{"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":"Under Proprietary Laboratory Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"0449U","description":"Under Proprietary Laboratory Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"811082020"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31022.96,"providers":[{"billed_charge":124091.84,"npi":[1598314437]}]}]}]},{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"934025601"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":16933.00,"providers":[{"billed_charge":233050.00,"npi":[1780452565]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1021210.47,"providers":[{"billed_charge":867901.23,"npi":[1831116441]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":95112.41,"providers":[{"billed_charge":251486.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":502694.60,"providers":[{"billed_charge":285560.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":391227.82,"providers":[{"billed_charge":210540.00,"npi":[1053356352]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"464719451"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":474795.79,"providers":[{"billed_charge":439200.00,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":14620.44,"providers":[{"billed_charge":7239.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":15650.13,"providers":[{"billed_charge":27852.00,"npi":[1982685384]}]}]}]},{"name":"MED-SUR-GY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"121","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"382383119"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":290506.68,"providers":[{"billed_charge":140296.00,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":380759.26,"providers":[{"billed_charge":179190.00,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":97130.05,"providers":[{"billed_charge":39339.00,"npi":[1376564088]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"382409580"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":937301.45,"providers":[{"billed_charge":1056000.00,"npi":[1053342220]}]}]},{"tin":{"type":"ein","value":"43232990"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":744579.73,"providers":[{"billed_charge":1505100.00,"npi":[1144381245]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":69189.10,"providers":[{"billed_charge":73441.35,"npi":[1831116441]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.41,"providers":[{"billed_charge":191.29,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":169.05,"providers":[{"billed_charge":19230.06,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":155.64,"providers":[{"billed_charge":775.00,"npi":[1790706901]}]},{"allowed_amount":12994.32,"providers":[{"billed_charge":94661.60,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.71,"providers":[{"billed_charge":3220.44,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.06,"providers":[{"billed_charge":71.65,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9738.26,"providers":[{"billed_charge":61662.70,"npi":[1982685384]}]},{"allowed_amount":269.35,"providers":[{"billed_charge":6259.10,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":101.02,"providers":[{"billed_charge":440.76,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.05,"providers":[{"billed_charge":305.95,"npi":[1295803377]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1451.01,"providers":[{"billed_charge":6600.20,"npi":[1790706901]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":241.20,"providers":[{"billed_charge":2412.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":355.03,"providers":[{"billed_charge":4049.50,"npi":[1982685384]}]},{"allowed_amount":1980.95,"providers":[{"billed_charge":9616.16,"npi":[1982685384]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2769.11,"providers":[{"billed_charge":9464.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":82351.84,"providers":[{"billed_charge":299432.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3565.80,"providers":[{"billed_charge":6712.00,"npi":[1831132133]}]},{"allowed_amount":149.36,"providers":[{"billed_charge":128.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1607.11,"providers":[{"billed_charge":13912.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2356.68,"providers":[{"billed_charge":10282.04,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15142.34,"providers":[{"billed_charge":121123.68,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2072.00,"providers":[{"billed_charge":3700.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5083.13,"providers":[{"billed_charge":30147.10,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32763.99,"providers":[{"billed_charge":149567.10,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43434.68,"providers":[{"billed_charge":121891.70,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2691.27,"providers":[{"billed_charge":11732.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":367.68,"providers":[{"billed_charge":5364.90,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3597.42,"providers":[{"billed_charge":9051.71,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6463.05,"providers":[{"billed_charge":13629.40,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":32028.72,"providers":[{"billed_charge":109282.00,"npi":[1790706901]}]},{"allowed_amount":10817.85,"providers":[{"billed_charge":53597.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":276.16,"providers":[{"billed_charge":684.57,"npi":[1831116441]}]},{"allowed_amount":2087.58,"providers":[{"billed_charge":27171.34,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39857.60,"providers":[{"billed_charge":168007.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":126.72,"providers":[{"billed_charge":2740.00,"npi":[1841245594]}]},{"allowed_amount":1376.08,"providers":[{"billed_charge":3056.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8405.96,"providers":[{"billed_charge":13991.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3055.52,"providers":[{"billed_charge":8430.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3820.32,"providers":[{"billed_charge":23381.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":66474.90,"providers":[{"billed_charge":113165.20,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12988.43,"providers":[{"billed_charge":35189.73,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13164.94,"providers":[{"billed_charge":38932.16,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11451.65,"providers":[{"billed_charge":21904.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16286.14,"providers":[{"billed_charge":51434.00,"npi":[1992761985]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.00,"providers":[{"billed_charge":345.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":139.20,"providers":[{"billed_charge":1052.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":615.21,"providers":[{"billed_charge":1185.17,"npi":[1831116441]}]},{"allowed_amount":1378.61,"providers":[{"billed_charge":10758.31,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":528.68,"providers":[{"billed_charge":8072.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":420.75,"providers":[{"billed_charge":599.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":885.29,"providers":[{"billed_charge":5243.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10.45,"providers":[{"billed_charge":19.00,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1299.17,"providers":[{"billed_charge":3456.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":18.18,"providers":[{"billed_charge":69.32,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":34.10,"providers":[{"billed_charge":148.78,"npi":[1962508259]}]},{"allowed_amount":435.36,"providers":[{"billed_charge":1899.27,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18.18,"providers":[{"billed_charge":46.83,"npi":[1083644579]}]},{"allowed_amount":79.44,"providers":[{"billed_charge":5979.73,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381358208"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.63,"providers":[{"billed_charge":1201.25,"npi":[1063414233]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":409.85,"providers":[{"billed_charge":11799.43,"npi":[1043625940]}]},{"allowed_amount":13.82,"providers":[{"billed_charge":90.90,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":33.60,"providers":[{"billed_charge":60.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":75.49,"providers":[{"billed_charge":233.40,"npi":[1982685384]}]},{"allowed_amount":193.98,"providers":[{"billed_charge":692.40,"npi":[1982685384]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":204.38,"providers":[{"billed_charge":5882.85,"npi":[1871672618]}]},{"allowed_amount":3.93,"providers":[{"billed_charge":32.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":309.21,"providers":[{"billed_charge":130439.09,"npi":[1053356352]}]},{"allowed_amount":25.82,"providers":[{"billed_charge":168.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":499.57,"providers":[{"billed_charge":2705.00,"npi":[1831132133]}]},{"allowed_amount":40.18,"providers":[{"billed_charge":9346.00,"npi":[1831132133]}]},{"allowed_amount":32.64,"providers":[{"billed_charge":96.00,"npi":[1285662981]}]},{"allowed_amount":156.20,"providers":[{"billed_charge":463.00,"npi":[1285662981]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":486.66,"providers":[{"billed_charge":2644.00,"npi":[1619923919]}]},{"allowed_amount":4.52,"providers":[{"billed_charge":2599.00,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":134.80,"providers":[{"billed_charge":588.05,"npi":[1962508259]}]},{"allowed_amount":2785.86,"providers":[{"billed_charge":12154.43,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3158.69,"providers":[{"billed_charge":142198.01,"npi":[1043625940]}]},{"allowed_amount":272.23,"providers":[{"billed_charge":1157.50,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5508.72,"providers":[{"billed_charge":9837.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.61,"providers":[{"billed_charge":17465.40,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10.96,"providers":[{"billed_charge":71.90,"npi":[1902894512]}]},{"allowed_amount":963.03,"providers":[{"billed_charge":104515.70,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":507.24,"providers":[{"billed_charge":70887.15,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"421707837"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":50.27,"providers":[{"billed_charge":110.00,"npi":[1407897309]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1563.16,"providers":[{"billed_charge":28279.70,"npi":[1982685384]}]},{"allowed_amount":5995.10,"providers":[{"billed_charge":24332.80,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39.30,"providers":[{"billed_charge":8909.58,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":189.39,"providers":[{"billed_charge":7431.95,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4862.36,"providers":[{"billed_charge":10253.80,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15966.48,"providers":[{"billed_charge":76579.00,"npi":[1790706901]}]},{"allowed_amount":15074.76,"providers":[{"billed_charge":87042.37,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":129.14,"providers":[{"billed_charge":60480.14,"npi":[1831116441]}]},{"allowed_amount":573.05,"providers":[{"billed_charge":2755.75,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"381434090"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":841.50,"providers":[{"billed_charge":1755.20,"npi":[1134104672]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8.46,"providers":[{"billed_charge":102.00,"npi":[1780658443]}]},{"allowed_amount":182.22,"providers":[{"billed_charge":83288.59,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3085.77,"providers":[{"billed_charge":7171.00,"npi":[1841245594]}]},{"allowed_amount":983.92,"providers":[{"billed_charge":2397.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":921.59,"providers":[{"billed_charge":145789.30,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19.63,"providers":[{"billed_charge":605.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":142.49,"providers":[{"billed_charge":2480.44,"npi":[1306227764]}]},{"allowed_amount":23.60,"providers":[{"billed_charge":56626.27,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":289.84,"providers":[{"billed_charge":34770.04,"npi":[1083644579]}]},{"allowed_amount":75.66,"providers":[{"billed_charge":612.40,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60.27,"providers":[{"billed_charge":26219.00,"npi":[1992761985]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.41,"providers":[{"billed_charge":1358.29,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19.86,"providers":[{"billed_charge":115.64,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":66.93,"providers":[{"billed_charge":10223.63,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":80.86,"providers":[{"billed_charge":1286.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":32.43,"providers":[{"billed_charge":2857.36,"npi":[1831116441]}]},{"allowed_amount":369.87,"providers":[{"billed_charge":1363.34,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.78,"providers":[{"billed_charge":1680.30,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5.67,"providers":[{"billed_charge":49.00,"npi":[1780658443]}]},{"allowed_amount":111.96,"providers":[{"billed_charge":1488.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.18,"providers":[{"billed_charge":2671.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":77.53,"providers":[{"billed_charge":644.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":486.12,"providers":[{"billed_charge":1414.50,"npi":[1982685384]}]},{"allowed_amount":38.80,"providers":[{"billed_charge":283.80,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.41,"providers":[{"billed_charge":26.01,"npi":[1346275856]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":67.90,"providers":[{"billed_charge":1579.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":463.68,"providers":[{"billed_charge":828.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2976.96,"providers":[{"billed_charge":19511.00,"npi":[1790706901]}]},{"allowed_amount":3180.47,"providers":[{"billed_charge":15624.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":75.66,"providers":[{"billed_charge":352.10,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.82,"providers":[{"billed_charge":22143.40,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":698.03,"providers":[{"billed_charge":1114.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":16.94,"providers":[{"billed_charge":395.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":499.79,"providers":[{"billed_charge":7540.40,"npi":[1982685384]}]},{"allowed_amount":1434.42,"providers":[{"billed_charge":5271.40,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":649.35,"providers":[{"billed_charge":2833.08,"npi":[1962508259]}]},{"allowed_amount":11.27,"providers":[{"billed_charge":49.18,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":821.88,"providers":[{"billed_charge":1733.15,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15.54,"providers":[{"billed_charge":300.00,"npi":[1306227764]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":105.99,"providers":[{"billed_charge":1499.00,"npi":[1871672618]}]},{"allowed_amount":212.00,"providers":[{"billed_charge":884.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4514.58,"providers":[{"billed_charge":19253.00,"npi":[1790706901]}]},{"allowed_amount":3429.46,"providers":[{"billed_charge":13007.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4810.30,"providers":[{"billed_charge":8653.50,"npi":[1831116441]}]},{"allowed_amount":8058.67,"providers":[{"billed_charge":30918.57,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51.31,"providers":[{"billed_charge":375.00,"npi":[1780658443]}]},{"allowed_amount":5211.77,"providers":[{"billed_charge":21912.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18209.63,"providers":[{"billed_charge":71022.00,"npi":[1053356352]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":508.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":641.85,"providers":[{"billed_charge":1567.00,"npi":[1831132133]}]},{"allowed_amount":108.02,"providers":[{"billed_charge":1191.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1142.15,"providers":[{"billed_charge":1960.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.95,"providers":[{"billed_charge":831.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":37.27,"providers":[{"billed_charge":92.00,"npi":[1811097223]}]},{"allowed_amount":2709.97,"providers":[{"billed_charge":32228.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14479.39,"providers":[{"billed_charge":62955.40,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1462.43,"providers":[{"billed_charge":23363.37,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":162.20,"providers":[{"billed_charge":707.69,"npi":[1962508259]}]},{"allowed_amount":2381.57,"providers":[{"billed_charge":10391.13,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5348.75,"providers":[{"billed_charge":17938.56,"npi":[1083644579]}]},{"allowed_amount":177.96,"providers":[{"billed_charge":317.32,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":230.91,"providers":[{"billed_charge":285.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8645.26,"providers":[{"billed_charge":71711.35,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6534.99,"providers":[{"billed_charge":67671.60,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9578.38,"providers":[{"billed_charge":28877.00,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1497.65,"providers":[{"billed_charge":4069.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3023.31,"providers":[{"billed_charge":10226.50,"npi":[1982685384]}]},{"allowed_amount":589.37,"providers":[{"billed_charge":3848.60,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":427.89,"providers":[{"billed_charge":4800.42,"npi":[1073588711]}]},{"allowed_amount":51.31,"providers":[{"billed_charge":307.86,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3598.32,"providers":[{"billed_charge":7252.65,"npi":[1346275856]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":254.90,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":460.88,"providers":[{"billed_charge":971.90,"npi":[1295803377]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":57.90,"providers":[{"billed_charge":208.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":39.64,"providers":[{"billed_charge":130.40,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":238.58,"providers":[{"billed_charge":984.00,"npi":[1790706901]}]},{"allowed_amount":222.52,"providers":[{"billed_charge":1492.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4.50,"providers":[{"billed_charge":42.44,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":35.47,"providers":[{"billed_charge":3066.80,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":131.70,"providers":[{"billed_charge":1426.30,"npi":[1982685384]}]},{"allowed_amount":126.10,"providers":[{"billed_charge":432.70,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":122.17,"providers":[{"billed_charge":533.11,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":65.03,"providers":[{"billed_charge":137.10,"npi":[1295803377]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4339.39,"providers":[{"billed_charge":4327.00,"npi":[1053356352]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":172.54,"providers":[{"billed_charge":1847.59,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":888.14,"providers":[{"billed_charge":6692.00,"npi":[1790706901]}]},{"allowed_amount":3210.57,"providers":[{"billed_charge":10953.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":843.74,"providers":[{"billed_charge":5748.48,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":85.85,"providers":[{"billed_charge":11316.40,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":93.78,"providers":[{"billed_charge":800.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":277.17,"providers":[{"billed_charge":1316.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":410.94,"providers":[{"billed_charge":2096.00,"npi":[1972564730]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1026.83,"providers":[{"billed_charge":4047.70,"npi":[1982685384]}]},{"allowed_amount":2161.94,"providers":[{"billed_charge":8256.30,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":216.32,"providers":[{"billed_charge":1905.00,"npi":[1811097223]}]},{"allowed_amount":2679.70,"providers":[{"billed_charge":26591.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1298.74,"providers":[{"billed_charge":5666.41,"npi":[1962508259]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3166.71,"providers":[{"billed_charge":10093.00,"npi":[1790706901]}]},{"allowed_amount":940.56,"providers":[{"billed_charge":6118.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":12207.53,"providers":[{"billed_charge":36447.34,"npi":[1831116441]}]},{"allowed_amount":86.27,"providers":[{"billed_charge":303.69,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4802.97,"providers":[{"billed_charge":14161.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10062.16,"providers":[{"billed_charge":29378.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10556.83,"providers":[{"billed_charge":19012.00,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2588.20,"providers":[{"billed_charge":8208.08,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":69.60,"providers":[{"billed_charge":303.69,"npi":[1962508259]}]},{"allowed_amount":1642.50,"providers":[{"billed_charge":7166.24,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5952.86,"providers":[{"billed_charge":16228.92,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2253.52,"providers":[{"billed_charge":3420.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6387.85,"providers":[{"billed_charge":41050.68,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5766.10,"providers":[{"billed_charge":13375.30,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7343.21,"providers":[{"billed_charge":20470.20,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":259.62,"providers":[{"billed_charge":1035.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1035.28,"providers":[{"billed_charge":2331.21,"npi":[1346275856]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1425.98,"providers":[{"billed_charge":7310.05,"npi":[1083644579]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":1514.09,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3965.32,"providers":[{"billed_charge":49179.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7317.16,"providers":[{"billed_charge":49297.85,"npi":[1831116441]}]},{"allowed_amount":913.31,"providers":[{"billed_charge":6727.11,"npi":[1831116441]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3693.07,"providers":[{"billed_charge":26832.80,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4012.78,"providers":[{"billed_charge":82637.01,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16752.29,"providers":[{"billed_charge":59634.00,"npi":[1790706901]}]},{"allowed_amount":7004.54,"providers":[{"billed_charge":71473.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5065.65,"providers":[{"billed_charge":54697.22,"npi":[1831116441]}]},{"allowed_amount":428.39,"providers":[{"billed_charge":5634.84,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7247.50,"providers":[{"billed_charge":108837.50,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4135.09,"providers":[{"billed_charge":85895.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11271.02,"providers":[{"billed_charge":149196.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5696.29,"providers":[{"billed_charge":58198.10,"npi":[1316938327]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":1555.50,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11348.92,"providers":[{"billed_charge":82512.00,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":486.31,"providers":[{"billed_charge":4438.00,"npi":[1306227764]}]}]}]},{"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":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24248.14,"providers":[{"billed_charge":191733.00,"npi":[1790706901]}]},{"allowed_amount":38251.49,"providers":[{"billed_charge":209340.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1579.17,"providers":[{"billed_charge":19866.29,"npi":[1831116441]}]},{"allowed_amount":10234.06,"providers":[{"billed_charge":156058.49,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13501.73,"providers":[{"billed_charge":244833.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18286.63,"providers":[{"billed_charge":376844.00,"npi":[1053356352]}]},{"allowed_amount":530.51,"providers":[{"billed_charge":9400.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6490.08,"providers":[{"billed_charge":99288.00,"npi":[1811097223]}]},{"allowed_amount":544.33,"providers":[{"billed_charge":6543.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":21549.96,"providers":[{"billed_charge":225521.30,"npi":[1376564088]}]},{"allowed_amount":236.83,"providers":[{"billed_charge":2083.70,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4725.39,"providers":[{"billed_charge":69344.06,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8527.55,"providers":[{"billed_charge":102481.92,"npi":[1083644579]}]},{"allowed_amount":348.84,"providers":[{"billed_charge":5927.93,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6952.33,"providers":[{"billed_charge":208823.14,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":261.63,"providers":[{"billed_charge":1910.60,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15717.62,"providers":[{"billed_charge":214935.40,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13456.49,"providers":[{"billed_charge":85499.10,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3481.28,"providers":[{"billed_charge":50838.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4252.58,"providers":[{"billed_charge":37518.40,"npi":[1982685384]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15775.81,"providers":[{"billed_charge":27108.33,"npi":[1831116441]}]},{"allowed_amount":19693.22,"providers":[{"billed_charge":30919.89,"npi":[1831116441]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":236.34,"providers":[{"billed_charge":260.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":180.00,"providers":[{"billed_charge":180.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":118.17,"providers":[{"billed_charge":260.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":272.70,"providers":[{"billed_charge":450.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"383593303"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.76,"providers":[{"billed_charge":288.00,"npi":[1669035366]}]}]},{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15.44,"providers":[{"billed_charge":60.00,"npi":[1649520784,1144990938]}]}]},{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32.82,"providers":[{"billed_charge":60.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":309.06,"providers":[{"billed_charge":680.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10677.09,"providers":[{"billed_charge":14682.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":263.61,"providers":[{"billed_charge":435.00,"npi":[1346693413]}]},{"allowed_amount":36.36,"providers":[{"billed_charge":60.00,"npi":[1629459904]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":38.65,"providers":[{"billed_charge":50.00,"npi":[1245982909]}]},{"allowed_amount":77.30,"providers":[{"billed_charge":100.00,"npi":[1154032670]}]},{"allowed_amount":54.11,"providers":[{"billed_charge":70.00,"npi":[1629753223]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":716.55,"providers":[{"billed_charge":11230.05,"npi":[1043625940]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1641.03,"providers":[{"billed_charge":12288.04,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":990.45,"providers":[{"billed_charge":16876.49,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3745.59,"providers":[{"billed_charge":13654.00,"npi":[1790706901]}]},{"allowed_amount":763.30,"providers":[{"billed_charge":5615.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2422.45,"providers":[{"billed_charge":20500.67,"npi":[1831116441]}]},{"allowed_amount":104.19,"providers":[{"billed_charge":1429.91,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1600.92,"providers":[{"billed_charge":18236.80,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":940.68,"providers":[{"billed_charge":7487.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3197.02,"providers":[{"billed_charge":36069.00,"npi":[1053356352]}]},{"allowed_amount":312.57,"providers":[{"billed_charge":3390.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1641.04,"providers":[{"billed_charge":21229.00,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":547.01,"providers":[{"billed_charge":2572.30,"npi":[1376564088]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":506.25,"providers":[{"billed_charge":2208.83,"npi":[1962508259]}]}]}]},{"name":"INHALATION SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"412","description":"RESPIRATORY SERVICES - INHALATION SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":111.74,"providers":[{"billed_charge":14698.06,"npi":[1043625940]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381359087"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":340.41,"providers":[{"billed_charge":1806.08,"npi":[1831116441]}]}]}]},{"name":"PHYS THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"421","description":"PHYSICAL THERAPY/VISIT","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":78.30,"providers":[{"billed_charge":290.00,"npi":[1790706901]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":103.58,"providers":[{"billed_charge":624.00,"npi":[1790706901]}]},{"allowed_amount":84.24,"providers":[{"billed_charge":312.00,"npi":[1790706901]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":338.00,"providers":[{"billed_charge":1014.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96.42,"providers":[{"billed_charge":279.25,"npi":[1831116441]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31717.57,"providers":[{"billed_charge":32660.00,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":461583.21,"providers":[{"billed_charge":928725.00,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34744.42,"providers":[{"billed_charge":50665.00,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20184.18,"providers":[{"billed_charge":19832.00,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2653.18,"providers":[{"billed_charge":10429.50,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":50484.22,"providers":[{"billed_charge":220261.63,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381358208"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2645.76,"providers":[{"billed_charge":14385.00,"npi":[1063414233]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5709.76,"providers":[{"billed_charge":10196.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":240006.60,"providers":[{"billed_charge":1739775.09,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30992.74,"providers":[{"billed_charge":53963.40,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":201912.05,"providers":[{"billed_charge":509369.40,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":341084.25,"providers":[{"billed_charge":308373.90,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":134227.73,"providers":[{"billed_charge":221744.70,"npi":[1982685384]}]},{"allowed_amount":15759.46,"providers":[{"billed_charge":89402.80,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381360584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12678.83,"providers":[{"billed_charge":47814.00,"npi":[1073588711]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":90827.15,"providers":[{"billed_charge":189291.31,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22664.90,"providers":[{"billed_charge":47796.45,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":149485.64,"providers":[{"billed_charge":381438.00,"npi":[1790706901]}]},{"allowed_amount":27445.97,"providers":[{"billed_charge":107218.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":441671.31,"providers":[{"billed_charge":916120.02,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":252518.92,"providers":[{"billed_charge":472995.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2189.08,"providers":[{"billed_charge":5695.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4474.35,"providers":[{"billed_charge":12474.00,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49556.79,"providers":[{"billed_charge":88815.00,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":93187.86,"providers":[{"billed_charge":285407.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":495644.78,"providers":[{"billed_charge":700268.50,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":106837.23,"providers":[{"billed_charge":308982.67,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":299510.24,"providers":[{"billed_charge":541551.41,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":77629.83,"providers":[{"billed_charge":175770.00,"npi":[1407877723]}]},{"allowed_amount":939.00,"providers":[{"billed_charge":96077.00,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15594.95,"providers":[{"billed_charge":34560.00,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"386108110"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5902.90,"providers":[{"billed_charge":13186.00,"npi":[1063471639]}]}]},{"tin":{"type":"ein","value":"381976271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4528.02,"providers":[{"billed_charge":8277.50,"npi":[1528031226]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60924.71,"providers":[{"billed_charge":144625.00,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7480.63,"providers":[{"billed_charge":23344.00,"npi":[1972564730]}]}]},{"tin":{"type":"ein","value":"381362830"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3695.16,"providers":[{"billed_charge":7988.00,"npi":[1952307852]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":606.12,"providers":[{"billed_charge":1534.00,"npi":[1871672618]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":391.16,"providers":[{"billed_charge":7790.24,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1161.12,"providers":[{"billed_charge":32593.00,"npi":[1053356352]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"381738615"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2578.15,"providers":[{"billed_charge":7043.40,"npi":[1497750608]}]}]}]},{"name":"SKILLED NURSE/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"551","description":"SKILLED NURSING - VISIT CHARGE","allowed_amounts":[{"tin":{"type":"ein","value":"832473075"},"service_code":["12"],"billing_class":"institutional","payments":[{"allowed_amount":230.00,"providers":[{"billed_charge":2250.00,"npi":[1811461734]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"382800065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.50,"providers":[{"billed_charge":2995.55,"npi":[1871672618]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6645.13,"providers":[{"billed_charge":43359.60,"npi":[1053356352]}]}]},{"tin":{"type":"ein","value":"382589966"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":990.72,"providers":[{"billed_charge":6160.75,"npi":[1831132133]}]},{"allowed_amount":645.18,"providers":[{"billed_charge":3001.10,"npi":[1831132133]}]}]},{"tin":{"type":"ein","value":"383369438"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.23,"providers":[{"billed_charge":2889.27,"npi":[1588656946]}]}]},{"tin":{"type":"ein","value":"380593405"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.45,"providers":[{"billed_charge":907.25,"npi":[1619923919]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":46.83,"providers":[{"billed_charge":204.27,"npi":[1962508259]}]},{"allowed_amount":2041.10,"providers":[{"billed_charge":8905.12,"npi":[1962508259]}]}]},{"tin":{"type":"ein","value":"381358208"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.95,"providers":[{"billed_charge":520.99,"npi":[1063414233]}]}]},{"tin":{"type":"ein","value":"42516906"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":177.56,"providers":[{"billed_charge":147945.54,"npi":[1871608612]}]},{"allowed_amount":345.86,"providers":[{"billed_charge":94818.40,"npi":[1699275487]}]}]},{"tin":{"type":"ein","value":"464719451"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1147.83,"providers":[{"billed_charge":9817.48,"npi":[1043625940]}]},{"allowed_amount":3329.23,"providers":[{"billed_charge":109290.29,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"381738615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11250.96,"providers":[{"billed_charge":20091.00,"npi":[1497750608]}]}]},{"tin":{"type":"ein","value":"382689033"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14.95,"providers":[{"billed_charge":3077.95,"npi":[1205824737]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":162.20,"providers":[{"billed_charge":16406.51,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":171.20,"providers":[{"billed_charge":27092.43,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5688.55,"providers":[{"billed_charge":34282.90,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381676780"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1025.71,"providers":[{"billed_charge":9540.79,"npi":[1346275856]}]}]},{"tin":{"type":"ein","value":"381359180"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3369.64,"providers":[{"billed_charge":7106.17,"npi":[1295803377]}]},{"allowed_amount":13299.82,"providers":[{"billed_charge":28046.96,"npi":[1295803377]}]}]},{"tin":{"type":"ein","value":"746000949"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":318.21,"providers":[{"billed_charge":1247.89,"npi":[1548226988]}]}]},{"tin":{"type":"ein","value":"383521763"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2938.81,"providers":[{"billed_charge":14473.65,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":32773.98,"providers":[{"billed_charge":172710.74,"npi":[1831116441]}]},{"allowed_amount":2503.33,"providers":[{"billed_charge":42379.26,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"381434090"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":85.71,"providers":[{"billed_charge":285.64,"npi":[1134104672]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9316.26,"providers":[{"billed_charge":48204.45,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":110.59,"providers":[{"billed_charge":626.35,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"383176445"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40.97,"providers":[{"billed_charge":1680.60,"npi":[1639111057]}]}]},{"tin":{"type":"ein","value":"383176225"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.25,"providers":[{"billed_charge":877.95,"npi":[1093748642]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1.00,"providers":[{"billed_charge":201.00,"npi":[1811097223]}]},{"allowed_amount":4368.29,"providers":[{"billed_charge":12250.00,"npi":[1811097223]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12250.92,"providers":[{"billed_charge":51430.47,"npi":[1376564088]}]}]},{"tin":{"type":"ein","value":"472361878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":103.17,"providers":[{"billed_charge":31168.59,"npi":[1306227764]}]}]},{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1144.83,"providers":[{"billed_charge":26449.22,"npi":[1083644579]}]},{"allowed_amount":2500.58,"providers":[{"billed_charge":24336.12,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"471161992"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2.85,"providers":[{"billed_charge":345.60,"npi":[1083010953]}]}]},{"tin":{"type":"ein","value":"382377821"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2523.33,"providers":[{"billed_charge":5153.60,"npi":[1407877723]}]}]},{"tin":{"type":"ein","value":"386108110"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5.38,"providers":[{"billed_charge":355.00,"npi":[1063471639]}]},{"allowed_amount":0.50,"providers":[{"billed_charge":41.00,"npi":[1063471639]}]}]},{"tin":{"type":"ein","value":"381976271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":991.87,"providers":[{"billed_charge":4548.99,"npi":[1528031226]}]}]},{"tin":{"type":"ein","value":"824757260"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9234.75,"providers":[{"billed_charge":37190.75,"npi":[1992761985]}]}]},{"tin":{"type":"ein","value":"382796005"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.75,"providers":[{"billed_charge":154.00,"npi":[1972564730]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"341788398"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":6903.00,"providers":[{"billed_charge":6903.00,"npi":[1114627890]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"381859770"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":79.38,"providers":[{"billed_charge":230.00,"npi":[1326422528]}]},{"allowed_amount":39.69,"providers":[{"billed_charge":115.00,"npi":[1104260603,1326422528]}]},{"allowed_amount":277.83,"providers":[{"billed_charge":805.00,"npi":[1326422528]}]},{"allowed_amount":119.07,"providers":[{"billed_charge":345.00,"npi":[1104260603]}]},{"allowed_amount":555.66,"providers":[{"billed_charge":1610.00,"npi":[1104260603]}]}]}]},{"name":"MRI BRAIN STEM W/O & W/DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70553","description":"MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FO","allowed_amounts":[{"tin":{"type":"ein","value":"381859770"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":215.34,"providers":[{"billed_charge":636.00,"npi":[1104260603]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"934891173"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":25.90,"providers":[{"billed_charge":50.00,"npi":[1265457485,1386904704]}]},{"allowed_amount":230.30,"providers":[{"billed_charge":450.00,"npi":[1265457485]}]}]},{"tin":{"type":"ein","value":"203696992"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":9.13,"providers":[{"billed_charge":39.00,"npi":[1881670594]}]},{"allowed_amount":52.80,"providers":[{"billed_charge":234.00,"npi":[1881670594]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":17.26,"providers":[{"billed_charge":66.00,"npi":[1396769378]}]},{"allowed_amount":8.63,"providers":[{"billed_charge":33.00,"npi":[1649685967,1992097760]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":132.16,"providers":[{"billed_charge":336.00,"npi":[1518157478]}]},{"allowed_amount":66.08,"providers":[{"billed_charge":168.00,"npi":[1659687408]}]},{"allowed_amount":181.72,"providers":[{"billed_charge":462.00,"npi":[1659687408]}]},{"allowed_amount":198.24,"providers":[{"billed_charge":504.00,"npi":[1518157478]}]},{"allowed_amount":16.52,"providers":[{"billed_charge":42.00,"npi":[1518157478,1659687408]}]}]},{"tin":{"type":"ein","value":"382492131"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":37.17,"providers":[{"billed_charge":81.00,"npi":[1336137264]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.95,"providers":[{"billed_charge":24.00,"npi":[1013171941]}]},{"allowed_amount":25.90,"providers":[{"billed_charge":48.00,"npi":[1013171941]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"381894009"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":20.48,"providers":[{"billed_charge":52.00,"npi":[1811275266,1942648662]}]},{"allowed_amount":40.96,"providers":[{"billed_charge":104.00,"npi":[1942648662]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":13.82,"providers":[{"billed_charge":40.00,"npi":[1881981652]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":88.65,"providers":[{"billed_charge":189.00,"npi":[1659687408]}]},{"allowed_amount":19.70,"providers":[{"billed_charge":42.00,"npi":[1659687408]}]},{"allowed_amount":9.85,"providers":[{"billed_charge":21.00,"npi":[1659687408]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":92.16,"providers":[{"billed_charge":168.00,"npi":[1013171941]}]},{"allowed_amount":15.36,"providers":[{"billed_charge":28.00,"npi":[1376755470]}]},{"allowed_amount":30.72,"providers":[{"billed_charge":56.00,"npi":[1386887750]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3286.00,"providers":[{"billed_charge":16152.00,"npi":[1790706901]}]},{"allowed_amount":1598.06,"providers":[{"billed_charge":6162.00,"npi":[1790706901]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":274.29,"providers":[{"billed_charge":8905.00,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":58.20,"providers":[{"billed_charge":213.80,"npi":[1316938327]}]}]},{"tin":{"type":"ein","value":"381369611"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":161.02,"providers":[{"billed_charge":2938.00,"npi":[1982685384]}]},{"allowed_amount":417.66,"providers":[{"billed_charge":1243.00,"npi":[1982685384]}]}]},{"tin":{"type":"ein","value":"381359218"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1183.46,"providers":[{"billed_charge":5217.60,"npi":[1962508259]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"386005601"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":246.33,"providers":[{"billed_charge":516.00,"npi":[1659687408]}]},{"allowed_amount":82.11,"providers":[{"billed_charge":172.00,"npi":[1659687408]}]}]},{"tin":{"type":"ein","value":"381693395"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":85.65,"providers":[{"billed_charge":299.00,"npi":[1457734162]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"382776791"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":499.04,"providers":[{"billed_charge":3768.74,"npi":[1083644579]}]},{"allowed_amount":252.52,"providers":[{"billed_charge":552.00,"npi":[1083644579]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2463.74,"providers":[{"billed_charge":2929.13,"npi":[1831116441]}]},{"allowed_amount":8183.69,"providers":[{"billed_charge":28183.05,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"381984289"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12562.29,"providers":[{"billed_charge":44800.00,"npi":[1811097223]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"383521763"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6660.80,"providers":[{"billed_charge":31720.00,"npi":[1790706901]}]},{"allowed_amount":364.54,"providers":[{"billed_charge":5246.00,"npi":[1790706901]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"381951356"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":246.66,"providers":[{"billed_charge":462.00,"npi":[1831545953]}]}]},{"tin":{"type":"ein","value":"382286062"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1000.11,"providers":[{"billed_charge":1776.00,"npi":[1033110549]}]}]},{"tin":{"type":"ein","value":"880602985"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":574.39,"providers":[{"billed_charge":2420.00,"npi":[1548279763]}]},{"allowed_amount":270.30,"providers":[{"billed_charge":1100.00,"npi":[1548279763]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":450.40,"providers":[{"billed_charge":560.00,"npi":[1396769378]}]},{"allowed_amount":197.05,"providers":[{"billed_charge":245.00,"npi":[1598887457]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":633.45,"providers":[{"billed_charge":1395.00,"npi":[1982774469]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"381951356"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":313.56,"providers":[{"billed_charge":438.00,"npi":[1831545953]}]}]},{"tin":{"type":"ein","value":"382286062"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1270.95,"providers":[{"billed_charge":2738.00,"npi":[1033110549]}]}]},{"tin":{"type":"ein","value":"381850302"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":250.67,"providers":[{"billed_charge":875.00,"npi":[1598887457]}]},{"allowed_amount":572.96,"providers":[{"billed_charge":2000.00,"npi":[1396769378]}]}]},{"tin":{"type":"ein","value":"880602985"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":549.60,"providers":[{"billed_charge":2176.00,"npi":[1548279763]}]}]},{"tin":{"type":"ein","value":"383612247"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":805.80,"providers":[{"billed_charge":1575.00,"npi":[1982774469]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":805.63,"providers":[{"billed_charge":2700.20,"npi":[1053314146]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1076.00,"providers":[{"billed_charge":3275.55,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19105.45,"providers":[{"billed_charge":67781.12,"npi":[1053314146]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1749.53,"providers":[{"billed_charge":2872.60,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23926.14,"providers":[{"billed_charge":80263.58,"npi":[1053314146]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":111.04,"providers":[{"billed_charge":512.00,"npi":[1053314146]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6934.20,"providers":[{"billed_charge":23525.63,"npi":[1053314146]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":202.74,"providers":[{"billed_charge":990.80,"npi":[1053314146]}]}]}]},{"name":"OBSTETRIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80081","description":"OBSTETRIC PANEL (INCLUDES HIV TESTING)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":359.34,"providers":[{"billed_charge":1490.00,"npi":[1053314146]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"813667937"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.80,"providers":[{"billed_charge":75.00,"npi":[1538422548]}]}]},{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":327.60,"providers":[{"billed_charge":520.00,"npi":[1265503031]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":14882.53,"providers":[{"billed_charge":47900.00,"npi":[1144606542]}]},{"allowed_amount":621.40,"providers":[{"billed_charge":2000.00,"npi":[1144606542]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23363.70,"providers":[{"billed_charge":46960.00,"npi":[1053314146]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":40.85,"providers":[{"billed_charge":66.25,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1282.70,"providers":[{"billed_charge":7563.00,"npi":[1053314146]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":48.72,"providers":[{"billed_charge":154.00,"npi":[1558354159]}]},{"allowed_amount":10.44,"providers":[{"billed_charge":33.00,"npi":[1982697454]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":8.88,"providers":[{"billed_charge":30.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":26.64,"providers":[{"billed_charge":90.00,"npi":[1245936012]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":243.00,"providers":[{"billed_charge":4536.00,"npi":[1114330974]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":706.02,"providers":[{"billed_charge":3444.00,"npi":[1114330974]}]}]}]},{"name":"FETAL CHRMOML ANEUPLOIDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI","allowed_amounts":[{"tin":{"type":"ein","value":"811082020"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":32259.63,"providers":[{"billed_charge":130556.60,"npi":[1598314437]}]}]}]},{"name":"ASSAY OF SERUM ALBUMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82040","description":"ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":558.36,"providers":[{"billed_charge":1974.00,"npi":[1053314146]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1838.76,"providers":[{"billed_charge":7156.80,"npi":[1053314146]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"42516906"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":922.00,"providers":[{"billed_charge":8832.00,"npi":[1760645139]}]},{"allowed_amount":5063.89,"providers":[{"billed_charge":150144.00,"npi":[1871608612]}]},{"allowed_amount":2103.57,"providers":[{"billed_charge":61824.00,"npi":[1699275487]}]}]},{"tin":{"type":"ein","value":"900754081"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":6324.64,"providers":[{"billed_charge":150144.00,"npi":[1417055542]}]}]},{"tin":{"type":"ein","value":"364525442"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":5872.15,"providers":[{"billed_charge":176640.00,"npi":[1407897465]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":202.02,"providers":[{"billed_charge":702.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82247","description":"BILIRUBIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":574.86,"providers":[{"billed_charge":2002.00,"npi":[1053314146]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":385.92,"providers":[{"billed_charge":1344.00,"npi":[1053314146]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1920.00,"providers":[{"billed_charge":1920.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":28131.84,"providers":[{"billed_charge":94779.20,"npi":[1053314146]}]}]}]},{"name":"CARCINOEMBRYONIC ANTIGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82378","description":"CARCINOEMBRYONIC ANTIGEN (CEA)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":75.85,"providers":[{"billed_charge":270.00,"npi":[1053314146]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":404.24,"providers":[{"billed_charge":1426.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":354.28,"providers":[{"billed_charge":1292.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82565","description":"CREATININE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4.10,"providers":[{"billed_charge":13.00,"npi":[1053314146]}]}]}]},{"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":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1109.52,"providers":[{"billed_charge":1742.00,"npi":[1053314146]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11071.08,"providers":[{"billed_charge":41160.16,"npi":[1053314146]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1102.36,"providers":[{"billed_charge":3906.00,"npi":[1053314146]}]}]}]},{"name":"VIT D 1 25-DIHYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82652","description":"VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6129.20,"providers":[{"billed_charge":19104.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":307.34,"providers":[{"billed_charge":363.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2838.45,"providers":[{"billed_charge":9906.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3749.60,"providers":[{"billed_charge":13041.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2598.96,"providers":[{"billed_charge":9231.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":200.88,"providers":[{"billed_charge":810.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":144.44,"providers":[{"billed_charge":506.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":253.44,"providers":[{"billed_charge":880.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2065.54,"providers":[{"billed_charge":7207.20,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1808.04,"providers":[{"billed_charge":6323.20,"npi":[1053314146]}]}]}]},{"name":"H PYLORI (C-13), BREATH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83013","description":"HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":323.34,"providers":[{"billed_charge":1104.00,"npi":[1053314146]}]}]}]},{"name":"HEMOGLOBIN ELECTROPHORESIS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83020","description":"HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":216.30,"providers":[{"billed_charge":1030.00,"npi":[1053314146]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1254.00,"providers":[{"billed_charge":1677.50,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15314.67,"providers":[{"billed_charge":62950.62,"npi":[1053314146]}]}]}]},{"name":"IG LIGHT CHAINS FREE EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83521","description":"IMMUNOGLOBULIN LIGHT CHAINS FREE EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":55.26,"providers":[{"billed_charge":128.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":283.34,"providers":[{"billed_charge":1550.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2626.26,"providers":[{"billed_charge":12094.54,"npi":[1053314146]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2173.89,"providers":[{"billed_charge":7425.60,"npi":[1053314146]}]}]}]},{"name":"LACTATE (LD) (LDH) ENZYME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83615","description":"LACTATE DEHYDROGENASE (LD), (LDH);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":115.92,"providers":[{"billed_charge":401.20,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":325.09,"providers":[{"billed_charge":1239.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2186.88,"providers":[{"billed_charge":8122.70,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF NATRIURETIC PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83880","description":"NATRIURETIC PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":596.79,"providers":[{"billed_charge":1900.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2146.30,"providers":[{"billed_charge":7493.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY ALKALINE PHOSPHATASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84075","description":"PHOSPHATASE, ALKALINE;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":608.61,"providers":[{"billed_charge":2058.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":830.01,"providers":[{"billed_charge":2628.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"383352287"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.60,"providers":[{"billed_charge":220.00,"npi":[1821188426]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":717.67,"providers":[{"billed_charge":2556.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1937.50,"providers":[{"billed_charge":7750.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6825.44,"providers":[{"billed_charge":18512.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84154","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":573.69,"providers":[{"billed_charge":1950.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84155","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":452.76,"providers":[{"billed_charge":1694.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":158.76,"providers":[{"billed_charge":643.20,"npi":[1053314146]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":231.93,"providers":[{"billed_charge":1755.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3163.16,"providers":[{"billed_charge":9060.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6608.00,"providers":[{"billed_charge":22953.60,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":423.50,"providers":[{"billed_charge":1526.87,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":69.87,"providers":[{"billed_charge":91.95,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7739.84,"providers":[{"billed_charge":42769.02,"npi":[1053314146]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1519.35,"providers":[{"billed_charge":1827.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":28560.00,"providers":[{"billed_charge":101764.80,"npi":[1053314146]}]}]}]},{"name":"TRANSFERASE (AST) (SGOT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84450","description":"TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":815.58,"providers":[{"billed_charge":2752.40,"npi":[1053314146]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84460","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":831.04,"providers":[{"billed_charge":2738.40,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":71.47,"providers":[{"billed_charge":238.00,"npi":[1053314146]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2766.96,"providers":[{"billed_charge":9760.00,"npi":[1053314146]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2628.70,"providers":[{"billed_charge":9249.88,"npi":[1053314146]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2208.20,"providers":[{"billed_charge":8540.00,"npi":[1053314146]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1818.04,"providers":[{"billed_charge":3765.05,"npi":[1053314146]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":812.24,"providers":[{"billed_charge":829.40,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12607.94,"providers":[{"billed_charge":50560.54,"npi":[1053314146]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":36.00,"providers":[{"billed_charge":44.85,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1196.58,"providers":[{"billed_charge":2997.80,"npi":[1053314146]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.85,"providers":[{"billed_charge":248.20,"npi":[1053314146]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":137.20,"providers":[{"billed_charge":633.60,"npi":[1053314146]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":382.32,"providers":[{"billed_charge":1942.60,"npi":[1053314146]}]}]}]},{"name":"THROMBOPLASTIN TIME, PARTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85730","description":"THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":57.72,"providers":[{"billed_charge":264.00,"npi":[1053314146]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":609.21,"providers":[{"billed_charge":2817.00,"npi":[1053314146]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":273.24,"providers":[{"billed_charge":984.00,"npi":[1053314146]}]}]}]},{"name":"C-REACTIVE PROTEIN, HS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86141","description":"C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":455.84,"providers":[{"billed_charge":1628.00,"npi":[1053314146]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":113.96,"providers":[{"billed_charge":550.00,"npi":[1053314146]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":637.42,"providers":[{"billed_charge":1972.00,"npi":[1053314146]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7014.13,"providers":[{"billed_charge":20403.60,"npi":[1053314146]}]}]}]},{"name":"IMMUNOFIX E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86334","description":"IMMUNOFIXATION ELECTROPHORESIS; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":125.09,"providers":[{"billed_charge":700.00,"npi":[1053314146]}]}]}]},{"name":"T CELL, ABSOLUTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86361","description":"T CELLS; ABSOLUTE CD4 COUNT","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":214.20,"providers":[{"billed_charge":500.00,"npi":[1053314146]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":756.60,"providers":[{"billed_charge":2584.00,"npi":[1053314146]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":167.98,"providers":[{"billed_charge":592.00,"npi":[1053314146]}]}]}]},{"name":"TB AG RESPONSE T-CELL SUSP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86481","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; ENUMERATION OF GAMMA INTERFE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1120.00,"providers":[{"billed_charge":2800.00,"npi":[1053314146]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":34.20,"providers":[{"billed_charge":360.00,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1044.45,"providers":[{"billed_charge":3639.19,"npi":[1053314146]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1594.44,"providers":[{"billed_charge":5665.00,"npi":[1053314146]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":780.84,"providers":[{"billed_charge":3212.05,"npi":[1053314146]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":893.36,"providers":[{"billed_charge":4130.74,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":693.70,"providers":[{"billed_charge":2358.39,"npi":[1053314146]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":230.20,"providers":[{"billed_charge":800.00,"npi":[1053314146]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":330.88,"providers":[{"billed_charge":506.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3166.41,"providers":[{"billed_charge":8953.24,"npi":[1053314146]}]}]}]},{"name":"VARICELLA-ZOSTER ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86787","description":"ANTIBODY; VARICELLA-ZOSTER","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":381.10,"providers":[{"billed_charge":1406.00,"npi":[1053314146]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":661.96,"providers":[{"billed_charge":2580.00,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":338.00,"providers":[{"billed_charge":600.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3334.64,"providers":[{"billed_charge":11648.00,"npi":[1053314146]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":172.04,"providers":[{"billed_charge":660.00,"npi":[1053314146]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.24,"providers":[{"billed_charge":160.00,"npi":[1053314146]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.41,"providers":[{"billed_charge":190.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":69.00,"providers":[{"billed_charge":300.00,"npi":[1053314146]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":555.64,"providers":[{"billed_charge":2580.00,"npi":[1053314146]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2183.48,"providers":[{"billed_charge":10128.00,"npi":[1053314146]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1319.88,"providers":[{"billed_charge":6120.00,"npi":[1053314146]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":429.04,"providers":[{"billed_charge":1860.00,"npi":[1053314146]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":293.59,"providers":[{"billed_charge":305.25,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":512.12,"providers":[{"billed_charge":1860.00,"npi":[1053314146]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":617.89,"providers":[{"billed_charge":1846.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6413.58,"providers":[{"billed_charge":17316.00,"npi":[1053314146]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"874116721"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":32.69,"providers":[{"billed_charge":100.00,"npi":[1376287169]}]}]},{"tin":{"type":"ein","value":"922410744"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":85.70,"providers":[{"billed_charge":432.00,"npi":[1548904808]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":105.99,"providers":[{"billed_charge":255.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"872462330"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":53.01,"providers":[{"billed_charge":259.20,"npi":[1982803540,1508072687]}]}]}]},{"name":"SARSCOV & INF VIR A&B AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87428","description":"IAAD IA SARSCOV & INFLUENZA VIRUS TYPES A&B","allowed_amounts":[{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":239.00,"providers":[{"billed_charge":400.00,"npi":[1245936012]}]}]}]},{"name":"CANDIDA, DNA, 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":328.16,"providers":[{"billed_charge":3640.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3256.12,"providers":[{"billed_charge":5800.00,"npi":[1053314146]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":593.06,"providers":[{"billed_charge":593.06,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1183.72,"providers":[{"billed_charge":13130.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7803.46,"providers":[{"billed_charge":27760.00,"npi":[1053314146]}]}]}]},{"name":"GARDNER VAG, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87511","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.60,"providers":[{"billed_charge":650.00,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1302.26,"providers":[{"billed_charge":3922.44,"npi":[1053314146]}]}]}]},{"name":"HIV-1 QUANT&REVRSE TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87536","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HIV-1, QUANTIFICATION, INCLUDES REVERSE TRA","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2178.56,"providers":[{"billed_charge":5600.00,"npi":[1053314146]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":703.20,"providers":[{"billed_charge":7800.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":224.56,"providers":[{"billed_charge":640.00,"npi":[1053314146]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":593.06,"providers":[{"billed_charge":593.06,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1183.72,"providers":[{"billed_charge":13130.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7775.39,"providers":[{"billed_charge":27660.00,"npi":[1053314146]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":140.00,"providers":[{"billed_charge":280.00,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":340.00,"npi":[1234567893]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6907.68,"providers":[{"billed_charge":12300.00,"npi":[1053314146]}]}]}]},{"name":"SARSCOV2&INF A&B&RSV AMP PRB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87637","description":"IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ","allowed_amounts":[{"tin":{"type":"ein","value":"474715923"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":5776.92,"providers":[{"billed_charge":20250.00,"npi":[1144606542]}]},{"allowed_amount":213.96,"providers":[{"billed_charge":750.00,"npi":[1144606542]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1141.00,"providers":[{"billed_charge":3500.00,"npi":[1053314146]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":91.24,"providers":[{"billed_charge":182.48,"npi":[1932414463]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":82.04,"providers":[{"billed_charge":910.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4771.90,"providers":[{"billed_charge":16960.00,"npi":[1053314146]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1054.73,"providers":[{"billed_charge":11975.40,"npi":[1234567893]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1797.12,"providers":[{"billed_charge":3160.00,"npi":[1053314146]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"821936174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":70.35,"providers":[{"billed_charge":150.00,"npi":[1194231597]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":347.55,"providers":[{"billed_charge":1260.00,"npi":[1114330974]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":49.59,"providers":[{"billed_charge":180.00,"npi":[1114330974]}]}]}]},{"name":"CYTOPATH C/V THIN LAYER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88142","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"273176652"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1151.70,"providers":[{"billed_charge":1452.00,"npi":[1932414463]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":106.68,"providers":[{"billed_charge":900.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4534.77,"providers":[{"billed_charge":15762.00,"npi":[1053314146]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","81","21"],"billing_class":"professional","payments":[{"allowed_amount":35.10,"providers":[{"billed_charge":320.00,"npi":[1234567893]}]},{"allowed_amount":32.87,"providers":[{"billed_charge":270.00,"npi":[1234567893]}]},{"allowed_amount":191.48,"providers":[{"billed_charge":1676.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":445.65,"providers":[{"billed_charge":1342.00,"npi":[1659574127]}]}]},{"tin":{"type":"ein","value":"383111008"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":632.27,"providers":[{"billed_charge":1840.00,"npi":[1053314146]}]}]},{"tin":{"type":"ein","value":"381857764"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":51.11,"providers":[{"billed_charge":150.00,"npi":[1902914062]}]},{"allowed_amount":562.19,"providers":[{"billed_charge":1650.00,"npi":[1902914062]}]}]},{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":618.21,"providers":[{"billed_charge":11745.92,"npi":[1326393307]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":261.30,"providers":[{"billed_charge":591.50,"npi":[1396368734]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"381357020"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":502.38,"providers":[{"billed_charge":990.00,"npi":[1174182976]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1139.18,"providers":[{"billed_charge":2406.00,"npi":[1679117063]}]}]},{"tin":{"type":"ein","value":"831910484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":574.14,"providers":[{"billed_charge":600.00,"npi":[1629416169]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":789.30,"providers":[{"billed_charge":1554.00,"npi":[1831338441]}]}]},{"tin":{"type":"ein","value":"382406558"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":523.80,"providers":[{"billed_charge":765.00,"npi":[1215541545]}]},{"allowed_amount":205.36,"providers":[{"billed_charge":340.00,"npi":[1215541545]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1565.76,"providers":[{"billed_charge":4900.00,"npi":[1043507833]}]},{"allowed_amount":1174.32,"providers":[{"billed_charge":3950.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2763.18,"providers":[{"billed_charge":6300.00,"npi":[1447323829]}]},{"allowed_amount":592.64,"providers":[{"billed_charge":1200.00,"npi":[1447323829]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"273742440"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1599.52,"providers":[{"billed_charge":1599.52,"npi":[1033203161]}]},{"allowed_amount":1013.65,"providers":[{"billed_charge":1099.67,"npi":[1033203161]}]}]},{"tin":{"type":"ein","value":"381402860"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":207.33,"providers":[{"billed_charge":496.14,"npi":[1396268447]}]},{"allowed_amount":69.11,"providers":[{"billed_charge":134.00,"npi":[1396268447]}]}]},{"tin":{"type":"ein","value":"813109737"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":313.32,"providers":[{"billed_charge":824.00,"npi":[1497520480]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":311.51,"providers":[{"billed_charge":780.00,"npi":[1275092348]}]},{"allowed_amount":3436.31,"providers":[{"billed_charge":8580.00,"npi":[1831338441]}]},{"allowed_amount":1874.88,"providers":[{"billed_charge":4680.00,"npi":[1417605833]}]},{"allowed_amount":1873.91,"providers":[{"billed_charge":4680.00,"npi":[1497889927]}]},{"allowed_amount":624.96,"providers":[{"billed_charge":1560.00,"npi":[1033515317]}]},{"allowed_amount":1041.60,"providers":[{"billed_charge":2600.00,"npi":[1467802744]}]},{"allowed_amount":312.48,"providers":[{"billed_charge":780.00,"npi":[1669538211,1831513886]}]},{"allowed_amount":520.80,"providers":[{"billed_charge":1300.00,"npi":[1912103268]}]}]},{"tin":{"type":"ein","value":"831910484"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1367.99,"providers":[{"billed_charge":2182.44,"npi":[1629416169]}]}]}]},{"name":"PSYTX W PT W E/M 45 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90836","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5065.86,"providers":[{"billed_charge":7175.00,"npi":[1255372058]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"474714944"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2458.26,"providers":[{"billed_charge":3600.00,"npi":[1811331481]}]}]},{"tin":{"type":"ein","value":"825510340"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":327.76,"providers":[{"billed_charge":880.00,"npi":[1114403136]}]},{"allowed_amount":1497.76,"providers":[{"billed_charge":3520.00,"npi":[1114403136]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":800.52,"providers":[{"billed_charge":840.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"933817534"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":682.85,"providers":[{"billed_charge":900.00,"npi":[1164450995]}]}]},{"tin":{"type":"ein","value":"382776209"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":200.58,"providers":[{"billed_charge":490.00,"npi":[1629263140]}]},{"allowed_amount":1053.18,"providers":[{"billed_charge":2205.00,"npi":[1740458538]}]},{"allowed_amount":512.15,"providers":[{"billed_charge":1225.00,"npi":[1740458538]}]},{"allowed_amount":303.38,"providers":[{"billed_charge":490.00,"npi":[1629263140]}]}]},{"tin":{"type":"ein","value":"852229929"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":234.04,"providers":[{"billed_charge":400.00,"npi":[1407536006]}]}]},{"tin":{"type":"ein","value":"821510432"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":102.43,"providers":[{"billed_charge":175.00,"npi":[1992169460]}]},{"allowed_amount":204.86,"providers":[{"billed_charge":350.00,"npi":[1992169460]}]},{"allowed_amount":468.08,"providers":[{"billed_charge":700.00,"npi":[1992169460]}]}]},{"tin":{"type":"ein","value":"822225208"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":227.54,"providers":[{"billed_charge":410.00,"npi":[1396054920]}]}]},{"tin":{"type":"ein","value":"833919424"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":320.92,"providers":[{"billed_charge":740.00,"npi":[1720771900]}]}]},{"tin":{"type":"ein","value":"472970145"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":5304.68,"providers":[{"billed_charge":8500.00,"npi":[1396913497]}]},{"allowed_amount":682.85,"providers":[{"billed_charge":1250.00,"npi":[1396913497]}]}]},{"tin":{"type":"ein","value":"853424902"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":5369.59,"providers":[{"billed_charge":8850.00,"npi":[1154652865]}]},{"allowed_amount":240.69,"providers":[{"billed_charge":450.00,"npi":[1508241787]}]},{"allowed_amount":3731.41,"providers":[{"billed_charge":6150.00,"npi":[1508241787]}]},{"allowed_amount":80.23,"providers":[{"billed_charge":150.00,"npi":[1508241787]}]}]},{"tin":{"type":"ein","value":"845134076"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":117.02,"providers":[{"billed_charge":225.00,"npi":[1952730624]}]},{"allowed_amount":204.86,"providers":[{"billed_charge":450.00,"npi":[1952730624]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1388.61,"providers":[{"billed_charge":3035.00,"npi":[1497889927]}]},{"allowed_amount":771.45,"providers":[{"billed_charge":1724.00,"npi":[1669538211]}]}]},{"tin":{"type":"ein","value":"460642468"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":819.14,"providers":[{"billed_charge":1225.00,"npi":[1326455320]}]}]},{"tin":{"type":"ein","value":"831910484"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":273.14,"providers":[{"billed_charge":501.56,"npi":[1629416169]}]},{"allowed_amount":1716.22,"providers":[{"billed_charge":2758.58,"npi":[1629416169]}]}]},{"tin":{"type":"ein","value":"382363235"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":273.14,"providers":[{"billed_charge":429.00,"npi":[1750393690]}]},{"allowed_amount":780.10,"providers":[{"billed_charge":1072.50,"npi":[1750393690]}]}]},{"tin":{"type":"ein","value":"814957518"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":902.52,"providers":[{"billed_charge":1620.00,"npi":[1205058344]}]}]},{"tin":{"type":"ein","value":"20779408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":468.08,"providers":[{"billed_charge":760.00,"npi":[1639760663]}]}]},{"tin":{"type":"ein","value":"883690599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1263.44,"providers":[{"billed_charge":1435.00,"npi":[1861694424]}]}]},{"tin":{"type":"ein","value":"383561584"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":300.84,"providers":[{"billed_charge":600.00,"npi":[1497368468]}]}]},{"tin":{"type":"ein","value":"863656058"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":910.10,"providers":[{"billed_charge":2000.00,"npi":[1437765336]}]},{"allowed_amount":1203.45,"providers":[{"billed_charge":3000.00,"npi":[1003278631]}]},{"allowed_amount":91.01,"providers":[{"billed_charge":200.00,"npi":[1003278631]}]},{"allowed_amount":481.38,"providers":[{"billed_charge":1200.00,"npi":[1437765336]}]},{"allowed_amount":182.02,"providers":[{"billed_charge":400.00,"npi":[1427423359]}]}]},{"tin":{"type":"ein","value":"383000735"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":682.62,"providers":[{"billed_charge":900.00,"npi":[1609419118]}]}]},{"tin":{"type":"ein","value":"383579022"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1638.88,"providers":[{"billed_charge":4000.00,"npi":[1215502265]}]},{"allowed_amount":351.06,"providers":[{"billed_charge":750.00,"npi":[1215502265]}]}]},{"tin":{"type":"ein","value":"454675306"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":300.84,"providers":[{"billed_charge":750.00,"npi":[1093049561]}]},{"allowed_amount":5214.69,"providers":[{"billed_charge":9750.00,"npi":[1487021978]}]},{"allowed_amount":151.69,"providers":[{"billed_charge":250.00,"npi":[1487021978]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":468.06,"providers":[{"billed_charge":894.00,"npi":[1447323829]}]},{"allowed_amount":1229.13,"providers":[{"billed_charge":2682.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"460974303"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":601.68,"providers":[{"billed_charge":1200.00,"npi":[1366672370]}]},{"allowed_amount":113.77,"providers":[{"billed_charge":200.00,"npi":[1366672370]}]}]},{"tin":{"type":"ein","value":"471173250"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1638.28,"providers":[{"billed_charge":2730.00,"npi":[1558916270]}]}]},{"tin":{"type":"ein","value":"381958763"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":117.02,"providers":[{"billed_charge":192.00,"npi":[1639830821]}]}]},{"tin":{"type":"ein","value":"834638904"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":187.22,"providers":[{"billed_charge":360.00,"npi":[1790499978]}]},{"allowed_amount":409.70,"providers":[{"billed_charge":900.00,"npi":[1790499978]}]}]}]},{"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":"386122756"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":66.44,"providers":[{"billed_charge":160.00,"npi":[1336339787]}]}]},{"tin":{"type":"ein","value":"386088382"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":207.60,"providers":[{"billed_charge":900.00,"npi":[1972037844]}]}]},{"tin":{"type":"ein","value":"383381605"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":93.42,"providers":[{"billed_charge":633.00,"npi":[1902227911]}]}]}]},{"name":"DIALYSIS PROCEDURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90999","description":"UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"852368872"},"service_code":["65"],"billing_class":"professional","payments":[{"allowed_amount":63063.00,"providers":[{"billed_charge":157657.50,"npi":[1437413168]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"320478538"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4600.20,"providers":[{"billed_charge":80000.00,"npi":[1346747235]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"464719451"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":258.15,"providers":[{"billed_charge":3323.25,"npi":[1043625940]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":734.14,"providers":[{"billed_charge":5220.18,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"382383119"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1355.24,"providers":[{"billed_charge":5406.50,"npi":[1902894512]}]}]},{"tin":{"type":"ein","value":"383175878"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1739.00,"providers":[{"billed_charge":10919.00,"npi":[1780658443]}]}]},{"tin":{"type":"ein","value":"383176536"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1577.29,"providers":[{"billed_charge":12077.00,"npi":[1053356352]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"382027689"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":53.55,"providers":[{"billed_charge":189.00,"npi":[1134625502]}]},{"allowed_amount":38.25,"providers":[{"billed_charge":135.00,"npi":[1770549099]}]},{"allowed_amount":45.90,"providers":[{"billed_charge":162.00,"npi":[1134625502]}]},{"allowed_amount":68.85,"providers":[{"billed_charge":243.00,"npi":[1770549099]}]},{"allowed_amount":15.30,"providers":[{"billed_charge":54.00,"npi":[1134625502]}]},{"allowed_amount":7.65,"providers":[{"billed_charge":27.00,"npi":[1770549099,1134625502]}]}]},{"tin":{"type":"ein","value":"465322251"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":255.36,"providers":[{"billed_charge":960.00,"npi":[1982834826]}]},{"allowed_amount":87.78,"providers":[{"billed_charge":330.00,"npi":[1982834826]}]}]},{"tin":{"type":"ein","value":"381359063"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":139.72,"providers":[{"billed_charge":896.00,"npi":[1992990089]}]},{"allowed_amount":179.64,"providers":[{"billed_charge":1152.00,"npi":[1992990089]}]},{"allowed_amount":19.96,"providers":[{"billed_charge":128.00,"npi":[1992990089]}]}]},{"tin":{"type":"ein","value":"380833014"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":11.48,"providers":[{"billed_charge":36.00,"npi":[1801150602]}]}]},{"tin":{"type":"ein","value":"383322109"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":99.80,"providers":[{"billed_charge":590.00,"npi":[1477599587]}]},{"allowed_amount":59.85,"providers":[{"billed_charge":295.00,"npi":[1386680494]}]},{"allowed_amount":299.40,"providers":[{"billed_charge":1770.00,"npi":[1124077953]}]},{"allowed_amount":179.64,"providers":[{"billed_charge":1062.00,"npi":[1619310885]}]},{"allowed_amount":109.78,"providers":[{"billed_charge":649.00,"npi":[1619310885]}]},{"allowed_amount":129.74,"providers":[{"billed_charge":767.00,"npi":[1124077953,1477599587]}]},{"allowed_amount":91.77,"providers":[{"billed_charge":590.00,"npi":[1386680494]}]},{"allowed_amount":19.96,"providers":[{"billed_charge":118.00,"npi":[1346774981]}]}]},{"tin":{"type":"ein","value":"382791823"},"service_code":["22","19","21"],"billing_class":"professional","payments":[{"allowed_amount":151.62,"providers":[{"billed_charge":513.00,"npi":[1164816476]}]},{"allowed_amount":103.74,"providers":[{"billed_charge":351.00,"npi":[1164816476]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":27.00,"npi":[1164816476]}]}]},{"tin":{"type":"ein","value":"381218516"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":59.85,"providers":[{"billed_charge":164.50,"npi":[1962889402]}]},{"allowed_amount":43.89,"providers":[{"billed_charge":164.50,"npi":[1275915092]}]},{"allowed_amount":215.46,"providers":[{"billed_charge":592.20,"npi":[1962889402]}]},{"allowed_amount":39.90,"providers":[{"billed_charge":164.50,"npi":[1275915092]}]},{"allowed_amount":466.83,"providers":[{"billed_charge":1283.10,"npi":[1275915092]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":32.90,"npi":[1962889402]}]}]},{"tin":{"type":"ein","value":"383316559"},"service_code":["22","23","19","51","21"],"billing_class":"professional","payments":[{"allowed_amount":23.94,"providers":[{"billed_charge":84.00,"npi":[1003883539,1720221542]}]},{"allowed_amount":23.61,"providers":[{"billed_charge":84.00,"npi":[1720221542]}]},{"allowed_amount":15.96,"providers":[{"billed_charge":56.00,"npi":[1003883539,1356318398,1073924189]}]},{"allowed_amount":31.92,"providers":[{"billed_charge":112.00,"npi":[1356318398]}]},{"allowed_amount":63.84,"providers":[{"billed_charge":224.00,"npi":[1356318398]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":28.00,"npi":[1003883539,1720221542,1073924189]}]},{"allowed_amount":55.86,"providers":[{"billed_charge":196.00,"npi":[1003883539]}]},{"allowed_amount":7.65,"providers":[{"billed_charge":28.00,"npi":[1073924189]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":47.55,"providers":[{"billed_charge":153.00,"npi":[1234567893]}]},{"allowed_amount":356.82,"providers":[{"billed_charge":821.00,"npi":[1234567893]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":28.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"386006309"},"service_code":["22","23","19","21"],"billing_class":"professional","payments":[{"allowed_amount":39.90,"providers":[{"billed_charge":375.00,"npi":[1073698809]}]},{"allowed_amount":31.92,"providers":[{"billed_charge":300.00,"npi":[1073698809]}]},{"allowed_amount":95.76,"providers":[{"billed_charge":900.00,"npi":[1073698809]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":75.00,"npi":[1073698809]}]}]},{"tin":{"type":"ein","value":"381428164"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":23.94,"providers":[{"billed_charge":65.80,"npi":[1588657076]}]},{"allowed_amount":35.91,"providers":[{"billed_charge":98.70,"npi":[1104266881,1588657076]}]},{"allowed_amount":263.34,"providers":[{"billed_charge":723.80,"npi":[1588657076]}]},{"allowed_amount":275.31,"providers":[{"billed_charge":756.70,"npi":[1104266881]}]},{"allowed_amount":7.98,"providers":[{"billed_charge":32.90,"npi":[1104266881]}]}]},{"tin":{"type":"ein","value":"991552518"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":19.95,"providers":[{"billed_charge":49.32,"npi":[1306191853]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"270391924"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":1743.84,"providers":[{"billed_charge":2700.00,"npi":[1831267376]}]},{"allowed_amount":211.77,"providers":[{"billed_charge":450.00,"npi":[1831267376]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"382319009"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":120.40,"providers":[{"billed_charge":240.00,"npi":[1215955422]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"382719621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":183.30,"providers":[{"billed_charge":468.00,"npi":[1578727335]}]}]},{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97.60,"providers":[{"billed_charge":184.00,"npi":[1649520784]}]},{"allowed_amount":24.70,"providers":[{"billed_charge":48.00,"npi":[1144990938]}]},{"allowed_amount":74.80,"providers":[{"billed_charge":144.00,"npi":[1164898722]}]}]}]},{"name":"HLTH BHV ASSMT/REASSESSMENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96156","description":"HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","allowed_amounts":[{"tin":{"type":"ein","value":"883690599"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":157.61,"providers":[{"billed_charge":165.00,"npi":[1861694424]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":11.93,"providers":[{"billed_charge":28.08,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2120.04,"providers":[{"billed_charge":4995.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":11.93,"providers":[{"billed_charge":56.88,"npi":[1457065930]}]},{"allowed_amount":143.16,"providers":[{"billed_charge":682.56,"npi":[1669243135]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.84,"providers":[{"billed_charge":152.00,"npi":[1275599979]}]},{"allowed_amount":174.44,"providers":[{"billed_charge":532.00,"npi":[1063844769]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":299.10,"providers":[{"billed_charge":1848.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1046.95,"providers":[{"billed_charge":3150.00,"npi":[1942704572]}]},{"allowed_amount":169.53,"providers":[{"billed_charge":510.00,"npi":[1861792186]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":124.60,"providers":[{"billed_charge":1200.00,"npi":[1609450956]}]},{"allowed_amount":971.94,"providers":[{"billed_charge":9360.00,"npi":[1326274168]}]}]}]},{"name":"ELECTRICAL STIMULATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97032","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (MANUAL), EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":233.46,"providers":[{"billed_charge":1530.00,"npi":[1477969533]}]}]}]},{"name":"ULTRASOUND THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97035","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":139.26,"providers":[{"billed_charge":605.00,"npi":[1164642302]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":40.52,"providers":[{"billed_charge":120.00,"npi":[1942704572]}]}]}]},{"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":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":646.70,"providers":[{"billed_charge":2880.00,"npi":[1477969533]}]}]},{"tin":{"type":"ein","value":"364877508"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":771.52,"providers":[{"billed_charge":3600.00,"npi":[1295004141]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":678.37,"providers":[{"billed_charge":2470.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":441.72,"providers":[{"billed_charge":1955.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.64,"providers":[{"billed_charge":138.96,"npi":[1821541566]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":51.97,"providers":[{"billed_charge":130.00,"npi":[1073089991]}]},{"allowed_amount":103.94,"providers":[{"billed_charge":260.00,"npi":[1538993217]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":519.70,"providers":[{"billed_charge":2400.00,"npi":[1609450956]}]},{"allowed_amount":3819.79,"providers":[{"billed_charge":17640.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":597.59,"providers":[{"billed_charge":1909.00,"npi":[1609678499]}]},{"allowed_amount":259.83,"providers":[{"billed_charge":830.00,"npi":[1376352732]}]},{"allowed_amount":840.11,"providers":[{"billed_charge":2656.00,"npi":[1376271007]}]},{"allowed_amount":472.15,"providers":[{"billed_charge":1577.00,"npi":[1669964243]}]},{"allowed_amount":1798.62,"providers":[{"billed_charge":5727.00,"npi":[1962062273]}]}]},{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":603.35,"providers":[{"billed_charge":1210.00,"npi":[1164642302]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":187.66,"providers":[{"billed_charge":581.00,"npi":[1063844769]}]},{"allowed_amount":661.15,"providers":[{"billed_charge":2075.00,"npi":[1760062905]}]},{"allowed_amount":311.81,"providers":[{"billed_charge":996.00,"npi":[1275599979]}]},{"allowed_amount":1928.54,"providers":[{"billed_charge":6142.00,"npi":[1184811747]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2834.37,"providers":[{"billed_charge":8840.00,"npi":[1942704572]}]},{"allowed_amount":441.15,"providers":[{"billed_charge":1365.00,"npi":[1861792186]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.62,"providers":[{"billed_charge":800.00,"npi":[1205582673]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1046.28,"providers":[{"billed_charge":5000.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1195.19,"providers":[{"billed_charge":5520.00,"npi":[1730566621]}]}]},{"tin":{"type":"ein","value":"571188400"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":314.68,"providers":[{"billed_charge":600.00,"npi":[1326219312]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":423.58,"providers":[{"billed_charge":1344.00,"npi":[1063844769]}]},{"allowed_amount":1161.63,"providers":[{"billed_charge":3744.00,"npi":[1184811747]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.21,"providers":[{"billed_charge":97.82,"npi":[1821541566]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3080.01,"providers":[{"billed_charge":8645.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":32.09,"providers":[{"billed_charge":65.00,"npi":[1073089991]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":541.62,"providers":[{"billed_charge":2200.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2692.26,"providers":[{"billed_charge":11160.00,"npi":[1326274168]}]},{"allowed_amount":545.52,"providers":[{"billed_charge":2160.00,"npi":[1609450956]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":760.51,"providers":[{"billed_charge":2496.00,"npi":[1609678499]}]},{"allowed_amount":609.69,"providers":[{"billed_charge":2016.00,"npi":[1376352732]}]},{"allowed_amount":994.76,"providers":[{"billed_charge":3264.00,"npi":[1962062273]}]},{"allowed_amount":138.15,"providers":[{"billed_charge":480.00,"npi":[1669964243]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1710.34,"providers":[{"billed_charge":7375.00,"npi":[1730566621]}]}]}]},{"name":"MASSAGE THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97124","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE A","allowed_amounts":[{"tin":{"type":"ein","value":"270069350"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":529.87,"providers":[{"billed_charge":1805.00,"npi":[1477969533]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"364877508"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":235.56,"providers":[{"billed_charge":1200.00,"npi":[1295004141]}]}]},{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":825.94,"providers":[{"billed_charge":2640.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":122.65,"providers":[{"billed_charge":525.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":245.30,"providers":[{"billed_charge":1200.00,"npi":[1609450956]}]},{"allowed_amount":1888.84,"providers":[{"billed_charge":9240.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"812090175"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.06,"providers":[{"billed_charge":130.00,"npi":[1538993217]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.06,"providers":[{"billed_charge":152.00,"npi":[1962062273]}]},{"allowed_amount":98.13,"providers":[{"billed_charge":304.00,"npi":[1376352732]}]}]},{"tin":{"type":"ein","value":"382820107"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":61.34,"providers":[{"billed_charge":170.00,"npi":[1770605842]}]}]},{"tin":{"type":"ein","value":"383456889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":269.83,"providers":[{"billed_charge":605.00,"npi":[1164642302]}]}]},{"tin":{"type":"ein","value":"381958736"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":117.78,"providers":[{"billed_charge":318.00,"npi":[1619608015]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":760.52,"providers":[{"billed_charge":2356.00,"npi":[1184811747]}]},{"allowed_amount":343.42,"providers":[{"billed_charge":1064.00,"npi":[1962940494]}]},{"allowed_amount":234.70,"providers":[{"billed_charge":760.00,"npi":[1508339961]}]},{"allowed_amount":220.78,"providers":[{"billed_charge":684.00,"npi":[1457690786]}]},{"allowed_amount":73.59,"providers":[{"billed_charge":228.00,"npi":[1275599979]}]},{"allowed_amount":367.95,"providers":[{"billed_charge":1140.00,"npi":[1063844769]}]}]},{"tin":{"type":"ein","value":"383558997"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":452.52,"providers":[{"billed_charge":1800.00,"npi":[1619673209]}]},{"allowed_amount":441.63,"providers":[{"billed_charge":1800.00,"npi":[1205582673]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":335.89,"providers":[{"billed_charge":1020.00,"npi":[1861792186]}]},{"allowed_amount":2379.59,"providers":[{"billed_charge":7260.00,"npi":[1942704572]}]}]},{"tin":{"type":"ein","value":"200955956"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":294.45,"providers":[{"billed_charge":1500.00,"npi":[1205863651]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":171.71,"providers":[{"billed_charge":770.00,"npi":[1730566621]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"461228277"},"service_code":["11","12","02"],"billing_class":"professional","payments":[{"allowed_amount":13558.40,"providers":[{"billed_charge":13587.27,"npi":[1891278487]}]},{"allowed_amount":19943.36,"providers":[{"billed_charge":20190.62,"npi":[1902506306]}]},{"allowed_amount":31855.77,"providers":[{"billed_charge":31855.77,"npi":[1043750904]}]},{"allowed_amount":24528.70,"providers":[{"billed_charge":24528.70,"npi":[1902506306]}]},{"allowed_amount":21061.67,"providers":[{"billed_charge":21119.40,"npi":[1770133456]}]},{"allowed_amount":322.80,"providers":[{"billed_charge":322.80,"npi":[1770133456]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"461228277"},"service_code":["11","12","02"],"billing_class":"professional","payments":[{"allowed_amount":5883.59,"providers":[{"billed_charge":7682.44,"npi":[1902506306]}]},{"allowed_amount":1813.31,"providers":[{"billed_charge":2317.80,"npi":[1902506306]}]},{"allowed_amount":1220.69,"providers":[{"billed_charge":1537.98,"npi":[1902506306]}]},{"allowed_amount":6314.94,"providers":[{"billed_charge":8269.87,"npi":[1043750904]}]},{"allowed_amount":3960.97,"providers":[{"billed_charge":5179.45,"npi":[1770133456]}]},{"allowed_amount":1823.45,"providers":[{"billed_charge":2400.33,"npi":[1891278487]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1224.84,"providers":[{"billed_charge":3330.00,"npi":[1174969877]}]}]},{"tin":{"type":"ein","value":"760376595"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":103.80,"providers":[{"billed_charge":315.00,"npi":[1962940494]}]},{"allowed_amount":34.60,"providers":[{"billed_charge":105.00,"npi":[1275599979]}]},{"allowed_amount":543.22,"providers":[{"billed_charge":1680.00,"npi":[1184811747]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":138.40,"providers":[{"billed_charge":500.00,"npi":[1316772411]}]}]},{"tin":{"type":"ein","value":"844612992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3731.24,"providers":[{"billed_charge":10200.00,"npi":[1942704572]}]},{"allowed_amount":387.52,"providers":[{"billed_charge":1050.00,"npi":[1861792186]}]}]},{"tin":{"type":"ein","value":"830404137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2920.24,"providers":[{"billed_charge":10320.00,"npi":[1326274168]}]}]},{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1283.66,"providers":[{"billed_charge":4095.00,"npi":[1962062273]}]},{"allowed_amount":954.96,"providers":[{"billed_charge":3045.00,"npi":[1376352732]}]},{"allowed_amount":443.87,"providers":[{"billed_charge":1470.00,"npi":[1669964243]}]},{"allowed_amount":460.18,"providers":[{"billed_charge":1470.00,"npi":[1609678499]}]}]},{"tin":{"type":"ein","value":"134220942"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2134.82,"providers":[{"billed_charge":8125.00,"npi":[1730566621]}]}]}]},{"name":"SELF CARE MNGMENT TRAINING","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97535","description":"SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIES OF DAILY LIVING (ADL) AND COMPENSATORY TRAINING,","allowed_amounts":[{"tin":{"type":"ein","value":"760424739"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":86.55,"providers":[{"billed_charge":276.00,"npi":[1376352732]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"462479137"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":308.60,"providers":[{"billed_charge":500.00,"npi":[1710321005]}]}]},{"tin":{"type":"ein","value":"382133559"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":578.70,"providers":[{"billed_charge":1053.75,"npi":[1851451637]}]}]},{"tin":{"type":"ein","value":"205182636"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":74.40,"providers":[{"billed_charge":120.00,"npi":[1255447306]}]}]}]},{"name":"CHIROPRACTIC MANJ 5 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98942","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 5 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"611507069"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":399.04,"providers":[{"billed_charge":472.00,"npi":[1992845598]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":336.45,"providers":[{"billed_charge":510.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":95.33,"providers":[{"billed_charge":275.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"842071867"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":381.32,"providers":[{"billed_charge":1628.00,"npi":[1013167162]}]}]},{"tin":{"type":"ein","value":"842580415"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1334.62,"providers":[{"billed_charge":2710.00,"npi":[1275863102]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":9084.15,"providers":[{"billed_charge":20250.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"872673604"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":224.30,"providers":[{"billed_charge":710.00,"npi":[1003987694]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":13790.76,"providers":[{"billed_charge":20500.00,"npi":[1114330974]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":113.30,"providers":[{"billed_charge":250.00,"npi":[1295227460]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.58,"providers":[{"billed_charge":120.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":315.54,"providers":[{"billed_charge":900.00,"npi":[1295227460]}]},{"allowed_amount":223.16,"providers":[{"billed_charge":400.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"382406558"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":28.37,"providers":[{"billed_charge":55.00,"npi":[1427489293]}]},{"allowed_amount":85.11,"providers":[{"billed_charge":165.00,"npi":[1427092147]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1180.27,"providers":[{"billed_charge":1255.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":493.92,"providers":[{"billed_charge":2112.00,"npi":[1285231662]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":540.19,"providers":[{"billed_charge":1848.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"842580415"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1774.91,"providers":[{"billed_charge":4030.00,"npi":[1275863102]}]}]},{"tin":{"type":"ein","value":"386005601"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":72.79,"providers":[{"billed_charge":141.00,"npi":[1407475494]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50","10"],"billing_class":"professional","payments":[{"allowed_amount":65.91,"providers":[{"billed_charge":234.69,"npi":[1538212485]}]},{"allowed_amount":635.53,"providers":[{"billed_charge":1642.83,"npi":[1558554998]}]},{"allowed_amount":1815.80,"providers":[{"billed_charge":4693.80,"npi":[1538212485]}]},{"allowed_amount":3903.97,"providers":[{"billed_charge":10091.67,"npi":[1396368734]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":13890.87,"providers":[{"billed_charge":22950.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"823482082"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":154.34,"providers":[{"billed_charge":440.00,"npi":[1295497279]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":77.17,"providers":[{"billed_charge":365.04,"npi":[1669243135]}]},{"allowed_amount":1311.89,"providers":[{"billed_charge":6205.68,"npi":[1669243135]}]},{"allowed_amount":1234.72,"providers":[{"billed_charge":5840.64,"npi":[1457065930]}]},{"allowed_amount":154.34,"providers":[{"billed_charge":730.08,"npi":[1457065930]}]}]},{"tin":{"type":"ein","value":"261358156"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":655.11,"providers":[{"billed_charge":1125.00,"npi":[1003656281]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1929.25,"providers":[{"billed_charge":6125.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"842847032"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1019.06,"providers":[{"billed_charge":1400.00,"npi":[1770303083]}]}]},{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1361.85,"providers":[{"billed_charge":1626.75,"npi":[1265503031]}]}]},{"tin":{"type":"ein","value":"464805855"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1271.06,"providers":[{"billed_charge":1498.00,"npi":[1780137927]}]}]},{"tin":{"type":"ein","value":"382406558"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":800.58,"providers":[{"billed_charge":825.00,"npi":[1427092147]}]}]},{"tin":{"type":"ein","value":"933109432"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":181.58,"providers":[{"billed_charge":544.74,"npi":[1932761467]}]}]},{"tin":{"type":"ein","value":"383251354"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2825.79,"providers":[{"billed_charge":3465.00,"npi":[1093339145]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":926.04,"providers":[{"billed_charge":2178.96,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"386004868"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":90.79,"providers":[{"billed_charge":434.73,"npi":[1538106059]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2546.61,"providers":[{"billed_charge":6141.96,"npi":[1245982909]}]},{"allowed_amount":771.70,"providers":[{"billed_charge":1861.20,"npi":[1629753223]}]},{"allowed_amount":1003.21,"providers":[{"billed_charge":2419.56,"npi":[1154032670]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":907.90,"providers":[{"billed_charge":1150.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":7807.94,"providers":[{"billed_charge":12900.00,"npi":[1295227460]}]},{"allowed_amount":725.01,"providers":[{"billed_charge":1650.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"824961447"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2109.12,"providers":[{"billed_charge":5120.00,"npi":[1447323829]}]},{"allowed_amount":453.95,"providers":[{"billed_charge":800.00,"npi":[1447323829]}]}]},{"tin":{"type":"ein","value":"863366964"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":363.95,"providers":[{"billed_charge":865.00,"npi":[1699199125]}]}]},{"tin":{"type":"ein","value":"383584702"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1027.56,"providers":[{"billed_charge":1440.00,"npi":[1215021472]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":65.91,"providers":[{"billed_charge":120.00,"npi":[1346693413]}]},{"allowed_amount":998.69,"providers":[{"billed_charge":1320.00,"npi":[1346693413]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"382311840"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1920.60,"providers":[{"billed_charge":2100.00,"npi":[1255499257]}]}]},{"tin":{"type":"ein","value":"821804736"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1131.91,"providers":[{"billed_charge":4862.00,"npi":[1952016941]}]},{"allowed_amount":1306.05,"providers":[{"billed_charge":5610.00,"npi":[1285231662]}]}]},{"tin":{"type":"ein","value":"472621929"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2285.43,"providers":[{"billed_charge":7854.00,"npi":[1851094940]}]}]},{"tin":{"type":"ein","value":"813667937"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":10115.16,"providers":[{"billed_charge":15010.00,"npi":[1538422548]}]},{"allowed_amount":1359.40,"providers":[{"billed_charge":2660.00,"npi":[1538422548]}]}]},{"tin":{"type":"ein","value":"465695978"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2304.64,"providers":[{"billed_charge":7854.00,"npi":[1770312514]}]}]},{"tin":{"type":"ein","value":"383844634"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":3457.08,"providers":[{"billed_charge":6214.86,"npi":[1558554998]}]},{"allowed_amount":4481.40,"providers":[{"billed_charge":8056.30,"npi":[1396368734]}]}]},{"tin":{"type":"ein","value":"823482082"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":979.47,"providers":[{"billed_charge":2835.00,"npi":[1871195727]}]}]},{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":14340.48,"providers":[{"billed_charge":22450.00,"npi":[1114330974]}]}]},{"tin":{"type":"ein","value":"821784717"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":348.28,"providers":[{"billed_charge":1496.00,"npi":[1891478889]}]}]},{"tin":{"type":"ein","value":"833394221"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2611.92,"providers":[{"billed_charge":12357.12,"npi":[1669243135]}]},{"allowed_amount":108.83,"providers":[{"billed_charge":514.88,"npi":[1457065930]}]}]},{"tin":{"type":"ein","value":"382027689"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":459.70,"providers":[{"billed_charge":1120.00,"npi":[1689682551]}]},{"allowed_amount":276.75,"providers":[{"billed_charge":672.00,"npi":[1548421167]}]}]},{"tin":{"type":"ein","value":"853275263"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":217.66,"providers":[{"billed_charge":630.00,"npi":[1043656135]}]}]},{"tin":{"type":"ein","value":"851404855"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1485.72,"providers":[{"billed_charge":3750.00,"npi":[1043507833]}]},{"allowed_amount":3053.98,"providers":[{"billed_charge":7900.00,"npi":[1043507833]}]}]},{"tin":{"type":"ein","value":"842494027"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":2005.86,"providers":[{"billed_charge":4352.00,"npi":[1629640479]}]},{"allowed_amount":1877.70,"providers":[{"billed_charge":4130.00,"npi":[1942891353]}]},{"allowed_amount":751.08,"providers":[{"billed_charge":1572.00,"npi":[1679117063]}]}]},{"tin":{"type":"ein","value":"821936174"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":544.15,"providers":[{"billed_charge":875.00,"npi":[1194231597]}]}]},{"tin":{"type":"ein","value":"382719621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3329.04,"providers":[{"billed_charge":4628.00,"npi":[1578727335]}]}]},{"tin":{"type":"ein","value":"320415553"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":761.81,"providers":[{"billed_charge":1386.00,"npi":[1366994816]}]}]},{"tin":{"type":"ein","value":"381358212"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":160.05,"providers":[{"billed_charge":246.00,"npi":[1194797035]}]},{"allowed_amount":121.38,"providers":[{"billed_charge":177.00,"npi":[1194797035]}]}]},{"tin":{"type":"ein","value":"382692114"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3201.00,"providers":[{"billed_charge":4375.00,"npi":[1083807176]}]}]},{"tin":{"type":"ein","value":"872465400"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":108.83,"providers":[{"billed_charge":315.00,"npi":[1124459284]}]}]},{"tin":{"type":"ein","value":"475372624"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1088.30,"providers":[{"billed_charge":2560.80,"npi":[1245936012]}]}]},{"tin":{"type":"ein","value":"861531584"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.04,"providers":[{"billed_charge":263.00,"npi":[1619545845]}]}]},{"tin":{"type":"ein","value":"474895529"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1632.45,"providers":[{"billed_charge":3961.80,"npi":[1245982909]}]},{"allowed_amount":2176.60,"providers":[{"billed_charge":5282.40,"npi":[1629753223]}]},{"allowed_amount":544.15,"providers":[{"billed_charge":1320.60,"npi":[1154032670]}]}]},{"tin":{"type":"ein","value":"832004627"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1408.44,"providers":[{"billed_charge":1925.00,"npi":[1255772604]}]}]},{"tin":{"type":"ein","value":"383246949"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":11267.52,"providers":[{"billed_charge":14520.00,"npi":[1376593228]}]}]},{"tin":{"type":"ein","value":"853595065"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3329.04,"providers":[{"billed_charge":5200.00,"npi":[1295227460]}]}]},{"tin":{"type":"ein","value":"382833497"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":108.83,"providers":[{"billed_charge":137.81,"npi":[1679390645]}]},{"allowed_amount":82.54,"providers":[{"billed_charge":137.81,"npi":[1679390645]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3841.20,"providers":[{"billed_charge":4500.00,"npi":[1346693413]}]},{"allowed_amount":1920.60,"providers":[{"billed_charge":2250.00,"npi":[1629459904]}]},{"allowed_amount":97.10,"providers":[{"billed_charge":150.00,"npi":[1346693413]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"462781294"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1221.90,"providers":[{"billed_charge":2000.00,"npi":[1093423824]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"382081222"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":782.36,"providers":[{"billed_charge":808.00,"npi":[1972584191]}]},{"allowed_amount":1760.31,"providers":[{"billed_charge":1818.00,"npi":[1972584191]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99223","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"991552518"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2601.60,"providers":[{"billed_charge":5133.00,"npi":[1306191853]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"220966774"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":588.16,"providers":[{"billed_charge":680.00,"npi":[1669576906]}]}]},{"tin":{"type":"ein","value":"853978891"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5200.00,"providers":[{"billed_charge":5200.00,"npi":[1417156332]}]}]},{"tin":{"type":"ein","value":"270723388"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":882.24,"providers":[{"billed_charge":900.00,"npi":[1528321809]}]}]},{"tin":{"type":"ein","value":"843331851"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1029.28,"providers":[{"billed_charge":1050.00,"npi":[1871611251]}]}]},{"tin":{"type":"ein","value":"364827394"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":954.36,"providers":[{"billed_charge":1760.00,"npi":[1841955846]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"263366822"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1053.08,"providers":[{"billed_charge":7000.00,"npi":[1235624719]}]}]},{"tin":{"type":"ein","value":"223883792"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":831.81,"providers":[{"billed_charge":1050.00,"npi":[1144239559]}]}]},{"tin":{"type":"ein","value":"814061406"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":356.49,"providers":[{"billed_charge":420.00,"npi":[1508120627]}]}]},{"tin":{"type":"ein","value":"451068969"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1300.00,"providers":[{"billed_charge":1300.00,"npi":[1265559488]}]}]},{"tin":{"type":"ein","value":"382789107"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1548.82,"providers":[{"billed_charge":2898.00,"npi":[1508521105]}]}]},{"tin":{"type":"ein","value":"382262467"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":118.83,"providers":[{"billed_charge":125.00,"npi":[1386657427]}]}]},{"tin":{"type":"ein","value":"680655441"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2138.44,"providers":[{"billed_charge":2160.00,"npi":[1003921891]}]}]},{"tin":{"type":"ein","value":"833394001"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1782.45,"providers":[{"billed_charge":4920.00,"npi":[1447554654]}]}]},{"tin":{"type":"ein","value":"382027689"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":752.20,"providers":[{"billed_charge":2280.00,"npi":[1548421167]}]}]},{"tin":{"type":"ein","value":"200760613"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4990.86,"providers":[{"billed_charge":5040.00,"npi":[1316938061]}]}]},{"tin":{"type":"ein","value":"161634286"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":356.49,"providers":[{"billed_charge":450.00,"npi":[1376616615]}]}]},{"tin":{"type":"ein","value":"383536668"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":9240.00,"providers":[{"billed_charge":9240.00,"npi":[1184661670]}]}]},{"tin":{"type":"ein","value":"20764814"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":95.07,"providers":[{"billed_charge":95.07,"npi":[1518951672]}]}]},{"tin":{"type":"ein","value":"383481310"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":1300.00,"providers":[{"billed_charge":1300.00,"npi":[1841272259]}]},{"allowed_amount":100.00,"providers":[{"billed_charge":100.00,"npi":[1841272259]}]}]},{"tin":{"type":"ein","value":"262719426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1029.86,"providers":[{"billed_charge":1560.00,"npi":[1043237951]}]}]},{"tin":{"type":"ein","value":"382796478"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4792.81,"providers":[{"billed_charge":6150.00,"npi":[1255372058]}]}]},{"tin":{"type":"ein","value":"382550047"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":712.98,"providers":[{"billed_charge":1125.00,"npi":[1447875976]}]},{"allowed_amount":158.44,"providers":[{"billed_charge":250.00,"npi":[1922673342]}]}]},{"tin":{"type":"ein","value":"383614942"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1425.96,"providers":[{"billed_charge":1440.00,"npi":[1770568198]}]}]},{"tin":{"type":"ein","value":"853366098"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":554.54,"providers":[{"billed_charge":1130.92,"npi":[1629432786]}]}]},{"tin":{"type":"ein","value":"752398395"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5703.84,"providers":[{"billed_charge":6000.00,"npi":[1124029335]}]}]},{"tin":{"type":"ein","value":"933895859"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":344.49,"providers":[{"billed_charge":1665.00,"npi":[1013142827]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":633.76,"providers":[{"billed_charge":1824.00,"npi":[1487722914]}]}]},{"tin":{"type":"ein","value":"43754400"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":202.02,"providers":[{"billed_charge":420.00,"npi":[1194103390]}]}]},{"tin":{"type":"ein","value":"822784244"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2471.76,"providers":[{"billed_charge":3816.00,"npi":[1679764997]}]}]},{"tin":{"type":"ein","value":"990777079"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":112.83,"providers":[{"billed_charge":395.10,"npi":[1386756740]}]},{"allowed_amount":63.94,"providers":[{"billed_charge":395.10,"npi":[1336859198]}]}]},{"tin":{"type":"ein","value":"814043627"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":118.83,"providers":[{"billed_charge":175.00,"npi":[1821239302]}]},{"allowed_amount":594.15,"providers":[{"billed_charge":875.00,"npi":[1821239302]}]}]},{"tin":{"type":"ein","value":"375088693"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":6600.00,"providers":[{"billed_charge":6600.00,"npi":[1417064502]}]}]},{"tin":{"type":"ein","value":"80660230"},"service_code":["51","21"],"billing_class":"professional","payments":[{"allowed_amount":3564.90,"providers":[{"billed_charge":3750.00,"npi":[1972585248]}]},{"allowed_amount":237.66,"providers":[{"billed_charge":250.00,"npi":[1972585248]}]}]},{"tin":{"type":"ein","value":"823744003"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":396.10,"providers":[{"billed_charge":550.00,"npi":[1740661982]}]}]},{"tin":{"type":"ein","value":"834605197"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1267.52,"providers":[{"billed_charge":1440.00,"npi":[1730854605]}]}]},{"tin":{"type":"ein","value":"161768956"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":450.00,"providers":[{"billed_charge":450.00,"npi":[1205834470]}]},{"allowed_amount":180.00,"providers":[{"billed_charge":180.00,"npi":[1205834470]}]}]},{"tin":{"type":"ein","value":"383447980"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":237.66,"providers":[{"billed_charge":291.00,"npi":[1396725305]}]}]},{"tin":{"type":"ein","value":"991552518"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2613.29,"providers":[{"billed_charge":5374.41,"npi":[1306191853]}]}]},{"tin":{"type":"ein","value":"811672122"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":316.88,"providers":[{"billed_charge":1200.00,"npi":[1881258820]}]}]},{"tin":{"type":"ein","value":"851540000"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":431.69,"providers":[{"billed_charge":1092.00,"npi":[1033745310]}]}]},{"tin":{"type":"ein","value":"382407635"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3400.00,"providers":[{"billed_charge":3400.00,"npi":[1902970619]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"263366822"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":560.40,"providers":[{"billed_charge":3590.00,"npi":[1750943981]}]}]},{"tin":{"type":"ein","value":"383189890"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":224.16,"providers":[{"billed_charge":300.00,"npi":[1629503024]}]}]},{"tin":{"type":"ein","value":"383276498"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2587.42,"providers":[{"billed_charge":3450.00,"npi":[1871949925]}]}]},{"tin":{"type":"ein","value":"382201764"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":352.83,"providers":[{"billed_charge":540.00,"npi":[1831274786]}]}]},{"tin":{"type":"ein","value":"382597466"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":672.48,"providers":[{"billed_charge":750.00,"npi":[1225426893]}]}]},{"tin":{"type":"ein","value":"205326061"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2800.00,"providers":[{"billed_charge":2800.00,"npi":[1912941477]}]}]},{"tin":{"type":"ein","value":"900977152"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":99.97,"providers":[{"billed_charge":400.00,"npi":[1780226613]}]}]},{"tin":{"type":"ein","value":"834368857"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":160.00,"providers":[{"billed_charge":160.00,"npi":[1689962136]}]},{"allowed_amount":5952.00,"providers":[{"billed_charge":5952.00,"npi":[1689962136]}]}]},{"tin":{"type":"ein","value":"382550047"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":5527.67,"providers":[{"billed_charge":8695.00,"npi":[1922673342]}]}]},{"tin":{"type":"ein","value":"991552518"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":8115.29,"providers":[{"billed_charge":17223.99,"npi":[1306191853]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1079.40,"providers":[{"billed_charge":5760.00,"npi":[1619910106]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":863.52,"providers":[{"billed_charge":3948.00,"npi":[1972562171]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"611442402"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":369.58,"providers":[{"billed_charge":1994.00,"npi":[1871857029]}]},{"allowed_amount":184.79,"providers":[{"billed_charge":997.00,"npi":[1598189334]}]}]},{"tin":{"type":"ein","value":"381914446"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":232.86,"providers":[{"billed_charge":1434.00,"npi":[1568663185]}]},{"allowed_amount":116.43,"providers":[{"billed_charge":717.00,"npi":[1063733038]}]},{"allowed_amount":582.15,"providers":[{"billed_charge":3585.00,"npi":[1922048800]}]}]},{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2402.27,"providers":[{"billed_charge":12597.00,"npi":[1700824968]}]},{"allowed_amount":369.58,"providers":[{"billed_charge":1938.00,"npi":[1811348691,1235716986,1790700292]}]},{"allowed_amount":13304.88,"providers":[{"billed_charge":69768.00,"npi":[1255373130]}]},{"allowed_amount":4065.38,"providers":[{"billed_charge":21318.00,"npi":[1669748091]}]},{"allowed_amount":184.79,"providers":[{"billed_charge":969.00,"npi":[1265926018,1366936031,1437680121,1275093114]}]},{"allowed_amount":554.37,"providers":[{"billed_charge":2907.00,"npi":[1346816774,1346251816,1073896346,1194216101,1801245618]}]},{"allowed_amount":923.95,"providers":[{"billed_charge":4845.00,"npi":[1144516352,1578050340,1447660212]}]},{"allowed_amount":1108.74,"providers":[{"billed_charge":5814.00,"npi":[1942865894,1396235685]}]},{"allowed_amount":5174.12,"providers":[{"billed_charge":27132.00,"npi":[1124642095]}]},{"allowed_amount":1413.63,"providers":[{"billed_charge":8721.00,"npi":[1386096964]}]},{"allowed_amount":739.16,"providers":[{"billed_charge":3876.00,"npi":[1982991824,1679198972]}]},{"allowed_amount":16631.10,"providers":[{"billed_charge":87210.00,"npi":[1619910106]}]},{"allowed_amount":5064.85,"providers":[{"billed_charge":28101.00,"npi":[1326088030]}]},{"allowed_amount":2217.48,"providers":[{"billed_charge":11628.00,"npi":[1164862561]}]},{"allowed_amount":5543.70,"providers":[{"billed_charge":29070.00,"npi":[1306056106]}]},{"allowed_amount":3141.43,"providers":[{"billed_charge":16473.00,"npi":[1417306184,1619916178]}]},{"allowed_amount":174.65,"providers":[{"billed_charge":969.00,"npi":[1669791760]}]},{"allowed_amount":1478.32,"providers":[{"billed_charge":7752.00,"npi":[1245404896,1740544915,1699902239]}]},{"allowed_amount":1663.11,"providers":[{"billed_charge":8721.00,"npi":[1033670724]}]},{"allowed_amount":1293.53,"providers":[{"billed_charge":6783.00,"npi":[1568774008,1518913557,1710079074]}]},{"allowed_amount":893.53,"providers":[{"billed_charge":4845.00,"npi":[1811334386,1124327366]}]},{"allowed_amount":4989.33,"providers":[{"billed_charge":26163.00,"npi":[1497800767]}]},{"allowed_amount":2032.69,"providers":[{"billed_charge":10659.00,"npi":[1407029564]}]},{"allowed_amount":3511.01,"providers":[{"billed_charge":18411.00,"npi":[1245646868]}]},{"allowed_amount":2956.64,"providers":[{"billed_charge":15504.00,"npi":[1487886685]}]},{"allowed_amount":1847.90,"providers":[{"billed_charge":9690.00,"npi":[1740696400,1588874374,1215135553,1275196669]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":732.97,"providers":[{"billed_charge":2807.00,"npi":[1619419553]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":369.57,"providers":[{"billed_charge":1881.00,"npi":[1386140366]}]},{"allowed_amount":5297.17,"providers":[{"billed_charge":26961.00,"npi":[1427255835]}]},{"allowed_amount":3572.51,"providers":[{"billed_charge":18183.00,"npi":[1588985923,1154553964]}]},{"allowed_amount":2402.27,"providers":[{"billed_charge":8151.00,"npi":[1104863349]}]},{"allowed_amount":369.58,"providers":[{"billed_charge":1254.00,"npi":[1003853201]}]},{"allowed_amount":2463.80,"providers":[{"billed_charge":12540.00,"npi":[1245686831]}]},{"allowed_amount":1724.66,"providers":[{"billed_charge":8778.00,"npi":[1598040677]}]},{"allowed_amount":4188.46,"providers":[{"billed_charge":21318.00,"npi":[1093378507]}]},{"allowed_amount":862.33,"providers":[{"billed_charge":4389.00,"npi":[1720547045]}]},{"allowed_amount":923.95,"providers":[{"billed_charge":3135.00,"npi":[1366688442]}]},{"allowed_amount":1108.71,"providers":[{"billed_charge":5643.00,"npi":[1497714265]}]},{"allowed_amount":2217.42,"providers":[{"billed_charge":11286.00,"npi":[1740592294]}]},{"allowed_amount":5174.12,"providers":[{"billed_charge":17556.00,"npi":[1679829667]}]},{"allowed_amount":123.19,"providers":[{"billed_charge":627.00,"npi":[1346694478]}]},{"allowed_amount":3326.13,"providers":[{"billed_charge":16929.00,"npi":[1023373503]}]},{"allowed_amount":3695.70,"providers":[{"billed_charge":18810.00,"npi":[1306883541]}]},{"allowed_amount":492.76,"providers":[{"billed_charge":2508.00,"npi":[1083827612]}]},{"allowed_amount":1847.85,"providers":[{"billed_charge":9405.00,"npi":[1922462183]}]},{"allowed_amount":739.14,"providers":[{"billed_charge":3762.00,"npi":[1790359792]}]},{"allowed_amount":246.38,"providers":[{"billed_charge":1254.00,"npi":[1740202316,1619997160,1427444843]}]},{"allowed_amount":3818.89,"providers":[{"billed_charge":19437.00,"npi":[1083633887]}]},{"allowed_amount":1478.28,"providers":[{"billed_charge":7524.00,"npi":[1063783181,1811330467]}]},{"allowed_amount":985.52,"providers":[{"billed_charge":5016.00,"npi":[1558894378]}]},{"allowed_amount":1355.09,"providers":[{"billed_charge":6897.00,"npi":[1700827490]}]},{"allowed_amount":2710.18,"providers":[{"billed_charge":13794.00,"npi":[1922628676,1508204587]}]},{"allowed_amount":4434.96,"providers":[{"billed_charge":15048.00,"npi":[1003875287]}]},{"allowed_amount":6898.64,"providers":[{"billed_charge":35112.00,"npi":[1972562171]}]},{"allowed_amount":1601.47,"providers":[{"billed_charge":8151.00,"npi":[1528379997]}]},{"allowed_amount":4311.65,"providers":[{"billed_charge":21945.00,"npi":[1063767457,1245209410]}]},{"allowed_amount":2340.61,"providers":[{"billed_charge":11913.00,"npi":[1689849002]}]}]},{"tin":{"type":"ein","value":"811230538"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":554.37,"providers":[{"billed_charge":2448.00,"npi":[1407066095]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":5063.74,"providers":[{"billed_charge":12540.00,"npi":[1114330974]}]},{"allowed_amount":3682.72,"providers":[{"billed_charge":9120.00,"npi":[1598028003,1396819900]}]},{"allowed_amount":6444.76,"providers":[{"billed_charge":15960.00,"npi":[1104137025]}]}]},{"tin":{"type":"ein","value":"843515632"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1746.50,"providers":[{"billed_charge":15340.00,"npi":[1700883204]}]},{"allowed_amount":1222.55,"providers":[{"billed_charge":10738.00,"npi":[1518587591]}]},{"allowed_amount":3667.65,"providers":[{"billed_charge":32214.00,"npi":[1134185051]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":10993.81,"providers":[{"billed_charge":53660.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"382988086"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":174.65,"providers":[{"billed_charge":446.00,"npi":[1407080286]}]},{"allowed_amount":2587.06,"providers":[{"billed_charge":6244.00,"npi":[1356733489]}]},{"allowed_amount":8685.13,"providers":[{"billed_charge":20962.00,"npi":[1861873390]}]},{"allowed_amount":1478.32,"providers":[{"billed_charge":3568.00,"npi":[1497923221]}]},{"allowed_amount":7945.97,"providers":[{"billed_charge":19178.00,"npi":[1861832552]}]},{"allowed_amount":10902.61,"providers":[{"billed_charge":26314.00,"npi":[1730292343]}]},{"allowed_amount":6652.44,"providers":[{"billed_charge":16056.00,"npi":[1588289003]}]},{"allowed_amount":5543.70,"providers":[{"billed_charge":13380.00,"npi":[1487183984]}]}]},{"tin":{"type":"ein","value":"873710985"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2032.69,"providers":[{"billed_charge":13684.00,"npi":[1508313313]}]},{"allowed_amount":739.16,"providers":[{"billed_charge":4976.00,"npi":[1609823921,1245218734]}]},{"allowed_amount":3829.89,"providers":[{"billed_charge":26124.00,"npi":[1467554949]}]},{"allowed_amount":2956.64,"providers":[{"billed_charge":19904.00,"npi":[1114986734]}]},{"allowed_amount":923.95,"providers":[{"billed_charge":6220.00,"npi":[1821451642]}]},{"allowed_amount":523.95,"providers":[{"billed_charge":3732.00,"npi":[1255521423]}]},{"allowed_amount":1108.74,"providers":[{"billed_charge":7464.00,"npi":[1336458249]}]},{"allowed_amount":1847.90,"providers":[{"billed_charge":12440.00,"npi":[1619048329]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"611442402"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":268.31,"providers":[{"billed_charge":1471.00,"npi":[1225234354]}]}]},{"tin":{"type":"ein","value":"383345124"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":4227.00,"npi":[1952325961,1033670724,1275196669,1184201048,1992123715]}]},{"allowed_amount":506.94,"providers":[{"billed_charge":2818.00,"npi":[1811334386]}]},{"allowed_amount":2832.69,"providers":[{"billed_charge":15499.00,"npi":[1124327366]}]},{"allowed_amount":1341.55,"providers":[{"billed_charge":7045.00,"npi":[1033796297]}]},{"allowed_amount":4292.96,"providers":[{"billed_charge":22544.00,"npi":[1619910106,1144516352]}]},{"allowed_amount":1609.86,"providers":[{"billed_charge":8454.00,"npi":[1568774008,1679198972,1790700292]}]},{"allowed_amount":4829.58,"providers":[{"billed_charge":25362.00,"npi":[1740696400]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":2818.00,"npi":[1790342996,1982991824,1366936031,1194216101]}]},{"allowed_amount":1878.17,"providers":[{"billed_charge":9863.00,"npi":[1255540894,1235579467,1710079074]}]},{"allowed_amount":9122.54,"providers":[{"billed_charge":47906.00,"npi":[1497800767]}]},{"allowed_amount":1073.24,"providers":[{"billed_charge":5636.00,"npi":[1841811072]}]},{"allowed_amount":5068.21,"providers":[{"billed_charge":26771.00,"npi":[1396235685]}]},{"allowed_amount":2951.41,"providers":[{"billed_charge":15499.00,"npi":[1124642095,1215135553]}]},{"allowed_amount":3756.34,"providers":[{"billed_charge":19726.00,"npi":[1215977343]}]},{"allowed_amount":2146.48,"providers":[{"billed_charge":11272.00,"npi":[1407029564,1255373130,1740544915]}]},{"allowed_amount":5619.67,"providers":[{"billed_charge":29589.00,"npi":[1487886685]}]},{"allowed_amount":2683.10,"providers":[{"billed_charge":14090.00,"npi":[1184245383,1346251816,1154618254,1346538766]}]},{"allowed_amount":4009.81,"providers":[{"billed_charge":21135.00,"npi":[1417306184]}]},{"allowed_amount":4024.65,"providers":[{"billed_charge":21135.00,"npi":[1700824968]}]},{"allowed_amount":6707.75,"providers":[{"billed_charge":35225.00,"npi":[1073896346]}]},{"allowed_amount":764.68,"providers":[{"billed_charge":4227.00,"npi":[1386096964]}]},{"allowed_amount":760.41,"providers":[{"billed_charge":4227.00,"npi":[1669791760]}]},{"allowed_amount":4561.27,"providers":[{"billed_charge":23953.00,"npi":[1588874374]}]},{"allowed_amount":253.47,"providers":[{"billed_charge":1409.00,"npi":[1184151631,1689889636,1487866976]}]},{"allowed_amount":2414.79,"providers":[{"billed_charge":12681.00,"npi":[1144631292,1578121703,1245404896,1801245618]}]},{"allowed_amount":4830.77,"providers":[{"billed_charge":26771.00,"npi":[1598250946]}]},{"allowed_amount":2534.70,"providers":[{"billed_charge":14090.00,"npi":[1407177884]}]},{"allowed_amount":3488.03,"providers":[{"billed_charge":18317.00,"npi":[1346816774,1669748091]}]},{"allowed_amount":268.31,"providers":[{"billed_charge":1409.00,"npi":[1881257129,1659505378,1245646868,1326616863,1215558317]}]},{"allowed_amount":6439.44,"providers":[{"billed_charge":33816.00,"npi":[1306056106,1992325542,1619916178]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":304.08,"providers":[{"billed_charge":1180.00,"npi":[1619419553]}]}]},{"tin":{"type":"ein","value":"844478409"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":253.47,"providers":[{"billed_charge":844.00,"npi":[1104127760]}]},{"allowed_amount":391.90,"providers":[{"billed_charge":1688.00,"npi":[1316443054]}]}]},{"tin":{"type":"ein","value":"382537427"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":2766.00,"npi":[1679829667]}]},{"allowed_amount":2146.44,"providers":[{"billed_charge":11064.00,"npi":[1790359792]}]},{"allowed_amount":536.61,"providers":[{"billed_charge":2766.00,"npi":[1922462183,1528379997,1245209410]}]},{"allowed_amount":2504.18,"providers":[{"billed_charge":12908.00,"npi":[1972562171,1720510209,1154553964]}]},{"allowed_amount":1609.83,"providers":[{"billed_charge":8298.00,"npi":[1740592294]}]},{"allowed_amount":3040.79,"providers":[{"billed_charge":15674.00,"npi":[1063783181]}]},{"allowed_amount":2861.92,"providers":[{"billed_charge":14752.00,"npi":[1245686831,1598040677]}]},{"allowed_amount":2325.31,"providers":[{"billed_charge":11986.00,"npi":[1811330467]}]},{"allowed_amount":715.48,"providers":[{"billed_charge":3688.00,"npi":[1619997160,1346287513,1083633887]}]},{"allowed_amount":894.35,"providers":[{"billed_charge":4610.00,"npi":[1427255835,1922628676]}]},{"allowed_amount":1430.96,"providers":[{"billed_charge":7376.00,"npi":[1063767457,1427444843]}]},{"allowed_amount":5366.10,"providers":[{"billed_charge":27660.00,"npi":[1700827490]}]},{"allowed_amount":1252.09,"providers":[{"billed_charge":6454.00,"npi":[1558894378,1689849002,1083827612,1508204587]}]},{"allowed_amount":268.31,"providers":[{"billed_charge":922.00,"npi":[1366688442]}]},{"allowed_amount":357.74,"providers":[{"billed_charge":1844.00,"npi":[1588985923]}]},{"allowed_amount":2683.05,"providers":[{"billed_charge":13830.00,"npi":[1023373503,1093378507]}]}]},{"tin":{"type":"ein","value":"811230538"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2951.41,"providers":[{"billed_charge":13222.00,"npi":[1407066095]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":2404.00,"npi":[1376807784]}]}]},{"tin":{"type":"ein","value":"382962430"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":536.61,"providers":[{"billed_charge":4764.00,"npi":[1841827599]}]}]},{"tin":{"type":"ein","value":"462593177"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":7419.50,"providers":[{"billed_charge":18392.00,"npi":[1750901443]}]},{"allowed_amount":16862.50,"providers":[{"billed_charge":41800.00,"npi":[1598028003]}]},{"allowed_amount":5396.00,"providers":[{"billed_charge":13376.00,"npi":[1710349543]}]},{"allowed_amount":25631.00,"providers":[{"billed_charge":63536.00,"npi":[1114330974]}]},{"allowed_amount":1349.00,"providers":[{"billed_charge":3344.00,"npi":[1952389421]}]},{"allowed_amount":22933.00,"providers":[{"billed_charge":56848.00,"npi":[1104137025]}]},{"allowed_amount":11466.50,"providers":[{"billed_charge":28424.00,"npi":[1396819900]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":12208.70,"providers":[{"billed_charge":63667.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"382988086"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":804.93,"providers":[{"billed_charge":2052.00,"npi":[1487183984,1730292343]}]},{"allowed_amount":253.47,"providers":[{"billed_charge":684.00,"npi":[1407080286]}]}]},{"tin":{"type":"ein","value":"873710985"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":760.41,"providers":[{"billed_charge":5406.00,"npi":[1114960630,1255521423]}]},{"allowed_amount":2027.76,"providers":[{"billed_charge":14416.00,"npi":[1437500949]}]},{"allowed_amount":1341.55,"providers":[{"billed_charge":9010.00,"npi":[1467554949]}]},{"allowed_amount":2951.41,"providers":[{"billed_charge":19822.00,"npi":[1821451642,1114986734]}]},{"allowed_amount":4024.65,"providers":[{"billed_charge":27030.00,"npi":[1245218734]}]},{"allowed_amount":2146.48,"providers":[{"billed_charge":14416.00,"npi":[1609823921]}]},{"allowed_amount":536.62,"providers":[{"billed_charge":3604.00,"npi":[1336458249]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"383433632"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1941.66,"providers":[{"billed_charge":4050.00,"npi":[1053517540]}]},{"allowed_amount":2804.62,"providers":[{"billed_charge":5850.00,"npi":[1134575798]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"272480925"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":2128.89,"providers":[{"billed_charge":3770.00,"npi":[1790940526]}]}]},{"tin":{"type":"ein","value":"874406123"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":124.80,"providers":[{"billed_charge":250.00,"npi":[1548705783]}]},{"allowed_amount":624.00,"providers":[{"billed_charge":1250.00,"npi":[1851855845]}]},{"allowed_amount":62.40,"providers":[{"billed_charge":125.00,"npi":[1144295510]}]}]},{"tin":{"type":"ein","value":"834368857"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":969.03,"providers":[{"billed_charge":1890.00,"npi":[1033803127]}]},{"allowed_amount":469.83,"providers":[{"billed_charge":910.00,"npi":[1033803127]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"208305340"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":272.43,"providers":[{"billed_charge":1574.31,"npi":[1932525524]}]}]},{"tin":{"type":"ein","value":"205326061"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1175.13,"providers":[{"billed_charge":1595.00,"npi":[1912941477]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"383232366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":913.24,"providers":[{"billed_charge":1968.00,"npi":[1649520784]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"383589415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":673.53,"providers":[{"billed_charge":1650.00,"npi":[1558354159]}]},{"allowed_amount":142.87,"providers":[{"billed_charge":350.00,"npi":[1982697454]}]}]},{"tin":{"type":"ein","value":"381914289"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.55,"providers":[{"billed_charge":44.00,"npi":[1275252322]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"20753921"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2127.43,"providers":[{"billed_charge":2805.50,"npi":[1215982749]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":127425.09,"providers":[{"billed_charge":185670.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382415274"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":113.04,"providers":[{"billed_charge":353.80,"npi":[1528071115]}]}]},{"tin":{"type":"ein","value":"386005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":205.89,"providers":[{"billed_charge":238.40,"npi":[1134164585]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2786.34,"providers":[{"billed_charge":3248.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3036.46,"providers":[{"billed_charge":3300.00,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"386004676"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1781.90,"providers":[{"billed_charge":1942.50,"npi":[1487722682]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":110702.91,"providers":[{"billed_charge":286617.65,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"386008155"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2429.42,"providers":[{"billed_charge":3086.30,"npi":[1669416947]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23127.39,"providers":[{"billed_charge":40884.80,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4241.23,"providers":[{"billed_charge":8475.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386006334"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":384.32,"providers":[{"billed_charge":445.50,"npi":[1538568902]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":867.00,"providers":[{"billed_charge":2872.10,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":29687.45,"providers":[{"billed_charge":39150.30,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19668.31,"providers":[{"billed_charge":22579.23,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35337.89,"providers":[{"billed_charge":106780.80,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"386031668"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":907.78,"providers":[{"billed_charge":976.00,"npi":[1730119504]}]}]},{"tin":{"type":"ein","value":"381712300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":549.01,"providers":[{"billed_charge":640.20,"npi":[1811010416]}]}]},{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54655.05,"providers":[{"billed_charge":123108.65,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2544.54,"providers":[{"billed_charge":3274.25,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"386006926"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":265.20,"providers":[{"billed_charge":861.90,"npi":[1790724656]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2428.95,"providers":[{"billed_charge":2665.50,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18131.04,"providers":[{"billed_charge":23902.86,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5050.90,"providers":[{"billed_charge":10352.40,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10714.98,"providers":[{"billed_charge":17860.12,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12178.62,"providers":[{"billed_charge":12181.05,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"386004685"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":356.86,"providers":[{"billed_charge":364.00,"npi":[1104864271]}]}]},{"tin":{"type":"ein","value":"382285796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2415.62,"providers":[{"billed_charge":4312.00,"npi":[1689621047]}]}]},{"tin":{"type":"ein","value":"382094795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1224.86,"providers":[{"billed_charge":1743.72,"npi":[1780688721]}]}]},{"tin":{"type":"ein","value":"386006902"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":199.02,"providers":[{"billed_charge":292.60,"npi":[1740221688]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10444.90,"providers":[{"billed_charge":13774.10,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386006306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2072.54,"providers":[{"billed_charge":2851.90,"npi":[1982644241]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19365.43,"providers":[{"billed_charge":30760.40,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"386007299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":109.81,"providers":[{"billed_charge":141.10,"npi":[1649210154]}]}]},{"tin":{"type":"ein","value":"381869375"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1613.88,"providers":[{"billed_charge":1860.80,"npi":[1669618989]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13972.49,"providers":[{"billed_charge":18319.00,"npi":[1699863704]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14201.60,"providers":[{"billed_charge":33600.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1440.90,"providers":[{"billed_charge":2265.00,"npi":[1598877268]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":56771.53,"providers":[{"billed_charge":167500.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1606.08,"providers":[{"billed_charge":1700.00,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"20753921"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2281.41,"providers":[{"billed_charge":3186.00,"npi":[1215982749]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":314791.68,"providers":[{"billed_charge":588000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15257.76,"providers":[{"billed_charge":16150.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":58556.19,"providers":[{"billed_charge":82164.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13688.46,"providers":[{"billed_charge":18227.52,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20000.00,"providers":[{"billed_charge":20000.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":68345.77,"providers":[{"billed_charge":157060.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"382441192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24335.04,"providers":[{"billed_charge":36064.00,"npi":[1457469462]}]}]},{"tin":{"type":"ein","value":"386008155"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4812.16,"providers":[{"billed_charge":5400.00,"npi":[1669416947]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26072.32,"providers":[{"billed_charge":27200.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":212805.60,"providers":[{"billed_charge":267181.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13651.68,"providers":[{"billed_charge":34850.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":825.72,"providers":[{"billed_charge":2175.00,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35333.76,"providers":[{"billed_charge":46728.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"382485700"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":89735.46,"providers":[{"billed_charge":96170.00,"npi":[1598877268]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":128486.40,"providers":[{"billed_charge":369414.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"381869375"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7300.00,"providers":[{"billed_charge":7300.00,"npi":[1669618989]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25697.28,"providers":[{"billed_charge":32000.00,"npi":[1699863704]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":137364.50,"providers":[{"billed_charge":227500.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3803.94,"providers":[{"billed_charge":7668.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":422.66,"providers":[{"billed_charge":2505.60,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":422.66,"providers":[{"billed_charge":1213.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":131762.68,"providers":[{"billed_charge":555480.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5071.92,"providers":[{"billed_charge":10150.00,"npi":[1699863704]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":581764.94,"providers":[{"billed_charge":1104584.38,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"386004605"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25697.50,"providers":[{"billed_charge":28500.00,"npi":[1346282183]}]}]},{"tin":{"type":"ein","value":"386006926"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1433.28,"providers":[{"billed_charge":4410.00,"npi":[1790724656]}]}]},{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40575.00,"providers":[{"billed_charge":57000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"381810301"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4057.50,"providers":[{"billed_charge":4200.00,"npi":[1114036464]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3842.40,"providers":[{"billed_charge":5544.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"382138484"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":46108.80,"providers":[{"billed_charge":69049.88,"npi":[1619932415]}]}]},{"tin":{"type":"ein","value":"822925189"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":676.25,"providers":[{"billed_charge":2764.80,"npi":[1205346319]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":103950.00,"providers":[{"billed_charge":103950.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"386004611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36850.00,"providers":[{"billed_charge":36850.00,"npi":[1154172435]}]}]},{"tin":{"type":"ein","value":"386007226"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35750.00,"providers":[{"billed_charge":35750.00,"npi":[1386634863]}]}]},{"tin":{"type":"ein","value":"386004676"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17000.00,"providers":[{"billed_charge":17000.00,"npi":[1487722682]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":171954.14,"providers":[{"billed_charge":221200.00,"npi":[1720046188]}]}]},{"tin":{"type":"ein","value":"386006306"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12848.75,"providers":[{"billed_charge":14250.00,"npi":[1982644241]}]}]},{"tin":{"type":"ein","value":"383198397"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":52990.08,"providers":[{"billed_charge":55350.00,"npi":[1306887260]}]}]},{"tin":{"type":"ein","value":"382483662"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27726.25,"providers":[{"billed_charge":64750.00,"npi":[1689730939]}]}]},{"tin":{"type":"ein","value":"386007202"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3105.44,"providers":[{"billed_charge":7590.00,"npi":[1477589596]}]}]},{"tin":{"type":"ein","value":"382200909"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16230.00,"providers":[{"billed_charge":22176.00,"npi":[1689600975]}]}]},{"tin":{"type":"ein","value":"990643623"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":251565.00,"providers":[{"billed_charge":731232.00,"npi":[1457112534]}]}]},{"tin":{"type":"ein","value":"386031668"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1900.00,"providers":[{"billed_charge":1900.00,"npi":[1730119504]}]}]},{"tin":{"type":"ein","value":"381712300"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":650.00,"providers":[{"billed_charge":650.00,"npi":[1811010416]}]}]},{"tin":{"type":"ein","value":"113687518"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43280.00,"providers":[{"billed_charge":54400.00,"npi":[1699863704]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"382666933"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2747.28,"providers":[{"billed_charge":5000.00,"npi":[1124056296]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28898.10,"providers":[{"billed_charge":157495.00,"npi":[1720046188]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"386004606"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53470.00,"providers":[{"billed_charge":133000.00,"npi":[1477599900]}]}]},{"tin":{"type":"ein","value":"382947312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1167.60,"providers":[{"billed_charge":2919.00,"npi":[1578510764]}]}]},{"tin":{"type":"ein","value":"383316836"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":347.20,"providers":[{"billed_charge":868.00,"npi":[1871521542]}]}]},{"tin":{"type":"ein","value":"841657548"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1620.00,"providers":[{"billed_charge":4050.00,"npi":[1871898452]}]}]},{"tin":{"type":"ein","value":"383716596"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4460.00,"providers":[{"billed_charge":11150.00,"npi":[1720046188]}]}]}]},{"name":"Disposable collection and storage bag for breast milk, any size, any type, each","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4287","description":"Disposable collection and storage bag for breast milk, any size, any type, each","allowed_amounts":[{"tin":{"type":"ein","value":"464408166"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1696.32,"providers":[{"billed_charge":5654.40,"npi":[1003462581]}]}]}]},{"name":"GLOVES NON-STERILE PER 100","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4927","description":"GLOVES, NONSTERILE, PER 100","allowed_amounts":[{"tin":{"type":"ein","value":"813717226"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.48,"providers":[{"billed_charge":40.00,"npi":[1174969877]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"824763691"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":862.23,"providers":[{"billed_charge":1575.00,"npi":[1730792664]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"382027689"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":198.12,"providers":[{"billed_charge":325.00,"npi":[1689682551]}]}]},{"tin":{"type":"ein","value":"381357020"},"service_code":["22","10"],"billing_class":"professional","payments":[{"allowed_amount":15.96,"providers":[{"billed_charge":25.00,"npi":[1588732010]}]},{"allowed_amount":47.88,"providers":[{"billed_charge":75.00,"npi":[1588732010]}]}]},{"tin":{"type":"ein","value":"382257883"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.92,"providers":[{"billed_charge":100.00,"npi":[1346693413]}]}]}]},{"name":"PROLNG OF/OP E&M BYND RT;EA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2212","description":"PROLONG OFC/OP E&M BYND REQ TIME; EA ADD 15 M","allowed_amounts":[{"tin":{"type":"ein","value":"462781294"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":780.93,"providers":[{"billed_charge":1800.00,"npi":[1093423824]}]}]}]},{"name":"COORD CARE FEE PHYS OVRSIGHT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G9008","description":"COORDINATED CARE FEE, PHYSICIAN COORDINATED CARE OVERSIGHT SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"382374946"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":938.40,"providers":[{"billed_charge":2346.00,"npi":[1265503031]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2.83,"providers":[{"billed_charge":870.00,"npi":[1114330974]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"830645679"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":54.90,"providers":[{"billed_charge":5130.00,"npi":[1114330974]}]}]}]},{"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":323.16,"providers":[{"billed_charge":425.64,"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":3344.00,"providers":[{"billed_charge":5360.64,"npi":[1234567893]}]}]}]}]}