{"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":"570542729"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31440.44,"providers":[{"billed_charge":32583.33,"npi":[1891795738]}]}]},{"tin":{"type":"ein","value":"541436102"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9702.00,"providers":[{"billed_charge":28600.00,"npi":[1902825169]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":25894.00,"providers":[{"billed_charge":23842.00,"npi":[1861496234]}]}]},{"tin":{"type":"ein","value":"472253438"},"service_code":["56","21"],"billing_class":"institutional","payments":[{"allowed_amount":543200.00,"providers":[{"billed_charge":2716000.00,"npi":[1629469549]}]},{"allowed_amount":9100.00,"providers":[{"billed_charge":45500.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"263075304"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":30720.00,"providers":[{"billed_charge":86400.00,"npi":[1669638821]}]}]},{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15300.00,"providers":[{"billed_charge":48600.00,"npi":[1033697099]}]}]},{"tin":{"type":"ein","value":"842277779"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":2070.00,"providers":[{"billed_charge":7500.00,"npi":[1861045767]}]}]}]},{"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":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":623724.56,"providers":[{"billed_charge":206925.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":45030.16,"providers":[{"billed_charge":11625.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":77323.23,"providers":[{"billed_charge":62775.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":58497.55,"providers":[{"billed_charge":40508.00,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":864440.89,"providers":[{"billed_charge":205989.00,"npi":[1326043548]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"850988160"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1108.00,"providers":[{"billed_charge":3456.00,"npi":[1306621578]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":143830.73,"providers":[{"billed_charge":116808.00,"npi":[1891148821]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":330515.85,"providers":[{"billed_charge":276168.00,"npi":[1891148821]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":292622.68,"providers":[{"billed_charge":962588.00,"npi":[1033120837]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"472253438"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":84000.01,"providers":[{"billed_charge":481500.00,"npi":[1629469549]}]}]},{"tin":{"type":"ein","value":"815105103"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":39900.00,"providers":[{"billed_charge":168000.00,"npi":[1033697099]}]}]}]},{"name":"ANESTH, LENS SURGERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"142","description":"ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":791.20,"providers":[{"billed_charge":5000.00,"npi":[1234567893]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":235484.91,"providers":[{"billed_charge":121345.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":450972.05,"providers":[{"billed_charge":433513.00,"npi":[1962472860]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5.01,"providers":[{"billed_charge":16.60,"npi":[1881647204]}]},{"allowed_amount":61.11,"providers":[{"billed_charge":246.50,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":136.14,"providers":[{"billed_charge":453.70,"npi":[1427030774]}]},{"allowed_amount":248.42,"providers":[{"billed_charge":884.55,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1584.00,"providers":[{"billed_charge":219228.80,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.03,"providers":[{"billed_charge":0.10,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"832550272"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23.77,"providers":[{"billed_charge":79.23,"npi":[1942224696]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1832.75,"providers":[{"billed_charge":5085.75,"npi":[1417432840]}]},{"allowed_amount":18.16,"providers":[{"billed_charge":3098.80,"npi":[1417432840]}]},{"allowed_amount":198.32,"providers":[{"billed_charge":547.45,"npi":[1396790325]}]},{"allowed_amount":47.03,"providers":[{"billed_charge":129.55,"npi":[1346297892]}]},{"allowed_amount":612.98,"providers":[{"billed_charge":1690.35,"npi":[1396790325]}]},{"allowed_amount":524.09,"providers":[{"billed_charge":1489.05,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":34.89,"providers":[{"billed_charge":92726.70,"npi":[1336603646]}]},{"allowed_amount":7.84,"providers":[{"billed_charge":4835.30,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":643.89,"providers":[{"billed_charge":4388.00,"npi":[1427055821]}]},{"allowed_amount":377.70,"providers":[{"billed_charge":1259.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11804.62,"providers":[{"billed_charge":32905.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":143.48,"providers":[{"billed_charge":543.50,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2613.20,"providers":[{"billed_charge":114345.40,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":487.47,"providers":[{"billed_charge":23581.30,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1632.30,"providers":[{"billed_charge":5441.00,"npi":[1962277343]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":458.19,"providers":[{"billed_charge":9852.70,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":108.06,"providers":[{"billed_charge":10548.80,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1.26,"providers":[{"billed_charge":1529.20,"npi":[1336603646]}]},{"allowed_amount":211.80,"providers":[{"billed_charge":7203.10,"npi":[1336603646]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":205579.80,"providers":[{"billed_charge":801955.00,"npi":[1649726738]}]},{"allowed_amount":30905.73,"providers":[{"billed_charge":155450.00,"npi":[1649726738]}]},{"allowed_amount":1412.10,"providers":[{"billed_charge":6956.00,"npi":[1851847974]}]},{"allowed_amount":40509.38,"providers":[{"billed_charge":117977.00,"npi":[1114473212]}]},{"allowed_amount":4036.82,"providers":[{"billed_charge":8232.00,"npi":[1841746948]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":683.97,"providers":[{"billed_charge":23246.00,"npi":[1851361778]}]},{"allowed_amount":116070.18,"providers":[{"billed_charge":102853.00,"npi":[1851361778]}]},{"allowed_amount":280.76,"providers":[{"billed_charge":518.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":147425.40,"providers":[{"billed_charge":131956.00,"npi":[1962472860]}]},{"allowed_amount":508.91,"providers":[{"billed_charge":51031.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":439.00,"providers":[{"billed_charge":7800.00,"npi":[1255645644]}]},{"allowed_amount":19593.11,"providers":[{"billed_charge":19867.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22.21,"providers":[{"billed_charge":54.30,"npi":[1417432840]}]},{"allowed_amount":3425.43,"providers":[{"billed_charge":9476.00,"npi":[1417432840]}]},{"allowed_amount":293.78,"providers":[{"billed_charge":809.30,"npi":[1396790325]}]},{"allowed_amount":2760.76,"providers":[{"billed_charge":7655.80,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":123092.18,"providers":[{"billed_charge":103535.00,"npi":[1336603646]}]},{"allowed_amount":182.12,"providers":[{"billed_charge":15867.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3063.02,"providers":[{"billed_charge":7809.00,"npi":[1326043548]}]},{"allowed_amount":84197.96,"providers":[{"billed_charge":279408.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"582296052"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":551.34,"providers":[{"billed_charge":1886.00,"npi":[1033889795]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":50.98,"providers":[{"billed_charge":155.98,"npi":[1417432840]}]},{"allowed_amount":28.31,"providers":[{"billed_charge":77.99,"npi":[1417432840]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5073.93,"providers":[{"billed_charge":14058.97,"npi":[1417432840]}]},{"allowed_amount":259.86,"providers":[{"billed_charge":5659.88,"npi":[1417432840]}]},{"allowed_amount":17948.56,"providers":[{"billed_charge":49445.07,"npi":[1396790325]}]},{"allowed_amount":3262.67,"providers":[{"billed_charge":8988.07,"npi":[1396790325]}]},{"allowed_amount":74477.15,"providers":[{"billed_charge":205778.59,"npi":[1417432840]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":35254.03,"providers":[{"billed_charge":1613230.91,"npi":[1649726738]}]},{"allowed_amount":1631.16,"providers":[{"billed_charge":96457.08,"npi":[1649726738]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1272.69,"providers":[{"billed_charge":2244.00,"npi":[1538164090]}]},{"allowed_amount":3702.15,"providers":[{"billed_charge":5996.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10286.66,"providers":[{"billed_charge":45833.00,"npi":[1013918960]}]},{"allowed_amount":30841.88,"providers":[{"billed_charge":52956.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":12311.26,"providers":[{"billed_charge":45390.00,"npi":[1649726738]}]},{"allowed_amount":50208.62,"providers":[{"billed_charge":156777.00,"npi":[1649726738]}]},{"allowed_amount":18.18,"providers":[{"billed_charge":252.00,"npi":[1851847974]}]},{"allowed_amount":16.27,"providers":[{"billed_charge":56.00,"npi":[1841746948]}]},{"allowed_amount":359.52,"providers":[{"billed_charge":1433.00,"npi":[1851846661]}]},{"allowed_amount":2796.08,"providers":[{"billed_charge":17858.00,"npi":[1114473212]}]},{"allowed_amount":3884.48,"providers":[{"billed_charge":12756.00,"npi":[1396207221]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11.20,"providers":[{"billed_charge":37.33,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1004.46,"providers":[{"billed_charge":69550.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":666.58,"providers":[{"billed_charge":46584.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":23.40,"providers":[{"billed_charge":8181.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560585243"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.84,"providers":[{"billed_charge":336.01,"npi":[1043218944]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":54.10,"providers":[{"billed_charge":43025.00,"npi":[1336603646]}]},{"allowed_amount":126.25,"providers":[{"billed_charge":777.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2327.13,"providers":[{"billed_charge":5233.00,"npi":[1477591055]}]},{"allowed_amount":1497.32,"providers":[{"billed_charge":4510.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18637.63,"providers":[{"billed_charge":47057.00,"npi":[1326043548]}]},{"allowed_amount":394.97,"providers":[{"billed_charge":4350.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":436.26,"providers":[{"billed_charge":790.00,"npi":[1811973100]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":719.17,"providers":[{"billed_charge":3694.00,"npi":[1720747496]}]},{"allowed_amount":8.46,"providers":[{"billed_charge":3079.00,"npi":[1396207221]}]},{"allowed_amount":84.95,"providers":[{"billed_charge":6974.00,"npi":[1851847974]}]},{"allowed_amount":1145.39,"providers":[{"billed_charge":52087.00,"npi":[1114473212]}]},{"allowed_amount":683.74,"providers":[{"billed_charge":8857.00,"npi":[1841746948]}]},{"allowed_amount":1050.31,"providers":[{"billed_charge":932580.00,"npi":[1649726738]}]},{"allowed_amount":2153.70,"providers":[{"billed_charge":26896.00,"npi":[1851846661]}]},{"allowed_amount":28120.86,"providers":[{"billed_charge":246574.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12672.53,"providers":[{"billed_charge":24561.00,"npi":[1881647204]}]},{"allowed_amount":4282.58,"providers":[{"billed_charge":13442.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"560530233"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":191.79,"providers":[{"billed_charge":564.00,"npi":[1427030774]}]},{"allowed_amount":351.30,"providers":[{"billed_charge":1171.00,"npi":[1427030774]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6868.00,"providers":[{"billed_charge":407020.00,"npi":[1962472860]}]},{"allowed_amount":121.11,"providers":[{"billed_charge":408121.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2418.60,"providers":[{"billed_charge":8062.00,"npi":[1740998020]}]},{"allowed_amount":5371.90,"providers":[{"billed_charge":9606.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"42697983"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":156.68,"providers":[{"billed_charge":590.00,"npi":[1023049236]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":42936.33,"providers":[{"billed_charge":118491.65,"npi":[1396790325]}]},{"allowed_amount":1196.93,"providers":[{"billed_charge":3188.35,"npi":[1396790325]}]},{"allowed_amount":3171.27,"providers":[{"billed_charge":14226.75,"npi":[1417432840]}]},{"allowed_amount":1848.45,"providers":[{"billed_charge":5180.00,"npi":[1396790325]}]},{"allowed_amount":101.65,"providers":[{"billed_charge":223.90,"npi":[1346297892]}]},{"allowed_amount":62776.89,"providers":[{"billed_charge":174121.10,"npi":[1417432840]}]},{"allowed_amount":101.48,"providers":[{"billed_charge":279.55,"npi":[1346297892]}]},{"allowed_amount":3101.64,"providers":[{"billed_charge":8792.75,"npi":[1417432840]}]},{"allowed_amount":5545.97,"providers":[{"billed_charge":15278.30,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":298.57,"providers":[{"billed_charge":397562.00,"npi":[1336603646]}]},{"allowed_amount":3062.30,"providers":[{"billed_charge":174961.00,"npi":[1336603646]}]},{"allowed_amount":268.97,"providers":[{"billed_charge":5353.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":245.08,"providers":[{"billed_charge":6001.00,"npi":[1326043548]}]},{"allowed_amount":213.09,"providers":[{"billed_charge":353046.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"582179986"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":23.99,"providers":[{"billed_charge":173.00,"npi":[1437186111]}]},{"allowed_amount":14.15,"providers":[{"billed_charge":563.75,"npi":[1437186111]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1620.54,"providers":[{"billed_charge":4541.00,"npi":[1427055821]}]},{"allowed_amount":495.07,"providers":[{"billed_charge":7432.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":420.00,"providers":[{"billed_charge":420.00,"npi":[1427075027]}]},{"allowed_amount":243.00,"providers":[{"billed_charge":810.00,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":18345.19,"providers":[{"billed_charge":43186.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":159.11,"providers":[{"billed_charge":593.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"570331865"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":135.82,"providers":[{"billed_charge":452.74,"npi":[1023046612]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4749.50,"providers":[{"billed_charge":204517.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4765.00,"providers":[{"billed_charge":75133.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"541848065"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":837.16,"providers":[{"billed_charge":2650.00,"npi":[1437175734]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9777.19,"providers":[{"billed_charge":37166.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":93.47,"providers":[{"billed_charge":526.00,"npi":[1376139139]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":479.48,"providers":[{"billed_charge":26218.10,"npi":[1649726738]}]},{"allowed_amount":2433.90,"providers":[{"billed_charge":29952.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11.32,"providers":[{"billed_charge":1214.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":416.20,"providers":[{"billed_charge":7587.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34.30,"providers":[{"billed_charge":3101.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1194.43,"providers":[{"billed_charge":3290.45,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":31.34,"providers":[{"billed_charge":222.00,"npi":[1326043548]}]},{"allowed_amount":110.32,"providers":[{"billed_charge":2289.00,"npi":[1326043548]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2182.61,"providers":[{"billed_charge":49708.00,"npi":[1649726738]}]},{"allowed_amount":306.02,"providers":[{"billed_charge":14735.00,"npi":[1114473212]}]},{"allowed_amount":69.55,"providers":[{"billed_charge":1148.00,"npi":[1841746948]}]},{"allowed_amount":31.08,"providers":[{"billed_charge":1259.00,"npi":[1851847974]},{"billed_charge":504.00,"npi":[1851846661]}]},{"allowed_amount":20.71,"providers":[{"billed_charge":1940.00,"npi":[1396207221]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":197.33,"providers":[{"billed_charge":796.00,"npi":[1881647204]}]},{"allowed_amount":1973.99,"providers":[{"billed_charge":2205.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1820.01,"providers":[{"billed_charge":3371.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1431.20,"providers":[{"billed_charge":55351.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1187.60,"providers":[{"billed_charge":116231.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":195.95,"providers":[{"billed_charge":214.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":333.45,"providers":[{"billed_charge":15868.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1197.38,"providers":[{"billed_charge":4658.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1406.27,"providers":[{"billed_charge":3954.55,"npi":[1417432840]}]},{"allowed_amount":10948.96,"providers":[{"billed_charge":30212.35,"npi":[1396790325]}]},{"allowed_amount":15729.06,"providers":[{"billed_charge":43632.35,"npi":[1417432840]}]},{"allowed_amount":232.99,"providers":[{"billed_charge":513.20,"npi":[1396790325]}]},{"allowed_amount":1362.67,"providers":[{"billed_charge":3754.10,"npi":[1346297892]}]},{"allowed_amount":644.30,"providers":[{"billed_charge":1828.45,"npi":[1396790325]}]},{"allowed_amount":48.22,"providers":[{"billed_charge":132.85,"npi":[1346297892]}]},{"allowed_amount":677.78,"providers":[{"billed_charge":2887.25,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":820.60,"providers":[{"billed_charge":45198.00,"npi":[1336603646]}]},{"allowed_amount":8.63,"providers":[{"billed_charge":742.00,"npi":[1336603646]}]},{"allowed_amount":162.13,"providers":[{"billed_charge":103637.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":31.77,"providers":[{"billed_charge":1621.00,"npi":[1326043548]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":40.53,"providers":[{"billed_charge":405.00,"npi":[1922788728]}]},{"allowed_amount":694.30,"providers":[{"billed_charge":133800.00,"npi":[1649726738]}]},{"allowed_amount":12387.87,"providers":[{"billed_charge":128577.00,"npi":[1649726738]}]},{"allowed_amount":516.51,"providers":[{"billed_charge":4533.00,"npi":[1851846661]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":509.85,"providers":[{"billed_charge":3562.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":43680.62,"providers":[{"billed_charge":68808.00,"npi":[1962472860]}]},{"allowed_amount":150.38,"providers":[{"billed_charge":216.00,"npi":[1962472860]}]},{"allowed_amount":722.70,"providers":[{"billed_charge":24600.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19466.94,"providers":[{"billed_charge":27129.00,"npi":[1851361778]}]},{"allowed_amount":594.25,"providers":[{"billed_charge":11949.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1937.76,"providers":[{"billed_charge":3761.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":335.05,"providers":[{"billed_charge":738.00,"npi":[1396790325]}]},{"allowed_amount":15907.68,"providers":[{"billed_charge":43822.45,"npi":[1396790325]}]},{"allowed_amount":16029.62,"providers":[{"billed_charge":44338.55,"npi":[1417432840]}]},{"allowed_amount":88.61,"providers":[{"billed_charge":244.10,"npi":[1396790325]}]},{"allowed_amount":1342.52,"providers":[{"billed_charge":3698.45,"npi":[1417432840]}]},{"allowed_amount":1505.35,"providers":[{"billed_charge":4396.10,"npi":[1417432840]}]},{"allowed_amount":73.34,"providers":[{"billed_charge":202.05,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":126.10,"providers":[{"billed_charge":10067.00,"npi":[1336603646]}]},{"allowed_amount":27963.89,"providers":[{"billed_charge":46019.00,"npi":[1336603646]}]},{"allowed_amount":293.01,"providers":[{"billed_charge":432.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2297.79,"providers":[{"billed_charge":68467.00,"npi":[1326043548]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":193.15,"providers":[{"billed_charge":5952.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":113.74,"providers":[{"billed_charge":6660.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":99.79,"providers":[{"billed_charge":11817.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":256.00,"providers":[{"billed_charge":1979.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":299.26,"providers":[{"billed_charge":838.95,"npi":[1396790325]}]},{"allowed_amount":51.98,"providers":[{"billed_charge":143.20,"npi":[1346297892]}]},{"allowed_amount":535.13,"providers":[{"billed_charge":1474.25,"npi":[1417432840]}]},{"allowed_amount":33.01,"providers":[{"billed_charge":80.70,"npi":[1417432840]}]},{"allowed_amount":2457.94,"providers":[{"billed_charge":6771.75,"npi":[1396790325]}]},{"allowed_amount":3791.90,"providers":[{"billed_charge":10488.65,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":278.30,"providers":[{"billed_charge":6372.00,"npi":[1336603646]}]},{"allowed_amount":3.52,"providers":[{"billed_charge":226.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5.67,"providers":[{"billed_charge":194.00,"npi":[1326043548]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":89.05,"providers":[{"billed_charge":230948.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/CYTOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"311","description":"LABORATORY PATHOLOGICAL - CYTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1573.13,"providers":[{"billed_charge":38159.00,"npi":[1649726738]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":885.15,"providers":[{"billed_charge":74047.00,"npi":[1649726738]}]},{"allowed_amount":285.61,"providers":[{"billed_charge":9200.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":623.09,"providers":[{"billed_charge":1716.50,"npi":[1417432840]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3708.57,"providers":[{"billed_charge":7444.00,"npi":[1013918960]}]},{"allowed_amount":519.21,"providers":[{"billed_charge":1801.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":12989.96,"providers":[{"billed_charge":117440.00,"npi":[1649726738]}]},{"allowed_amount":805.76,"providers":[{"billed_charge":276874.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":487.02,"providers":[{"billed_charge":824.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":983.10,"providers":[{"billed_charge":15750.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5783.39,"providers":[{"billed_charge":15932.10,"npi":[1396790325]}]},{"allowed_amount":3614.75,"providers":[{"billed_charge":10049.45,"npi":[1417432840]}]},{"allowed_amount":1863.49,"providers":[{"billed_charge":5133.55,"npi":[1417432840]}]},{"allowed_amount":2859.21,"providers":[{"billed_charge":8045.75,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":105.20,"providers":[{"billed_charge":5954.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10186.49,"providers":[{"billed_charge":55662.00,"npi":[1326043548]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":47614.60,"providers":[{"billed_charge":160450.00,"npi":[1649726738]}]},{"allowed_amount":733.80,"providers":[{"billed_charge":7615.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36173.83,"providers":[{"billed_charge":82839.00,"npi":[1962472860]}]},{"allowed_amount":537.40,"providers":[{"billed_charge":25786.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17699.16,"providers":[{"billed_charge":39600.00,"npi":[1851361778]}]},{"allowed_amount":95.40,"providers":[{"billed_charge":10396.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1795.78,"providers":[{"billed_charge":5471.00,"npi":[1255645644]}]},{"allowed_amount":125.00,"providers":[{"billed_charge":1436.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":145.70,"providers":[{"billed_charge":8208.00,"npi":[1336603646]}]},{"allowed_amount":21364.20,"providers":[{"billed_charge":48985.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5043.14,"providers":[{"billed_charge":13967.55,"npi":[1417432840]}]},{"allowed_amount":472.93,"providers":[{"billed_charge":1302.85,"npi":[1417432840]}]},{"allowed_amount":337.30,"providers":[{"billed_charge":929.20,"npi":[1396790325]}]},{"allowed_amount":359.66,"providers":[{"billed_charge":838.25,"npi":[1417432840]}]},{"allowed_amount":6878.57,"providers":[{"billed_charge":19016.75,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":737.75,"providers":[{"billed_charge":3070.00,"npi":[1326043548]}]},{"allowed_amount":25231.05,"providers":[{"billed_charge":75855.00,"npi":[1326043548]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":38256.73,"providers":[{"billed_charge":172334.00,"npi":[1649726738]}]},{"allowed_amount":206110.86,"providers":[{"billed_charge":766377.00,"npi":[1114473212]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3144.60,"providers":[{"billed_charge":8662.80,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8663.54,"providers":[{"billed_charge":59638.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":87135.31,"providers":[{"billed_charge":284581.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"582296052"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1944.70,"providers":[{"billed_charge":7018.00,"npi":[1033889795]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":992.79,"providers":[{"billed_charge":3116.00,"npi":[1851847974]}]},{"allowed_amount":51824.23,"providers":[{"billed_charge":100210.00,"npi":[1114473212]}]},{"allowed_amount":22869.38,"providers":[{"billed_charge":43477.00,"npi":[1649726738]}]}]}]},{"name":"NUC MED/DX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"341","description":"NUCLEAR MEDICINE - DIAGNOSTIC","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":669.73,"providers":[{"billed_charge":2374.00,"npi":[1649726738]}]}]}]},{"name":"NUC MED/DX RADIOPHARM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"343","description":"DIAGNOSTIC RADIOPHARMACEUTICALS","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7015.91,"providers":[{"billed_charge":97108.90,"npi":[1649726738]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":296.71,"providers":[{"billed_charge":3083.00,"npi":[1649726738]}]},{"allowed_amount":69653.60,"providers":[{"billed_charge":700193.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21250.48,"providers":[{"billed_charge":182169.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20301.25,"providers":[{"billed_charge":148974.00,"npi":[1851361778]}]},{"allowed_amount":1396.00,"providers":[{"billed_charge":15030.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19604.62,"providers":[{"billed_charge":54007.25,"npi":[1417432840]}]},{"allowed_amount":2420.48,"providers":[{"billed_charge":6668.00,"npi":[1417432840]}]},{"allowed_amount":1210.24,"providers":[{"billed_charge":3334.00,"npi":[1396790325]}]},{"allowed_amount":2763.66,"providers":[{"billed_charge":7613.40,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16080.33,"providers":[{"billed_charge":136052.00,"npi":[1336603646]}]},{"allowed_amount":1067.00,"providers":[{"billed_charge":7515.00,"npi":[1336603646]}]},{"allowed_amount":98.30,"providers":[{"billed_charge":2505.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":894.96,"providers":[{"billed_charge":7955.00,"npi":[1326043548]}]},{"allowed_amount":30546.47,"providers":[{"billed_charge":271841.00,"npi":[1326043548]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1892.80,"providers":[{"billed_charge":34460.00,"npi":[1790264497]}]},{"allowed_amount":6567.31,"providers":[{"billed_charge":80421.00,"npi":[1649726738]}]},{"allowed_amount":99425.65,"providers":[{"billed_charge":1685927.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2874.00,"providers":[{"billed_charge":108432.00,"npi":[1851361778]}]},{"allowed_amount":56054.06,"providers":[{"billed_charge":467626.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":64530.03,"providers":[{"billed_charge":532786.00,"npi":[1962472860]}]},{"allowed_amount":789.00,"providers":[{"billed_charge":175966.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12024.39,"providers":[{"billed_charge":109832.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":66160.93,"providers":[{"billed_charge":457115.00,"npi":[1336603646]}]},{"allowed_amount":553.58,"providers":[{"billed_charge":8488.00,"npi":[1336603646]}]},{"allowed_amount":533.50,"providers":[{"billed_charge":37304.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13813.61,"providers":[{"billed_charge":38054.00,"npi":[1396790325]}]},{"allowed_amount":42325.56,"providers":[{"billed_charge":116599.30,"npi":[1417432840]}]},{"allowed_amount":66830.81,"providers":[{"billed_charge":184106.85,"npi":[1396790325]}]},{"allowed_amount":1713.08,"providers":[{"billed_charge":4188.45,"npi":[1417432840]}]},{"allowed_amount":101014.44,"providers":[{"billed_charge":279620.85,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":56132.24,"providers":[{"billed_charge":785850.00,"npi":[1326043548]}]},{"allowed_amount":7115.02,"providers":[{"billed_charge":70811.00,"npi":[1326043548]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":172191.18,"providers":[{"billed_charge":371893.98,"npi":[1649726738]}]},{"allowed_amount":1265728.00,"providers":[{"billed_charge":3004850.04,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":641.74,"providers":[{"billed_charge":1578.00,"npi":[1851361778]}]},{"allowed_amount":27847.99,"providers":[{"billed_charge":29767.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":6859.18,"providers":[{"billed_charge":18895.80,"npi":[1417432840]}]},{"allowed_amount":54879.95,"providers":[{"billed_charge":153644.47,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":10109.74,"providers":[{"billed_charge":42122.00,"npi":[1326043548]}]},{"allowed_amount":141328.66,"providers":[{"billed_charge":391773.99,"npi":[1326043548]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":792625.91,"providers":[{"billed_charge":1964295.00,"npi":[1649726738]}]},{"allowed_amount":24031.80,"providers":[{"billed_charge":41474.00,"npi":[1649726738]}]},{"allowed_amount":12526.62,"providers":[{"billed_charge":30223.00,"npi":[1629432869]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":19520.34,"providers":[{"billed_charge":53775.05,"npi":[1417432840]}]},{"allowed_amount":3058.40,"providers":[{"billed_charge":8425.35,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":27441.70,"providers":[{"billed_charge":54856.00,"npi":[1326043548]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1089.93,"providers":[{"billed_charge":2820.00,"npi":[1134675978]}]},{"allowed_amount":15.46,"providers":[{"billed_charge":40.00,"npi":[1720899875]}]},{"allowed_amount":262.82,"providers":[{"billed_charge":680.00,"npi":[1720899875]}]},{"allowed_amount":324.66,"providers":[{"billed_charge":840.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":174.98,"providers":[{"billed_charge":312.00,"npi":[1750795183,1952982563,1477991479]}]},{"allowed_amount":215.36,"providers":[{"billed_charge":384.00,"npi":[1235152349]}]},{"allowed_amount":619.16,"providers":[{"billed_charge":1104.00,"npi":[1912986977]}]}]},{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":9.10,"providers":[{"billed_charge":10.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":49.86,"providers":[{"billed_charge":144.00,"npi":[1447313630]}]},{"allowed_amount":182.82,"providers":[{"billed_charge":528.00,"npi":[1336423599]}]},{"allowed_amount":214.94,"providers":[{"billed_charge":528.00,"npi":[1194037853]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":54.04,"providers":[{"billed_charge":213.22,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.84,"providers":[{"billed_charge":719.88,"npi":[1234567893]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":371.30,"providers":[{"billed_charge":14234.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":49259.65,"providers":[{"billed_charge":136954.65,"npi":[1417432840]}]}]}]},{"name":"MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"401","description":"OTHER IMAGING SERVICES - MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3164.47,"providers":[{"billed_charge":10344.00,"npi":[1326043548]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":296.31,"providers":[{"billed_charge":3164.00,"npi":[1790264497]}]},{"allowed_amount":16953.32,"providers":[{"billed_charge":178212.00,"npi":[1649726738]}]},{"allowed_amount":18308.84,"providers":[{"billed_charge":123624.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":826.30,"providers":[{"billed_charge":5923.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3029.29,"providers":[{"billed_charge":36218.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3409.57,"providers":[{"billed_charge":30298.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":343.54,"providers":[{"billed_charge":946.40,"npi":[1396790325]}]},{"allowed_amount":5617.08,"providers":[{"billed_charge":15800.85,"npi":[1417432840]}]},{"allowed_amount":5609.16,"providers":[{"billed_charge":15924.30,"npi":[1417432840]}]},{"allowed_amount":1064.26,"providers":[{"billed_charge":2931.85,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9834.93,"providers":[{"billed_charge":59251.00,"npi":[1326043548]}]},{"allowed_amount":3385.63,"providers":[{"billed_charge":37336.00,"npi":[1326043548]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1768.18,"providers":[{"billed_charge":5188.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":13278.24,"providers":[{"billed_charge":39130.00,"npi":[1326043548]}]}]}]},{"name":"PET SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"404","description":"POSITION EMISSION TOMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9724.12,"providers":[{"billed_charge":23120.00,"npi":[1649726738]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4214.36,"providers":[{"billed_charge":21521.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1565.46,"providers":[{"billed_charge":11332.00,"npi":[1326043548]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":42.33,"providers":[{"billed_charge":1286.00,"npi":[1649726738]}]},{"allowed_amount":7970.87,"providers":[{"billed_charge":34493.00,"npi":[1760963243]}]},{"allowed_amount":5898.43,"providers":[{"billed_charge":26893.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":318.78,"providers":[{"billed_charge":952.45,"npi":[1396790325]}]},{"allowed_amount":61.34,"providers":[{"billed_charge":187.75,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":20412.68,"providers":[{"billed_charge":81968.00,"npi":[1326043548]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3928.84,"providers":[{"billed_charge":8940.00,"npi":[1649726738]}]},{"allowed_amount":1907.49,"providers":[{"billed_charge":4114.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":232.88,"providers":[{"billed_charge":602.00,"npi":[1326043548]}]},{"allowed_amount":838.55,"providers":[{"billed_charge":1569.00,"npi":[1326043548]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":182.87,"providers":[{"billed_charge":708.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2135.84,"providers":[{"billed_charge":10651.00,"npi":[1326043548]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1891.45,"providers":[{"billed_charge":5141.00,"npi":[1649726738]}]},{"allowed_amount":515.85,"providers":[{"billed_charge":1474.00,"npi":[1649726738]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9205.88,"providers":[{"billed_charge":31315.00,"npi":[1013918960]}]},{"allowed_amount":63756.31,"providers":[{"billed_charge":121592.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"311626179"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":561.63,"providers":[{"billed_charge":2304.50,"npi":[1538164090]}]},{"allowed_amount":4394.39,"providers":[{"billed_charge":7702.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1488437.75,"providers":[{"billed_charge":3347454.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":44969.31,"providers":[{"billed_charge":63799.00,"npi":[1881647204]}]},{"allowed_amount":5177.67,"providers":[{"billed_charge":20881.00,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1052204.40,"providers":[{"billed_charge":2508907.00,"npi":[1962472860]}]},{"allowed_amount":4384.00,"providers":[{"billed_charge":209280.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":25699.75,"providers":[{"billed_charge":37744.00,"npi":[1740998020]}]},{"allowed_amount":1553.70,"providers":[{"billed_charge":5179.00,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":697969.99,"providers":[{"billed_charge":1666851.00,"npi":[1336603646]}]},{"allowed_amount":2411.60,"providers":[{"billed_charge":130460.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":256033.12,"providers":[{"billed_charge":706476.25,"npi":[1396790325]}]},{"allowed_amount":26773.44,"providers":[{"billed_charge":73756.15,"npi":[1346297892]}]},{"allowed_amount":253655.48,"providers":[{"billed_charge":703264.00,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"581588823"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2355.58,"providers":[{"billed_charge":4679.00,"npi":[1477591055]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":626935.40,"providers":[{"billed_charge":1597222.00,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"561376368"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1169.83,"providers":[{"billed_charge":4465.00,"npi":[1063463156]}]},{"allowed_amount":61.80,"providers":[{"billed_charge":206.00,"npi":[1063463156]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1553.74,"providers":[{"billed_charge":4711.00,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":34423.58,"providers":[{"billed_charge":92302.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":604461.41,"providers":[{"billed_charge":1469677.00,"npi":[1851361778]}]},{"allowed_amount":4486.60,"providers":[{"billed_charge":173596.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2548.00,"providers":[{"billed_charge":45253.00,"npi":[1255645644]}]},{"allowed_amount":146834.19,"providers":[{"billed_charge":348636.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"332454250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16003.52,"providers":[{"billed_charge":22716.00,"npi":[1205889458]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":70983.45,"providers":[{"billed_charge":156316.00,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2812.53,"providers":[{"billed_charge":8605.00,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3831.96,"providers":[{"billed_charge":14249.00,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4455.79,"providers":[{"billed_charge":9440.25,"npi":[1053358945]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3652.74,"providers":[{"billed_charge":11710.00,"npi":[1326043548]}]}]}]},{"name":"CARDIAC CATH LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"481","description":"CARDIOLOGY - CARDIAC CATH LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":87137.02,"providers":[{"billed_charge":116645.00,"npi":[1649726738]}]},{"allowed_amount":327720.81,"providers":[{"billed_charge":832702.00,"npi":[1649726738]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":13088.83,"providers":[{"billed_charge":57928.00,"npi":[1649726738]}]},{"allowed_amount":5345.53,"providers":[{"billed_charge":77536.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2967.70,"providers":[{"billed_charge":78599.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1837.62,"providers":[{"billed_charge":6122.00,"npi":[1326043548]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":3985.49,"providers":[{"billed_charge":11256.00,"npi":[1871674481]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":665.90,"providers":[{"billed_charge":1828.00,"npi":[1649726738]}]},{"allowed_amount":10444.85,"providers":[{"billed_charge":12700.00,"npi":[1649726738]}]},{"allowed_amount":719.94,"providers":[{"billed_charge":1152.00,"npi":[1851847974]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7383.63,"providers":[{"billed_charge":14657.00,"npi":[1326043548]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1894.65,"providers":[{"billed_charge":4064.00,"npi":[1053358945]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"586076010"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":6498.10,"providers":[{"billed_charge":19771.16,"npi":[1316794639]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1424.75,"providers":[{"billed_charge":41104.00,"npi":[1649726738]}]},{"allowed_amount":1593.34,"providers":[{"billed_charge":12016.00,"npi":[1649726738]}]}]}]},{"name":"MRI-SPINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"612","description":"MRI - SPINAL CORD (INCLUDING SPINE)","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1424.75,"providers":[{"billed_charge":3689.00,"npi":[1649726738]}]}]}]},{"name":"MAGNETIC RESONANCE TECHNOLOG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"614","description":"MAGNETIC RESONANCE TECHNOLOGY - MRI -OTHER","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4377.14,"providers":[{"billed_charge":30386.00,"npi":[1649726738]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2675.92,"providers":[{"billed_charge":73333.60,"npi":[1013918960]}]},{"allowed_amount":2563.58,"providers":[{"billed_charge":8588.90,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":745881.55,"providers":[{"billed_charge":2652814.04,"npi":[1649726738]}]},{"allowed_amount":4.16,"providers":[{"billed_charge":1865.40,"npi":[1629432869]}]},{"allowed_amount":5039.18,"providers":[{"billed_charge":432248.20,"npi":[1649726738]}]},{"allowed_amount":60764.71,"providers":[{"billed_charge":201849.30,"npi":[1841746948]}]},{"allowed_amount":776572.10,"providers":[{"billed_charge":2373956.50,"npi":[1114473212]}]},{"allowed_amount":1.75,"providers":[{"billed_charge":598.48,"npi":[1922788728]}]},{"allowed_amount":37979.42,"providers":[{"billed_charge":224918.80,"npi":[1851847974]}]},{"allowed_amount":41.61,"providers":[{"billed_charge":24872.90,"npi":[1639656713]}]}]},{"tin":{"type":"ein","value":"560554230"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2320.25,"providers":[{"billed_charge":7551.70,"npi":[1881647204]}]},{"allowed_amount":3192.03,"providers":[{"billed_charge":17366.45,"npi":[1881647204]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11133.95,"providers":[{"billed_charge":74000.28,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"863305323"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1081.06,"providers":[{"billed_charge":3603.40,"npi":[1740998020]}]}]},{"tin":{"type":"ein","value":"850105601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36.20,"providers":[{"billed_charge":56.00,"npi":[1215913470]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5259.17,"providers":[{"billed_charge":14596.05,"npi":[1417432840]}]},{"allowed_amount":1791.38,"providers":[{"billed_charge":4934.90,"npi":[1346297892]}]},{"allowed_amount":10725.93,"providers":[{"billed_charge":29903.70,"npi":[1417432840]}]},{"allowed_amount":60.27,"providers":[{"billed_charge":265.50,"npi":[1396790325]}]},{"allowed_amount":3375.87,"providers":[{"billed_charge":9328.70,"npi":[1396790325]}]},{"allowed_amount":72.02,"providers":[{"billed_charge":198.40,"npi":[1346297892]}]},{"allowed_amount":3379.98,"providers":[{"billed_charge":9354.95,"npi":[1396790325]}]},{"allowed_amount":431.60,"providers":[{"billed_charge":2644.55,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":111.91,"providers":[{"billed_charge":863.80,"npi":[1336603646]}]},{"allowed_amount":722.97,"providers":[{"billed_charge":44381.98,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7328.38,"providers":[{"billed_charge":155402.70,"npi":[1326043548]}]},{"allowed_amount":40104.81,"providers":[{"billed_charge":156853.80,"npi":[1326043548]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2345.47,"providers":[{"billed_charge":6881.00,"npi":[1427055821]}]},{"allowed_amount":2161.60,"providers":[{"billed_charge":9650.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"560543246"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6148.34,"providers":[{"billed_charge":6248.31,"npi":[1427075027]}]}]},{"tin":{"type":"ein","value":"560928089"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":471.82,"providers":[{"billed_charge":1572.90,"npi":[1447200233]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26621.98,"providers":[{"billed_charge":100046.06,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":126.81,"providers":[{"billed_charge":8882.46,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"332454250"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.24,"providers":[{"billed_charge":2334.00,"npi":[1205889458]}]}]},{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1354.05,"providers":[{"billed_charge":4513.50,"npi":[1962277343]}]}]},{"tin":{"type":"ein","value":"853777599"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4.51,"providers":[{"billed_charge":2293.05,"npi":[1376139139]}]},{"allowed_amount":890.91,"providers":[{"billed_charge":6784.21,"npi":[1376139139]}]}]},{"tin":{"type":"ein","value":"582190713"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":675.75,"providers":[{"billed_charge":2252.50,"npi":[1265486278]}]}]},{"tin":{"type":"ein","value":"582296052"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":24761.16,"providers":[{"billed_charge":84948.30,"npi":[1033889795]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":446.95,"providers":[{"billed_charge":1877.20,"npi":[1013918960]}]},{"allowed_amount":426.03,"providers":[{"billed_charge":1429.30,"npi":[1013918960]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"450699531"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":900.00,"providers":[{"billed_charge":900.00,"npi":[1205915188]}]}]}]},{"name":"TRAUMA LEVEL 1","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"681","description":"TRAUMA LEVEL 1","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4410.66,"providers":[{"billed_charge":115731.00,"npi":[1649726738]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1552.08,"providers":[{"billed_charge":4275.70,"npi":[1417432840]}]},{"allowed_amount":22572.33,"providers":[{"billed_charge":62819.90,"npi":[1417432840]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"273818647"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":140.76,"providers":[{"billed_charge":486.00,"npi":[1154385193]}]},{"allowed_amount":15.64,"providers":[{"billed_charge":54.00,"npi":[1154385193]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560619359"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":201.22,"providers":[{"billed_charge":768.00,"npi":[1013918960]}]},{"allowed_amount":1465.60,"providers":[{"billed_charge":1792.00,"npi":[1013918960]}]}]},{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":594.00,"providers":[{"billed_charge":18600.00,"npi":[1649726738]}]},{"allowed_amount":55.31,"providers":[{"billed_charge":2574.00,"npi":[1396207221]}]}]},{"tin":{"type":"ein","value":"571098556"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1091.86,"providers":[{"billed_charge":1606.00,"npi":[1033120837]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":420.80,"providers":[{"billed_charge":28653.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":249.40,"providers":[{"billed_charge":18417.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570360499"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":163.00,"providers":[{"billed_charge":3129.00,"npi":[1255645644]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13520.60,"providers":[{"billed_charge":38060.40,"npi":[1417432840]}]},{"allowed_amount":10253.25,"providers":[{"billed_charge":28495.95,"npi":[1396790325]}]},{"allowed_amount":237.85,"providers":[{"billed_charge":581.55,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":285.61,"providers":[{"billed_charge":8493.00,"npi":[1336603646]}]},{"allowed_amount":192.76,"providers":[{"billed_charge":90027.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1094.94,"providers":[{"billed_charge":7293.00,"npi":[1326043548]}]}]}]},{"name":"EEG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"740","description":"EEG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":782.31,"providers":[{"billed_charge":2955.00,"npi":[1649726738]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7593.56,"providers":[{"billed_charge":26971.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":332.96,"providers":[{"billed_charge":3367.00,"npi":[1326043548]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"571067254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":246.00,"providers":[{"billed_charge":2352.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4212.46,"providers":[{"billed_charge":11604.60,"npi":[1417432840]}]},{"allowed_amount":12344.00,"providers":[{"billed_charge":34618.50,"npi":[1417432840]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3044.83,"providers":[{"billed_charge":6258.43,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8069.75,"providers":[{"billed_charge":22750.00,"npi":[1205495884]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":911.24,"providers":[{"billed_charge":2375.00,"npi":[1497293773]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"812719403"},"service_code":["15"],"billing_class":"professional","payments":[{"allowed_amount":2197.92,"providers":[{"billed_charge":5700.00,"npi":[1497293773]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1967.12,"providers":[{"billed_charge":3293.00,"npi":[1649726738]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":439.96,"providers":[{"billed_charge":1212.10,"npi":[1811005150]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":476.32,"providers":[{"billed_charge":1312.20,"npi":[1811005150]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":49.42,"providers":[{"billed_charge":591.36,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2466.76,"providers":[{"billed_charge":6838.60,"npi":[1811005150]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":22.35,"providers":[{"billed_charge":267.80,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1625.83,"providers":[{"billed_charge":4513.50,"npi":[1811005150]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"844246379"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":428.80,"providers":[{"billed_charge":2400.00,"npi":[1821683186]}]},{"allowed_amount":996.96,"providers":[{"billed_charge":5580.00,"npi":[1609451194]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2676.42,"providers":[{"billed_charge":23143.14,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":56.56,"providers":[{"billed_charge":155.80,"npi":[1811005150]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"204068094"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.68,"providers":[{"billed_charge":160.00,"npi":[1285387084]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":32.47,"providers":[{"billed_charge":170.00,"npi":[1134675978]}]},{"allowed_amount":28.65,"providers":[{"billed_charge":150.00,"npi":[1134675978]}]}]}]},{"name":"FETAL CHRMOML ANEUPLOIDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI","allowed_amounts":[{"tin":{"type":"ein","value":"811082020"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10247.18,"providers":[{"billed_charge":42506.80,"npi":[1598314437]}]}]}]},{"name":"Under Multianalyte Assays with Algorithmic Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81515","description":"Under Multianalyte Assays with Algorithmic Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1931.88,"providers":[{"billed_charge":5322.00,"npi":[1811005150]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":35.59,"providers":[{"billed_charge":98.05,"npi":[1811005150]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"273795223"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":28160.00,"providers":[{"billed_charge":262786.56,"npi":[1912209123]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1500.80,"providers":[{"billed_charge":4134.20,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":205.91,"providers":[{"billed_charge":575.40,"npi":[1811005150]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1679.10,"providers":[{"billed_charge":4625.50,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":541.80,"providers":[{"billed_charge":1492.40,"npi":[1811005150]}]}]}]},{"name":"HEMOGLOBIN ELECTROPHORESIS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83020","description":"HEMOGLOBIN FRACTIONATION AND QUANTITATION; ELECTROPHORESIS (EG, A2, S, C, AND/OR F)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":219.90,"providers":[{"billed_charge":605.75,"npi":[1811005150]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":24.30,"providers":[{"billed_charge":205.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.65,"providers":[{"billed_charge":145.00,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1898.56,"providers":[{"billed_charge":5278.00,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3507.84,"providers":[{"billed_charge":9664.20,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.89,"providers":[{"billed_charge":35.50,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.02,"providers":[{"billed_charge":72.16,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":363.81,"providers":[{"billed_charge":1017.90,"npi":[1811005150]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.32,"providers":[{"billed_charge":806.40,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2346.80,"providers":[{"billed_charge":6482.80,"npi":[1811005150]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":501.12,"providers":[{"billed_charge":1380.60,"npi":[1811005150]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":39.60,"providers":[{"billed_charge":103.56,"npi":[1134675978]}]},{"allowed_amount":46.20,"providers":[{"billed_charge":120.82,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":224.40,"providers":[{"billed_charge":400.00,"npi":[1912986977]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":39.00,"providers":[{"billed_charge":466.20,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5322.80,"providers":[{"billed_charge":14704.10,"npi":[1811005150]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":874.76,"providers":[{"billed_charge":2424.20,"npi":[1811005150]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":111.24,"providers":[{"billed_charge":306.45,"npi":[1811005150]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":867.01,"providers":[{"billed_charge":2398.90,"npi":[1811005150]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2422.35,"providers":[{"billed_charge":6752.40,"npi":[1811005150]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1535.84,"providers":[{"billed_charge":4248.00,"npi":[1811005150]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":131.37,"providers":[{"billed_charge":371.20,"npi":[1811005150]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":706.80,"providers":[{"billed_charge":1991.25,"npi":[1811005150]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1679.15,"providers":[{"billed_charge":4684.00,"npi":[1811005150]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":240.79,"providers":[{"billed_charge":663.30,"npi":[1811005150]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2243.69,"providers":[{"billed_charge":6361.60,"npi":[1811005150]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2983.40,"providers":[{"billed_charge":8314.80,"npi":[1811005150]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":476.64,"providers":[{"billed_charge":1362.35,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":97.93,"providers":[{"billed_charge":269.85,"npi":[1811005150]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":157.03,"providers":[{"billed_charge":445.20,"npi":[1811005150]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":780.80,"providers":[{"billed_charge":2151.00,"npi":[1811005150]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":43.06,"providers":[{"billed_charge":124.80,"npi":[1811005150]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3354.03,"providers":[{"billed_charge":9290.70,"npi":[1811005150]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":199.36,"providers":[{"billed_charge":549.20,"npi":[1811005150]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":370.00,"providers":[{"billed_charge":1019.20,"npi":[1811005150]}]}]}]},{"name":"SMEAR, WET MOUNT, SALINE/INK","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87210","description":"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; WET MOUNT FOR INFECTIOUS AGENTS (EG, SALINE, INDIA INK, K","allowed_amounts":[{"tin":{"type":"ein","value":"571004971"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.86,"providers":[{"billed_charge":20.00,"npi":[1780465732]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1762.82,"providers":[{"billed_charge":4918.55,"npi":[1811005150]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13023.14,"providers":[{"billed_charge":36281.25,"npi":[1811005150]}]}]}]},{"name":"CANDIDA, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87480","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.70,"providers":[{"billed_charge":123.15,"npi":[1811005150]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":210.96,"providers":[{"billed_charge":2265.81,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1220.33,"providers":[{"billed_charge":3480.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3984.33,"providers":[{"billed_charge":11113.55,"npi":[1811005150]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":260.00,"npi":[1234567893]}]}]}]},{"name":"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":11.72,"providers":[{"billed_charge":130.00,"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":210.96,"providers":[{"billed_charge":2265.81,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1220.52,"providers":[{"billed_charge":3480.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3948.63,"providers":[{"billed_charge":11015.20,"npi":[1811005150]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":128.92,"providers":[{"billed_charge":1611.08,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":609.88,"providers":[{"billed_charge":1740.00,"npi":[1023098928]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5502.05,"providers":[{"billed_charge":15299.20,"npi":[1811005150]}]}]}]},{"name":"TRICHOMONAS VAGIN, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87660","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.70,"providers":[{"billed_charge":123.15,"npi":[1811005150]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":260.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1073.17,"providers":[{"billed_charge":3060.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":380.46,"providers":[{"billed_charge":1122.60,"npi":[1811005150]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":117.20,"providers":[{"billed_charge":1300.00,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":70.35,"providers":[{"billed_charge":165.50,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":344.47,"providers":[{"billed_charge":2450.00,"npi":[1992282297]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":246.26,"providers":[{"billed_charge":2688.00,"npi":[1992282297]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":28.12,"providers":[{"billed_charge":172.00,"npi":[1992282297]}]}]}]},{"name":"CYTOPATH, C/V, INTERPRET","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88141","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING INTERPRETATION BY PHYSICIAN","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.38,"providers":[{"billed_charge":369.00,"npi":[1023098928]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":266.70,"providers":[{"billed_charge":2470.08,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1945.70,"providers":[{"billed_charge":5490.00,"npi":[1023098928]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7920.60,"providers":[{"billed_charge":21912.00,"npi":[1811005150]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"571122647"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":39.07,"providers":[{"billed_charge":215.00,"npi":[1225524069]}]}]},{"tin":{"type":"ein","value":"800564919"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":169.00,"providers":[{"billed_charge":3380.00,"npi":[1689237844]}]}]},{"tin":{"type":"ein","value":"463666116"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":128.44,"providers":[{"billed_charge":200.00,"npi":[1609306315]}]}]},{"tin":{"type":"ein","value":"570560638"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":16.99,"providers":[{"billed_charge":145.00,"npi":[1942361688]}]},{"allowed_amount":203.86,"providers":[{"billed_charge":1740.00,"npi":[1942361688]}]}]},{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3401.00,"providers":[{"billed_charge":9408.00,"npi":[1811005150]}]}]}]},{"name":"ELECTRO SHOCK","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"901","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - ELECTROSCHOCK TREATMENT","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9703.98,"providers":[{"billed_charge":26411.00,"npi":[1639656713]}]}]}]},{"name":"PSYCH DIAGNOSTIC EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90791","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["99","12","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":2829.45,"providers":[{"billed_charge":4386.00,"npi":[1508811324]}]},{"allowed_amount":488.64,"providers":[{"billed_charge":1224.00,"npi":[1508811324]}]},{"allowed_amount":909.15,"providers":[{"billed_charge":1224.00,"npi":[1841374972]}]},{"allowed_amount":7627.08,"providers":[{"billed_charge":10506.00,"npi":[1609979640]}]},{"allowed_amount":243.03,"providers":[{"billed_charge":408.00,"npi":[1508811324]}]},{"allowed_amount":282.06,"providers":[{"billed_charge":408.00,"npi":[1831200310]}]},{"allowed_amount":325.76,"providers":[{"billed_charge":408.00,"npi":[1831200310,1609979640]}]},{"allowed_amount":162.88,"providers":[{"billed_charge":204.00,"npi":[1508811324,1609979640]}]},{"allowed_amount":794.64,"providers":[{"billed_charge":1020.00,"npi":[1841374972]}]},{"allowed_amount":2586.42,"providers":[{"billed_charge":4080.00,"npi":[1831200310]}]},{"allowed_amount":4326.66,"providers":[{"billed_charge":6018.00,"npi":[1841374972]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":160.64,"providers":[{"billed_charge":330.00,"npi":[1508811324]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":884.13,"providers":[{"billed_charge":1144.00,"npi":[1508811324]}]},{"allowed_amount":408.06,"providers":[{"billed_charge":528.00,"npi":[1841374972]}]},{"allowed_amount":1292.19,"providers":[{"billed_charge":1672.00,"npi":[1508811324]}]},{"allowed_amount":1768.26,"providers":[{"billed_charge":2288.00,"npi":[1609979640]}]},{"allowed_amount":617.36,"providers":[{"billed_charge":704.00,"npi":[1841374972]}]},{"allowed_amount":77.17,"providers":[{"billed_charge":88.00,"npi":[1508811324]}]},{"allowed_amount":952.14,"providers":[{"billed_charge":1232.00,"npi":[1841374972]}]},{"allowed_amount":68.01,"providers":[{"billed_charge":88.00,"npi":[1609979640]}]},{"allowed_amount":385.85,"providers":[{"billed_charge":440.00,"npi":[1508811324]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1760970529]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["11","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":1166.49,"providers":[{"billed_charge":2275.00,"npi":[1508811324]}]},{"allowed_amount":628.11,"providers":[{"billed_charge":1225.00,"npi":[1841374972]}]},{"allowed_amount":1120.13,"providers":[{"billed_charge":1925.00,"npi":[1508811324]}]},{"allowed_amount":1345.95,"providers":[{"billed_charge":2625.00,"npi":[1508811324]}]},{"allowed_amount":509.15,"providers":[{"billed_charge":875.00,"npi":[1508811324]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["99","11","12","02","03","53"],"billing_class":"professional","payments":[{"allowed_amount":150.84,"providers":[{"billed_charge":265.00,"npi":[1508811324,1609979640]}]},{"allowed_amount":1726.66,"providers":[{"billed_charge":3445.00,"npi":[1508811324,1609979640]}]},{"allowed_amount":1593.84,"providers":[{"billed_charge":3180.00,"npi":[1841374972]}]},{"allowed_amount":3718.96,"providers":[{"billed_charge":7420.00,"npi":[1841374972]}]},{"allowed_amount":2413.44,"providers":[{"billed_charge":4240.00,"npi":[1508811324]}]},{"allowed_amount":10227.14,"providers":[{"billed_charge":20405.00,"npi":[1508811324]}]},{"allowed_amount":603.36,"providers":[{"billed_charge":1060.00,"npi":[1609979640]}]},{"allowed_amount":132.82,"providers":[{"billed_charge":265.00,"npi":[1831200310]}]},{"allowed_amount":2390.76,"providers":[{"billed_charge":4770.00,"npi":[1831200310]}]},{"allowed_amount":301.68,"providers":[{"billed_charge":530.00,"npi":[1831200310]}]}]},{"tin":{"type":"ein","value":"932266390"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":2601.99,"providers":[{"billed_charge":5750.00,"npi":[1588729313]}]},{"allowed_amount":2149.47,"providers":[{"billed_charge":4750.00,"npi":[1144607524]}]},{"allowed_amount":99.62,"providers":[{"billed_charge":250.00,"npi":[1376990218]}]},{"allowed_amount":1810.08,"providers":[{"billed_charge":3867.43,"npi":[1376990218]}]}]},{"tin":{"type":"ein","value":"871200580"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":300.00,"providers":[{"billed_charge":300.00,"npi":[1326631771]}]}]}]},{"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":"811567573"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":29808.00,"providers":[{"billed_charge":189750.00,"npi":[1649715517]}]}]},{"tin":{"type":"ein","value":"465287425"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10230.00,"providers":[{"billed_charge":101975.28,"npi":[1952719189]}]}]}]},{"name":"PSTAY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"919","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - OTHER","allowed_amounts":[{"tin":{"type":"ein","value":"621768106"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3431.10,"providers":[{"billed_charge":13902.00,"npi":[1962277343]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":670.56,"providers":[{"billed_charge":4112.00,"npi":[1649726738]}]},{"allowed_amount":502.93,"providers":[{"billed_charge":3076.00,"npi":[1649726738]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8205.95,"providers":[{"billed_charge":67283.00,"npi":[1649726738]}]},{"allowed_amount":1595.25,"providers":[{"billed_charge":11028.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"571067254"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1222.37,"providers":[{"billed_charge":7033.00,"npi":[1851361778]}]}]},{"tin":{"type":"ein","value":"570828733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":680.29,"providers":[{"billed_charge":4193.00,"npi":[1962472860]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1173.48,"providers":[{"billed_charge":3580.40,"npi":[1417432840]}]},{"allowed_amount":839.17,"providers":[{"billed_charge":2311.75,"npi":[1417432840]}]}]},{"tin":{"type":"ein","value":"263710229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":329.70,"providers":[{"billed_charge":6797.00,"npi":[1336603646]}]},{"allowed_amount":3964.87,"providers":[{"billed_charge":21663.00,"npi":[1336603646]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4617.32,"providers":[{"billed_charge":23883.00,"npi":[1326043548]}]},{"allowed_amount":3171.37,"providers":[{"billed_charge":16116.00,"npi":[1326043548]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"830770746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":200.00,"providers":[{"billed_charge":200.00,"npi":[1194395590]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":162.96,"providers":[{"billed_charge":560.60,"npi":[1417432840]}]},{"allowed_amount":8297.04,"providers":[{"billed_charge":23105.90,"npi":[1417432840]}]},{"allowed_amount":85.92,"providers":[{"billed_charge":236.70,"npi":[1346297892]}]},{"allowed_amount":6747.31,"providers":[{"billed_charge":18607.30,"npi":[1396790325]}]},{"allowed_amount":192.97,"providers":[{"billed_charge":471.80,"npi":[1417432840]}]},{"allowed_amount":83.47,"providers":[{"billed_charge":280.30,"npi":[1396790325]}]}]}]},{"name":"EDUC/TRAINING","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"942","description":"OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8911.18,"providers":[{"billed_charge":14308.00,"npi":[1649726738]}]}]}]},{"name":"CARDIAC REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"943","description":"OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"811723202"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5876.08,"providers":[{"billed_charge":11284.00,"npi":[1649726738]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":152.39,"providers":[{"billed_charge":419.80,"npi":[1396790325]}]}]},{"tin":{"type":"ein","value":"474914917"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":12026.43,"providers":[{"billed_charge":22971.00,"npi":[1326043548]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":457.19,"providers":[{"billed_charge":1572.00,"npi":[1134675978]}]},{"allowed_amount":184.97,"providers":[{"billed_charge":636.00,"npi":[1720899875]}]},{"allowed_amount":3.49,"providers":[{"billed_charge":12.00,"npi":[1720899875]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":111.80,"providers":[{"billed_charge":390.00,"npi":[1134675978]}]},{"allowed_amount":145.34,"providers":[{"billed_charge":507.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["99","53"],"billing_class":"professional","payments":[{"allowed_amount":511.55,"providers":[{"billed_charge":950.00,"npi":[1609979640]}]},{"allowed_amount":157.80,"providers":[{"billed_charge":300.00,"npi":[1841374972]}]},{"allowed_amount":263.00,"providers":[{"billed_charge":500.00,"npi":[1508811324]}]},{"allowed_amount":26.30,"providers":[{"billed_charge":50.00,"npi":[1609979640]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.90,"providers":[{"billed_charge":40.00,"npi":[1093941346]}]},{"allowed_amount":149.50,"providers":[{"billed_charge":250.00,"npi":[1376789891]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":127.70,"providers":[{"billed_charge":250.00,"npi":[1376789891]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"203152516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":244.40,"providers":[{"billed_charge":600.00,"npi":[1134813975]}]}]},{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.20,"providers":[{"billed_charge":600.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"462814974"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.45,"providers":[{"billed_charge":255.00,"npi":[1053141796]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.46,"providers":[{"billed_charge":240.42,"npi":[1932922440]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":220.40,"providers":[{"billed_charge":700.00,"npi":[1780230680]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"822819223"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3887.26,"providers":[{"billed_charge":4275.00,"npi":[1417386822]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"851502637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":249.35,"providers":[{"billed_charge":750.00,"npi":[1780230680]}]}]},{"tin":{"type":"ein","value":"830770746"},"service_code":["99","11","12"],"billing_class":"professional","payments":[{"allowed_amount":524.90,"providers":[{"billed_charge":1000.00,"npi":[1740749985]}]},{"allowed_amount":1181.04,"providers":[{"billed_charge":2250.00,"npi":[1740749985]}]},{"allowed_amount":1094.41,"providers":[{"billed_charge":2100.00,"npi":[1740749985]}]}]},{"tin":{"type":"ein","value":"474438367"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":388.46,"providers":[{"billed_charge":800.00,"npi":[1821677782]}]}]},{"tin":{"type":"ein","value":"474797980"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":228.32,"providers":[{"billed_charge":635.22,"npi":[1932922440]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"843983650"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":371.10,"providers":[{"billed_charge":600.00,"npi":[1649689969]}]}]},{"tin":{"type":"ein","value":"582068734"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1212.90,"providers":[{"billed_charge":1350.00,"npi":[1093941346]}]},{"allowed_amount":404.30,"providers":[{"billed_charge":550.00,"npi":[1376789891]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":397.05,"providers":[{"billed_charge":1176.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"571021048"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1004.34,"providers":[{"billed_charge":2322.00,"npi":[1447824115]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":8.15,"providers":[{"billed_charge":96.00,"npi":[1508811324]}]},{"allowed_amount":32.60,"providers":[{"billed_charge":480.00,"npi":[1831200310]}]},{"allowed_amount":24.45,"providers":[{"billed_charge":288.00,"npi":[1508811324]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":1940.76,"providers":[{"billed_charge":4779.00,"npi":[1134675978]}]},{"allowed_amount":4815.96,"providers":[{"billed_charge":11859.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"570992733"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":71.88,"providers":[{"billed_charge":185.00,"npi":[1871998302]}]}]},{"tin":{"type":"ein","value":"844246379"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":679.90,"providers":[{"billed_charge":1625.00,"npi":[1821683186]}]},{"allowed_amount":246.12,"providers":[{"billed_charge":500.00,"npi":[1629285150]}]},{"allowed_amount":2039.70,"providers":[{"billed_charge":4875.00,"npi":[1821683186]}]},{"allowed_amount":7340.43,"providers":[{"billed_charge":17500.00,"npi":[1609451194]}]},{"allowed_amount":253.68,"providers":[{"billed_charge":375.00,"npi":[1629285150]}]},{"allowed_amount":123.06,"providers":[{"billed_charge":250.00,"npi":[1629285150]}]},{"allowed_amount":6469.20,"providers":[{"billed_charge":11250.00,"npi":[1609451194]}]},{"allowed_amount":5386.54,"providers":[{"billed_charge":12875.00,"npi":[1609451194]}]},{"allowed_amount":4672.20,"providers":[{"billed_charge":8125.00,"npi":[1821683186]}]}]},{"tin":{"type":"ein","value":"237085643"},"service_code":["11","50"],"billing_class":"professional","payments":[{"allowed_amount":253.68,"providers":[{"billed_charge":276.00,"npi":[1548344096]}]},{"allowed_amount":169.12,"providers":[{"billed_charge":184.00,"npi":[1548344096]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1623.20,"providers":[{"billed_charge":3640.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"271734536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":84.56,"providers":[{"billed_charge":100.00,"npi":[1033432778]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":2635.10,"providers":[{"billed_charge":6760.00,"npi":[1134675978]}]},{"allowed_amount":9628.25,"providers":[{"billed_charge":24700.00,"npi":[1134675978]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":5013.16,"providers":[{"billed_charge":10960.00,"npi":[1215146352]}]}]},{"tin":{"type":"ein","value":"561667838"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":133.82,"providers":[{"billed_charge":324.00,"npi":[1912986977]}]},{"allowed_amount":4527.25,"providers":[{"billed_charge":8100.00,"npi":[1235152349,1750795183]}]},{"allowed_amount":2354.17,"providers":[{"billed_charge":4212.00,"npi":[1952982563]}]},{"allowed_amount":267.64,"providers":[{"billed_charge":648.00,"npi":[1750795183]}]},{"allowed_amount":10684.31,"providers":[{"billed_charge":19116.00,"npi":[1912986977]}]},{"allowed_amount":1267.63,"providers":[{"billed_charge":2268.00,"npi":[1720378136]}]}]},{"tin":{"type":"ein","value":"576000922"},"service_code":["02","53"],"billing_class":"professional","payments":[{"allowed_amount":1630.44,"providers":[{"billed_charge":4504.00,"npi":[1841374972]}]},{"allowed_amount":905.80,"providers":[{"billed_charge":1719.00,"npi":[1508811324]}]},{"allowed_amount":90.58,"providers":[{"billed_charge":132.00,"npi":[1609979640]}]},{"allowed_amount":2355.08,"providers":[{"billed_charge":4697.00,"npi":[1841374972]}]},{"allowed_amount":452.90,"providers":[{"billed_charge":1325.00,"npi":[1609979640]}]},{"allowed_amount":543.48,"providers":[{"billed_charge":1457.00,"npi":[1831200310]}]},{"allowed_amount":1992.76,"providers":[{"billed_charge":4453.00,"npi":[1831200310]}]},{"allowed_amount":271.74,"providers":[{"billed_charge":396.00,"npi":[1508811324]}]}]},{"tin":{"type":"ein","value":"570722653"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1907.68,"providers":[{"billed_charge":4432.00,"npi":[1780141093]}]}]},{"tin":{"type":"ein","value":"570664826"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2330.82,"providers":[{"billed_charge":5740.80,"npi":[1225482524]}]}]},{"tin":{"type":"ein","value":"271467095"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3141.54,"providers":[{"billed_charge":5208.00,"npi":[1992282297]}]}]},{"tin":{"type":"ein","value":"560583151"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11951.94,"providers":[{"billed_charge":17292.00,"npi":[1831452853]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99221","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2363.50,"providers":[{"billed_charge":8381.00,"npi":[1093943466]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":454.56,"providers":[{"billed_charge":585.00,"npi":[1982678660]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":485.40,"providers":[{"billed_charge":1030.00,"npi":[1093943466]}]}]},{"tin":{"type":"ein","value":"471345819"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":245.31,"providers":[{"billed_charge":279.00,"npi":[1497137038]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"204086208"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":3636.60,"providers":[{"billed_charge":6670.00,"npi":[1225762933]}]}]},{"tin":{"type":"ein","value":"562039679"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":147.54,"providers":[{"billed_charge":250.00,"npi":[1407056401]}]}]},{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":12817.19,"providers":[{"billed_charge":16680.00,"npi":[1982678660]}]}]},{"tin":{"type":"ein","value":"861770820"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":564.88,"providers":[{"billed_charge":1152.00,"npi":[1760642268]}]}]},{"tin":{"type":"ein","value":"931341544"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":70.61,"providers":[{"billed_charge":152.68,"npi":[1740711787]}]}]},{"tin":{"type":"ein","value":"471345819"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1056.40,"providers":[{"billed_charge":1192.00,"npi":[1497137038]}]}]},{"tin":{"type":"ein","value":"203566888"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":223.32,"providers":[{"billed_charge":876.00,"npi":[1144633660]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"262976526"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":6553.26,"providers":[{"billed_charge":10535.00,"npi":[1164951950]}]},{"allowed_amount":4012.20,"providers":[{"billed_charge":6450.00,"npi":[1841671344]}]},{"allowed_amount":3610.98,"providers":[{"billed_charge":5805.00,"npi":[1891923181]}]},{"allowed_amount":133.74,"providers":[{"billed_charge":215.00,"npi":[1891923181]}]}]},{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":711.76,"providers":[{"billed_charge":4529.00,"npi":[1255307898]}]},{"allowed_amount":16832.42,"providers":[{"billed_charge":78287.00,"npi":[1700466323]}]},{"allowed_amount":17104.80,"providers":[{"billed_charge":79581.00,"npi":[1952861536]}]},{"allowed_amount":1303.60,"providers":[{"billed_charge":5176.00,"npi":[1124086400]}]}]},{"tin":{"type":"ein","value":"582569828"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1652.70,"providers":[{"billed_charge":7156.80,"npi":[1124682323]}]}]}]},{"name":"HOSPITAL DISCHARGE DAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99239","description":"HOSPITAL DISCHARGE DAY MANAGEMENT; MORE THAN 30 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"571106645"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":266.38,"providers":[{"billed_charge":340.00,"npi":[1982678660]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":497.76,"providers":[{"billed_charge":1282.00,"npi":[1801271739]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":846.10,"providers":[{"billed_charge":2382.00,"npi":[1114017118]}]},{"allowed_amount":10153.20,"providers":[{"billed_charge":28272.00,"npi":[1801271739]}]},{"allowed_amount":11422.35,"providers":[{"billed_charge":31806.00,"npi":[1568813327]}]},{"allowed_amount":2961.35,"providers":[{"billed_charge":8246.00,"npi":[1457665994]}]},{"allowed_amount":13960.65,"providers":[{"billed_charge":39303.00,"npi":[1346732641]}]},{"allowed_amount":10576.25,"providers":[{"billed_charge":29450.00,"npi":[1134357726]}]},{"allowed_amount":1269.15,"providers":[{"billed_charge":3810.00,"npi":[1154716769]}]},{"allowed_amount":423.05,"providers":[{"billed_charge":1033.00,"npi":[1740453646]}]},{"allowed_amount":8461.00,"providers":[{"billed_charge":23820.00,"npi":[1366604944]}]},{"allowed_amount":5076.60,"providers":[{"billed_charge":14136.00,"npi":[1649443607]}]},{"allowed_amount":9307.10,"providers":[{"billed_charge":25916.00,"npi":[1124766134]}]},{"allowed_amount":2115.25,"providers":[{"billed_charge":5929.00,"npi":[1619220589]},{"billed_charge":5890.00,"npi":[1417065467]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"650691102"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1849.17,"providers":[{"billed_charge":5178.00,"npi":[1689916074]}]},{"allowed_amount":14793.36,"providers":[{"billed_charge":41712.00,"npi":[1568813327]}]},{"allowed_amount":4931.12,"providers":[{"billed_charge":11728.00,"npi":[1285695635]}]},{"allowed_amount":6163.90,"providers":[{"billed_charge":17380.00,"npi":[1457665994,1417065467]}]},{"allowed_amount":8013.07,"providers":[{"billed_charge":22438.00,"npi":[1497046411]}]},{"allowed_amount":14176.97,"providers":[{"billed_charge":39974.00,"npi":[1134357726]}]},{"allowed_amount":8629.46,"providers":[{"billed_charge":24164.00,"npi":[1366604944,1114017118]},{"billed_charge":24332.00,"npi":[1700121324]}]},{"allowed_amount":1232.78,"providers":[{"billed_charge":3452.00,"npi":[1952842148]}]},{"allowed_amount":3081.95,"providers":[{"billed_charge":8690.00,"npi":[1598897951]}]},{"allowed_amount":2465.56,"providers":[{"billed_charge":6940.00,"npi":[1619220589]}]},{"allowed_amount":3698.34,"providers":[{"billed_charge":10588.00,"npi":[1841759628]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1094.20,"providers":[{"billed_charge":8465.00,"npi":[1255307898]}]},{"allowed_amount":745.14,"providers":[{"billed_charge":5079.00,"npi":[1700466323]}]}]}]},{"name":"PREV VISIT EST AGE 18-39","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99395","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3781.43,"providers":[{"billed_charge":14555.00,"npi":[1134675978]}]},{"allowed_amount":830.07,"providers":[{"billed_charge":3195.00,"npi":[1720899875]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3040.48,"providers":[{"billed_charge":11718.00,"npi":[1720899875]}]},{"allowed_amount":8144.86,"providers":[{"billed_charge":31374.00,"npi":[1134675978]}]}]}]},{"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":"571004971"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":28.76,"providers":[{"billed_charge":51.00,"npi":[1780465732]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11754.98,"providers":[{"billed_charge":25384.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8683.84,"providers":[{"billed_charge":18322.94,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31581.48,"providers":[{"billed_charge":84229.02,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33500.10,"providers":[{"billed_charge":43892.40,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000399"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3879.60,"providers":[{"billed_charge":5512.00,"npi":[1891170056]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8038.80,"providers":[{"billed_charge":14931.85,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27818.46,"providers":[{"billed_charge":27824.44,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4071.11,"providers":[{"billed_charge":5524.64,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31141.29,"providers":[{"billed_charge":45984.05,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10579.40,"providers":[{"billed_charge":16593.01,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"570684922"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":146.40,"providers":[{"billed_charge":181.20,"npi":[1790936235]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":131926.93,"providers":[{"billed_charge":372573.75,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4267.56,"providers":[{"billed_charge":6148.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8390.55,"providers":[{"billed_charge":15589.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"581608892"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":109.81,"providers":[{"billed_charge":537.20,"npi":[1538211081]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27358.50,"providers":[{"billed_charge":72597.20,"npi":[1982198289]}]},{"allowed_amount":4003.07,"providers":[{"billed_charge":20015.52,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14291.28,"providers":[{"billed_charge":14363.10,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11309.76,"providers":[{"billed_charge":23243.49,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7414.05,"providers":[{"billed_charge":11959.50,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17020.40,"providers":[{"billed_charge":25985.40,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2706.75,"providers":[{"billed_charge":4467.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":777.75,"providers":[{"billed_charge":1183.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8759.52,"providers":[{"billed_charge":14220.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4110.00,"providers":[{"billed_charge":5307.60,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"237099373"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2064.61,"providers":[{"billed_charge":2433.42,"npi":[1487623203]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3979.92,"providers":[{"billed_charge":7659.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49028.26,"providers":[{"billed_charge":80385.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34681.92,"providers":[{"billed_charge":44775.60,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15940.74,"providers":[{"billed_charge":36533.70,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"831579694"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1848.30,"providers":[{"billed_charge":2175.40,"npi":[1194200063]}]}]},{"tin":{"type":"ein","value":"576008064"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":979.05,"providers":[{"billed_charge":1268.40,"npi":[1417954587]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4841.96,"providers":[{"billed_charge":9176.06,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000299"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":109.80,"providers":[{"billed_charge":152.10,"npi":[1861456600]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6581.27,"providers":[{"billed_charge":10402.66,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5660.30,"providers":[{"billed_charge":8559.60,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"566000297"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":581.40,"providers":[{"billed_charge":581.40,"npi":[1437159613]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3385.50,"providers":[{"billed_charge":4758.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2340.04,"providers":[{"billed_charge":4439.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14181.71,"providers":[{"billed_charge":18331.98,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19893.72,"providers":[{"billed_charge":90354.60,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":102359.03,"providers":[{"billed_charge":468245.11,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25313.69,"providers":[{"billed_charge":48199.42,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14328.61,"providers":[{"billed_charge":23277.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"566000347"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":94.74,"providers":[{"billed_charge":94.74,"npi":[1922098029]}]}]},{"tin":{"type":"ein","value":"570963511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":805.20,"providers":[{"billed_charge":1230.60,"npi":[1588605299]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3843.84,"providers":[{"billed_charge":5257.60,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":59603.10,"providers":[{"billed_charge":137659.80,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31509.00,"providers":[{"billed_charge":31509.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4223.49,"providers":[{"billed_charge":12471.41,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1815.45,"providers":[{"billed_charge":1840.50,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"560845796"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28.50,"providers":[{"billed_charge":28.50,"npi":[1689786717]}]}]},{"tin":{"type":"ein","value":"570996371"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2077.05,"providers":[{"billed_charge":3177.00,"npi":[1760409718]}]}]},{"tin":{"type":"ein","value":"831047162"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1226.10,"providers":[{"billed_charge":1881.60,"npi":[1285101717]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35410.50,"providers":[{"billed_charge":39667.50,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19524.00,"providers":[{"billed_charge":37058.93,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2681.44,"providers":[{"billed_charge":2885.00,"npi":[1720052723]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2565.44,"providers":[{"billed_charge":19274.71,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18278.76,"providers":[{"billed_charge":85500.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4489.52,"providers":[{"billed_charge":43434.45,"npi":[1891782595]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21533.82,"providers":[{"billed_charge":32550.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4614.39,"providers":[{"billed_charge":5130.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4614.39,"providers":[{"billed_charge":5697.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28199.05,"providers":[{"billed_charge":41643.79,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42042.22,"providers":[{"billed_charge":62100.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":76668.74,"providers":[{"billed_charge":108818.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":23855.66,"providers":[{"billed_charge":67116.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":120764.14,"providers":[{"billed_charge":327993.33,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":92408.68,"providers":[{"billed_charge":131950.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25122.79,"providers":[{"billed_charge":35525.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576008064"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1015.48,"providers":[{"billed_charge":1450.00,"npi":[1417954587]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":114241.50,"providers":[{"billed_charge":120895.88,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3554.18,"providers":[{"billed_charge":4901.74,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12693.50,"providers":[{"billed_charge":23125.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7616.10,"providers":[{"billed_charge":12750.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":176693.52,"providers":[{"billed_charge":262432.72,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36049.54,"providers":[{"billed_charge":57258.47,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3046.44,"providers":[{"billed_charge":4500.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5090.76,"providers":[{"billed_charge":12600.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12666.54,"providers":[{"billed_charge":13300.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13843.17,"providers":[{"billed_charge":62316.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":245746.16,"providers":[{"billed_charge":983304.35,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10150.65,"providers":[{"billed_charge":10746.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40103.34,"providers":[{"billed_charge":55300.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14216.72,"providers":[{"billed_charge":52069.64,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"571125775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1523.22,"providers":[{"billed_charge":5400.00,"npi":[1114088234]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2500.00,"providers":[{"billed_charge":2500.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32495.36,"providers":[{"billed_charge":105640.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17902.79,"providers":[{"billed_charge":89513.95,"npi":[1407361512]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26402.48,"providers":[{"billed_charge":37700.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":97993.82,"providers":[{"billed_charge":136300.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18970.27,"providers":[{"billed_charge":26228.27,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26402.48,"providers":[{"billed_charge":49400.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28150.00,"providers":[{"billed_charge":28150.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1694.12,"providers":[{"billed_charge":7960.00,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"576001084"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10662.54,"providers":[{"billed_charge":15800.00,"npi":[1275532855]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":108148.62,"providers":[{"billed_charge":154425.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27925.70,"providers":[{"billed_charge":55368.92,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8716.07,"providers":[{"billed_charge":11594.00,"npi":[1720052723]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"582363827"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":389.26,"providers":[{"billed_charge":1750.00,"npi":[1164445391]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14964.88,"providers":[{"billed_charge":47460.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"570996371"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2939.53,"providers":[{"billed_charge":3850.00,"npi":[1760409718]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21912.86,"providers":[{"billed_charge":102500.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10421.97,"providers":[{"billed_charge":34837.25,"npi":[1982198289]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5879.06,"providers":[{"billed_charge":10800.46,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39280.84,"providers":[{"billed_charge":319757.35,"npi":[1891782595]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"331030968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5181.12,"providers":[{"billed_charge":5400.00,"npi":[1043246325]}]}]},{"tin":{"type":"ein","value":"576000339"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20724.48,"providers":[{"billed_charge":37200.00,"npi":[1427154780]}]}]},{"tin":{"type":"ein","value":"576000337"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11657.52,"providers":[{"billed_charge":13608.00,"npi":[1659992089]}]}]},{"tin":{"type":"ein","value":"576000358"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":62605.20,"providers":[{"billed_charge":92082.60,"npi":[1982608709]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":85056.72,"providers":[{"billed_charge":148650.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"882224618"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1710.28,"providers":[{"billed_charge":3608.00,"npi":[1861131450]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":113719.94,"providers":[{"billed_charge":193381.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000312"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":59432.23,"providers":[{"billed_charge":62133.00,"npi":[1457428146]}]}]},{"tin":{"type":"ein","value":"576000356"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":139175.82,"providers":[{"billed_charge":371245.51,"npi":[1871530667]}]}]},{"tin":{"type":"ein","value":"576000311"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8635.20,"providers":[{"billed_charge":10700.00,"npi":[1821073115]}]}]},{"tin":{"type":"ein","value":"576000376"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5417.76,"providers":[{"billed_charge":7360.00,"npi":[1326018490]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":173165.85,"providers":[{"billed_charge":217570.46,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"576000298"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4703.27,"providers":[{"billed_charge":8250.00,"npi":[1013996867]}]}]},{"tin":{"type":"ein","value":"576000353"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5130.84,"providers":[{"billed_charge":6942.18,"npi":[1144375718]}]}]},{"tin":{"type":"ein","value":"576000331"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11544.39,"providers":[{"billed_charge":12150.00,"npi":[1639162886]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24799.06,"providers":[{"billed_charge":39336.57,"npi":[1649268798]}]}]},{"tin":{"type":"ein","value":"576000351"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":71397.35,"providers":[{"billed_charge":105823.72,"npi":[1205887874]}]}]},{"tin":{"type":"ein","value":"576000372"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5985.98,"providers":[{"billed_charge":8400.00,"npi":[1225138472]}]}]},{"tin":{"type":"ein","value":"576000370"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6627.42,"providers":[{"billed_charge":16200.00,"npi":[1104820752]}]}]},{"tin":{"type":"ein","value":"570515034"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12000.00,"providers":[{"billed_charge":12000.00,"npi":[1922091172]}]}]},{"tin":{"type":"ein","value":"934305357"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14248.08,"providers":[{"billed_charge":64119.00,"npi":[1780458935]}]}]},{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":132967.43,"providers":[{"billed_charge":541394.85,"npi":[1891782595]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":56743.86,"providers":[{"billed_charge":214500.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"561989558"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3799.04,"providers":[{"billed_charge":4776.00,"npi":[1336226034]}]}]},{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":82948.58,"providers":[{"billed_charge":97000.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"454597543"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5130.84,"providers":[{"billed_charge":16284.00,"npi":[1982978375]}]}]},{"tin":{"type":"ein","value":"576000368"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4000.00,"providers":[{"billed_charge":4000.00,"npi":[1598145237]}]}]},{"tin":{"type":"ein","value":"454301492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20523.36,"providers":[{"billed_charge":36512.00,"npi":[1962768440]}]}]},{"tin":{"type":"ein","value":"576000344"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35200.00,"providers":[{"billed_charge":35200.00,"npi":[1942223219]}]}]},{"tin":{"type":"ein","value":"576000365"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":123995.30,"providers":[{"billed_charge":132100.00,"npi":[1700839370]}]}]},{"tin":{"type":"ein","value":"576000342"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31640.18,"providers":[{"billed_charge":55500.00,"npi":[1124076385]}]}]},{"tin":{"type":"ein","value":"576000386"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9930.48,"providers":[{"billed_charge":14446.52,"npi":[1992369110]}]}]},{"tin":{"type":"ein","value":"576000340"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34300.00,"providers":[{"billed_charge":34300.00,"npi":[1558491316]}]}]},{"tin":{"type":"ein","value":"576000384"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7268.69,"providers":[{"billed_charge":12750.00,"npi":[1194899856]}]}]},{"tin":{"type":"ein","value":"311836178"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1426.62,"providers":[{"billed_charge":7960.00,"npi":[1821028945]}]}]},{"tin":{"type":"ein","value":"570803108"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":400.00,"providers":[{"billed_charge":400.00,"npi":[1053310623]}]}]},{"tin":{"type":"ein","value":"576001289"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":153070.06,"providers":[{"billed_charge":160026.00,"npi":[1376546788]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19668.22,"providers":[{"billed_charge":40057.25,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"20662511"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3022.32,"providers":[{"billed_charge":3227.00,"npi":[1720052723]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"582465552"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1737.00,"providers":[{"billed_charge":9902.76,"npi":[1891782595]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"576000405"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1640.00,"providers":[{"billed_charge":4100.00,"npi":[1295728350]}]}]},{"tin":{"type":"ein","value":"576000379"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2895.20,"providers":[{"billed_charge":7238.00,"npi":[1154314409]}]}]},{"tin":{"type":"ein","value":"576000775"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1000.00,"providers":[{"billed_charge":2500.00,"npi":[1225021504]}]}]},{"tin":{"type":"ein","value":"576000398"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":989.82,"providers":[{"billed_charge":2475.02,"npi":[1437142742]}]}]},{"tin":{"type":"ein","value":"271670174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1108.08,"providers":[{"billed_charge":2770.20,"npi":[1902120397]}]}]},{"tin":{"type":"ein","value":"576000395"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1981.80,"providers":[{"billed_charge":4954.40,"npi":[1649268798]}]}]}]},{"name":"SPLY ALW NONIMPL CGM 1 MO SP=1 UOS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4239","description":"SPLY ALW NONADJUNC NONIMPL CGM 1 MO SPLY= 1 UOS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6363.10,"providers":[{"billed_charge":21437.64,"npi":[1234567893]}]}]}]},{"name":"Disposable collection and storage bag for breast milk, any size, any type, each","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4287","description":"Disposable collection and storage bag for breast milk, any size, any type, each","allowed_amounts":[{"tin":{"type":"ein","value":"464408166"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":655.20,"providers":[{"billed_charge":2184.00,"npi":[1003462581]}]}]}]},{"name":"SLINGS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4565","description":"SLINGS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":150.00,"npi":[1234567893]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1060.32,"providers":[{"billed_charge":1274.88,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"561398929"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1146.50,"providers":[{"billed_charge":3180.80,"npi":[1811005150]}]}]}]},{"name":"FQHC VISIT ESTABLISHED PATIE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0467","description":"FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"570604703"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":49.22,"providers":[{"billed_charge":193.00,"npi":[1992957146]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":24172.18,"providers":[{"billed_charge":58512.18,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":37577.95,"providers":[{"billed_charge":37930.80,"npi":[1235909367]}]}]}]},{"name":"TH SUP METHADONE;TO 7 ADD D","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2078","description":"TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;","allowed_amounts":[{"tin":{"type":"ein","value":"274134994"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":294.91,"providers":[{"billed_charge":742.00,"npi":[1578006433]}]}]},{"tin":{"type":"ein","value":"863941799"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":3663.90,"providers":[{"billed_charge":3663.90,"npi":[1235909367]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"561667838"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":426.36,"providers":[{"billed_charge":760.00,"npi":[1750795183]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;6-","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6012","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3904.50,"providers":[{"billed_charge":5052.00,"npi":[1033178330]}]}]}]},{"name":"INTENS MOD TX DEL 1/MX FLDS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6015","description":"INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM","allowed_amounts":[{"tin":{"type":"ein","value":"562084824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12813.22,"providers":[{"billed_charge":34356.00,"npi":[1033178330]}]}]},{"tin":{"type":"ein","value":"570787600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21243.00,"providers":[{"billed_charge":73320.00,"npi":[1205495884]}]}]}]},{"name":"ALCOHL&/RX SRVC; INTENSV OP;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0015","description":"ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"871411317"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":18538.00,"providers":[{"billed_charge":46345.00,"npi":[1760671655]}]}]}]},{"name":"ASTV CMTY TX PROGRM PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0040","description":"ASSERTIVE COMMUNITY TREATMENT PROGRAM, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"576000922"},"service_code":["12","53"],"billing_class":"professional","payments":[{"allowed_amount":87.82,"providers":[{"billed_charge":351.30,"npi":[1508811324]}]},{"allowed_amount":2107.68,"providers":[{"billed_charge":8431.20,"npi":[1508811324]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"823789092"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":3.76,"providers":[{"billed_charge":200.00,"npi":[1134675978]}]},{"allowed_amount":5.73,"providers":[{"billed_charge":350.00,"npi":[1134675978]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1054.00,"providers":[{"billed_charge":1642.03,"npi":[1234567893]}]}]}]},{"name":"SURGICAL BOOT/SHOE EACH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3260","description":"SURGICAL BOOT/SHOE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":360.00,"providers":[{"billed_charge":600.00,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1062.88,"providers":[{"billed_charge":1703.80,"npi":[1234567893]}]}]}]},{"name":"WHF ORTHO NO JOINTS PREFAB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3809","description":"WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, OFF-THE-SHELF, ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":184.71,"providers":[{"billed_charge":198.00,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2566.50,"providers":[{"billed_charge":4114.52,"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":16876.56,"providers":[{"billed_charge":25463.04,"npi":[1234567893]}]}]}]}]}