"ein","value":"571049603"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":67.82,"providers":[{"billed_charge":384.00,"npi":[1205893187]}]},{"allowed_amount":1794.46,"providers":[{"billed_charge":10176.00,"npi":[1205893187]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":66.45,"providers":[{"billed_charge":86.00,"npi":[1295949220]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":425.06,"providers":[{"billed_charge":668.00,"npi":[1649726738]}]}]}]},{"name":"RADIATION TX MANAGEMENT X5","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77427","description":"RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS","allowed_amounts":[{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":414.52,"providers":[{"billed_charge":1250.00,"npi":[1205495884]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":543.06,"providers":[{"billed_charge":1494.80,"npi":[1811005150]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1425.02,"providers":[{"billed_charge":3913.50,"npi":[1811005150]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.36,"providers":[{"billed_charge":506.88,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2931.62,"providers":[{"billed_charge":8117.95,"npi":[1811005150]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.88,"providers":[{"billed_charge":214.24,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2138.85,"providers":[{"billed_charge":5923.30,"npi":[1811005150]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"844246379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":798.64,"providers":[{"billed_charge":4470.00,"npi":[1821683186]}]},{"allowed_amount":1200.64,"providers":[{"billed_charge":6720.00,"npi":[1609451194]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3060.13,"providers":[{"billed_charge":26233.02,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":113.12,"providers":[{"billed_charge":311.60,"npi":[1811005150]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"204068094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.20,"providers":[{"billed_charge":150.00,"npi":[1285387084]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":38.20,"providers":[{"billed_charge":200.00,"npi":[1134675978]}]},{"allowed_amount":49.66,"providers":[{"billed_charge":260.00,"npi":[1134675978]}]}]}]},{"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":26566.76,"providers":[{"billed_charge":115375.60,"npi":[1598314437]}]}]}]},{"name":"Under Multianalyte Assays with Algorithmic Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81515","description":"Under Multianalyte Assays with Algorithmic Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1899.82,"providers":[{"billed_charge":5322.00,"npi":[1811005150]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":319.72,"providers":[{"billed_charge":879.00,"npi":[1811005150]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"273795223"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":14960.00,"providers":[{"billed_charge":139605.36,"npi":[1912209123]}]}]},{"tin":{"type":"ein","value":"472503725"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":1760.00,"providers":[{"billed_charge":16424.16,"npi":[1578961389]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2087.73,"providers":[{"billed_charge":5742.75,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":325.02,"providers":[{"billed_charge":902.75,"npi":[1811005150]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2083.44,"providers":[{"billed_charge":5736.40,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":890.10,"providers":[{"billed_charge":2451.80,"npi":[1811005150]}]}]}]},{"name":"HEMOGLOBIN ELECTROPHORESIS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83020","description":"HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F)","allowed_amounts":[{"tin":{"type":"ein","value":"571122647"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":76.85,"providers":[{"billed_charge":196.00,"npi":[1922460955]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":263.88,"providers":[{"billed_charge":726.90,"npi":[1811005150]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":19.44,"providers":[{"billed_charge":164.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":53.69,"providers":[{"billed_charge":377.00,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2274.94,"providers":[{"billed_charge":6327.90,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4282.76,"providers":[{"billed_charge":11784.80,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.45,"providers":[{"billed_charge":105.25,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":647.54,"providers":[{"billed_charge":1798.15,"npi":[1811005150]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.88,"providers":[{"billed_charge":537.60,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2702.94,"providers":[{"billed_charge":7488.40,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":889.04,"providers":[{"billed_charge":2443.60,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.00,"providers":[{"billed_charge":184.60,"npi":[1811005150]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":59.40,"providers":[{"billed_charge":155.34,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":157.08,"providers":[{"billed_charge":280.00,"npi":[1912986977]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.49,"providers":[{"billed_charge":361.88,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6523.18,"providers":[{"billed_charge":18003.10,"npi":[1811005150]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1003.74,"providers":[{"billed_charge":2778.20,"npi":[1811005150]}]}]}]},{"name":"CCPD/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"851","description":"CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"273836308"},"service_code":["12"],"billing_class":"institutional","payments":[{"allowed_amount":2040.00,"providers":[{"billed_charge":73469.16,"npi":[1649607573]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":197.55,"providers":[{"billed_charge":543.60,"npi":[1811005150]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":999.52,"providers":[{"billed_charge":2763.95,"npi":[1811005150]}]}]}]},{"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":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":65.78,"providers":[{"billed_charge":181.20,"npi":[1811005150]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3457.92,"providers":[{"billed_charge":9518.80,"npi":[1811005150]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1766.62,"providers":[{"billed_charge":4864.40,"npi":[1811005150]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":122.44,"providers":[{"billed_charge":337.30,"npi":[1811005150]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":62.93,"providers":[{"billed_charge":185.70,"npi":[1811005150]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":218.92,"providers":[{"billed_charge":603.20,"npi":[1811005150]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":867.42,"providers":[{"billed_charge":2433.75,"npi":[1811005150]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1997.96,"providers":[{"billed_charge":5562.25,"npi":[1811005150]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":306.10,"providers":[{"billed_charge":842.10,"npi":[1811005150]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2604.41,"providers":[{"billed_charge":7258.40,"npi":[1811005150]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3331.64,"providers":[{"billed_charge":9274.20,"npi":[1811005150]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":575.52,"providers":[{"billed_charge":1610.05,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":111.92,"providers":[{"billed_charge":308.40,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":184.72,"providers":[{"billed_charge":508.80,"npi":[1811005150]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1160.82,"providers":[{"billed_charge":3211.30,"npi":[1811005150]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":56.65,"providers":[{"billed_charge":156.00,"npi":[1811005150]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3863.44,"providers":[{"billed_charge":10707.70,"npi":[1811005150]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":299.04,"providers":[{"billed_charge":823.80,"npi":[1811005150]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":465.19,"providers":[{"billed_charge":1310.40,"npi":[1811005150]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1914.78,"providers":[{"billed_charge":5337.15,"npi":[1811005150]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14708.90,"providers":[{"billed_charge":40925.25,"npi":[1811005150]}]}]}]},{"name":"CANDIDA, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87480","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":214.60,"providers":[{"billed_charge":615.75,"npi":[1811005150]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":199.24,"providers":[{"billed_charge":2135.81,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1155.09,"providers":[{"billed_charge":3300.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4475.25,"providers":[{"billed_charge":12480.10,"npi":[1811005150]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":969.01,"providers":[{"billed_charge":1496.00,"npi":[1215655402]}]}]}]},{"name":"GARDNER VAG, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87510","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":89.40,"providers":[{"billed_charge":246.30,"npi":[1811005150]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":260.00,"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":199.24,"providers":[{"billed_charge":2160.54,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1155.28,"providers":[{"billed_charge":3300.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4431.85,"providers":[{"billed_charge":12378.30,"npi":[1811005150]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":82.04,"providers":[{"billed_charge":1190.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":651.03,"providers":[{"billed_charge":1860.00,"npi":[1023098928]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5502.05,"providers":[{"billed_charge":15299.20,"npi":[1811005150]}]}]}]},{"name":"TRICHOMONAS VAGIN, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87660","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":222.76,"providers":[{"billed_charge":611.40,"npi":[1811005150]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":35.16,"providers":[{"billed_charge":365.27,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1050.03,"providers":[{"billed_charge":3000.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":448.38,"providers":[{"billed_charge":1309.70,"npi":[1811005150]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":117.20,"providers":[{"billed_charge":1300.00,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":70.35,"providers":[{"billed_charge":165.50,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"208870333"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14.07,"providers":[{"billed_charge":82.76,"npi":[1376037721]}]},{"allowed_amount":42.21,"providers":[{"billed_charge":248.28,"npi":[1467297408]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":302.29,"providers":[{"billed_charge":2150.00,"npi":[1992282297]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":193.49,"providers":[{"billed_charge":2112.00,"npi":[1992282297]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14.06,"providers":[{"billed_charge":86.00,"npi":[1992282297]}]}]}]},{"name":"CYTOPATH, C/V, INTERPRET","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88141","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING INTERPRETATION BY PHYSICIAN","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.12,"providers":[{"billed_charge":123.00,"npi":[1023098928]}]}]}]},{"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":195.58,"providers":[{"billed_charge":1744.32,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1877.20,"providers":[{"billed_charge":5310.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9057.10,"providers":[{"billed_charge":25067.25,"npi":[1811005150]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"463666116"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":128.44,"providers":[{"billed_charge":200.00,"npi":[1609306315]}]}]},{"tin":{"type":"ein","value":"570560638"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":16.99,"providers":[{"billed_charge":145.00,"npi":[1942361688]}]},{"allowed_amount":67.95,"providers":[{"billed_charge":580.00,"npi":[1942361688]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4750.46,"providers":[{"billed_charge":13118.20,"npi":[1811005150]}]}]}]},{"name":"ELECTRO SHOCK","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"901","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - ELECTROSCHOCK TREATMENT","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8821.80,"providers":[{"billed_charge":24010.00,"npi":[1639656713]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"873746039"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3600.00,"providers":[{"billed_charge":19104.00,"npi":[1053002204]}]}]}]},{"name":"PSYCH DIAGNOSTIC EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90791","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["12","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":855.52,"providers":[{"billed_charge":1122.00,"npi":[1841374972]}]},{"allowed_amount":345.03,"providers":[{"billed_charge":510.00,"npi":[1508811324]}]},{"allowed_amount":4378.95,"providers":[{"billed_charge":6018.00,"npi":[1609979640]}]},{"allowed_amount":325.76,"providers":[{"billed_charge":918.00,"npi":[1508811324]}]},{"allowed_amount":4526.22,"providers":[{"billed_charge":6936.00,"npi":[1508811324]}]},{"allowed_amount":5274.84,"providers":[{"billed_charge":7344.00,"npi":[1841374972]}]},{"allowed_amount":102.00,"providers":[{"billed_charge":102.00,"npi":[1609979640]}]},{"allowed_amount":162.88,"providers":[{"billed_charge":204.00,"npi":[1831200310,1609979640]}]},{"allowed_amount":2100.36,"providers":[{"billed_charge":3264.00,"npi":[1831200310]}]},{"allowed_amount":1317.15,"providers":[{"billed_charge":1632.00,"npi":[1841374972]}]},{"allowed_amount":564.12,"providers":[{"billed_charge":816.00,"npi":[1831200310]}]}]}]},{"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":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":321.28,"providers":[{"billed_charge":660.00,"npi":[1841374972]}]},{"allowed_amount":160.64,"providers":[{"billed_charge":661.00,"npi":[1508811324]},{"billed_charge":330.00,"npi":[1508811324]}]}]},{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":4814.50,"providers":[{"billed_charge":5400.00,"npi":[1144780206]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":884.13,"providers":[{"billed_charge":1144.00,"npi":[1841374972]}]},{"allowed_amount":308.68,"providers":[{"billed_charge":352.00,"npi":[1508811324]}]},{"allowed_amount":77.17,"providers":[{"billed_charge":88.00,"npi":[1508811324]}]},{"allowed_amount":1562.81,"providers":[{"billed_charge":2024.00,"npi":[1841374972]}]},{"allowed_amount":1222.76,"providers":[{"billed_charge":1584.00,"npi":[1609979640]}]},{"allowed_amount":1088.16,"providers":[{"billed_charge":1408.00,"npi":[1508811324]}]},{"allowed_amount":1835.56,"providers":[{"billed_charge":2376.00,"npi":[1508811324]}]},{"allowed_amount":385.85,"providers":[{"billed_charge":440.00,"npi":[1841374972]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1760970529]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":538.38,"providers":[{"billed_charge":1050.00,"npi":[1841374972]}]},{"allowed_amount":1018.30,"providers":[{"billed_charge":1750.00,"npi":[1508811324]}]},{"allowed_amount":897.30,"providers":[{"billed_charge":1750.00,"npi":[1841374972]}]},{"allowed_amount":1615.14,"providers":[{"billed_charge":3150.00,"npi":[1508811324]}]},{"allowed_amount":712.81,"providers":[{"billed_charge":1225.00,"npi":[1508811324]}]},{"allowed_amount":101.83,"providers":[{"billed_charge":175.00,"npi":[1831200310]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["11","12","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":150.84,"providers":[{"billed_charge":265.00,"npi":[1508811324,1831200310,1609979640]}]},{"allowed_amount":1726.66,"providers":[{"billed_charge":3445.00,"npi":[1508811324]}]},{"allowed_amount":1859.48,"providers":[{"billed_charge":3710.00,"npi":[1841374972]}]},{"allowed_amount":4778.54,"providers":[{"billed_charge":9540.00,"npi":[1841374972]}]},{"allowed_amount":3318.48,"providers":[{"billed_charge":5830.00,"npi":[1508811324]}]},{"allowed_amount":11816.51,"providers":[{"billed_charge":23585.00,"npi":[1508811324]}]},{"allowed_amount":132.82,"providers":[{"billed_charge":265.00,"npi":[1609979640]}]},{"allowed_amount":1992.30,"providers":[{"billed_charge":3975.00,"npi":[1831200310]}]}]},{"tin":{"type":"ein","value":"932266390"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1696.95,"providers":[{"billed_charge":3750.00,"npi":[1588729313]}]},{"allowed_amount":565.65,"providers":[{"billed_charge":1250.00,"npi":[1144607524]}]}]}]},{"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":107163.00,"providers":[{"billed_charge":291600.00,"npi":[1902825169]}]}]},{"tin":{"type":"ein","value":"811567573"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":26352.00,"providers":[{"billed_charge":167750.00,"npi":[1649715517]}]}]},{"tin":{"type":"ein","value":"873746039"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2310.00,"providers":[{"billed_charge":16038.00,"npi":[1053002204]}]}]},{"tin":{"type":"ein","value":"465287425"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":22010.00,"providers":[{"billed_charge":218794.88,"npi":[1952719189]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"932779549"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1320.90,"providers":[{"billed_charge":18500.00,"npi":[1023884038]}]}]}]},{"name":"PSTAY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"919","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - OTHER","allowed_amounts":[{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1650.30,"providers":[{"billed_charge":5501.00,"npi":[1962277343]}]}]}]},{"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":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":335.28,"providers":[{"billed_charge":1686.00,"npi":[1649726738]}]},{"allowed_amount":198.00,"providers":[{"billed_charge":2326.00,"npi":[1649726738]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8893.23,"providers":[{"billed_charge":68713.00,"npi":[1649726738]}]},{"allowed_amount":934.63,"providers":[{"billed_charge":6082.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1563.10,"providers":[{"billed_charge":9032.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":778.88,"providers":[{"billed_charge":5741.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":966.65,"providers":[{"billed_charge":2662.95,"npi":[1417432840]}]},{"allowed_amount":831.72,"providers":[{"billed_charge":2291.25,"npi":[1396790325]}]},{"allowed_amount":2936.34,"providers":[{"billed_charge":8404.25,"npi":[1417432840]}]},{"allowed_amount":945.51,"providers":[{"billed_charge":2311.75,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":329.70,"providers":[{"billed_charge":2599.00,"npi":[1336603646]}]},{"allowed_amount":2957.93,"providers":[{"billed_charge":17626.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":988.31,"providers":[{"billed_charge":4718.00,"npi":[1326043548]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"830770746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":150.00,"providers":[{"billed_charge":150.00,"npi":[1194395590]}]}]},{"tin":{"type":"ein","value":"473826361"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":415.19,"providers":[{"billed_charge":600.00,"npi":[1568189751]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":162.96,"providers":[{"billed_charge":560.60,"npi":[1417432840]}]},{"allowed_amount":11966.59,"providers":[{"billed_charge":33244.00,"npi":[1417432840]}]},{"allowed_amount":192.97,"providers":[{"billed_charge":471.80,"npi":[1417432840]}]},{"allowed_amount":83.47,"providers":[{"billed_charge":280.30,"npi":[1396790325]}]},{"allowed_amount":10091.05,"providers":[{"billed_charge":27775.25,"npi":[1396790325]}]},{"allowed_amount":600.17,"providers":[{"billed_charge":1648.15,"npi":[1346297892]}]}]}]},{"name":"EDUC/TRAINING","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"942","description":"OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8530.46,"providers":[{"billed_charge":13660.00,"npi":[1649726738]}]},{"allowed_amount":49.65,"providers":[{"billed_charge":292.00,"npi":[1649726738]}]}]}]},{"name":"CARDIAC REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"943","description":"OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3987.34,"providers":[{"billed_charge":7657.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":152.39,"providers":[{"billed_charge":419.80,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7173.66,"providers":[{"billed_charge":13702.00,"npi":[1326043548]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.43,"providers":[{"billed_charge":84.00,"npi":[1720899875]}]},{"allowed_amount":530.78,"providers":[{"billed_charge":1824.00,"npi":[1134675978]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":134.16,"providers":[{"billed_charge":468.00,"npi":[1134675978]}]},{"allowed_amount":178.74,"providers":[{"billed_charge":624.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["99","53"],"billing_class":"professional","payments":[{"allowed_amount":355.43,"providers":[{"billed_charge":675.00,"npi":[1508811324]}]},{"allowed_amount":498.78,"providers":[{"billed_charge":925.00,"npi":[1609979640]}]},{"allowed_amount":276.91,"providers":[{"billed_charge":525.00,"npi":[1841374972]}]},{"allowed_amount":13.15,"providers":[{"billed_charge":25.00,"npi":[1609979640]}]}]}]},{"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":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.90,"providers":[{"billed_charge":50.00,"npi":[1376789891]}]},{"allowed_amount":14.95,"providers":[{"billed_charge":20.00,"npi":[1093941346]}]}]}]},{"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":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":25.54,"providers":[{"billed_charge":50.00,"npi":[1376789891]}]}]}]},{"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":"203152516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":483.69,"providers":[{"billed_charge":1150.00,"npi":[1134813975]}]}]},{"tin":{"type":"ein","value":"61651287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":523.98,"providers":[{"billed_charge":1920.00,"npi":[1023047453]}]}]},{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":158.31,"providers":[{"billed_charge":480.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"462814974"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.45,"providers":[{"billed_charge":255.00,"npi":[1053141796]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":178.12,"providers":[{"billed_charge":718.93,"npi":[1932922440]}]},{"allowed_amount":557.04,"providers":[{"billed_charge":2243.92,"npi":[1912704123]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":176.00,"providers":[{"billed_charge":560.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":95.51,"providers":[{"billed_charge":313.68,"npi":[1912704123]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"822819223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8577.39,"providers":[{"billed_charge":9400.00,"npi":[1417386822]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":204.42,"providers":[{"billed_charge":600.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"830770746"},"service_code":["99","11","12"],"billing_class":"professional","payments":[{"allowed_amount":419.92,"providers":[{"billed_charge":800.00,"npi":[1740749985]}]},{"allowed_amount":1513.06,"providers":[{"billed_charge":2900.00,"npi":[1740749985]}]},{"allowed_amount":1312.26,"providers":[{"billed_charge":2500.00,"npi":[1740749985]}]}]},{"tin":{"type":"ein","value":"474438367"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":481.80,"providers":[{"billed_charge":1000.00,"npi":[1821677782]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":577.37,"providers":[{"billed_charge":1623.34,"npi":[1912704123]}]},{"allowed_amount":545.66,"providers":[{"billed_charge":1552.76,"npi":[1932922440]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"843983650"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":371.10,"providers":[{"billed_charge":600.00,"npi":[1649689969]}]}]},{"tin":{"type":"ein","value":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":929.08,"providers":[{"billed_charge":1035.00,"npi":[1093941346]}]},{"allowed_amount":80.86,"providers":[{"billed_charge":110.00,"npi":[1376789891]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":438.77,"providers":[{"billed_charge":1285.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":149.60,"providers":[{"billed_charge":341.00,"npi":[1740489111]}]},{"allowed_amount":299.20,"providers":[{"billed_charge":682.00,"npi":[1215655402]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":132.35,"providers":[{"billed_charge":392.00,"npi":[1134675978]}]},{"allowed_amount":926.45,"providers":[{"billed_charge":2744.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"571021048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1004.34,"providers":[{"billed_charge":2322.00,"npi":[1447824115]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":32.60,"providers":[{"billed_charge":432.00,"npi":[1508811324]}]},{"allowed_amount":8.15,"providers":[{"billed_charge":96.00,"npi":[1508811324]},{"billed_charge":48.00,"npi":[1841374972]}]},{"allowed_amount":16.30,"providers":[{"billed_charge":240.00,"npi":[1841374972]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":2156.96,"providers":[{"billed_charge":5310.00,"npi":[1134675978]}]},{"allowed_amount":6604.54,"providers":[{"billed_charge":16284.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"994277174"},"service_code":["02","20","10"],"billing_class":"professional","payments":[{"allowed_amount":752.25,"providers":[{"billed_charge":906.00,"npi":[1093744849]}]},{"allowed_amount":287.50,"providers":[{"billed_charge":390.00,"npi":[1700990587,1730147778]}]},{"allowed_amount":104.60,"providers":[{"billed_charge":195.00,"npi":[1700990587]}]},{"allowed_amount":3459.40,"providers":[{"billed_charge":5907.00,"npi":[1700990587]}]},{"allowed_amount":2989.99,"providers":[{"billed_charge":4519.00,"npi":[1215655402]}]},{"allowed_amount":962.33,"providers":[{"billed_charge":1472.00,"npi":[1740489111]}]}]},{"tin":{"type":"ein","value":"570992733"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":429.26,"providers":[{"billed_charge":1110.00,"npi":[1871998302]}]}]},{"tin":{"type":"ein","value":"844246379"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":6490.96,"providers":[{"billed_charge":15500.00,"npi":[1609451194]}]},{"allowed_amount":7686.29,"providers":[{"billed_charge":13375.00,"npi":[1821683186]}]},{"allowed_amount":1726.46,"providers":[{"billed_charge":4125.00,"npi":[1821683186]}]},{"allowed_amount":7480.94,"providers":[{"billed_charge":13000.00,"npi":[1609451194]}]},{"allowed_amount":10119.53,"providers":[{"billed_charge":24125.00,"npi":[1609451194]}]},{"allowed_amount":2873.54,"providers":[{"billed_charge":6875.00,"npi":[1821683186]}]}]},{"tin":{"type":"ein","value":"237085643"},"service_code":["11","50"],"billing_class":"professional","payments":[{"allowed_amount":253.68,"providers":[{"billed_charge":276.00,"npi":[1548344096]}]},{"allowed_amount":169.12,"providers":[{"billed_charge":184.00,"npi":[1548344096]}]}]},{"tin":{"type":"ein","value":"463813098"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":57.77,"providers":[{"billed_charge":150.00,"npi":[1417548660]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.19,"providers":[{"billed_charge":191.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"271734536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":253.68,"providers":[{"billed_charge":300.00,"npi":[1033432778]}]}]}]},{"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":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":3039.99,"providers":[{"billed_charge":7800.00,"npi":[1134675978]}]},{"allowed_amount":11757.52,"providers":[{"billed_charge":30160.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":3889.52,"providers":[{"billed_charge":8402.00,"npi":[1215146352]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2535.26,"providers":[{"billed_charge":4536.00,"npi":[1235152349]}]},{"allowed_amount":133.82,"providers":[{"billed_charge":324.00,"npi":[1912986977]}]},{"allowed_amount":4527.25,"providers":[{"billed_charge":8100.00,"npi":[1750795183]}]},{"allowed_amount":9235.59,"providers":[{"billed_charge":16524.00,"npi":[1912986977]}]},{"allowed_amount":267.64,"providers":[{"billed_charge":648.00,"npi":[1750795183]}]},{"allowed_amount":1267.63,"providers":[{"billed_charge":2268.00,"npi":[1720378136,1952982563]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":1904.54,"providers":[{"billed_charge":5166.00,"npi":[1841374972]}]},{"allowed_amount":2807.98,"providers":[{"billed_charge":5242.00,"npi":[1841374972]}]},{"allowed_amount":1086.96,"providers":[{"billed_charge":1929.00,"npi":[1508811324]}]},{"allowed_amount":362.32,"providers":[{"billed_charge":1060.00,"npi":[1609979640]}]},{"allowed_amount":543.48,"providers":[{"billed_charge":1324.00,"npi":[1508811324]}]},{"allowed_amount":2083.34,"providers":[{"billed_charge":4754.00,"npi":[1831200310]}]},{"allowed_amount":271.74,"providers":[{"billed_charge":662.00,"npi":[1831200310]}]}]},{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":2142.07,"providers":[{"billed_charge":4986.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"994277174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1478.45,"providers":[{"billed_charge":1920.00,"npi":[1093744849]}]},{"allowed_amount":671.87,"providers":[{"billed_charge":1028.00,"npi":[1215655402]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3655.62,"providers":[{"billed_charge":8985.60,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"570969793"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":716.53,"providers":[{"billed_charge":1644.00,"npi":[1760050512]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2330.82,"providers":[{"billed_charge":3864.00,"npi":[1992282297]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10496.14,"providers":[{"billed_charge":15196.00,"npi":[1831452853]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99221","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2851.70,"providers":[{"billed_charge":10115.00,"npi":[1093943466]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1365.11,"providers":[{"billed_charge":1755.00,"npi":[1982678660]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":680.30,"providers":[{"billed_charge":1442.00,"npi":[1093943466]}]}]},{"tin":{"type":"ein","value":"300701952"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2291.52,"providers":[{"billed_charge":9072.00,"npi":[1619078417]}]},{"allowed_amount":4317.25,"providers":[{"billed_charge":16968.00,"npi":[1972388031]}]}]},{"tin":{"type":"ein","value":"471345819"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":82.74,"providers":[{"billed_charge":93.00,"npi":[1497137038]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"851417767"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":564.88,"providers":[{"billed_charge":1472.00,"npi":[1326454745]}]}]},{"tin":{"type":"ein","value":"562039679"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":959.01,"providers":[{"billed_charge":1625.01,"npi":[1407056401]}]}]},{"tin":{"type":"ein","value":"571124822"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":988.54,"providers":[{"billed_charge":2520.00,"npi":[1154361723]}]}]},{"tin":{"type":"ein","value":"993250322"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":353.05,"providers":[{"billed_charge":490.00,"npi":[1467958181]}]}]},{"tin":{"type":"ein","value":"300701952"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1659.95,"providers":[{"billed_charge":4704.00,"npi":[1619078417]}]},{"allowed_amount":1163.11,"providers":[{"billed_charge":3332.00,"npi":[1972388031]}]}]},{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":16215.07,"providers":[{"billed_charge":17600.00,"npi":[1144780206]}]}]},{"tin":{"type":"ein","value":"203566888"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":297.76,"providers":[{"billed_charge":1168.00,"npi":[1144633660]}]}]},{"tin":{"type":"ein","value":"576000094"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":163.76,"providers":[{"billed_charge":422.00,"npi":[1356403588]}]}]},{"tin":{"type":"ein","value":"204086208"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":3882.76,"providers":[{"billed_charge":7130.00,"npi":[1225762933]}]}]},{"tin":{"type":"ein","value":"460881518"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":145.60,"providers":[{"billed_charge":350.00,"npi":[1700896156]}]}]},{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":473.62,"providers":[{"billed_charge":720.00,"npi":[1164547071]}]},{"allowed_amount":15219.53,"providers":[{"billed_charge":19800.00,"npi":[1982678660]}]}]},{"tin":{"type":"ein","value":"861770820"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":141.22,"providers":[{"billed_charge":288.00,"npi":[1063040533]}]},{"allowed_amount":917.93,"providers":[{"billed_charge":1872.00,"npi":[1760642268]}]},{"allowed_amount":564.88,"providers":[{"billed_charge":1152.00,"npi":[1578008991]}]}]},{"tin":{"type":"ein","value":"880606916"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":988.54,"providers":[{"billed_charge":2450.00,"npi":[1477966828]}]}]},{"tin":{"type":"ein","value":"472781928"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":847.32,"providers":[{"billed_charge":1680.00,"npi":[1316983729]}]}]},{"tin":{"type":"ein","value":"844744245"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":564.88,"providers":[{"billed_charge":1400.00,"npi":[1710255732]}]}]},{"tin":{"type":"ein","value":"472527918"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":423.66,"providers":[{"billed_charge":840.00,"npi":[1760463491]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"262976526"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4279.68,"providers":[{"billed_charge":6880.00,"npi":[1164951950]}]},{"allowed_amount":4415.92,"providers":[{"billed_charge":7095.00,"npi":[1891923181]}]},{"allowed_amount":2541.06,"providers":[{"billed_charge":4085.00,"npi":[1841671344]}]}]},{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1118.48,"providers":[{"billed_charge":7117.00,"npi":[1255307898]}]},{"allowed_amount":1634.03,"providers":[{"billed_charge":6470.00,"npi":[1124086400]}]},{"allowed_amount":8594.70,"providers":[{"billed_charge":40114.00,"npi":[1952861536]}]},{"allowed_amount":7894.50,"providers":[{"billed_charge":36879.00,"npi":[1700466323]}]}]},{"tin":{"type":"ein","value":"582569828"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1766.05,"providers":[{"billed_charge":7633.92,"npi":[1124682323]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99238","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; 30 MINUTES OR LESS","allowed_amounts":[{"tin":{"type":"ein","value":"233044427"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2725.25,"providers":[{"billed_charge":3335.00,"npi":[1144780206]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99239","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":802.30,"providers":[{"billed_charge":1020.00,"npi":[1982678660]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":73.28,"providers":[{"billed_charge":288.72,"npi":[1730612342]}]}]},{"tin":{"type":"ein","value":"932543044"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":375.60,"providers":[{"billed_charge":11644.00,"npi":[1174507578]}]},{"allowed_amount":295.84,"providers":[{"billed_charge":7896.00,"npi":[1538466206]}]}]},{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":248.88,"providers":[{"billed_charge":641.00,"npi":[1801271739]}]}]}]},{"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":"831057917"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1375.11,"providers":[{"billed_charge":5826.80,"npi":[1730612342]}]}]},{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":14383.70,"providers":[{"billed_charge":40494.00,"npi":[1346732641]}]},{"allowed_amount":4653.55,"providers":[{"billed_charge":12958.00,"npi":[1457665994,1750960290]}]},{"allowed_amount":11845.40,"providers":[{"billed_charge":32984.00,"npi":[1568813327]}]},{"allowed_amount":8037.95,"providers":[{"billed_charge":22382.00,"npi":[1124766134]}]},{"allowed_amount":6345.75,"providers":[{"billed_charge":17670.00,"npi":[1649443607]}]},{"allowed_amount":2961.35,"providers":[{"billed_charge":8522.00,"npi":[1154716769]}]},{"allowed_amount":5922.70,"providers":[{"billed_charge":16757.00,"npi":[1780263780]}]},{"allowed_amount":3807.45,"providers":[{"billed_charge":10503.00,"npi":[1588244388]}]},{"allowed_amount":10576.25,"providers":[{"billed_charge":29450.00,"npi":[1801271739]}]},{"allowed_amount":423.05,"providers":[{"billed_charge":1198.00,"npi":[1700121324]}]},{"allowed_amount":5499.65,"providers":[{"billed_charge":15483.00,"npi":[1366604944]}]},{"allowed_amount":9307.10,"providers":[{"billed_charge":26202.00,"npi":[1235793621]}]},{"allowed_amount":5076.60,"providers":[{"billed_charge":14292.00,"npi":[1942638564]}]},{"allowed_amount":2115.25,"providers":[{"billed_charge":5890.00,"npi":[1619220589]}]},{"allowed_amount":8884.05,"providers":[{"billed_charge":24738.00,"npi":[1134357726]}]},{"allowed_amount":846.10,"providers":[{"billed_charge":2356.00,"npi":[1811975550]}]},{"allowed_amount":1692.20,"providers":[{"billed_charge":4792.00,"npi":[1194589135]},{"billed_charge":4764.00,"npi":[1114017118]}]},{"allowed_amount":7191.85,"providers":[{"billed_charge":20026.00,"npi":[1417065467]},{"billed_charge":20031.00,"npi":[1669091633]}]},{"allowed_amount":2538.30,"providers":[{"billed_charge":6930.00,"npi":[1669050589,1891374435]},{"billed_charge":7146.00,"npi":[1902485592]}]},{"allowed_amount":1269.15,"providers":[{"billed_charge":3594.00,"npi":[1497333439]}]},{"allowed_amount":8461.00,"providers":[{"billed_charge":23820.00,"npi":[1740929637]}]}]}]},{"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":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":17875.31,"providers":[{"billed_charge":50054.00,"npi":[1942638564]}]},{"allowed_amount":1232.78,"providers":[{"billed_charge":3464.00,"npi":[1619220589]}]},{"allowed_amount":3081.95,"providers":[{"billed_charge":8870.00,"npi":[1093387490]},{"billed_charge":8630.00,"npi":[1588244388]}]},{"allowed_amount":616.39,"providers":[{"billed_charge":1738.00,"npi":[1659952992,1154716769,1598897951]}]},{"allowed_amount":2465.56,"providers":[{"billed_charge":6904.00,"npi":[1669050589]}]},{"allowed_amount":7396.68,"providers":[{"billed_charge":20856.00,"npi":[1457665994]}]},{"allowed_amount":7562.27,"providers":[{"billed_charge":22438.00,"npi":[1235793621]}]},{"allowed_amount":1849.17,"providers":[{"billed_charge":4398.00,"npi":[1285695635]},{"billed_charge":5214.00,"npi":[1124766134]}]},{"allowed_amount":19724.48,"providers":[{"billed_charge":55232.00,"npi":[1891374435]}]},{"allowed_amount":6163.90,"providers":[{"billed_charge":17530.00,"npi":[1376129254]}]},{"allowed_amount":13560.58,"providers":[{"billed_charge":38236.00,"npi":[1134357726]},{"billed_charge":37972.00,"npi":[1902485592]}]},{"allowed_amount":10478.63,"providers":[{"billed_charge":30256.00,"npi":[1073199808]}]},{"allowed_amount":5547.51,"providers":[{"billed_charge":15534.00,"npi":[1497046411]},{"billed_charge":15812.00,"npi":[1841759628]},{"billed_charge":15672.00,"npi":[1700121324]}]},{"allowed_amount":9862.24,"providers":[{"billed_charge":27808.00,"npi":[1417065467]}]},{"allowed_amount":9245.85,"providers":[{"billed_charge":25890.00,"npi":[1366604944]},{"billed_charge":26680.00,"npi":[1780263780]}]},{"allowed_amount":11711.41,"providers":[{"billed_charge":32794.00,"npi":[1114017118]}]},{"allowed_amount":4314.73,"providers":[{"billed_charge":12082.00,"npi":[1689916074,1669091633]}]},{"allowed_amount":17258.92,"providers":[{"billed_charge":48664.00,"npi":[1568813327]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1759.96,"providers":[{"billed_charge":10158.00,"npi":[1124086400]}]},{"allowed_amount":6127.52,"providers":[{"billed_charge":47404.00,"npi":[1255307898]}]},{"allowed_amount":248.38,"providers":[{"billed_charge":1693.00,"npi":[1700466323]}]}]}]},{"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":"824444968"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":396.88,"providers":[{"billed_charge":460.00,"npi":[1093550014]}]}]}]},{"name":"PREV VISIT EST AGE 18-39","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99395","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4440.55,"providers":[{"billed_charge":17040.00,"npi":[1134675978]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9539.08,"providers":[{"billed_charge":36666.00,"npi":[1134675978]}]}]}]},{"name":"BEHAV CHNG SMOKING 3-10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99406","description":"SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI","allowed_amounts":[{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.64,"providers":[{"billed_charge":50.00,"npi":[1225482524]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11898.88,"providers":[{"billed_charge":26488.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7564.42,"providers":[{"billed_charge":15914.23,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000314"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":246.28,"providers":[{"billed_charge":662.20,"npi":[1013900257]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31273.11,"providers":[{"billed_charge":41029.20,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35904.48,"providers":[{"billed_charge":95714.37,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7508.16,"providers":[{"billed_charge":14015.89,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27534.96,"providers":[{"billed_charge":27542.86,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4296.30,"providers":[{"billed_charge":5826.76,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10812.29,"providers":[{"billed_charge":16943.80,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28471.25,"providers":[{"billed_charge":42036.30,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"570684922"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":114.75,"providers":[{"billed_charge":138.00,"npi":[1790936235]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4529.25,"providers":[{"billed_charge":6519.20,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":110270.49,"providers":[{"billed_charge":337496.25,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9096.12,"providers":[{"billed_charge":16932.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4272.36,"providers":[{"billed_charge":21361.92,"npi":[1407361512]}]},{"allowed_amount":34004.76,"providers":[{"billed_charge":90394.44,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12173.37,"providers":[{"billed_charge":12240.90,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10118.46,"providers":[{"billed_charge":20769.35,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6766.11,"providers":[{"billed_charge":10983.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14572.02,"providers":[{"billed_charge":22296.40,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2984.40,"providers":[{"billed_charge":4881.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1734.39,"providers":[{"billed_charge":2653.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8063.74,"providers":[{"billed_charge":13125.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5167.02,"providers":[{"billed_charge":6674.40,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"237099373"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2994.81,"providers":[{"billed_charge":3511.41,"npi":[1487623203]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4909.76,"providers":[{"billed_charge":9532.80,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15172.53,"providers":[{"billed_charge":34746.60,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53341.29,"providers":[{"billed_charge":87660.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30001.52,"providers":[{"billed_charge":38730.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"831579694"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1590.84,"providers":[{"billed_charge":1896.90,"npi":[1194200063]}]}]},{"tin":{"type":"ein","value":"576008064"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":722.22,"providers":[{"billed_charge":933.60,"npi":[1417954587]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5176.96,"providers":[{"billed_charge":8680.84,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":668.91,"providers":[{"billed_charge":950.30,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4704.08,"providers":[{"billed_charge":7099.40,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5962.37,"providers":[{"billed_charge":9427.27,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1665.99,"providers":[{"billed_charge":1666.80,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3367.49,"providers":[{"billed_charge":4730.70,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1738.44,"providers":[{"billed_charge":3270.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14403.67,"providers":[{"billed_charge":18712.08,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19941.48,"providers":[{"billed_charge":90629.30,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":104095.01,"providers":[{"billed_charge":477123.91,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"541533323"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":360.36,"providers":[{"billed_charge":1193.50,"npi":[1134124431]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15921.57,"providers":[{"billed_charge":25926.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24640.11,"providers":[{"billed_charge":46962.58,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":364.07,"providers":[{"billed_charge":364.07,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4757.28,"providers":[{"billed_charge":6464.40,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"570963511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1304.88,"providers":[{"billed_charge":2004.80,"npi":[1588605299]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":62857.11,"providers":[{"billed_charge":145339.20,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32506.59,"providers":[{"billed_charge":32528.70,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1907.70,"providers":[{"billed_charge":5659.15,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2248.02,"providers":[{"billed_charge":2269.80,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"831047162"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":741.15,"providers":[{"billed_charge":1136.80,"npi":[1285101717]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38695.80,"providers":[{"billed_charge":43490.75,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21586.14,"providers":[{"billed_charge":41076.38,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2417.22,"providers":[{"billed_charge":2625.00,"npi":[1720052723]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3848.16,"providers":[{"billed_charge":28357.83,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16334.58,"providers":[{"billed_charge":76500.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3841.87,"providers":[{"billed_charge":38695.80,"npi":[1891782595]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20472.37,"providers":[{"billed_charge":31000.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8179.34,"providers":[{"billed_charge":9120.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5115.09,"providers":[{"billed_charge":6330.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28175.03,"providers":[{"billed_charge":41607.75,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21293.25,"providers":[{"billed_charge":59976.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":83546.70,"providers":[{"billed_charge":118842.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32276.71,"providers":[{"billed_charge":47750.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":92277.67,"providers":[{"billed_charge":131950.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":141127.18,"providers":[{"billed_charge":386005.65,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25038.72,"providers":[{"billed_charge":35525.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":512.71,"providers":[{"billed_charge":550.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":106918.76,"providers":[{"billed_charge":113840.11,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5573.23,"providers":[{"billed_charge":7798.22,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8111.93,"providers":[{"billed_charge":14800.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7096.45,"providers":[{"billed_charge":11900.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31438.09,"providers":[{"billed_charge":49882.10,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":157232.66,"providers":[{"billed_charge":232723.56,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4557.75,"providers":[{"billed_charge":6750.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3959.48,"providers":[{"billed_charge":9800.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14631.48,"providers":[{"billed_charge":15400.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13315.53,"providers":[{"billed_charge":60008.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":237075.78,"providers":[{"billed_charge":938373.20,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7894.95,"providers":[{"billed_charge":8358.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13661.34,"providers":[{"billed_charge":50210.01,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40075.73,"providers":[{"billed_charge":55300.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2019.05,"providers":[{"billed_charge":7200.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5000.00,"providers":[{"billed_charge":5000.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22764.98,"providers":[{"billed_charge":113824.88,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33996.71,"providers":[{"billed_charge":106694.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21822.86,"providers":[{"billed_charge":31175.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":96246.26,"providers":[{"billed_charge":134000.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22328.65,"providers":[{"billed_charge":41800.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18946.25,"providers":[{"billed_charge":26166.40,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27700.00,"providers":[{"billed_charge":27700.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2541.18,"providers":[{"billed_charge":11940.00,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12669.68,"providers":[{"billed_charge":18700.00,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":113820.33,"providers":[{"billed_charge":163125.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29337.62,"providers":[{"billed_charge":58510.32,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8680.04,"providers":[{"billed_charge":11594.00,"npi":[1720052723]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1946.30,"providers":[{"billed_charge":8750.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13072.29,"providers":[{"billed_charge":41545.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13609.95,"providers":[{"billed_charge":45147.82,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26915.11,"providers":[{"billed_charge":126250.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7715.17,"providers":[{"billed_charge":14176.97,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36486.26,"providers":[{"billed_charge":303771.55,"npi":[1891782595]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18921.68,"providers":[{"billed_charge":34100.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4307.48,"providers":[{"billed_charge":4500.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13354.20,"providers":[{"billed_charge":15624.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":58186.40,"providers":[{"billed_charge":85482.10,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2565.42,"providers":[{"billed_charge":5412.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":121889.98,"providers":[{"billed_charge":207467.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":77193.96,"providers":[{"billed_charge":135450.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":155621.64,"providers":[{"billed_charge":413208.28,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":55911.37,"providers":[{"billed_charge":58557.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7584.80,"providers":[{"billed_charge":9350.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":179756.22,"providers":[{"billed_charge":227785.53,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576008064"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":427.57,"providers":[{"billed_charge":447.00,"npi":[1417954587]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4190.46,"providers":[{"billed_charge":5060.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":417.54,"providers":[{"billed_charge":500.00,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3839.74,"providers":[{"billed_charge":6750.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4693.24,"providers":[{"billed_charge":6191.68,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9815.69,"providers":[{"billed_charge":10350.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4215.00,"providers":[{"billed_charge":4215.00,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":65810.49,"providers":[{"billed_charge":97161.90,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30252.06,"providers":[{"billed_charge":47884.50,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7677.84,"providers":[{"billed_charge":10800.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5891.04,"providers":[{"billed_charge":14400.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14500.00,"providers":[{"billed_charge":14500.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14215.26,"providers":[{"billed_charge":64029.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":130467.93,"providers":[{"billed_charge":520022.50,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49285.56,"providers":[{"billed_charge":207187.50,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3799.04,"providers":[{"billed_charge":4776.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3838.10,"providers":[{"billed_charge":12213.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":84518.44,"providers":[{"billed_charge":99000.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6400.00,"providers":[{"billed_charge":6400.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"570963511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":855.14,"providers":[{"billed_charge":950.00,"npi":[1588605299]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21289.87,"providers":[{"billed_charge":37594.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34280.00,"providers":[{"billed_charge":34400.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":125925.80,"providers":[{"billed_charge":134350.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28991.05,"providers":[{"billed_charge":51000.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7329.80,"providers":[{"billed_charge":10628.06,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21350.00,"providers":[{"billed_charge":21350.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9386.48,"providers":[{"billed_charge":16500.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2800.00,"providers":[{"billed_charge":2800.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":171349.15,"providers":[{"billed_charge":179694.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26871.62,"providers":[{"billed_charge":55582.45,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3012.20,"providers":[{"billed_charge":3227.00,"npi":[1720052723]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":868.50,"providers":[{"billed_charge":4951.38,"npi":[1891782595]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1600.00,"providers":[{"billed_charge":4000.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1080.00,"providers":[{"billed_charge":2700.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2956.80,"providers":[{"billed_charge":7392.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":438.00,"providers":[{"billed_charge":1095.00,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":758.16,"providers":[{"billed_charge":1895.76,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1723.68,"providers":[{"billed_charge":4309.20,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1548.10,"providers":[{"billed_charge":3870.20,"npi":[1649268798]}]}]}]},{"name":"SPLY ALW NONIMPL CGM 1 MO SP=1 UOS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4239","description":"SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":9036.02,"providers":[{"billed_charge":33322.60,"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":1076.40,"providers":[{"billed_charge":3588.00,"npi":[1003462581]}]}]}]},{"name":"SLINGS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4565","description":"SLINGS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":150.00,"npi":[1234567893]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1189.74,"providers":[{"billed_charge":1434.24,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1509.44,"providers":[{"billed_charge":4203.20,"npi":[1811005150]}]}]}]},{"name":"FQHC VISIT ESTABLISHED PATIE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0467","description":"FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"570604703"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":65.62,"providers":[{"billed_charge":193.00,"npi":[1992957146]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":28182.47,"providers":[{"billed_charge":68471.70,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":38931.37,"providers":[{"billed_charge":39489.60,"npi":[1235909367]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":543.43,"providers":[{"billed_charge":1378.00,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":3460.35,"providers":[{"billed_charge":3460.35,"npi":[1235909367]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":22.44,"providers":[{"billed_charge":40.00,"npi":[1750795183]}]},{"allowed_amount":403.92,"providers":[{"billed_charge":720.00,"npi":[1750795183]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;6-","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6012","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4536.20,"providers":[{"billed_charge":5894.00,"npi":[1033178330]}]}]}]},{"name":"INTENS MOD TX DEL 1/MX FLDS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6015","description":"INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8183.47,"providers":[{"billed_charge":22086.00,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24783.50,"providers":[{"billed_charge":85540.00,"npi":[1205495884]}]}]}]},{"name":"ALCOHL&/RX SRVC; INTENSV OP;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0015","description":"ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":22126.00,"providers":[{"billed_charge":55315.00,"npi":[1760671655]}]}]}]},{"name":"ASTV CMTY TX PROGRM PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0040","description":"ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["12","53"],"billing_class":"professional","payments":[{"allowed_amount":2283.32,"providers":[{"billed_charge":9133.80,"npi":[1508811324]}]},{"allowed_amount":131.73,"providers":[{"billed_charge":526.95,"npi":[1508811324]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":5.47,"providers":[{"billed_charge":300.00,"npi":[1134675978]}]},{"allowed_amount":7.95,"providers":[{"billed_charge":450.00,"npi":[1134675978]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":806.00,"providers":[{"billed_charge":1255.67,"npi":[1234567893]}]}]}]},{"name":"SURGICAL BOOT/SHOE EACH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3260","description":"SURGICAL BOOT/SHOE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":240.00,"providers":[{"billed_charge":400.00,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1061.10,"providers":[{"billed_charge":1703.80,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2211.47,"providers":[{"billed_charge":3547.00,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":15084.45,"providers":[{"billed_charge":22782.72,"npi":[1234567893]}]}]}]},{"name":"INTNSVE OP PSYC SVC PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9480","description":"INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":13156.00,"providers":[{"billed_charge":32890.00,"npi":[1760671655]}]}]}]}]}