{"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":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"SMEAR, COMPLEX STAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) F","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"FIBRIN DEGRADATION, QUANT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF TROPONIN, QUANT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"TROPONIN, QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"OVA AND PARASITES SMEARS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"60646659"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.84,"providers":[{"billed_charge":69.00,"npi":[1609846088]}]},{"allowed_amount":6.88,"providers":[{"billed_charge":23.58,"npi":[1609846088]}]},{"allowed_amount":45.15,"providers":[{"billed_charge":142.00,"npi":[1609846088]}]},{"allowed_amount":19.02,"providers":[{"billed_charge":19.02,"npi":[1609846088]}]},{"allowed_amount":121.05,"providers":[{"billed_charge":210.00,"npi":[1609846088]}]},{"allowed_amount":7.91,"providers":[{"billed_charge":47.00,"npi":[1609846088]}]},{"allowed_amount":21.21,"providers":[{"billed_charge":38.82,"npi":[1609846088]}]},{"allowed_amount":48.58,"providers":[{"billed_charge":127.00,"npi":[1609846088]}]},{"allowed_amount":8.89,"providers":[{"billed_charge":67.00,"npi":[1609846088]}]},{"allowed_amount":39.43,"providers":[{"billed_charge":92.00,"npi":[1609846088]}]},{"allowed_amount":8.76,"providers":[{"billed_charge":27.00,"npi":[1609846088]}]},{"allowed_amount":128.66,"providers":[{"billed_charge":202.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"131624096"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25.32,"providers":[{"billed_charge":385.00,"npi":[1033206362]}]},{"allowed_amount":17.88,"providers":[{"billed_charge":240.00,"npi":[1033206362]}]},{"allowed_amount":20.10,"providers":[{"billed_charge":285.00,"npi":[1033206362]}]},{"allowed_amount":27.25,"providers":[{"billed_charge":175.00,"npi":[1033206362]}]},{"allowed_amount":123.34,"providers":[{"billed_charge":800.00,"npi":[1033206362]}]},{"allowed_amount":42.30,"providers":[{"billed_charge":210.00,"npi":[1033206362]}]},{"allowed_amount":41.40,"providers":[{"billed_charge":390.00,"npi":[1033206362]}]},{"allowed_amount":7.44,"providers":[{"billed_charge":60.00,"npi":[1033206362]}]}]},{"tin":{"type":"ein","value":"150622079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.48,"providers":[{"billed_charge":86.40,"npi":[1669236261]}]},{"allowed_amount":5.08,"providers":[{"billed_charge":50.43,"npi":[1669236261]},{"billed_charge":55.00,"npi":[1669236261]},{"billed_charge":43.20,"npi":[1669236261]}]},{"allowed_amount":7.86,"providers":[{"billed_charge":67.02,"npi":[1669236261]}]},{"allowed_amount":10.16,"providers":[{"billed_charge":121.74,"npi":[1669236261]}]},{"allowed_amount":60.96,"providers":[{"billed_charge":1285.92,"npi":[1669236261]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":39.86,"npi":[1669236261]}]}]},{"tin":{"type":"ein","value":"60646659"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.32,"providers":[{"billed_charge":50.76,"npi":[1609846088]}]},{"allowed_amount":24.41,"providers":[{"billed_charge":49.00,"npi":[1609846088]}]}]}]},{"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":"844522008"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":100.72,"providers":[{"billed_charge":1274.00,"npi":[1255962783]}]},{"allowed_amount":652.16,"providers":[{"billed_charge":7731.34,"npi":[1255962783]}]},{"allowed_amount":2726.51,"providers":[{"billed_charge":32238.00,"npi":[1255962783]}]},{"allowed_amount":146.04,"providers":[{"billed_charge":1911.00,"npi":[1255962783]}]}]}]},{"name":"MRI BRAIN STEM W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70551","description":"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":87.26,"providers":[{"billed_charge":1043.00,"npi":[1255962783]}]}]}]},{"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":"844522008"},"service_code":["22","23","19","20","21"],"billing_class":"professional","payments":[{"allowed_amount":10.82,"providers":[{"billed_charge":153.00,"npi":[1255962783]}]},{"allowed_amount":76.79,"providers":[{"billed_charge":1232.00,"npi":[1255962783]}]},{"allowed_amount":855.51,"providers":[{"billed_charge":13705.00,"npi":[1255962783]}]},{"allowed_amount":10.97,"providers":[{"billed_charge":176.00,"npi":[1255962783]}]},{"allowed_amount":1604.80,"providers":[{"billed_charge":23510.77,"npi":[1255962783]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","20","21"],"billing_class":"professional","payments":[{"allowed_amount":13.00,"providers":[{"billed_charge":196.00,"npi":[1255962783]}]},{"allowed_amount":589.66,"providers":[{"billed_charge":8142.00,"npi":[1255962783]}]},{"allowed_amount":78.00,"providers":[{"billed_charge":1176.00,"npi":[1255962783]}]},{"allowed_amount":846.48,"providers":[{"billed_charge":12668.00,"npi":[1255962783]}]}]}]},{"name":"CT ANGIOGRAPHY CHEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71275","description":"COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTR","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":1388.28,"providers":[{"billed_charge":19980.00,"npi":[1255962783]}]},{"allowed_amount":211.05,"providers":[{"billed_charge":3330.00,"npi":[1255962783]}]}]}]},{"name":"X-RAY EXAM OF KNEE 3","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73562","description":"RADIOLOGIC EXAMINATION, KNEE; 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","20"],"billing_class":"professional","payments":[{"allowed_amount":11.41,"providers":[{"billed_charge":140.00,"npi":[1255962783]}]},{"allowed_amount":36.54,"providers":[{"billed_charge":413.00,"npi":[1255962783]}]}]}]},{"name":"X-RAY EXAM OF ANKLE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73610","description":"RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","19"],"billing_class":"professional","payments":[{"allowed_amount":21.14,"providers":[{"billed_charge":268.00,"npi":[1255962783]}]},{"allowed_amount":22.98,"providers":[{"billed_charge":268.00,"npi":[1255962783]}]},{"allowed_amount":10.57,"providers":[{"billed_charge":134.00,"npi":[1255962783]}]}]}]},{"name":"X-RAY EXAM OF FOOT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73630","description":"RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":22.00,"providers":[{"billed_charge":254.00,"npi":[1255962783]}]},{"allowed_amount":50.60,"providers":[{"billed_charge":635.00,"npi":[1255962783]}]}]}]},{"name":"CT ABD & PELVIS W/O CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74176","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":1334.58,"providers":[{"billed_charge":19404.00,"npi":[1255962783]}]},{"allowed_amount":513.70,"providers":[{"billed_charge":8085.00,"npi":[1255962783]}]},{"allowed_amount":308.22,"providers":[{"billed_charge":4851.00,"npi":[1255962783]}]}]}]},{"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":"844522008"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":434.72,"providers":[{"billed_charge":5262.94,"npi":[1255962783]}]},{"allowed_amount":326.04,"providers":[{"billed_charge":5076.00,"npi":[1255962783]}]},{"allowed_amount":5672.34,"providers":[{"billed_charge":80995.00,"npi":[1255962783]}]}]}]},{"name":"ULTRASOUND BREAST COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76641","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":1692.25,"providers":[{"billed_charge":19698.00,"npi":[1255962783]}]},{"allowed_amount":1289.92,"providers":[{"billed_charge":14865.00,"npi":[1255962783]}]}]}]},{"name":"ULTRASOUND BREAST LIMITED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76642","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":245.64,"providers":[{"billed_charge":2820.00,"npi":[1255962783]}]},{"allowed_amount":65.50,"providers":[{"billed_charge":940.00,"npi":[1255962783]}]}]}]},{"name":"US EXAM, ABDOM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76700","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":47.87,"providers":[{"billed_charge":554.00,"npi":[1255962783]}]}]}]},{"name":"ECHO EXAM OF ABDOMEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76705","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":209.28,"providers":[{"billed_charge":2772.00,"npi":[1255962783]}]},{"allowed_amount":295.68,"providers":[{"billed_charge":3696.00,"npi":[1255962783]}]},{"allowed_amount":68.02,"providers":[{"billed_charge":924.00,"npi":[1255962783]}]}]}]},{"name":"TRANSVAGINAL US, NON-OB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76830","description":"ULTRASOUND, TRANSVAGINAL","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":82.89,"providers":[{"billed_charge":956.00,"npi":[1255962783]}]},{"allowed_amount":41.08,"providers":[{"billed_charge":501.00,"npi":[1255962783]}]}]}]},{"name":"US XTR NON-VASC LMTD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76882","description":"ULTRASOUND, LIMITED, JOINT OR OTHER NONVASCULAR EXTREMITY STRUCTURE(S) (EG, JOINT SPACE, PERI-ARTICU","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":41.34,"providers":[{"billed_charge":420.00,"npi":[1255962783]}]},{"allowed_amount":89.88,"providers":[{"billed_charge":840.00,"npi":[1255962783]}]},{"allowed_amount":248.04,"providers":[{"billed_charge":2520.00,"npi":[1255962783]}]},{"allowed_amount":124.02,"providers":[{"billed_charge":1260.00,"npi":[1255962783]}]}]}]},{"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":"844522008"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":1072.19,"providers":[{"billed_charge":5957.00,"npi":[1255962783]}]},{"allowed_amount":2287.85,"providers":[{"billed_charge":12697.00,"npi":[1255962783]}]}]}]},{"name":"DX MAMMO INCL CAD UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77065","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"844522008"},"service_code":["19","21"],"billing_class":"professional","payments":[{"allowed_amount":95.74,"providers":[{"billed_charge":638.00,"npi":[1255962783]}]},{"allowed_amount":47.87,"providers":[{"billed_charge":319.00,"npi":[1255962783]}]}]}]},{"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":"844522008"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":2910.52,"providers":[{"billed_charge":18842.00,"npi":[1255962783]}]},{"allowed_amount":1592.47,"providers":[{"billed_charge":10287.00,"npi":[1255962783]}]}]}]},{"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":"831187935"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":670.96,"providers":[{"billed_charge":1785.00,"npi":[1720051907]}]}]}]},{"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":"465223892"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":995.00,"providers":[{"billed_charge":995.00,"npi":[1649694506]}]}]},{"tin":{"type":"ein","value":"118562993"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":340.77,"providers":[{"billed_charge":900.00,"npi":[1124376801]}]},{"allowed_amount":525.44,"providers":[{"billed_charge":1200.00,"npi":[1124376801]}]}]},{"tin":{"type":"ein","value":"134137499"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5500.00,"providers":[{"billed_charge":5500.00,"npi":[1578703195]}]}]}]},{"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":"834140142"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":16500.00,"providers":[{"billed_charge":16500.00,"npi":[1326393919]}]}]},{"tin":{"type":"ein","value":"263073888"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1175.00,"providers":[{"billed_charge":1175.00,"npi":[1356576151]}]}]},{"tin":{"type":"ein","value":"465223892"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5871.81,"providers":[{"billed_charge":5975.00,"npi":[1649694506]}]}]},{"tin":{"type":"ein","value":"943435384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3840.00,"providers":[{"billed_charge":3750.00,"npi":[1912064163]}]}]},{"tin":{"type":"ein","value":"143805789"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1250.00,"providers":[{"billed_charge":1250.00,"npi":[1336652155]}]}]}]},{"name":"TCRANIAL MAGN STIM TX DELI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90868","description":"THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MA","allowed_amounts":[{"tin":{"type":"ein","value":"863089181"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1050.00,"providers":[{"billed_charge":1400.00,"npi":[1578516969]}]}]},{"tin":{"type":"ein","value":"822894814"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4837.78,"providers":[{"billed_charge":7600.00,"npi":[1194769976]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"112050523"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":55.00,"providers":[{"billed_charge":135.00,"npi":[1467501858]}]},{"allowed_amount":50.60,"providers":[{"billed_charge":135.00,"npi":[1467501858]}]}]},{"tin":{"type":"ein","value":"135562308"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":10.82,"providers":[{"billed_charge":55.00,"npi":[1326035205]}]}]},{"tin":{"type":"ein","value":"112558775"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":101.50,"providers":[{"billed_charge":400.00,"npi":[1013932250]}]},{"allowed_amount":143.00,"providers":[{"billed_charge":520.00,"npi":[1013932250]}]}]}]},{"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":"800071212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1434.39,"providers":[{"billed_charge":4170.00,"npi":[1396799409]}]}]},{"tin":{"type":"ein","value":"113322995"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":75.46,"providers":[{"billed_charge":200.00,"npi":[1891376661]}]}]}]},{"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":"800071212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1094.72,"providers":[{"billed_charge":2610.00,"npi":[1396799409]}]}]},{"tin":{"type":"ein","value":"113322995"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":41.94,"providers":[{"billed_charge":100.00,"npi":[1891376661]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"800071212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":35.60,"providers":[{"billed_charge":60.00,"npi":[1396799409]}]}]}]},{"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":"813278370"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":15435.00,"providers":[{"billed_charge":78750.00,"npi":[1043769466]}]},{"allowed_amount":23696.80,"providers":[{"billed_charge":122500.00,"npi":[1043769466]}]}]},{"tin":{"type":"ein","value":"813535131"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":103354.56,"providers":[{"billed_charge":717000.00,"npi":[1427502939]}]}]},{"tin":{"type":"ein","value":"831357703"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2157.12,"providers":[{"billed_charge":8400.00,"npi":[1891352415]}]}]}]},{"name":"GRP ADAPT BHV TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97154","description":"GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"813535131"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":616.20,"providers":[{"billed_charge":6400.00,"npi":[1427502939]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"813278370"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":1551.00,"providers":[{"billed_charge":6815.00,"npi":[1043769466]}]}]},{"tin":{"type":"ein","value":"813535131"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":8897.16,"providers":[{"billed_charge":62200.00,"npi":[1427502939]}]}]}]},{"name":"FAM ADAPT BHV TX GDN PHY/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97156","description":"FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"813535131"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6678.04,"providers":[{"billed_charge":47800.00,"npi":[1427502939]}]}]}]},{"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":"113538970"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10478.40,"providers":[{"billed_charge":11400.00,"npi":[1134634843]}]}]},{"tin":{"type":"ein","value":"117826635"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1282.82,"providers":[{"billed_charge":1400.00,"npi":[1871521781]}]}]},{"tin":{"type":"ein","value":"800071212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1423.11,"providers":[{"billed_charge":2545.00,"npi":[1396799409]}]}]},{"tin":{"type":"ein","value":"464893551"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31713.62,"providers":[{"billed_charge":77445.12,"npi":[1760807093]}]}]},{"tin":{"type":"ein","value":"113180653"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":549.78,"providers":[{"billed_charge":1200.00,"npi":[1588058275]}]}]}]},{"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":"462931956"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":299.14,"providers":[{"billed_charge":1235.00,"npi":[1871070938]}]}]}]},{"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":"922826272"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":706.20,"providers":[{"billed_charge":4370.00,"npi":[1073386421]}]}]},{"tin":{"type":"ein","value":"474961193"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1680.60,"providers":[{"billed_charge":9360.00,"npi":[1922460542]}]}]}]},{"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":"922826272"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":6773.49,"providers":[{"billed_charge":42376.00,"npi":[1073386421]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"364746865"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":94.68,"providers":[{"billed_charge":400.00,"npi":[1962756015]}]}]}]},{"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":"116000463"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":337.50,"providers":[{"billed_charge":337.50,"npi":[1912009812]}]}]},{"tin":{"type":"ein","value":"133062687"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1852.36,"providers":[{"billed_charge":1913.52,"npi":[1053351700]}]}]},{"tin":{"type":"ein","value":"202081121"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1395.13,"providers":[{"billed_charge":1772.85,"npi":[1265542765]}]}]},{"tin":{"type":"ein","value":"141597784"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":360.00,"providers":[{"billed_charge":360.00,"npi":[1770562910]}]}]},{"tin":{"type":"ein","value":"132646815"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8248.50,"providers":[{"billed_charge":12463.50,"npi":[1003878596]}]}]},{"tin":{"type":"ein","value":"132655001"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2384.50,"providers":[{"billed_charge":2772.00,"npi":[1083715460]}]}]},{"tin":{"type":"ein","value":"112420013"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3120.00,"providers":[{"billed_charge":3120.00,"npi":[1033343389]}]}]}]},{"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":"132655001"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15375.00,"providers":[{"billed_charge":16932.00,"npi":[1083715460]}]}]},{"tin":{"type":"ein","value":"112420013"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22690.00,"providers":[{"billed_charge":24000.00,"npi":[1033343389]}]}]}]},{"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":"132646815"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4236.00,"providers":[{"billed_charge":5850.00,"npi":[1003878596]}]}]},{"tin":{"type":"ein","value":"132655001"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53197.00,"providers":[{"billed_charge":62325.00,"npi":[1083715460]}]}]},{"tin":{"type":"ein","value":"112420013"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20000.00,"providers":[{"billed_charge":20000.00,"npi":[1033343389]}]}]}]},{"name":"INJECTION, PROPOFOL, 10 MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J2704","description":"INJECTION, PROPOFOL, 10 MG","allowed_amounts":[{"tin":{"type":"ein","value":"472961712"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.76,"providers":[{"billed_charge":267.60,"npi":[1043247539]}]}]}]}]}