{"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":"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":"843462728"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":33975.00,"providers":[{"billed_charge":255000.00,"npi":[1891338661]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":91549.18,"providers":[{"billed_charge":55765.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":461375.13,"providers":[{"billed_charge":148008.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":204353.94,"providers":[{"billed_charge":61172.00,"npi":[1912085184]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"831362276"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":7833.20,"providers":[{"billed_charge":2473.00,"npi":[1033698543]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":251552.93,"providers":[{"billed_charge":290030.00,"npi":[1396969499]}]}]}]},{"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":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3914.12,"providers":[{"billed_charge":6456.00,"npi":[1427283795]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":17033.85,"providers":[{"billed_charge":23928.00,"npi":[1508941097]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":447756.88,"providers":[{"billed_charge":155750.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":138920.73,"providers":[{"billed_charge":60144.00,"npi":[1912085184]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":880.01,"providers":[{"billed_charge":1851.60,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6786.84,"providers":[{"billed_charge":12925.65,"npi":[1962594622]}]},{"allowed_amount":264.25,"providers":[{"billed_charge":880.75,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4298.79,"providers":[{"billed_charge":21067.80,"npi":[1265517759]}]},{"allowed_amount":28.39,"providers":[{"billed_charge":11807.40,"npi":[1508941097]}]},{"allowed_amount":127.90,"providers":[{"billed_charge":498679.15,"npi":[1508941097]}]},{"allowed_amount":280.87,"providers":[{"billed_charge":936.15,"npi":[1265517759]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1246.68,"providers":[{"billed_charge":186352.45,"npi":[1912085184]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5904.40,"providers":[{"billed_charge":16346.35,"npi":[1962594622]}]},{"allowed_amount":3011.03,"providers":[{"billed_charge":6948.60,"npi":[1962594622]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470376615"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":212.76,"providers":[{"billed_charge":16272.40,"npi":[1912085184]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470443636"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":221.78,"providers":[{"billed_charge":466.64,"npi":[1528016995]}]},{"allowed_amount":12713.24,"providers":[{"billed_charge":26748.00,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1284.67,"providers":[{"billed_charge":2018.00,"npi":[1861765034]}]},{"allowed_amount":208.27,"providers":[{"billed_charge":104306.00,"npi":[1215006101]}]},{"allowed_amount":814.41,"providers":[{"billed_charge":111542.00,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"440577118"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2053.89,"providers":[{"billed_charge":4540.66,"npi":[1093740128]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4203.64,"providers":[{"billed_charge":133950.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"362604009"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3719.27,"providers":[{"billed_charge":8280.00,"npi":[1588713440]}]},{"allowed_amount":2169.12,"providers":[{"billed_charge":7390.00,"npi":[1588713440]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1258.68,"providers":[{"billed_charge":2901.19,"npi":[1962594622]}]},{"allowed_amount":614.87,"providers":[{"billed_charge":1692.05,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470399853"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1584.15,"providers":[{"billed_charge":2870.00,"npi":[1568547032]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2249.69,"providers":[{"billed_charge":273390.00,"npi":[1336155738]}]},{"allowed_amount":574.25,"providers":[{"billed_charge":2700.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7600.06,"providers":[{"billed_charge":673197.23,"npi":[1508941097]}]},{"allowed_amount":14123.33,"providers":[{"billed_charge":57422.00,"npi":[1265517759]}]},{"allowed_amount":10033.12,"providers":[{"billed_charge":73440.00,"npi":[1265517759]}]},{"allowed_amount":801.32,"providers":[{"billed_charge":2387.60,"npi":[1508941097]}]},{"allowed_amount":1077.27,"providers":[{"billed_charge":1038975.92,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":51.31,"providers":[{"billed_charge":153.00,"npi":[1982675955]}]},{"allowed_amount":1162.79,"providers":[{"billed_charge":94045.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":235.12,"providers":[{"billed_charge":561071.50,"npi":[1912085184]}]},{"allowed_amount":2126.60,"providers":[{"billed_charge":408899.00,"npi":[1912085184]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":235.29,"providers":[{"billed_charge":253.00,"npi":[1093802688]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3335.70,"providers":[{"billed_charge":6137.61,"npi":[1962594622]}]},{"allowed_amount":3607.68,"providers":[{"billed_charge":7047.37,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"311407377"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":32.61,"providers":[{"billed_charge":168.00,"npi":[1538199617]}]},{"allowed_amount":154.22,"providers":[{"billed_charge":5271.00,"npi":[1538199617]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3846.48,"providers":[{"billed_charge":4136.00,"npi":[1093802688]}]},{"allowed_amount":2218.05,"providers":[{"billed_charge":2385.00,"npi":[1093802688]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1306.64,"providers":[{"billed_charge":2634.48,"npi":[1962594622]}]},{"allowed_amount":565.60,"providers":[{"billed_charge":1214.14,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":170.19,"providers":[{"billed_charge":183.00,"npi":[1093802688]}]},{"allowed_amount":486.39,"providers":[{"billed_charge":523.00,"npi":[1093802688]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2102.36,"providers":[{"billed_charge":16491.00,"npi":[1649355132]}]},{"allowed_amount":300.34,"providers":[{"billed_charge":2493.00,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1583.84,"providers":[{"billed_charge":18059.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3564.12,"providers":[{"billed_charge":48589.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":115.67,"providers":[{"billed_charge":486.00,"npi":[1265517759]}]},{"allowed_amount":2353.86,"providers":[{"billed_charge":4175.00,"npi":[1265517759]}]},{"allowed_amount":24698.30,"providers":[{"billed_charge":127350.00,"npi":[1508941097]}]},{"allowed_amount":167.58,"providers":[{"billed_charge":70988.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2126.78,"providers":[{"billed_charge":13783.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4440.67,"providers":[{"billed_charge":42203.00,"npi":[1912085184]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4394.74,"providers":[{"billed_charge":14819.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":51017.57,"providers":[{"billed_charge":47886.00,"npi":[1508941097]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":742.09,"providers":[{"billed_charge":4517.00,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2030.99,"providers":[{"billed_charge":25991.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2684.11,"providers":[{"billed_charge":39586.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":103.63,"providers":[{"billed_charge":1604.00,"npi":[1508941097]}]},{"allowed_amount":25428.63,"providers":[{"billed_charge":186382.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":101.97,"providers":[{"billed_charge":5098.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":424.05,"providers":[{"billed_charge":5507.00,"npi":[1912085184]}]},{"allowed_amount":4557.29,"providers":[{"billed_charge":58406.00,"npi":[1912085184]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5005.58,"providers":[{"billed_charge":59596.00,"npi":[1215006101]}]},{"allowed_amount":2810.41,"providers":[{"billed_charge":44122.00,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10161.34,"providers":[{"billed_charge":147212.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10125.07,"providers":[{"billed_charge":197668.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1087.80,"providers":[{"billed_charge":291005.00,"npi":[1508941097]}]},{"allowed_amount":61198.50,"providers":[{"billed_charge":655007.00,"npi":[1508941097]}]},{"allowed_amount":1101.99,"providers":[{"billed_charge":5172.00,"npi":[1265517759]}]},{"allowed_amount":1424.87,"providers":[{"billed_charge":16710.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5926.00,"providers":[{"billed_charge":76808.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2102.48,"providers":[{"billed_charge":77233.00,"npi":[1912085184]}]},{"allowed_amount":11034.27,"providers":[{"billed_charge":180158.00,"npi":[1912085184]}]}]}]},{"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":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5630.97,"providers":[{"billed_charge":1.00,"npi":[1336155738]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3536.00,"providers":[{"billed_charge":3536.00,"npi":[1710176367]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.20,"providers":[{"billed_charge":40.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":98.16,"providers":[{"billed_charge":201.00,"npi":[1699115394]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3.04,"providers":[{"billed_charge":5.00,"npi":[1234567893]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":923.68,"providers":[{"billed_charge":10970.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2085.53,"providers":[{"billed_charge":20535.00,"npi":[1508941097]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":52.92,"providers":[{"billed_charge":191013.00,"npi":[1508941097]}]}]}]},{"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":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":29.89,"providers":[{"billed_charge":17429.00,"npi":[1508941097]}]},{"allowed_amount":77.73,"providers":[{"billed_charge":324.00,"npi":[1508941097]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":64.54,"providers":[{"billed_charge":176.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":163.14,"providers":[{"billed_charge":212.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":64.54,"providers":[{"billed_charge":212.00,"npi":[1912085184]}]},{"allowed_amount":95.12,"providers":[{"billed_charge":3025.00,"npi":[1912085184]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.59,"providers":[{"billed_charge":182.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":167.28,"providers":[{"billed_charge":219.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.59,"providers":[{"billed_charge":219.00,"npi":[1912085184]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23874.78,"providers":[{"billed_charge":50231.00,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":72119.50,"providers":[{"billed_charge":276825.00,"npi":[1649355132]}]},{"allowed_amount":77705.69,"providers":[{"billed_charge":217726.00,"npi":[1215006101]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":56740.25,"providers":[{"billed_charge":222004.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2140.19,"providers":[{"billed_charge":6094.05,"npi":[1962594622]}]},{"allowed_amount":15058.58,"providers":[{"billed_charge":27812.52,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":136419.04,"providers":[{"billed_charge":412416.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":591425.01,"providers":[{"billed_charge":1782395.00,"npi":[1508941097]}]},{"allowed_amount":56019.17,"providers":[{"billed_charge":109171.00,"npi":[1265517759]}]},{"allowed_amount":2007.72,"providers":[{"billed_charge":351897.00,"npi":[1508941097]}]},{"allowed_amount":9971.29,"providers":[{"billed_charge":37291.00,"npi":[1265517759]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":133069.42,"providers":[{"billed_charge":336222.00,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1248.16,"providers":[{"billed_charge":210458.00,"npi":[1912085184]}]},{"allowed_amount":186894.49,"providers":[{"billed_charge":895706.00,"npi":[1912085184]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":151.01,"providers":[{"billed_charge":5838.00,"npi":[1336155738]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":609.07,"providers":[{"billed_charge":2270.00,"npi":[1508941097]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"470379755"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":17137.48,"providers":[{"billed_charge":69016.00,"npi":[1336184019]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"470443636"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3129.10,"providers":[{"billed_charge":6683.25,"npi":[1528016995]}]}]},{"tin":{"type":"ein","value":"470757164"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59.93,"providers":[{"billed_charge":24331.50,"npi":[1215006101]}]},{"allowed_amount":5519.86,"providers":[{"billed_charge":36330.50,"npi":[1649355132]}]}]},{"tin":{"type":"ein","value":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":139.13,"providers":[{"billed_charge":28713.65,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"421019872"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1820.27,"providers":[{"billed_charge":6067.40,"npi":[1962594622]}]}]},{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":111.34,"providers":[{"billed_charge":66338.35,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"460319070"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":41.00,"providers":[{"billed_charge":136.82,"npi":[1437122009]}]},{"allowed_amount":4596.80,"providers":[{"billed_charge":20906.95,"npi":[1437122009]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19353.98,"providers":[{"billed_charge":187801.47,"npi":[1508941097]}]},{"allowed_amount":1260.89,"providers":[{"billed_charge":4500.65,"npi":[1265517759]}]},{"allowed_amount":125.69,"providers":[{"billed_charge":72365.41,"npi":[1508941097]}]},{"allowed_amount":3397.51,"providers":[{"billed_charge":11286.05,"npi":[1265517759]}]}]},{"tin":{"type":"ein","value":"470376601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":256.87,"providers":[{"billed_charge":35059.30,"npi":[1982675955]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":368.13,"providers":[{"billed_charge":43933.70,"npi":[1912085184]}]},{"allowed_amount":64.60,"providers":[{"billed_charge":71020.35,"npi":[1912085184]}]}]},{"tin":{"type":"ein","value":"470487831"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":180.42,"providers":[{"billed_charge":194.00,"npi":[1093802688]}]},{"allowed_amount":45.57,"providers":[{"billed_charge":49.00,"npi":[1093802688]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"470385129"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":91.48,"providers":[{"billed_charge":190.64,"npi":[1396974069]}]},{"allowed_amount":12.00,"providers":[{"billed_charge":23.83,"npi":[1396974069]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":44.80,"providers":[{"billed_charge":88.00,"npi":[1598116360]}]},{"allowed_amount":92.80,"providers":[{"billed_charge":154.00,"npi":[1598116360]}]},{"allowed_amount":54.40,"providers":[{"billed_charge":88.00,"npi":[1598116360]}]}]}]},{"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":"470379755"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":341.85,"providers":[{"billed_charge":10296.00,"npi":[1336184019]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":978.89,"providers":[{"billed_charge":4113.00,"npi":[1265517759]}]},{"allowed_amount":242.07,"providers":[{"billed_charge":66319.00,"npi":[1508941097]}]},{"allowed_amount":516.17,"providers":[{"billed_charge":1371.00,"npi":[1265517759]}]},{"allowed_amount":111.97,"providers":[{"billed_charge":56283.00,"npi":[1508941097]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":38.25,"providers":[{"billed_charge":75.00,"npi":[1912085184]}]},{"allowed_amount":134.12,"providers":[{"billed_charge":45700.00,"npi":[1912085184]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"470379836"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":222.65,"providers":[{"billed_charge":3714.00,"npi":[1336155738]}]}]},{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4325.53,"providers":[{"billed_charge":8715.00,"npi":[1508941097]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"470385129"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":850.87,"providers":[{"billed_charge":1718.64,"npi":[1154687549]}]},{"allowed_amount":826.35,"providers":[{"billed_charge":1640.52,"npi":[1154687549]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":356.72,"providers":[{"billed_charge":520.00,"npi":[1598116360]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"470385129"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":1129.36,"providers":[{"billed_charge":2280.22,"npi":[1154687549]}]},{"allowed_amount":979.60,"providers":[{"billed_charge":1982.80,"npi":[1154687549]}]}]},{"tin":{"type":"ein","value":"470548630"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":692.23,"providers":[{"billed_charge":1023.00,"npi":[1598116360]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":54.16,"providers":[{"billed_charge":128.00,"npi":[1710176367]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":26312.00,"providers":[{"billed_charge":32890.00,"npi":[1710176367]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2484.30,"providers":[{"billed_charge":5880.00,"npi":[1710176367]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5076.54,"providers":[{"billed_charge":13268.37,"npi":[1710176367]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":27.84,"providers":[{"billed_charge":192.00,"npi":[1679530505]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":39.60,"providers":[{"billed_charge":141.00,"npi":[1710176367]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":148.00,"providers":[{"billed_charge":370.56,"npi":[1710176367]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"391884072"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":10747.00,"providers":[{"billed_charge":97152.00,"npi":[1609981448]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3599.36,"providers":[{"billed_charge":8740.00,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":232.12,"providers":[{"billed_charge":1085.84,"npi":[1710176367]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":627.38,"providers":[{"billed_charge":1413.96,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1922.10,"providers":[{"billed_charge":4559.29,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1417.65,"providers":[{"billed_charge":3219.30,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":921.63,"providers":[{"billed_charge":2108.00,"npi":[1710176367]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2952.60,"providers":[{"billed_charge":8589.90,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":569.25,"providers":[{"billed_charge":1271.79,"npi":[1710176367]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":782.88,"providers":[{"billed_charge":1758.72,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.88,"providers":[{"billed_charge":167.28,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":133.52,"providers":[{"billed_charge":304.00,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1824.04,"providers":[{"billed_charge":4216.00,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":521.55,"providers":[{"billed_charge":1461.36,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2560.60,"providers":[{"billed_charge":5796.00,"npi":[1710176367]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":894.66,"providers":[{"billed_charge":2569.28,"npi":[1710176367]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1263.36,"providers":[{"billed_charge":3050.00,"npi":[1710176367]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1138.20,"providers":[{"billed_charge":4252.08,"npi":[1710176367]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":894.96,"providers":[{"billed_charge":2167.00,"npi":[1710176367]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":393.30,"providers":[{"billed_charge":1140.00,"npi":[1710176367]}]}]}]},{"name":"RBC SED RATE, NONAUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85651","description":"SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.47,"providers":[{"billed_charge":138.69,"npi":[1710176367]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":132.64,"providers":[{"billed_charge":1451.55,"npi":[1710176367]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":442.32,"providers":[{"billed_charge":1074.29,"npi":[1710176367]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":423.60,"providers":[{"billed_charge":759.20,"npi":[1710176367]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":229.14,"providers":[{"billed_charge":526.12,"npi":[1710176367]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":68.49,"providers":[{"billed_charge":180.00,"npi":[1710176367]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":16.53,"providers":[{"billed_charge":38.00,"npi":[1710176367]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.52,"providers":[{"billed_charge":1913.11,"npi":[1234567893]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":222.68,"providers":[{"billed_charge":2470.00,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.52,"providers":[{"billed_charge":1993.10,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1908.76,"providers":[{"billed_charge":4488.00,"npi":[1710176367]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":164.08,"providers":[{"billed_charge":2380.00,"npi":[1234567893]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":445.36,"providers":[{"billed_charge":4203.05,"npi":[1234567893]}]}]}]},{"name":"CYTOPATH C/V THIN LAYER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88142","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"470644046"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2463.92,"providers":[{"billed_charge":6460.00,"npi":[1710176367]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":222.25,"providers":[{"billed_charge":1875.00,"npi":[1234567893]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"470549869"},"service_code":["22","81","21"],"billing_class":"professional","payments":[{"allowed_amount":1111.53,"providers":[{"billed_charge":6732.00,"npi":[1437209350]}]},{"allowed_amount":16.92,"providers":[{"billed_charge":104.00,"npi":[1437209350]}]},{"allowed_amount":2047.79,"providers":[{"billed_charge":12584.00,"npi":[1437209350]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"470390618"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":136.48,"providers":[{"billed_charge":300.00,"npi":[1356068746]}]}]},{"tin":{"type":"ein","value":"391901298"},"service_code":["53","10"],"billing_class":"professional","payments":[{"allowed_amount":75.82,"providers":[{"billed_charge":175.00,"npi":[1811777907]}]},{"allowed_amount":133.40,"providers":[{"billed_charge":350.00,"npi":[1811777907]}]}]},{"tin":{"type":"ein","value":"270631628"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":151.64,"providers":[{"billed_charge":500.00,"npi":[1275314429]}]}]},{"tin":{"type":"ein","value":"262125507"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":530.74,"providers":[{"billed_charge":1015.00,"npi":[1942397674]}]}]},{"tin":{"type":"ein","value":"833296621"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":227.46,"providers":[{"billed_charge":600.00,"npi":[1225133044]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"813456428"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":101.01,"providers":[{"billed_charge":250.00,"npi":[1366053969]}]},{"allowed_amount":3434.34,"providers":[{"billed_charge":8500.00,"npi":[1366053969]}]}]},{"tin":{"type":"ein","value":"476000611"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":2901.73,"providers":[{"billed_charge":4760.00,"npi":[1770854895]}]},{"allowed_amount":5632.77,"providers":[{"billed_charge":9240.00,"npi":[1689129025]}]}]},{"tin":{"type":"ein","value":"853644816"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":909.09,"providers":[{"billed_charge":1710.00,"npi":[1639947476]}]},{"allowed_amount":808.08,"providers":[{"billed_charge":1520.00,"npi":[1639947476]}]}]},{"tin":{"type":"ein","value":"873262015"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1571.22,"providers":[{"billed_charge":3220.00,"npi":[1952183527]}]},{"allowed_amount":2244.60,"providers":[{"billed_charge":4600.00,"npi":[1952183527]}]},{"allowed_amount":224.46,"providers":[{"billed_charge":460.00,"npi":[1689428815]}]},{"allowed_amount":112.23,"providers":[{"billed_charge":230.00,"npi":[1689428815]}]}]},{"tin":{"type":"ein","value":"421629846"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2699.32,"providers":[{"billed_charge":4641.00,"npi":[1598820912]}]}]},{"tin":{"type":"ein","value":"931462174"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2132.37,"providers":[{"billed_charge":4275.00,"npi":[1376131706]}]}]},{"tin":{"type":"ein","value":"820710193"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":8652.99,"providers":[{"billed_charge":17775.00,"npi":[1790065670]}]},{"allowed_amount":303.03,"providers":[{"billed_charge":675.00,"npi":[1790065670]}]}]},{"tin":{"type":"ein","value":"470529089"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1420.80,"providers":[{"billed_charge":1800.00,"npi":[1639809239]}]}]},{"tin":{"type":"ein","value":"881187757"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":448.92,"providers":[{"billed_charge":500.00,"npi":[1689284374]}]}]},{"tin":{"type":"ein","value":"470814384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1122.40,"providers":[{"billed_charge":1500.00,"npi":[1316486210]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"470390618"},"service_code":["11","99","02"],"billing_class":"professional","payments":[{"allowed_amount":18.33,"providers":[{"billed_charge":80.00,"npi":[1356068746]}]},{"allowed_amount":219.96,"providers":[{"billed_charge":960.00,"npi":[1356068746]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"650101421"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10925.00,"providers":[{"billed_charge":79707.60,"npi":[1801227046]}]}]},{"tin":{"type":"ein","value":"470376615"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1352.25,"providers":[{"billed_charge":40320.00,"npi":[1912085184]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"470484764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3380.25,"providers":[{"billed_charge":15212.00,"npi":[1508941097]}]}]}]},{"name":"ELECTROCARDIOGRAM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93000","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":71.52,"providers":[{"billed_charge":336.00,"npi":[1679530505]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"470765154"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":14.76,"providers":[{"billed_charge":46.00,"npi":[1639599467]}]},{"allowed_amount":155.04,"providers":[{"billed_charge":276.00,"npi":[1811075773]}]},{"allowed_amount":38.76,"providers":[{"billed_charge":69.00,"npi":[1811075773]}]},{"allowed_amount":88.56,"providers":[{"billed_charge":276.00,"npi":[1740664911]}]},{"allowed_amount":44.28,"providers":[{"billed_charge":138.00,"npi":[1740664911]}]},{"allowed_amount":15.44,"providers":[{"billed_charge":46.00,"npi":[1891137758]}]},{"allowed_amount":103.36,"providers":[{"billed_charge":184.00,"npi":[1164490140]}]},{"allowed_amount":7.38,"providers":[{"billed_charge":23.00,"npi":[1164475729,1790861920]}]},{"allowed_amount":8.52,"providers":[{"billed_charge":23.00,"npi":[1891137758]}]},{"allowed_amount":22.14,"providers":[{"billed_charge":69.00,"npi":[1164490140]}]},{"allowed_amount":348.84,"providers":[{"billed_charge":621.00,"npi":[1164490140]}]},{"allowed_amount":12.92,"providers":[{"billed_charge":23.00,"npi":[1790861920]}]},{"allowed_amount":51.68,"providers":[{"billed_charge":92.00,"npi":[1316973381]}]},{"allowed_amount":42.60,"providers":[{"billed_charge":115.00,"npi":[1891137758]}]},{"allowed_amount":64.60,"providers":[{"billed_charge":115.00,"npi":[1164475729]}]}]},{"tin":{"type":"ein","value":"823898488"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":51.66,"providers":[{"billed_charge":161.00,"npi":[1366549933]}]},{"allowed_amount":7.38,"providers":[{"billed_charge":23.00,"npi":[1114128261,1366549933]}]},{"allowed_amount":162.36,"providers":[{"billed_charge":506.00,"npi":[1114128261]}]}]}]},{"name":"RHYTHM ECG REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93042","description":"RHYTHM ECG, 1-3 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":43.00,"providers":[{"billed_charge":196.00,"npi":[1386174449]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"900286511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":140.66,"providers":[{"billed_charge":390.00,"npi":[1336182773]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":462.40,"providers":[{"billed_charge":1000.00,"npi":[1194509075]}]},{"allowed_amount":1838.04,"providers":[{"billed_charge":3975.00,"npi":[1245849215]}]}]},{"tin":{"type":"ein","value":"470845219"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.08,"providers":[{"billed_charge":342.00,"npi":[1245952274]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":57.90,"providers":[{"billed_charge":105.00,"npi":[1234567893]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":98.68,"providers":[{"billed_charge":235.00,"npi":[1518563816]}]},{"allowed_amount":19.74,"providers":[{"billed_charge":47.00,"npi":[1063118990]}]}]},{"tin":{"type":"ein","value":"273017327"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":249.96,"providers":[{"billed_charge":900.00,"npi":[1013399179]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":382.14,"providers":[{"billed_charge":880.08,"npi":[1811057664]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":233.52,"providers":[{"billed_charge":472.00,"npi":[1295453496]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":59.20,"providers":[{"billed_charge":168.00,"npi":[1164098869]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.97,"providers":[{"billed_charge":50.00,"npi":[1063118990]}]},{"allowed_amount":153.77,"providers":[{"billed_charge":350.00,"npi":[1518563816]}]}]},{"tin":{"type":"ein","value":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10506.92,"providers":[{"billed_charge":19890.00,"npi":[1245849215]}]},{"allowed_amount":646.84,"providers":[{"billed_charge":1305.00,"npi":[1194509075]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":36.61,"providers":[{"billed_charge":81.00,"npi":[1184362477]}]},{"allowed_amount":32.95,"providers":[{"billed_charge":77.00,"npi":[1295453496]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":1156.91,"providers":[{"billed_charge":3325.00,"npi":[1164098869]}]},{"allowed_amount":32.95,"providers":[{"billed_charge":95.00,"npi":[1164098869]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"844570495"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":35198.80,"providers":[{"billed_charge":158842.24,"npi":[1497486823]}]}]}]},{"name":"GRP ADAPT BHV TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97154","description":"GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"844570495"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":394.56,"providers":[{"billed_charge":13040.64,"npi":[1497486823]}]}]}]},{"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":"844570495"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":180.61,"providers":[{"billed_charge":815.04,"npi":[1497486823]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":612.59,"providers":[{"billed_charge":1400.00,"npi":[1518563816]}]},{"allowed_amount":70.68,"providers":[{"billed_charge":168.00,"npi":[1063118990]}]}]},{"tin":{"type":"ein","value":"470820773"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1070.73,"providers":[{"billed_charge":1890.00,"npi":[1245849215]}]},{"allowed_amount":2976.41,"providers":[{"billed_charge":5310.00,"npi":[1194509075]}]}]},{"tin":{"type":"ein","value":"201970309"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":287.98,"providers":[{"billed_charge":495.00,"npi":[1770552531]}]}]},{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1223.73,"providers":[{"billed_charge":1989.00,"npi":[1316673700]}]}]},{"tin":{"type":"ein","value":"263192763"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":1252.57,"providers":[{"billed_charge":3960.00,"npi":[1164098869]}]},{"allowed_amount":74.59,"providers":[{"billed_charge":240.00,"npi":[1164098869]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"470868784"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":619.38,"providers":[{"billed_charge":1086.00,"npi":[1114171998]}]}]},{"tin":{"type":"ein","value":"454832680"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":516.15,"providers":[{"billed_charge":750.00,"npi":[1245484872]}]}]},{"tin":{"type":"ein","value":"201970309"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":206.46,"providers":[{"billed_charge":330.00,"npi":[1770552531]}]}]},{"tin":{"type":"ein","value":"911781681"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2886.78,"providers":[{"billed_charge":3900.00,"npi":[1467535062]}]}]},{"tin":{"type":"ein","value":"874821653"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2924.85,"providers":[{"billed_charge":5270.00,"npi":[1093427874]}]}]},{"tin":{"type":"ein","value":"834285049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":550.56,"providers":[{"billed_charge":992.00,"npi":[1982428678]}]}]},{"tin":{"type":"ein","value":"470845219"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1582.86,"providers":[{"billed_charge":2760.00,"npi":[1245952274]}]}]},{"tin":{"type":"ein","value":"812700983"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.05,"providers":[{"billed_charge":325.00,"npi":[1083035869]}]}]},{"tin":{"type":"ein","value":"852260473"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":412.92,"providers":[{"billed_charge":900.00,"npi":[1487948378]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":484.02,"providers":[{"billed_charge":770.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"900286511"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1110.30,"providers":[{"billed_charge":1650.00,"npi":[1336182773]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"874821653"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":747.98,"providers":[{"billed_charge":1260.00,"npi":[1093427874]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"470666715"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":436.20,"providers":[{"billed_charge":937.30,"npi":[1376153197]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"883950938"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":423.72,"providers":[{"billed_charge":912.00,"npi":[1588343917]}]}]},{"tin":{"type":"ein","value":"470553173"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":127.11,"providers":[{"billed_charge":216.70,"npi":[1114705217]}]}]},{"tin":{"type":"ein","value":"470421272"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":360.15,"providers":[{"billed_charge":411.00,"npi":[1851378434]}]}]},{"tin":{"type":"ein","value":"452808338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6064.84,"providers":[{"billed_charge":21900.00,"npi":[1093752883]}]}]},{"tin":{"type":"ein","value":"470388012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":398.76,"providers":[{"billed_charge":664.00,"npi":[1124137039]}]}]},{"tin":{"type":"ein","value":"470564743"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":495.00,"providers":[{"billed_charge":495.00,"npi":[1487300182]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":437.49,"providers":[{"billed_charge":570.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":448.62,"providers":[{"billed_charge":520.00,"npi":[1699115394]}]}]},{"tin":{"type":"ein","value":"470616017"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1163.12,"providers":[{"billed_charge":2968.60,"npi":[1679530505]}]}]},{"tin":{"type":"ein","value":"470538792"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1121.58,"providers":[{"billed_charge":1800.60,"npi":[1255914040]}]}]},{"tin":{"type":"ein","value":"462459722"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":249.24,"providers":[{"billed_charge":450.00,"npi":[1801006325]}]},{"allowed_amount":2575.48,"providers":[{"billed_charge":4650.00,"npi":[1801006325]}]}]},{"tin":{"type":"ein","value":"470375220"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":889.77,"providers":[{"billed_charge":1218.00,"npi":[1093852972]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":419.91,"providers":[{"billed_charge":960.70,"npi":[1234567893]}]},{"allowed_amount":220.89,"providers":[{"billed_charge":696.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"470532605"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1525.32,"providers":[{"billed_charge":2790.00,"npi":[1659969426]}]}]},{"tin":{"type":"ein","value":"470750886"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":747.72,"providers":[{"billed_charge":1510.00,"npi":[1023571197]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"470421272"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2028.24,"providers":[{"billed_charge":2400.00,"npi":[1851378434]}]}]},{"tin":{"type":"ein","value":"834455142"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3976.98,"providers":[{"billed_charge":4012.00,"npi":[1386274520]}]},{"allowed_amount":233.94,"providers":[{"billed_charge":236.00,"npi":[1386274520]}]}]},{"tin":{"type":"ein","value":"452808338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":584.85,"providers":[{"billed_charge":1800.00,"npi":[1093752883]}]}]},{"tin":{"type":"ein","value":"271700281"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1988.60,"providers":[{"billed_charge":3880.00,"npi":[1043894199]}]}]},{"tin":{"type":"ein","value":"470551694"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1037.00,"providers":[{"billed_charge":1350.00,"npi":[1740842640]}]}]},{"tin":{"type":"ein","value":"470592379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1473.85,"providers":[{"billed_charge":1632.00,"npi":[1699115394]}]}]},{"tin":{"type":"ein","value":"271191270"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1093.73,"providers":[{"billed_charge":2200.00,"npi":[1851642466]}]}]},{"tin":{"type":"ein","value":"470662290"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":670.32,"providers":[{"billed_charge":1096.00,"npi":[1699081208]}]}]},{"tin":{"type":"ein","value":"932991859"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":99.43,"providers":[{"billed_charge":210.00,"npi":[1720138266]}]},{"allowed_amount":198.86,"providers":[{"billed_charge":420.00,"npi":[1720138266]}]}]},{"tin":{"type":"ein","value":"462459722"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2690.31,"providers":[{"billed_charge":5750.00,"npi":[1427498120]}]},{"allowed_amount":5967.00,"providers":[{"billed_charge":12750.00,"npi":[1801006325]}]},{"allowed_amount":818.79,"providers":[{"billed_charge":1750.00,"npi":[1013688530]}]},{"allowed_amount":233.94,"providers":[{"billed_charge":500.00,"npi":[1013688530]}]},{"allowed_amount":116.97,"providers":[{"billed_charge":250.00,"npi":[1801006325,1427498120]}]}]},{"tin":{"type":"ein","value":"470583290"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3158.25,"providers":[{"billed_charge":3375.00,"npi":[1174567572]}]},{"allowed_amount":4116.31,"providers":[{"billed_charge":5175.00,"npi":[1073066304]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":333.37,"providers":[{"billed_charge":734.86,"npi":[1234567893]}]},{"allowed_amount":1098.46,"providers":[{"billed_charge":1684.00,"npi":[1234567893]}]},{"allowed_amount":500.72,"providers":[{"billed_charge":1088.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"833424514"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3957.71,"providers":[{"billed_charge":4288.00,"npi":[1679823967]}]}]},{"tin":{"type":"ein","value":"873486516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1789.65,"providers":[{"billed_charge":2286.00,"npi":[1417290560]}]}]},{"tin":{"type":"ein","value":"451775323"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1169.70,"providers":[{"billed_charge":2900.00,"npi":[1285104513]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"470765154"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":666.32,"providers":[{"billed_charge":1200.00,"npi":[1194285908]}]},{"allowed_amount":2229.85,"providers":[{"billed_charge":7000.00,"npi":[1528053006]}]},{"allowed_amount":108.30,"providers":[{"billed_charge":400.00,"npi":[1114446028]}]},{"allowed_amount":780.43,"providers":[{"billed_charge":1400.00,"npi":[1518490135]}]},{"allowed_amount":1137.15,"providers":[{"billed_charge":4200.00,"npi":[1629063920]}]},{"allowed_amount":891.92,"providers":[{"billed_charge":1600.00,"npi":[1013570266]}]},{"allowed_amount":3249.21,"providers":[{"billed_charge":10200.00,"npi":[1568759207]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":758.72,"providers":[{"billed_charge":3392.00,"npi":[1902259633]}]},{"allowed_amount":322.46,"providers":[{"billed_charge":1696.00,"npi":[1043969223]}]},{"allowed_amount":1138.08,"providers":[{"billed_charge":5088.00,"npi":[1386174449]}]},{"allowed_amount":806.15,"providers":[{"billed_charge":4240.00,"npi":[1558833277]}]}]},{"tin":{"type":"ein","value":"911769718"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":967.38,"providers":[{"billed_charge":4452.00,"npi":[1790452977]}]}]},{"tin":{"type":"ein","value":"470765154"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":189.68,"providers":[{"billed_charge":339.00,"npi":[1013570266,1891101259]}]},{"allowed_amount":1409.07,"providers":[{"billed_charge":4407.00,"npi":[1528053006]}]},{"allowed_amount":108.39,"providers":[{"billed_charge":339.00,"npi":[1083873756]}]},{"allowed_amount":569.04,"providers":[{"billed_charge":1017.00,"npi":[1598891863,1568099786]}]},{"allowed_amount":758.73,"providers":[{"billed_charge":2373.00,"npi":[1568759207]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"470809403"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1635.27,"providers":[{"billed_charge":8603.00,"npi":[1932891330]}]},{"allowed_amount":2569.71,"providers":[{"billed_charge":13519.00,"npi":[1043969223]}]},{"allowed_amount":6871.00,"providers":[{"billed_charge":30725.00,"npi":[1386174449]}]},{"allowed_amount":1923.88,"providers":[{"billed_charge":8603.00,"npi":[1902259633]}]}]},{"tin":{"type":"ein","value":"911769718"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":274.84,"providers":[{"billed_charge":1076.00,"npi":[1649493420]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"476006099"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":101.78,"providers":[{"billed_charge":252.00,"npi":[1154584639]}]}]},{"tin":{"type":"ein","value":"476006293"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":108.00,"providers":[{"billed_charge":108.00,"npi":[1730183369]}]}]},{"tin":{"type":"ein","value":"332332868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8976.82,"providers":[{"billed_charge":47069.40,"npi":[1295542520]}]}]},{"tin":{"type":"ein","value":"476006192"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14.68,"providers":[{"billed_charge":38.00,"npi":[1205825981]}]}]},{"tin":{"type":"ein","value":"476006205"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":370.77,"providers":[{"billed_charge":998.00,"npi":[1093748212]}]}]},{"tin":{"type":"ein","value":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8985.72,"providers":[{"billed_charge":19776.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006092"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":931.00,"providers":[{"billed_charge":931.00,"npi":[1649203720]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16892.58,"providers":[{"billed_charge":23193.21,"npi":[1477588101]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":71932.94,"providers":[{"billed_charge":170587.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":145779.20,"providers":[{"billed_charge":196947.20,"npi":[1477588101]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"476006304"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":67343.59,"providers":[{"billed_charge":151837.00,"npi":[1083798912]}]}]},{"tin":{"type":"ein","value":"476006256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36444.66,"providers":[{"billed_charge":49276.50,"npi":[1477588101]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3024.75,"providers":[{"billed_charge":11252.62,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7321.75,"providers":[{"billed_charge":35060.08,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":8097.74,"providers":[{"billed_charge":25792.56,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1721.92,"providers":[{"billed_charge":6665.92,"npi":[1234567893]}]}]}]},{"name":"PILLW NASL CANNULA TYPE INTF","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7033","description":"PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":147.84,"providers":[{"billed_charge":1079.82,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1817.82,"providers":[{"billed_charge":8879.74,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1667.83,"providers":[{"billed_charge":6897.37,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":833.66,"providers":[{"billed_charge":3582.70,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1449.11,"providers":[{"billed_charge":6546.64,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":339.87,"providers":[{"billed_charge":1706.50,"npi":[1234567893]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2750.45,"providers":[{"billed_charge":11824.47,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"470490912"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":109.64,"providers":[{"billed_charge":130.80,"npi":[1265628259]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7036.79,"providers":[{"billed_charge":21426.80,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":184.42,"providers":[{"billed_charge":1389.58,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"470737313"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1234.09,"providers":[{"billed_charge":2600.00,"npi":[1376885921]}]}]},{"tin":{"type":"ein","value":"470490912"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":949.30,"providers":[{"billed_charge":1443.90,"npi":[1265628259]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":9159.82,"providers":[{"billed_charge":37490.04,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":17065.15,"providers":[{"billed_charge":91763.97,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1252.81,"providers":[{"billed_charge":7470.00,"npi":[1234567893]}]}]}]},{"name":"NEG PRSS WND TX PUMP STATN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E2402","description":"NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":63612.00,"providers":[{"billed_charge":166806.20,"npi":[1234567893]}]}]}]},{"name":"E-STIM 1/>NOT WND CARE PART","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0283","description":"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A","allowed_amounts":[{"tin":{"type":"ein","value":"810653461"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12.48,"providers":[{"billed_charge":29.00,"npi":[1184362477]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":39478.21,"providers":[{"billed_charge":42405.76,"npi":[1234567893]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":1327.15,"providers":[{"billed_charge":1424.85,"npi":[1234567893]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4512.00,"providers":[{"billed_charge":11280.00,"npi":[1234567893]}]}]}]},{"name":"MULTISYS THERAPY JUVS PER 15","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H2033","description":"MULTISYSTEMIC THERAPY FOR JUVENILES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"391901298"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":3191.49,"providers":[{"billed_charge":10860.00,"npi":[1548912025]}]}]}]}]}