{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-07-31","out_of_network":[{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":178.11,"providers":[{"billed_charge":6634.75,"npi":[1447457775]}]},{"allowed_amount":119.41,"providers":[{"billed_charge":398.00,"npi":[1740488386]}]},{"allowed_amount":30.84,"providers":[{"billed_charge":822.75,"npi":[1740488386]}]},{"allowed_amount":29.72,"providers":[{"billed_charge":99.00,"npi":[1992701429]}]},{"allowed_amount":428.09,"providers":[{"billed_charge":2526.25,"npi":[1992701429]}]},{"allowed_amount":7.88,"providers":[{"billed_charge":26.25,"npi":[1447457775]}]}]},{"tin":{"type":"ein","value":"611238190"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.91,"providers":[{"billed_charge":59.90,"npi":[1063484483]}]},{"allowed_amount":93.96,"providers":[{"billed_charge":313.17,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"611285331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":134.13,"providers":[{"billed_charge":447.13,"npi":[1346247962]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.15,"providers":[{"billed_charge":0.50,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"610605336"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":425.69,"providers":[{"billed_charge":1198.17,"npi":[1124078696]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":979.14,"providers":[{"billed_charge":3263.76,"npi":[1427095488]}]},{"allowed_amount":1906.86,"providers":[{"billed_charge":17383.63,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.35,"providers":[{"billed_charge":74.50,"npi":[1124868963]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":113.22,"providers":[{"billed_charge":377.40,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4777.62,"providers":[{"billed_charge":8016.24,"npi":[1871547703]}]},{"allowed_amount":1539.97,"providers":[{"billed_charge":5133.20,"npi":[1871547703]}]}]}]},{"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":"610600313"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":257.16,"providers":[{"billed_charge":1470.00,"npi":[1346244126]}]},{"allowed_amount":4511.93,"providers":[{"billed_charge":14218.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1167.75,"providers":[{"billed_charge":3889.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"610594620"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":490.72,"providers":[{"billed_charge":1768.21,"npi":[1811922347]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":496.03,"providers":[{"billed_charge":1763.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":310.02,"providers":[{"billed_charge":963.33,"npi":[1124868963]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"204474637"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":113.69,"providers":[{"billed_charge":379.18,"npi":[1225161524]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"853033915"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2597.27,"providers":[{"billed_charge":4834.85,"npi":[1285221416]}]},{"allowed_amount":122.73,"providers":[{"billed_charge":362.04,"npi":[1285221416]}]}]},{"tin":{"type":"ein","value":"610600313"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":378.36,"providers":[{"billed_charge":520.00,"npi":[1346244126]}]},{"allowed_amount":376.22,"providers":[{"billed_charge":1121.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":765.27,"providers":[{"billed_charge":2829.00,"npi":[1437150984]}]},{"allowed_amount":6798.64,"providers":[{"billed_charge":14286.00,"npi":[1740488386]}]},{"allowed_amount":19515.76,"providers":[{"billed_charge":45917.00,"npi":[1992701429]}]},{"allowed_amount":1670.89,"providers":[{"billed_charge":6969.00,"npi":[1447457775]}]},{"allowed_amount":64.59,"providers":[{"billed_charge":9589.00,"npi":[1740488386]}]},{"allowed_amount":746.67,"providers":[{"billed_charge":3403.00,"npi":[1861650814]}]},{"allowed_amount":949.14,"providers":[{"billed_charge":2232.00,"npi":[1679679146]}]},{"allowed_amount":351.01,"providers":[{"billed_charge":23872.00,"npi":[1447457775]}]},{"allowed_amount":841.54,"providers":[{"billed_charge":22477.00,"npi":[1992701429]}]},{"allowed_amount":677.00,"providers":[{"billed_charge":2814.00,"npi":[1437150984]}]}]},{"tin":{"type":"ein","value":"610601267"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1059.25,"providers":[{"billed_charge":2366.00,"npi":[1568528594]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2123.40,"providers":[{"billed_charge":10496.00,"npi":[1871588772]}]},{"allowed_amount":5607.41,"providers":[{"billed_charge":15269.00,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"610605336"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":261.61,"providers":[{"billed_charge":473.00,"npi":[1124078696]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":906.90,"providers":[{"billed_charge":1496.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"204474637"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3198.70,"providers":[{"billed_charge":3930.91,"npi":[1225161524]}]}]},{"tin":{"type":"ein","value":"610676546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1396.85,"providers":[{"billed_charge":2287.00,"npi":[1689761942]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"610600313"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5381.58,"providers":[{"billed_charge":15705.00,"npi":[1346244126]}]},{"allowed_amount":2325.92,"providers":[{"billed_charge":9985.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"621772321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5253.54,"providers":[{"billed_charge":24866.44,"npi":[1811213994]}]}]},{"tin":{"type":"ein","value":"611285331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3865.03,"providers":[{"billed_charge":7688.67,"npi":[1346247962]}]}]},{"tin":{"type":"ein","value":"610605336"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":558.55,"providers":[{"billed_charge":1095.00,"npi":[1124078696]}]}]},{"tin":{"type":"ein","value":"550675666"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":17.26,"providers":[{"billed_charge":438.74,"npi":[1073518007]}]},{"allowed_amount":60.48,"providers":[{"billed_charge":100.15,"npi":[1073518007]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19643.81,"providers":[{"billed_charge":156080.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"621757920"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2108.95,"providers":[{"billed_charge":9325.95,"npi":[1619038247]}]}]},{"tin":{"type":"ein","value":"610676546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4228.35,"providers":[{"billed_charge":6024.40,"npi":[1689761942]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7096.76,"providers":[{"billed_charge":45118.85,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17307.74,"providers":[{"billed_charge":202207.25,"npi":[1871547703]}]},{"allowed_amount":6824.26,"providers":[{"billed_charge":95684.29,"npi":[1871547703]}]}]},{"tin":{"type":"ein","value":"610927491"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1693.46,"providers":[{"billed_charge":2773.00,"npi":[1487643821]}]}]},{"tin":{"type":"ein","value":"611238190"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":355.79,"providers":[{"billed_charge":2695.36,"npi":[1063484483]}]},{"allowed_amount":3216.29,"providers":[{"billed_charge":11868.27,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"610594620"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3730.93,"providers":[{"billed_charge":10246.84,"npi":[1811922347]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19477.18,"providers":[{"billed_charge":97201.05,"npi":[1427095488]}]},{"allowed_amount":10519.78,"providers":[{"billed_charge":83641.38,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"200155414"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58.42,"providers":[{"billed_charge":409.22,"npi":[1780746420]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1866.10,"providers":[{"billed_charge":5448.88,"npi":[1124868963]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"610600313"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":50.17,"providers":[{"billed_charge":226.00,"npi":[1346244126]}]},{"allowed_amount":972.58,"providers":[{"billed_charge":2837.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"621772321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":335.27,"providers":[{"billed_charge":1464.48,"npi":[1811213994]}]}]},{"tin":{"type":"ein","value":"611238190"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":398.22,"providers":[{"billed_charge":1220.78,"npi":[1063484483]}]},{"allowed_amount":53.74,"providers":[{"billed_charge":407.11,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"610594620"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":647.22,"providers":[{"billed_charge":2135.33,"npi":[1811922347]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":912.12,"providers":[{"billed_charge":6104.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3347.55,"providers":[{"billed_charge":17923.61,"npi":[1427095488]}]},{"allowed_amount":933.86,"providers":[{"billed_charge":11267.64,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610676546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1689.64,"providers":[{"billed_charge":2820.00,"npi":[1689761942]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":68.46,"providers":[{"billed_charge":1297.14,"npi":[1326107319]}]},{"allowed_amount":1297.77,"providers":[{"billed_charge":8771.22,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2345.29,"providers":[{"billed_charge":24130.05,"npi":[1871547703]}]},{"allowed_amount":4972.96,"providers":[{"billed_charge":63679.72,"npi":[1871547703]}]}]}]},{"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":"611238190"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":335.37,"providers":[{"billed_charge":1719.55,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":61.74,"providers":[{"billed_charge":808.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3582.94,"providers":[{"billed_charge":12087.33,"npi":[1427095488]}]},{"allowed_amount":130.10,"providers":[{"billed_charge":808.06,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4933.90,"providers":[{"billed_charge":16114.23,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3818.14,"providers":[{"billed_charge":26238.38,"npi":[1871547703]}]},{"allowed_amount":242.94,"providers":[{"billed_charge":4130.67,"npi":[1871547703]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":288.96,"providers":[{"billed_charge":1291.96,"npi":[1427095488]}]},{"allowed_amount":104.40,"providers":[{"billed_charge":648.87,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":209.65,"providers":[{"billed_charge":2320.36,"npi":[1871547703]}]},{"allowed_amount":3219.94,"providers":[{"billed_charge":30411.98,"npi":[1871547703]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":158.13,"providers":[{"billed_charge":901.74,"npi":[1326107319]}]}]}]},{"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":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1144.49,"providers":[{"billed_charge":4385.00,"npi":[1992701429]}]},{"allowed_amount":2179.71,"providers":[{"billed_charge":3992.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":852.52,"providers":[{"billed_charge":2811.00,"npi":[1871588772]}]},{"allowed_amount":444.45,"providers":[{"billed_charge":1367.00,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1744.46,"providers":[{"billed_charge":5877.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":869.78,"providers":[{"billed_charge":3213.59,"npi":[1326107319]}]}]}]},{"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":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1312.18,"providers":[{"billed_charge":3821.10,"npi":[1427095488]}]},{"allowed_amount":205.00,"providers":[{"billed_charge":1273.70,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":164.05,"providers":[{"billed_charge":2571.08,"npi":[1871547703]}]},{"allowed_amount":2193.06,"providers":[{"billed_charge":8444.40,"npi":[1871547703]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3291.51,"providers":[{"billed_charge":12666.00,"npi":[1992701429]}]}]}]},{"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":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11081.27,"providers":[{"billed_charge":75728.60,"npi":[1871547703]}]},{"allowed_amount":1638.00,"providers":[{"billed_charge":14050.14,"npi":[1871547703]}]}]}]},{"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":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10295.36,"providers":[{"billed_charge":29440.41,"npi":[1427095488]}]},{"allowed_amount":800.31,"providers":[{"billed_charge":4970.89,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10493.85,"providers":[{"billed_charge":127214.93,"npi":[1871547703]}]},{"allowed_amount":100.37,"providers":[{"billed_charge":7698.16,"npi":[1871547703]}]},{"allowed_amount":32737.18,"providers":[{"billed_charge":355905.84,"npi":[1871547703]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":95.94,"providers":[{"billed_charge":504.00,"npi":[1588257133]}]},{"allowed_amount":69.29,"providers":[{"billed_charge":364.00,"npi":[1902575715]}]},{"allowed_amount":63.96,"providers":[{"billed_charge":336.00,"npi":[1184252777]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18063.87,"providers":[{"billed_charge":50119.08,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":86.47,"providers":[{"billed_charge":328.09,"npi":[1234567893]}]}]}]},{"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":"522260534"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2314.33,"providers":[{"billed_charge":2873.22,"npi":[1588745012]}]}]},{"tin":{"type":"ein","value":"610600313"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17426.02,"providers":[{"billed_charge":32712.00,"npi":[1346244126]}]},{"allowed_amount":1116.52,"providers":[{"billed_charge":2495.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"621772321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22112.16,"providers":[{"billed_charge":47743.08,"npi":[1811213994]}]}]},{"tin":{"type":"ein","value":"611285331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12640.06,"providers":[{"billed_charge":33390.03,"npi":[1346247962]}]}]},{"tin":{"type":"ein","value":"610601267"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":153.10,"providers":[{"billed_charge":512.40,"npi":[1568528594]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12021.23,"providers":[{"billed_charge":22100.00,"npi":[1871588772]}]},{"allowed_amount":415.52,"providers":[{"billed_charge":3700.00,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"610605336"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8560.56,"providers":[{"billed_charge":16556.00,"npi":[1124078696]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2997.86,"providers":[{"billed_charge":8077.00,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"621757920"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1999.25,"providers":[{"billed_charge":6048.85,"npi":[1619038247]}]}]},{"tin":{"type":"ein","value":"204474637"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5320.97,"providers":[{"billed_charge":6160.63,"npi":[1225161524]}]}]},{"tin":{"type":"ein","value":"610676546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17923.06,"providers":[{"billed_charge":22157.00,"npi":[1689761942]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":84385.49,"providers":[{"billed_charge":243011.73,"npi":[1871547703]}]},{"allowed_amount":5152.98,"providers":[{"billed_charge":30258.15,"npi":[1871547703]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":255.59,"providers":[{"billed_charge":4697.44,"npi":[1326107319]}]},{"allowed_amount":41902.57,"providers":[{"billed_charge":103967.97,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4550.44,"providers":[{"billed_charge":6298.00,"npi":[1861650814]}]},{"allowed_amount":7029.87,"providers":[{"billed_charge":12212.00,"npi":[1740488386]}]},{"allowed_amount":1339.11,"providers":[{"billed_charge":2298.00,"npi":[1447457775]}]},{"allowed_amount":877.48,"providers":[{"billed_charge":5618.00,"npi":[1992701429]}]},{"allowed_amount":42443.32,"providers":[{"billed_charge":89137.00,"npi":[1992701429]}]},{"allowed_amount":1656.30,"providers":[{"billed_charge":2850.00,"npi":[1740488386]}]}]},{"tin":{"type":"ein","value":"611238190"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":767.94,"providers":[{"billed_charge":5817.71,"npi":[1063484483]}]},{"allowed_amount":17153.82,"providers":[{"billed_charge":48774.33,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"610594620"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12802.78,"providers":[{"billed_charge":17243.95,"npi":[1811922347]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":59926.39,"providers":[{"billed_charge":217114.24,"npi":[1427095488]}]},{"allowed_amount":4975.27,"providers":[{"billed_charge":38824.12,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12505.74,"providers":[{"billed_charge":20207.84,"npi":[1124868963]}]}]}]},{"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":"853033915"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":382.20,"providers":[{"billed_charge":1273.96,"npi":[1285221416]}]}]},{"tin":{"type":"ein","value":"610600313"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":216.85,"providers":[{"billed_charge":723.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"621772321"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1387.48,"providers":[{"billed_charge":4625.18,"npi":[1811213994]}]}]},{"tin":{"type":"ein","value":"611285331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":129.93,"providers":[{"billed_charge":433.06,"npi":[1346247962]}]}]},{"tin":{"type":"ein","value":"610601267"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.20,"providers":[{"billed_charge":24.00,"npi":[1568528594]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":153.46,"providers":[{"billed_charge":511.50,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"550675666"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":37587.41,"providers":[{"billed_charge":161224.15,"npi":[1073518007]}]}]},{"tin":{"type":"ein","value":"822577178"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1.15,"providers":[{"billed_charge":218.25,"npi":[1437813441]}]},{"allowed_amount":2.55,"providers":[{"billed_charge":823.50,"npi":[1437813441]}]}]},{"tin":{"type":"ein","value":"204474637"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":206.04,"providers":[{"billed_charge":686.77,"npi":[1225161524]}]}]},{"tin":{"type":"ein","value":"610676546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1076.23,"providers":[{"billed_charge":3587.60,"npi":[1689761942]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4663.56,"providers":[{"billed_charge":35050.20,"npi":[1871547703]}]},{"allowed_amount":22785.83,"providers":[{"billed_charge":75956.23,"npi":[1871547703]}]}]},{"tin":{"type":"ein","value":"621757921"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1620.03,"providers":[{"billed_charge":5400.06,"npi":[1326107319]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39.38,"providers":[{"billed_charge":131.25,"npi":[1447457775]}]},{"allowed_amount":608.58,"providers":[{"billed_charge":1821.50,"npi":[1740488386]}]},{"allowed_amount":100.35,"providers":[{"billed_charge":334.50,"npi":[1679679146]}]},{"allowed_amount":1332.59,"providers":[{"billed_charge":4284.25,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"610927491"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20.67,"providers":[{"billed_charge":68.90,"npi":[1487643821]}]}]},{"tin":{"type":"ein","value":"611238190"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1832.29,"providers":[{"billed_charge":6107.66,"npi":[1063484483]}]},{"allowed_amount":76.44,"providers":[{"billed_charge":579.06,"npi":[1063484483]}]}]},{"tin":{"type":"ein","value":"610594620"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":350.94,"providers":[{"billed_charge":1128.95,"npi":[1811922347]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1077.71,"providers":[{"billed_charge":12626.99,"npi":[1427095488]}]},{"allowed_amount":10188.20,"providers":[{"billed_charge":33962.94,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"200155414"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45.27,"providers":[{"billed_charge":150.88,"npi":[1780746420]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":698.26,"providers":[{"billed_charge":2211.58,"npi":[1124868963]}]}]}]},{"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":"311010160"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":15689.34,"providers":[{"billed_charge":15689.34,"npi":[1003892977]}]}]}]},{"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":"610920842"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":79.38,"providers":[{"billed_charge":240.00,"npi":[1477729234]}]},{"allowed_amount":31.59,"providers":[{"billed_charge":90.00,"npi":[1477729234]}]},{"allowed_amount":16.20,"providers":[{"billed_charge":60.00,"npi":[1760443840]}]}]}]},{"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":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1045.84,"providers":[{"billed_charge":2455.00,"npi":[1992701429]}]},{"allowed_amount":46.52,"providers":[{"billed_charge":491.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"610859329"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":57.83,"providers":[{"billed_charge":359.19,"npi":[1427095488]}]},{"allowed_amount":1680.73,"providers":[{"billed_charge":2873.52,"npi":[1427095488]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3118.64,"providers":[{"billed_charge":13641.82,"npi":[1871547703]}]},{"allowed_amount":147.65,"providers":[{"billed_charge":802.46,"npi":[1871547703]}]}]}]},{"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":"205497203"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":310.41,"providers":[{"billed_charge":522.00,"npi":[1336270057]}]},{"allowed_amount":655.31,"providers":[{"billed_charge":1102.00,"npi":[1336270057]}]}]}]},{"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":"205497203"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":350.56,"providers":[{"billed_charge":576.00,"npi":[1336270057]}]},{"allowed_amount":876.40,"providers":[{"billed_charge":1440.00,"npi":[1336270057]}]}]},{"tin":{"type":"ein","value":"610920842"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":87.64,"providers":[{"billed_charge":138.00,"npi":[1831198811]}]},{"allowed_amount":330.34,"providers":[{"billed_charge":552.00,"npi":[1477729234]}]},{"allowed_amount":208.99,"providers":[{"billed_charge":345.00,"npi":[1851335012]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":165.00,"providers":[{"billed_charge":960.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2687.68,"providers":[{"billed_charge":7681.68,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7477.62,"providers":[{"billed_charge":25994.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":214.44,"providers":[{"billed_charge":831.60,"npi":[1234567893]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1618.96,"providers":[{"billed_charge":9204.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16982.22,"providers":[{"billed_charge":48533.76,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":28.18,"providers":[{"billed_charge":147.84,"npi":[1234567893]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4045.50,"providers":[{"billed_charge":48825.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17681.25,"providers":[{"billed_charge":50507.08,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":151.88,"providers":[{"billed_charge":616.04,"npi":[1234567893]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":60.75,"providers":[{"billed_charge":173.60,"npi":[1811154388]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":200.04,"providers":[{"billed_charge":571.56,"npi":[1811154388]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1670.24,"providers":[{"billed_charge":4771.28,"npi":[1811154388]}]}]}]},{"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":"933448504"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":590.33,"providers":[{"billed_charge":4237.38,"npi":[1164518080]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9570.00,"providers":[{"billed_charge":27341.60,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"371874451"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":52.82,"providers":[{"billed_charge":200.00,"npi":[1700415320]}]},{"allowed_amount":422.56,"providers":[{"billed_charge":1600.00,"npi":[1558649848]}]}]},{"tin":{"type":"ein","value":"473870208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":633.84,"providers":[{"billed_charge":4800.00,"npi":[1174992382]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":115.44,"providers":[{"billed_charge":329.68,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":85.05,"providers":[{"billed_charge":243.00,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":240.64,"providers":[{"billed_charge":1792.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1342.94,"providers":[{"billed_charge":3837.92,"npi":[1811154388]}]}]}]},{"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":"042546968"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":27900.00,"providers":[{"billed_charge":264960.00,"npi":[1235401142]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4329.00,"providers":[{"billed_charge":29250.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19020.96,"providers":[{"billed_charge":54345.60,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":340.47,"providers":[{"billed_charge":1287.60,"npi":[1234567893]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":365.12,"providers":[{"billed_charge":1043.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":54.66,"providers":[{"billed_charge":156.24,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1377.50,"providers":[{"billed_charge":3936.80,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":784.00,"providers":[{"billed_charge":5760.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5319.72,"providers":[{"billed_charge":15200.64,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":153.34,"providers":[{"billed_charge":550.42,"npi":[1234567893]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":342.32,"providers":[{"billed_charge":978.12,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1408.32,"providers":[{"billed_charge":4023.36,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.74,"providers":[{"billed_charge":594.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1469.16,"providers":[{"billed_charge":4198.04,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.56,"providers":[{"billed_charge":70.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2963.52,"providers":[{"billed_charge":8467.20,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":29.40,"providers":[{"billed_charge":88.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":143.22,"providers":[{"billed_charge":409.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1092.42,"providers":[{"billed_charge":3121.44,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":466.74,"providers":[{"billed_charge":1333.44,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2423.04,"providers":[{"billed_charge":32640.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9186.84,"providers":[{"billed_charge":26255.84,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":100.44,"providers":[{"billed_charge":417.62,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":224.00,"providers":[{"billed_charge":640.08,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.93,"providers":[{"billed_charge":1056.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":951.30,"providers":[{"billed_charge":2717.40,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.12,"providers":[{"billed_charge":64.72,"npi":[1234567893]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":187.44,"providers":[{"billed_charge":1188.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1162.80,"providers":[{"billed_charge":3321.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":154.40,"providers":[{"billed_charge":440.96,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":403.34,"providers":[{"billed_charge":1152.40,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":866.85,"providers":[{"billed_charge":2476.80,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":488.34,"providers":[{"billed_charge":1395.36,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":370.45,"providers":[{"billed_charge":2728.00,"npi":[1285745612]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":41.12,"providers":[{"billed_charge":117.44,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":395.46,"providers":[{"billed_charge":1129.96,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FREE TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84402","description":"TESTOSTERONE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":534.90,"providers":[{"billed_charge":1528.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2420.71,"providers":[{"billed_charge":6917.08,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":445.36,"providers":[{"billed_charge":3268.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2387.07,"providers":[{"billed_charge":6819.12,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.10,"providers":[{"billed_charge":180.40,"npi":[1234567893]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":928.20,"providers":[{"billed_charge":6885.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18886.56,"providers":[{"billed_charge":53961.60,"npi":[1811154388]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.02,"providers":[{"billed_charge":162.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":735.32,"providers":[{"billed_charge":2100.56,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":215.22,"providers":[{"billed_charge":614.72,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":421.40,"providers":[{"billed_charge":1204.00,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":530.25,"providers":[{"billed_charge":7245.00,"npi":[1285745612]}]}]},{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8312.32,"providers":[{"billed_charge":23745.12,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2582.10,"providers":[{"billed_charge":7375.80,"npi":[1811154388]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":90.15,"providers":[{"billed_charge":257.40,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":279.72,"providers":[{"billed_charge":799.20,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":203.16,"providers":[{"billed_charge":580.32,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":688.75,"providers":[{"billed_charge":1968.40,"npi":[1811154388]}]}]}]},{"name":"TISS TRNSGLTMNASE EA IG CLAS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86364","description":"TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":64.56,"providers":[{"billed_charge":184.48,"npi":[1811154388]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.11,"providers":[{"billed_charge":174.60,"npi":[1811154388]}]}]}]},{"name":"RHEUMATOID FACTOR TEST QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86430","description":"RHEUMATOID FACTOR; QUALITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":103.20,"providers":[{"billed_charge":294.72,"npi":[1811154388]}]}]}]},{"name":"TB AG RESPONSE T-CELL SUSP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86481","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1540.00,"providers":[{"billed_charge":4400.00,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":225.60,"providers":[{"billed_charge":644.40,"npi":[1811154388]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":60.45,"providers":[{"billed_charge":172.68,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":574.74,"providers":[{"billed_charge":1641.76,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":539.46,"providers":[{"billed_charge":1541.16,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":95.76,"providers":[{"billed_charge":273.56,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.09,"providers":[{"billed_charge":131.56,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.09,"providers":[{"billed_charge":131.56,"npi":[1811154388]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":565.50,"providers":[{"billed_charge":1616.00,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2034.00,"providers":[{"billed_charge":5810.40,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":520.73,"providers":[{"billed_charge":1487.80,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":202.44,"providers":[{"billed_charge":578.48,"npi":[1811154388]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":35.16,"providers":[{"billed_charge":295.09,"npi":[1234567893]}]}]}]},{"name":"CHYLMD PNEUM, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87486","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":410.14,"providers":[{"billed_charge":1271.32,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4814.74,"providers":[{"billed_charge":13755.28,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":562.38,"providers":[{"billed_charge":4815.45,"npi":[1234567893]}]}]}]},{"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":81.97,"providers":[{"billed_charge":530.37,"npi":[1234567893]}]}]}]},{"name":"LEGION PNEUMO, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87541","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); LEGIONELLA PNEUMOPHILA, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":29.27,"providers":[{"billed_charge":87.73,"npi":[1234567893]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":603.43,"providers":[{"billed_charge":3420.63,"npi":[1234567893]}]}]}]},{"name":"M.PNEUMON, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87581","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":433.58,"providers":[{"billed_charge":1455.51,"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4814.74,"providers":[{"billed_charge":13755.28,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":574.04,"providers":[{"billed_charge":4850.56,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5306.04,"providers":[{"billed_charge":15158.88,"npi":[1811154388]}]}]}]},{"name":"RESP VIRUS 3-5 TARGETS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87631","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1286.28,"providers":[{"billed_charge":3851.01,"npi":[1234567893]}]}]}]},{"name":"STAPH A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87640","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":603.31,"providers":[{"billed_charge":2566.46,"npi":[1234567893]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":982.60,"providers":[{"billed_charge":2807.20,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":433.58,"providers":[{"billed_charge":1593.59,"npi":[1234567893]}]}]}]},{"name":"STREP B, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87653","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":661.97,"providers":[{"billed_charge":3501.18,"npi":[1234567893]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1326.51,"providers":[{"billed_charge":3789.72,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":222.62,"providers":[{"billed_charge":1804.72,"npi":[1234567893]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":515.68,"providers":[{"billed_charge":4770.90,"npi":[1234567893]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.90,"providers":[{"billed_charge":140.40,"npi":[1234567893]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5699.25,"providers":[{"billed_charge":16211.88,"npi":[1811154388]}]}]}]},{"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":"824338775"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1112.65,"providers":[{"billed_charge":2200.00,"npi":[1538622295]}]},{"allowed_amount":1314.95,"providers":[{"billed_charge":2600.00,"npi":[1538622295]}]},{"allowed_amount":101.15,"providers":[{"billed_charge":200.00,"npi":[1255193314]}]},{"allowed_amount":202.30,"providers":[{"billed_charge":400.00,"npi":[1255193314]}]}]},{"tin":{"type":"ein","value":"994771966"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112.39,"providers":[{"billed_charge":125.00,"npi":[1235730888]}]}]},{"tin":{"type":"ein","value":"812613387"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":910.35,"providers":[{"billed_charge":1350.00,"npi":[1821713348]}]},{"allowed_amount":404.60,"providers":[{"billed_charge":600.00,"npi":[1235974007]}]},{"allowed_amount":1011.50,"providers":[{"billed_charge":1500.00,"npi":[1821713348]}]}]},{"tin":{"type":"ein","value":"250255506"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1798.24,"providers":[{"billed_charge":2800.00,"npi":[1093863441]}]}]},{"tin":{"type":"ein","value":"871960212"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":202.30,"providers":[{"billed_charge":325.00,"npi":[1093051229]}]}]},{"tin":{"type":"ein","value":"883585868"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":663.10,"providers":[{"billed_charge":900.00,"npi":[1730897976]}]}]},{"tin":{"type":"ein","value":"993818057"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":112.39,"providers":[{"billed_charge":150.00,"npi":[1407318058]}]},{"allowed_amount":1685.85,"providers":[{"billed_charge":2170.00,"npi":[1407318058]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"205497203"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.83,"providers":[{"billed_charge":159.00,"npi":[1063050128]}]}]},{"tin":{"type":"ein","value":"461783124"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":162.82,"providers":[{"billed_charge":220.00,"npi":[1427400977]}]},{"allowed_amount":20.00,"providers":[{"billed_charge":20.00,"npi":[1427400977]}]}]}]},{"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":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4707.88,"providers":[{"billed_charge":6498.00,"npi":[1992701429]}]},{"allowed_amount":212.05,"providers":[{"billed_charge":1299.00,"npi":[1992701429]}]}]}]},{"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":"611326062"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":92.08,"providers":[{"billed_charge":192.00,"npi":[1043234339]}]}]},{"tin":{"type":"ein","value":"611363192"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":172.65,"providers":[{"billed_charge":675.00,"npi":[1548802291]}]},{"allowed_amount":184.16,"providers":[{"billed_charge":720.00,"npi":[1265409312]}]}]},{"tin":{"type":"ein","value":"371916656"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":207.26,"providers":[{"billed_charge":416.00,"npi":[1164023271]}]}]},{"tin":{"type":"ein","value":"400350065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":126.69,"providers":[{"billed_charge":253.00,"npi":[1205107083]}]}]}]},{"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":"371916656"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":541.00,"providers":[{"billed_charge":1100.00,"npi":[1164023271]}]}]},{"tin":{"type":"ein","value":"454534912"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":27.05,"providers":[{"billed_charge":40.80,"npi":[1538175815]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97.40,"providers":[{"billed_charge":389.50,"npi":[1497448112]}]},{"allowed_amount":99.55,"providers":[{"billed_charge":352.50,"npi":[1770651234]}]},{"allowed_amount":311.61,"providers":[{"billed_charge":1128.00,"npi":[1629217369]}]},{"allowed_amount":19.48,"providers":[{"billed_charge":89.00,"npi":[1275140790]},{"billed_charge":70.50,"npi":[1134959984]}]},{"allowed_amount":253.23,"providers":[{"billed_charge":953.50,"npi":[1124413315]}]},{"allowed_amount":506.46,"providers":[{"billed_charge":1944.00,"npi":[1740892249]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":214.28,"providers":[{"billed_charge":1120.00,"npi":[1629309521]}]},{"allowed_amount":362.96,"providers":[{"billed_charge":1515.00,"npi":[1932760717]}]},{"allowed_amount":116.85,"providers":[{"billed_charge":610.00,"npi":[1649320250]}]},{"allowed_amount":38.96,"providers":[{"billed_charge":200.00,"npi":[1558037812]}]}]},{"tin":{"type":"ein","value":"616060814"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":78.44,"providers":[{"billed_charge":165.00,"npi":[1861007783]}]}]}]},{"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":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.66,"providers":[{"billed_charge":99.00,"npi":[1013683580]},{"billed_charge":69.00,"npi":[1275140790]}]},{"allowed_amount":303.24,"providers":[{"billed_charge":1056.00,"npi":[1740892249]}]},{"allowed_amount":173.28,"providers":[{"billed_charge":582.00,"npi":[1124413315]}]},{"allowed_amount":45.73,"providers":[{"billed_charge":168.00,"npi":[1356004402]}]},{"allowed_amount":209.40,"providers":[{"billed_charge":621.00,"npi":[1629217369]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":329.73,"providers":[{"billed_charge":1500.00,"npi":[1528586005]}]},{"allowed_amount":262.33,"providers":[{"billed_charge":1203.00,"npi":[1881166320]}]},{"allowed_amount":21.66,"providers":[{"billed_charge":99.00,"npi":[1659051639]}]},{"allowed_amount":433.23,"providers":[{"billed_charge":1990.00,"npi":[1629309521]}]},{"allowed_amount":390.49,"providers":[{"billed_charge":1629.00,"npi":[1932760717]}]},{"allowed_amount":43.32,"providers":[{"billed_charge":198.00,"npi":[1992484711]}]},{"allowed_amount":454.90,"providers":[{"billed_charge":2079.00,"npi":[1346841335]}]},{"allowed_amount":89.05,"providers":[{"billed_charge":396.00,"npi":[1558037812]}]},{"allowed_amount":129.99,"providers":[{"billed_charge":594.00,"npi":[1942982947]}]}]}]},{"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":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.18,"providers":[{"billed_charge":567.00,"npi":[1497448112]}]},{"allowed_amount":515.14,"providers":[{"billed_charge":1992.00,"npi":[1740892249]}]},{"allowed_amount":312.78,"providers":[{"billed_charge":1203.00,"npi":[1124413315]}]},{"allowed_amount":167.64,"providers":[{"billed_charge":621.00,"npi":[1629217369]}]},{"allowed_amount":91.99,"providers":[{"billed_charge":345.00,"npi":[1770651234]},{"billed_charge":375.00,"npi":[1356004402]}]},{"allowed_amount":18.40,"providers":[{"billed_charge":69.00,"npi":[1275140790]},{"billed_charge":84.00,"npi":[1134959984]}]},{"allowed_amount":92.00,"providers":[{"billed_charge":360.00,"npi":[1669189197]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":294.40,"providers":[{"billed_charge":1424.00,"npi":[1346841335]}]},{"allowed_amount":459.93,"providers":[{"billed_charge":2237.00,"npi":[1528586005]}]},{"allowed_amount":445.67,"providers":[{"billed_charge":2152.00,"npi":[1881166320]}]},{"allowed_amount":110.40,"providers":[{"billed_charge":538.00,"npi":[1629309521]}]},{"allowed_amount":128.77,"providers":[{"billed_charge":627.00,"npi":[1356864706]}]},{"allowed_amount":255.53,"providers":[{"billed_charge":979.00,"npi":[1932760717]}]}]}]},{"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":"331195715"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5787.68,"providers":[{"billed_charge":6050.00,"npi":[1255970828]}]}]}]},{"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":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":354.53,"providers":[{"billed_charge":1179.50,"npi":[1669189197]}]},{"allowed_amount":631.99,"providers":[{"billed_charge":2136.00,"npi":[1740892249]}]},{"allowed_amount":77.07,"providers":[{"billed_charge":272.00,"npi":[1770651234]}]},{"allowed_amount":292.90,"providers":[{"billed_charge":1039.00,"npi":[1497448112]}]},{"allowed_amount":25.69,"providers":[{"billed_charge":82.50,"npi":[1144730169]}]},{"allowed_amount":403.33,"providers":[{"billed_charge":1369.00,"npi":[1124413315]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":848.04,"providers":[{"billed_charge":3700.00,"npi":[1629309521]}]},{"allowed_amount":74.52,"providers":[{"billed_charge":315.00,"npi":[1558037812,1942982947]}]},{"allowed_amount":1056.21,"providers":[{"billed_charge":4555.00,"npi":[1881166320]}]},{"allowed_amount":146.49,"providers":[{"billed_charge":650.00,"npi":[1649320250]}]},{"allowed_amount":1639.35,"providers":[{"billed_charge":7065.00,"npi":[1528586005]}]},{"allowed_amount":51.38,"providers":[{"billed_charge":210.00,"npi":[1992484711]}]},{"allowed_amount":241.57,"providers":[{"billed_charge":1080.00,"npi":[1356864706]}]},{"allowed_amount":449.65,"providers":[{"billed_charge":1900.00,"npi":[1124055462]}]},{"allowed_amount":349.42,"providers":[{"billed_charge":1470.00,"npi":[1659051639]}]},{"allowed_amount":465.73,"providers":[{"billed_charge":1585.00,"npi":[1932760717]}]},{"allowed_amount":477.90,"providers":[{"billed_charge":2090.00,"npi":[1700420858]}]},{"allowed_amount":835.18,"providers":[{"billed_charge":3570.00,"npi":[1346841335]}]}]},{"tin":{"type":"ein","value":"352071262"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":395.65,"providers":[{"billed_charge":1695.00,"npi":[1750366175]}]},{"allowed_amount":1341.14,"providers":[{"billed_charge":5675.00,"npi":[1295719847]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"611326062"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50.20,"providers":[{"billed_charge":100.00,"npi":[1043234339]}]}]},{"tin":{"type":"ein","value":"611363192"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":200.80,"providers":[{"billed_charge":440.00,"npi":[1548802291]}]},{"allowed_amount":476.90,"providers":[{"billed_charge":1045.00,"npi":[1265409312]}]}]},{"tin":{"type":"ein","value":"200875867"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":50.20,"providers":[{"billed_charge":126.00,"npi":[1285408286]}]}]},{"tin":{"type":"ein","value":"400350065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":577.30,"providers":[{"billed_charge":805.00,"npi":[1205107083]}]}]},{"tin":{"type":"ein","value":"934236895"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.36,"providers":[{"billed_charge":100.00,"npi":[1255894135]}]}]}]},{"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":"832777853"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1390.42,"providers":[{"billed_charge":1520.00,"npi":[1346710894]}]}]},{"tin":{"type":"ein","value":"371916656"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.18,"providers":[{"billed_charge":130.00,"npi":[1164023271]}]}]},{"tin":{"type":"ein","value":"200875867"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":402.49,"providers":[{"billed_charge":745.00,"npi":[1285408286]}]},{"allowed_amount":146.36,"providers":[{"billed_charge":304.00,"npi":[1821869199]}]}]},{"tin":{"type":"ein","value":"454534912"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":36.59,"providers":[{"billed_charge":52.00,"npi":[1538175815]}]}]},{"tin":{"type":"ein","value":"934236895"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1007.51,"providers":[{"billed_charge":2775.00,"npi":[1255894135]}]}]},{"tin":{"type":"ein","value":"843980931"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":109.77,"providers":[{"billed_charge":186.25,"npi":[1528779006]}]}]},{"tin":{"type":"ein","value":"311515706"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1500.19,"providers":[{"billed_charge":2255.00,"npi":[1215962519]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"934236895"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":778.71,"providers":[{"billed_charge":1980.00,"npi":[1255894135]}]}]},{"tin":{"type":"ein","value":"843980931"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":142.26,"providers":[{"billed_charge":240.00,"npi":[1528779006]}]}]}]},{"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":"933448504"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":922.68,"providers":[{"billed_charge":2200.00,"npi":[1164518080]}]},{"allowed_amount":181.86,"providers":[{"billed_charge":600.00,"npi":[1164518080]}]}]},{"tin":{"type":"ein","value":"205497203"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":552.30,"providers":[{"billed_charge":1032.00,"npi":[1447969357]}]}]},{"tin":{"type":"ein","value":"311545520"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":644.35,"providers":[{"billed_charge":1120.00,"npi":[1679334338]}]}]},{"tin":{"type":"ein","value":"461507241"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":52.00,"providers":[{"billed_charge":150.00,"npi":[1881738169]}]},{"allowed_amount":708.10,"providers":[{"billed_charge":1500.00,"npi":[1881738169]}]}]},{"tin":{"type":"ein","value":"611748048"},"service_code":["72","10"],"billing_class":"professional","payments":[{"allowed_amount":75.76,"providers":[{"billed_charge":173.00,"npi":[1851020648]}]},{"allowed_amount":378.80,"providers":[{"billed_charge":865.00,"npi":[1851020648]}]}]},{"tin":{"type":"ein","value":"061819197"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1082.90,"providers":[{"billed_charge":1430.00,"npi":[1184719874]}]}]},{"tin":{"type":"ein","value":"383892466"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":70.81,"providers":[{"billed_charge":150.00,"npi":[1366076150]}]}]},{"tin":{"type":"ein","value":"371874451"},"service_code":["02","57"],"billing_class":"professional","payments":[{"allowed_amount":70.81,"providers":[{"billed_charge":200.00,"npi":[1780097691]}]},{"allowed_amount":1331.16,"providers":[{"billed_charge":3200.00,"npi":[1629601638]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1834.56,"providers":[{"billed_charge":4272.00,"npi":[1952399669]}]},{"allowed_amount":5103.78,"providers":[{"billed_charge":13172.00,"npi":[1588257133]}]}]},{"tin":{"type":"ein","value":"273645560"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":419.82,"providers":[{"billed_charge":762.00,"npi":[1881673515]}]}]},{"tin":{"type":"ein","value":"205497203"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":611.52,"providers":[{"billed_charge":972.00,"npi":[1356929152]}]},{"allowed_amount":152.88,"providers":[{"billed_charge":243.00,"npi":[1831417302]}]}]},{"tin":{"type":"ein","value":"263083364"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":199.92,"providers":[{"billed_charge":496.00,"npi":[1699335968]}]}]},{"tin":{"type":"ein","value":"843777847"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2499.00,"providers":[{"billed_charge":4375.00,"npi":[1669171641]}]}]},{"tin":{"type":"ein","value":"371874451"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":799.68,"providers":[{"billed_charge":2000.00,"npi":[1558649848]}]}]}]},{"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":"461507241"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":124.82,"providers":[{"billed_charge":456.00,"npi":[1013251370]}]}]}]},{"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":"611204942"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":329.00,"providers":[{"billed_charge":2772.00,"npi":[1467958280]}]}]}]},{"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":"931641861"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2122.84,"providers":[{"billed_charge":12264.00,"npi":[1386337657]}]}]},{"tin":{"type":"ein","value":"610858140"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":647.03,"providers":[{"billed_charge":1101.25,"npi":[1508823857]}]}]}]},{"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":"610858140"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":782.06,"providers":[{"billed_charge":1690.00,"npi":[1508823857]}]}]}]},{"name":"INFUS SET EXT INSULIN PUMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4230","description":"INFUSION SET FOR EXTERNAL INSULIN PUMP, NONNEEDLE CANNULA TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":677.60,"providers":[{"billed_charge":1190.00,"npi":[1234567893]}]}]}]},{"name":"SYRINGE NDLE EXT INSULIN PUM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4232","description":"SYRINGE WITH NEEDLE FOR EXTERNAL INSULIN PUMP, STERILE, 3 CC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":473.00,"providers":[{"billed_charge":946.00,"npi":[1234567893]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":743.68,"providers":[{"billed_charge":2455.48,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":80.75,"providers":[{"billed_charge":512.16,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":172.88,"providers":[{"billed_charge":1112.00,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":85.92,"providers":[{"billed_charge":399.40,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":282.79,"providers":[{"billed_charge":727.08,"npi":[1234567893]}]}]}]},{"name":"SENSOR; INVSV INTRSTL GLU MO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A9276","description":"SENSOR; INVASIVE (E.G., SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4704.00,"providers":[{"billed_charge":6300.00,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1377.93,"providers":[{"billed_charge":5997.90,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1100.55,"providers":[{"billed_charge":20118.56,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":100.00,"providers":[{"billed_charge":1130.08,"npi":[1234567893]}]}]}]},{"name":"NEG PRSS WND TX PUMP STATN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E2402","description":"NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":19543.40,"providers":[{"billed_charge":60795.90,"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3216.57,"providers":[{"billed_charge":9191.56,"npi":[1811154388]}]}]}]},{"name":"HIV ANTIGEN/ANTIBODY, COMBIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0475","description":"HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1179.85,"providers":[{"billed_charge":3371.20,"npi":[1811154388]}]}]}]},{"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":"611276316"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":252.72,"providers":[{"billed_charge":624.00,"npi":[1952399669]}]},{"allowed_amount":280.64,"providers":[{"billed_charge":768.00,"npi":[1588257133]}]}]},{"tin":{"type":"ein","value":"461507241"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":165.23,"providers":[{"billed_charge":520.00,"npi":[1881738169]}]},{"allowed_amount":63.55,"providers":[{"billed_charge":200.00,"npi":[1477854115]}]},{"allowed_amount":12.71,"providers":[{"billed_charge":40.00,"npi":[1881738169]}]}]}]},{"name":"KNEE ORTHOSIS ELASTIC W/JNTS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1812","description":"KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":154.18,"providers":[{"billed_charge":238.34,"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":442.50,"providers":[{"billed_charge":709.40,"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":6661.80,"providers":[{"billed_charge":10051.20,"npi":[1234567893]}]}]}]}]}