{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-09-29","out_of_network":[{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"350892672"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31121.71,"providers":[{"billed_charge":9724.35,"npi":[1063457380]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"340714456"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":54.49,"providers":[{"billed_charge":181.25,"npi":[1790837235]}]}]},{"tin":{"type":"ein","value":"370662569"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":590.32,"providers":[{"billed_charge":7755.45,"npi":[1043260482]}]},{"allowed_amount":270.74,"providers":[{"billed_charge":902.40,"npi":[1043260482]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12.33,"providers":[{"billed_charge":4708.50,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":22641.43,"providers":[{"billed_charge":187887.81,"npi":[1063457380]}]}]}]},{"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":"350892672"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":51.04,"providers":[{"billed_charge":25245.43,"npi":[1063457380]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38942.84,"providers":[{"billed_charge":88150.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10855.35,"providers":[{"billed_charge":18334.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":49405.18,"providers":[{"billed_charge":118881.25,"npi":[1063457380]}]},{"allowed_amount":212.90,"providers":[{"billed_charge":46127.34,"npi":[1063457380]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3352.49,"providers":[{"billed_charge":6723.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":911.79,"providers":[{"billed_charge":2155.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"440584290"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":283.85,"providers":[{"billed_charge":638.55,"npi":[1760443980]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11.08,"providers":[{"billed_charge":31.22,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"370662569"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":586.35,"providers":[{"billed_charge":1840.00,"npi":[1043260482]}]},{"allowed_amount":1209.68,"providers":[{"billed_charge":6726.00,"npi":[1043260482]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1281.28,"providers":[{"billed_charge":7069.00,"npi":[1841245594]}]},{"allowed_amount":8.00,"providers":[{"billed_charge":16.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3.00,"providers":[{"billed_charge":8.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"610444707"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1861.13,"providers":[{"billed_charge":12255.59,"npi":[1689282147]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11.74,"providers":[{"billed_charge":452.63,"npi":[1063457380]}]},{"allowed_amount":116.49,"providers":[{"billed_charge":65678.89,"npi":[1063457380]}]},{"allowed_amount":280.07,"providers":[{"billed_charge":78653.66,"npi":[1063457380]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"351461805"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":883.50,"providers":[{"billed_charge":115707.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"922355855"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58.86,"providers":[{"billed_charge":5927.00,"npi":[1144914532]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":243.07,"providers":[{"billed_charge":716.54,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4453.60,"providers":[{"billed_charge":45927.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":37.64,"providers":[{"billed_charge":981.00,"npi":[1841245594]}]},{"allowed_amount":70.25,"providers":[{"billed_charge":127301.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"370860281"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":319.13,"providers":[{"billed_charge":352.80,"npi":[1679502322]}]},{"allowed_amount":256.14,"providers":[{"billed_charge":623.52,"npi":[1679502322]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":61.26,"providers":[{"billed_charge":23090.00,"npi":[1174571129]}]},{"allowed_amount":90.51,"providers":[{"billed_charge":612.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":67.29,"providers":[{"billed_charge":56257.57,"npi":[1063457380]}]},{"allowed_amount":24.35,"providers":[{"billed_charge":407.24,"npi":[1063457380]}]},{"allowed_amount":923.24,"providers":[{"billed_charge":57083.43,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19.01,"providers":[{"billed_charge":565.00,"npi":[1851833230]}]}]},{"tin":{"type":"ein","value":"621764613"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":193.21,"providers":[{"billed_charge":2358.00,"npi":[1164475711]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":508.78,"providers":[{"billed_charge":5449.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39.17,"providers":[{"billed_charge":484.04,"npi":[1063457380]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"351461805"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":69.90,"providers":[{"billed_charge":19475.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":295.85,"providers":[{"billed_charge":3055.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7.77,"providers":[{"billed_charge":428.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":70.16,"providers":[{"billed_charge":22848.31,"npi":[1063457380]}]},{"allowed_amount":54.51,"providers":[{"billed_charge":35574.30,"npi":[1063457380]}]},{"allowed_amount":7.77,"providers":[{"billed_charge":258.26,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":13.99,"providers":[{"billed_charge":284.00,"npi":[1851833230]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":407.52,"providers":[{"billed_charge":7806.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":105.60,"providers":[{"billed_charge":222.61,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6811.91,"providers":[{"billed_charge":51017.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1738.54,"providers":[{"billed_charge":6595.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":614.65,"providers":[{"billed_charge":12264.92,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1662.48,"providers":[{"billed_charge":27836.00,"npi":[1851833230]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":48.14,"providers":[{"billed_charge":6634.85,"npi":[1063457380]}]}]}]},{"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":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":399.43,"providers":[{"billed_charge":1450.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":82.55,"providers":[{"billed_charge":458.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":221.34,"providers":[{"billed_charge":52456.61,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":80.21,"providers":[{"billed_charge":473.00,"npi":[1851833230]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":855.20,"providers":[{"billed_charge":2310.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1035.28,"providers":[{"billed_charge":2265.67,"npi":[1831116441]}]},{"allowed_amount":96.18,"providers":[{"billed_charge":270.92,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6127.03,"providers":[{"billed_charge":17605.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11634.14,"providers":[{"billed_charge":31361.66,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2988.54,"providers":[{"billed_charge":5334.00,"npi":[1851833230]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7792.86,"providers":[{"billed_charge":10848.00,"npi":[1851833230]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1690.46,"providers":[{"billed_charge":22044.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7968.44,"providers":[{"billed_charge":63109.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19521.06,"providers":[{"billed_charge":56803.84,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1251.54,"providers":[{"billed_charge":29981.00,"npi":[1073550133]}]},{"allowed_amount":1532.10,"providers":[{"billed_charge":17387.00,"npi":[1073550133]}]},{"allowed_amount":168.01,"providers":[{"billed_charge":6998.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":25805.56,"providers":[{"billed_charge":357258.00,"npi":[1841245594]}]},{"allowed_amount":407.94,"providers":[{"billed_charge":9460.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":34244.47,"providers":[{"billed_charge":213726.92,"npi":[1063457380]}]},{"allowed_amount":750.83,"providers":[{"billed_charge":46113.30,"npi":[1063457380]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2851.52,"providers":[{"billed_charge":7911.68,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":39.52,"providers":[{"billed_charge":445.64,"npi":[1234567893]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2816.96,"providers":[{"billed_charge":21267.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":802.08,"providers":[{"billed_charge":2692.00,"npi":[1851833230]}]}]}]},{"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":"351461805"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2001.60,"providers":[{"billed_charge":105304.00,"npi":[1073550133]}]},{"allowed_amount":48541.35,"providers":[{"billed_charge":206680.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45808.38,"providers":[{"billed_charge":93668.29,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"922355855"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1395.30,"providers":[{"billed_charge":4651.00,"npi":[1144914532]}]},{"allowed_amount":919.22,"providers":[{"billed_charge":4056.00,"npi":[1144914532]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5934.11,"providers":[{"billed_charge":31079.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23005.14,"providers":[{"billed_charge":44854.69,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":257276.22,"providers":[{"billed_charge":351487.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52887.00,"providers":[{"billed_charge":92994.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":416218.99,"providers":[{"billed_charge":1115623.68,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":238541.61,"providers":[{"billed_charge":977226.00,"npi":[1851833230]}]}]}]},{"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":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2295.20,"providers":[{"billed_charge":65345.00,"npi":[1003866740]}]}]}]},{"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":"351461805"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":229.20,"providers":[{"billed_charge":146387.10,"npi":[1073550133]}]},{"allowed_amount":85.23,"providers":[{"billed_charge":16958.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23.12,"providers":[{"billed_charge":2558.53,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":661.65,"providers":[{"billed_charge":801.75,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2.30,"providers":[{"billed_charge":3984.15,"npi":[1457366189]}]},{"allowed_amount":48360.24,"providers":[{"billed_charge":210289.28,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.53,"providers":[{"billed_charge":646.95,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":156.33,"providers":[{"billed_charge":7982.67,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":463.36,"providers":[{"billed_charge":2497.25,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":226.04,"providers":[{"billed_charge":104217.89,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5022.11,"providers":[{"billed_charge":30002.50,"npi":[1851833230]}]},{"allowed_amount":561.65,"providers":[{"billed_charge":1098.99,"npi":[1851833230]}]}]}]},{"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":"274591786"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":14.87,"providers":[{"billed_charge":176.00,"npi":[1467410068]}]},{"allowed_amount":104.09,"providers":[{"billed_charge":1232.00,"npi":[1699162511]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":71.08,"providers":[{"billed_charge":784.00,"npi":[1699162511]}]},{"allowed_amount":53.31,"providers":[{"billed_charge":588.00,"npi":[1699162511]}]}]}]},{"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":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":60.07,"providers":[{"billed_charge":328.89,"npi":[1063457380]}]},{"allowed_amount":196.74,"providers":[{"billed_charge":36506.79,"npi":[1063457380]}]}]}]},{"name":"ULTRASOUND BREAST LIMITED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76642","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":976.50,"providers":[{"billed_charge":8460.00,"npi":[1659725323]}]}]}]},{"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":"352091937"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":215.75,"providers":[{"billed_charge":825.00,"npi":[1457841157]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":639.99,"providers":[{"billed_charge":4278.00,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":42.30,"providers":[{"billed_charge":100.00,"npi":[1407902786]}]},{"allowed_amount":153.32,"providers":[{"billed_charge":400.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":1805.96,"providers":[{"billed_charge":7363.00,"npi":[1366647034]}]},{"allowed_amount":243.45,"providers":[{"billed_charge":995.00,"npi":[1659725323]}]},{"allowed_amount":48.69,"providers":[{"billed_charge":199.00,"npi":[1578724894,1366647034]}]},{"allowed_amount":6493.49,"providers":[{"billed_charge":26467.00,"npi":[1659725323]}]}]}]},{"name":"DX MAMMO INCL CAD UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77065","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":63.51,"providers":[{"billed_charge":319.00,"npi":[1659725323]}]}]}]},{"name":"DX MAMMO INCL CAD BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77066","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":868.45,"providers":[{"billed_charge":4411.00,"npi":[1659725323]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":2625.00,"providers":[{"billed_charge":13330.80,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":278.46,"providers":[{"billed_charge":825.00,"npi":[1407902786]}]},{"allowed_amount":60.41,"providers":[{"billed_charge":450.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":60.18,"providers":[{"billed_charge":295.00,"npi":[1578724894,1366647034]}]},{"allowed_amount":8086.00,"providers":[{"billed_charge":39530.00,"npi":[1659725323]}]},{"allowed_amount":2226.66,"providers":[{"billed_charge":10915.00,"npi":[1366647034]}]},{"allowed_amount":240.72,"providers":[{"billed_charge":1180.00,"npi":[1659725323]}]}]}]},{"name":"DXA BONE DENSITY, AXIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77080","description":"DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":564.40,"providers":[{"billed_charge":6596.00,"npi":[1952558561]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":189.44,"providers":[{"billed_charge":541.44,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5941.56,"providers":[{"billed_charge":16980.48,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3.53,"providers":[{"billed_charge":42.24,"npi":[1234567893]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6037.50,"providers":[{"billed_charge":17246.32,"npi":[1811154388]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":60.75,"providers":[{"billed_charge":173.60,"npi":[1811154388]}]}]}]},{"name":"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":"351302836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.72,"providers":[{"billed_charge":60.00,"npi":[1548945389]}]}]}]},{"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":"271700231"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":32.00,"providers":[{"billed_charge":32.00,"npi":[1821319526]}]},{"allowed_amount":384.00,"providers":[{"billed_charge":384.00,"npi":[1821319526]}]},{"allowed_amount":288.00,"providers":[{"billed_charge":288.00,"npi":[1821319526]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.76,"providers":[{"billed_charge":50.72,"npi":[1811154388]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":396.41,"providers":[{"billed_charge":1132.88,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5221.44,"providers":[{"billed_charge":14918.40,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":442.25,"providers":[{"billed_charge":1263.92,"npi":[1811154388]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":907.73,"providers":[{"billed_charge":2593.76,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":477.00,"providers":[{"billed_charge":1363.00,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":432.18,"providers":[{"billed_charge":1234.80,"npi":[1811154388]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2500.56,"providers":[{"billed_charge":7146.56,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":181.20,"providers":[{"billed_charge":517.60,"npi":[1811154388]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":244.80,"providers":[{"billed_charge":699.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":37.52,"providers":[{"billed_charge":107.20,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":216.78,"providers":[{"billed_charge":619.44,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":429.42,"providers":[{"billed_charge":1226.72,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4186.56,"providers":[{"billed_charge":11961.60,"npi":[1811154388]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.44,"providers":[{"billed_charge":135.52,"npi":[1811154388]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3274.88,"providers":[{"billed_charge":9355.08,"npi":[1811154388]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":289.92,"providers":[{"billed_charge":828.16,"npi":[1811154388]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":36.06,"providers":[{"billed_charge":102.96,"npi":[1811154388]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":79.75,"providers":[{"billed_charge":227.92,"npi":[1811154388]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.54,"providers":[{"billed_charge":52.96,"npi":[1811154388]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":219.78,"providers":[{"billed_charge":627.88,"npi":[1811154388]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.03,"providers":[{"billed_charge":420.16,"npi":[1811154388]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":655.40,"providers":[{"billed_charge":1872.24,"npi":[1811154388]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":72.66,"providers":[{"billed_charge":207.60,"npi":[1811154388]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.39,"providers":[{"billed_charge":421.08,"npi":[1811154388]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":98.26,"providers":[{"billed_charge":280.72,"npi":[1811154388]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":98.26,"providers":[{"billed_charge":280.72,"npi":[1811154388]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":98.26,"providers":[{"billed_charge":280.72,"npi":[1811154388]}]}]}]},{"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":"463964102"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":21.09,"providers":[{"billed_charge":171.00,"npi":[1023833696]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":335.25,"providers":[{"billed_charge":953.64,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":62.23,"providers":[{"billed_charge":745.08,"npi":[1234567893]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"351604525"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":135.16,"providers":[{"billed_charge":810.00,"npi":[1215225305]}]},{"allowed_amount":1428.84,"providers":[{"billed_charge":8230.00,"npi":[1093057911]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["22","24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":9579.66,"providers":[{"billed_charge":26950.00,"npi":[1841448180]}]},{"allowed_amount":43.14,"providers":[{"billed_charge":550.00,"npi":[1194767780,1598154452]}]},{"allowed_amount":21.57,"providers":[{"billed_charge":275.00,"npi":[1164586434]}]},{"allowed_amount":429.42,"providers":[{"billed_charge":1200.00,"npi":[1164586434]}]},{"allowed_amount":815.88,"providers":[{"billed_charge":2280.00,"npi":[1841448180]}]},{"allowed_amount":215.70,"providers":[{"billed_charge":650.00,"npi":[1164586434]}]},{"allowed_amount":1803.55,"providers":[{"billed_charge":5040.00,"npi":[1194767780]}]},{"allowed_amount":85.88,"providers":[{"billed_charge":240.00,"npi":[1801117387]}]},{"allowed_amount":2389.29,"providers":[{"billed_charge":6965.00,"npi":[1194767780]}]},{"allowed_amount":42.94,"providers":[{"billed_charge":120.00,"npi":[1508312133]}]},{"allowed_amount":776.52,"providers":[{"billed_charge":9900.00,"npi":[1194767780]}]}]},{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":154.56,"providers":[{"billed_charge":2936.48,"npi":[1326393307]}]}]}]},{"name":"IMMUNOHISTO ANTB 1ST STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88342","description":"IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE","allowed_amounts":[{"tin":{"type":"ein","value":"352037910"},"service_code":["22","24","81"],"billing_class":"professional","payments":[{"allowed_amount":20.17,"providers":[{"billed_charge":150.00,"npi":[1841448180]}]},{"allowed_amount":100.85,"providers":[{"billed_charge":750.00,"npi":[1194767780]}]},{"allowed_amount":1414.39,"providers":[{"billed_charge":3394.00,"npi":[1841448180]}]},{"allowed_amount":141.20,"providers":[{"billed_charge":847.00,"npi":[1194767780]}]},{"allowed_amount":201.70,"providers":[{"billed_charge":610.00,"npi":[1194767780]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":250.85,"providers":[{"billed_charge":593.70,"npi":[1083141287]}]}]}]},{"name":"IMMUNIZATION ADMIN EACH ADD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90472","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":86.75,"providers":[{"billed_charge":242.90,"npi":[1083141287]}]}]}]},{"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":"352147791"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":115.34,"providers":[{"billed_charge":314.00,"npi":[1417314287]}]}]}]},{"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":"842463346"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1295.82,"providers":[{"billed_charge":2760.00,"npi":[1578551495]}]},{"allowed_amount":55.88,"providers":[{"billed_charge":120.00,"npi":[1578551495]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["19","10"],"billing_class":"professional","payments":[{"allowed_amount":223.52,"providers":[{"billed_charge":780.00,"npi":[1467279794]}]},{"allowed_amount":391.16,"providers":[{"billed_charge":595.00,"npi":[1740850874]}]},{"allowed_amount":111.76,"providers":[{"billed_charge":170.00,"npi":[1467279794]}]}]},{"tin":{"type":"ein","value":"351328806"},"service_code":["53","10"],"billing_class":"professional","payments":[{"allowed_amount":1325.72,"providers":[{"billed_charge":2200.00,"npi":[1851949200]}]},{"allowed_amount":137.04,"providers":[{"billed_charge":200.00,"npi":[1851949200]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1666.56,"providers":[{"billed_charge":4160.00,"npi":[1861667636]}]},{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1720585565]}]}]},{"tin":{"type":"ein","value":"351925641"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":903.96,"providers":[{"billed_charge":1539.00,"npi":[1174143119]}]}]}]},{"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":"920404194"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2773.96,"providers":[{"billed_charge":4900.00,"npi":[1447011127]}]},{"allowed_amount":2367.12,"providers":[{"billed_charge":3675.00,"npi":[1447011127]}]}]},{"tin":{"type":"ein","value":"460722516"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":12737.36,"providers":[{"billed_charge":19775.00,"npi":[1629085717]}]},{"allowed_amount":112.12,"providers":[{"billed_charge":175.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"263205722"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":375.72,"providers":[{"billed_charge":600.00,"npi":[1942871306]}]}]},{"tin":{"type":"ein","value":"351147323"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":252.27,"providers":[{"billed_charge":828.00,"npi":[1851162762]}]},{"allowed_amount":588.63,"providers":[{"billed_charge":1932.00,"npi":[1851162762]}]}]},{"tin":{"type":"ein","value":"823874275"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":561.95,"providers":[{"billed_charge":875.00,"npi":[1568016798]}]}]},{"tin":{"type":"ein","value":"813929887"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":336.36,"providers":[{"billed_charge":800.00,"npi":[1629570650]}]},{"allowed_amount":676.32,"providers":[{"billed_charge":1600.00,"npi":[1629570650]}]},{"allowed_amount":420.45,"providers":[{"billed_charge":1000.00,"npi":[1629570650]}]}]},{"tin":{"type":"ein","value":"820783414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1099.02,"providers":[{"billed_charge":2275.00,"npi":[1023428208]}]}]},{"tin":{"type":"ein","value":"350593390"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":986.30,"providers":[{"billed_charge":2086.00,"npi":[1801316336]}]},{"allowed_amount":247.66,"providers":[{"billed_charge":596.00,"npi":[1801316336]}]}]},{"tin":{"type":"ein","value":"814409045"},"service_code":["11","12","02","10"],"billing_class":"professional","payments":[{"allowed_amount":840.90,"providers":[{"billed_charge":1500.00,"npi":[1821468794]}]},{"allowed_amount":338.16,"providers":[{"billed_charge":600.00,"npi":[1821468794]}]},{"allowed_amount":84.09,"providers":[{"billed_charge":150.00,"npi":[1821468794]}]},{"allowed_amount":2958.90,"providers":[{"billed_charge":5250.00,"npi":[1821468794]}]}]},{"tin":{"type":"ein","value":"932834934"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":3467.45,"providers":[{"billed_charge":7000.00,"npi":[1356934582]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":978.25,"providers":[{"billed_charge":1720.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":67.36,"providers":[{"billed_charge":124.00,"npi":[1164925798]}]},{"allowed_amount":84.20,"providers":[{"billed_charge":155.00,"npi":[1578243028]}]},{"allowed_amount":16.84,"providers":[{"billed_charge":31.00,"npi":[1891520490]}]}]},{"tin":{"type":"ein","value":"351057889"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":18.43,"providers":[{"billed_charge":35.00,"npi":[1760990022]}]}]},{"tin":{"type":"ein","value":"350983617"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":124.75,"providers":[{"billed_charge":300.00,"npi":[1558621060]}]}]}]},{"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":"851648079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":395.74,"providers":[{"billed_charge":5500.00,"npi":[1861089690]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":143.45,"providers":[{"billed_charge":5640.00,"npi":[1003866740]}]}]}]},{"name":"SPECIAL EYE EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92060","description":"SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR PARETIC","allowed_amounts":[{"tin":{"type":"ein","value":"824133617"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":311.50,"providers":[{"billed_charge":340.00,"npi":[1255367686]}]}]}]},{"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":"463204426"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1498.64,"providers":[{"billed_charge":2990.00,"npi":[1538784236]}]}]},{"tin":{"type":"ein","value":"331195715"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":285.74,"providers":[{"billed_charge":800.00,"npi":[1285246215]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":13775.96,"providers":[{"billed_charge":55351.92,"npi":[1912166075]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"351180407"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":62.28,"providers":[{"billed_charge":153.00,"npi":[1487658761]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"611389493"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":81.04,"providers":[{"billed_charge":296.00,"npi":[1285977033]}]},{"allowed_amount":273.51,"providers":[{"billed_charge":999.00,"npi":[1497968366]}]}]}]},{"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":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.23,"providers":[{"billed_charge":196.00,"npi":[1801838743]}]},{"allowed_amount":206.91,"providers":[{"billed_charge":532.00,"npi":[1396889788]}]}]}]},{"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":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":279.60,"providers":[{"billed_charge":672.00,"npi":[1396889788]}]},{"allowed_amount":69.90,"providers":[{"billed_charge":168.00,"npi":[1801887138]}]},{"allowed_amount":104.85,"providers":[{"billed_charge":252.00,"npi":[1134219652]}]}]}]},{"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":"351955872"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":82.62,"providers":[{"billed_charge":250.00,"npi":[1316385719]}]}]},{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":82.61,"providers":[{"billed_charge":273.00,"npi":[1215691084]}]}]},{"tin":{"type":"ein","value":"351790012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":572.78,"providers":[{"billed_charge":1248.00,"npi":[1255059085]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.27,"providers":[{"billed_charge":1035.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":242.33,"providers":[{"billed_charge":1150.00,"npi":[1316549868]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":440.60,"providers":[{"billed_charge":1400.00,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":264.36,"providers":[{"billed_charge":576.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352133454"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":264.36,"providers":[{"billed_charge":660.96,"npi":[1639942568]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":660.90,"providers":[{"billed_charge":1590.00,"npi":[1245913888]}]}]},{"tin":{"type":"ein","value":"270550856"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1189.62,"providers":[{"billed_charge":6418.44,"npi":[1821885930]}]},{"allowed_amount":154.21,"providers":[{"billed_charge":832.02,"npi":[1356022818]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":308.42,"providers":[{"billed_charge":798.00,"npi":[1801838743]}]},{"allowed_amount":242.34,"providers":[{"billed_charge":627.00,"npi":[1801887138]}]},{"allowed_amount":1145.56,"providers":[{"billed_charge":2964.00,"npi":[1396889788]}]},{"allowed_amount":418.58,"providers":[{"billed_charge":1083.00,"npi":[1134219652]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.71,"providers":[{"billed_charge":267.00,"npi":[1215691084]}]}]},{"tin":{"type":"ein","value":"470996714"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":318.72,"providers":[{"billed_charge":494.00,"npi":[1558117358]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":343.26,"providers":[{"billed_charge":1680.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":49.03,"providers":[{"billed_charge":208.00,"npi":[1356129803]}]},{"allowed_amount":73.55,"providers":[{"billed_charge":297.00,"npi":[1972258523]}]},{"allowed_amount":637.43,"providers":[{"billed_charge":2664.00,"npi":[1316549868]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.56,"providers":[{"billed_charge":156.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2672.31,"providers":[{"billed_charge":7630.00,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":392.31,"providers":[{"billed_charge":848.00,"npi":[1245913888]}]}]}]},{"name":"THER IVNTJ 1ST 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97129","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1671.12,"providers":[{"billed_charge":4233.24,"npi":[1912166075]}]}]}]},{"name":"THER IVNTJ EA ADDL 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97130","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4902.51,"providers":[{"billed_charge":13041.80,"npi":[1912166075]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"351790012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":374.32,"providers":[{"billed_charge":864.00,"npi":[1255059085]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":249.58,"providers":[{"billed_charge":1260.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":103.99,"providers":[{"billed_charge":465.00,"npi":[1316549868]}]}]},{"tin":{"type":"ein","value":"352133454"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.00,"providers":[{"billed_charge":520.00,"npi":[1639942568]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":935.83,"providers":[{"billed_charge":2250.00,"npi":[1245913888]}]}]},{"tin":{"type":"ein","value":"270550856"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":41.59,"providers":[{"billed_charge":195.26,"npi":[1356022818]}]}]}]},{"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":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4188.29,"providers":[{"billed_charge":7400.00,"npi":[1245019769]}]}]},{"tin":{"type":"ein","value":"921710393"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":789.34,"providers":[{"billed_charge":4200.00,"npi":[1790448595]}]}]},{"tin":{"type":"ein","value":"991245599"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2705.67,"providers":[{"billed_charge":7437.50,"npi":[1609555226]}]}]},{"tin":{"type":"ein","value":"473746811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2165.04,"providers":[{"billed_charge":5400.00,"npi":[1801470836]}]}]},{"tin":{"type":"ein","value":"453668959"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20569.00,"providers":[{"billed_charge":85960.00,"npi":[1982389656]}]},{"allowed_amount":39814.75,"providers":[{"billed_charge":166390.00,"npi":[1336772748]}]}]},{"tin":{"type":"ein","value":"874098369"},"service_code":["03"],"billing_class":"professional","payments":[{"allowed_amount":9178.87,"providers":[{"billed_charge":45787.50,"npi":[1992388912]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"453668959"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1010.36,"providers":[{"billed_charge":4466.00,"npi":[1336772748]}]},{"allowed_amount":888.42,"providers":[{"billed_charge":3927.00,"npi":[1336772748]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":184.12,"providers":[{"billed_charge":320.00,"npi":[1215691084]}]}]},{"tin":{"type":"ein","value":"463204426"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":447.18,"providers":[{"billed_charge":765.00,"npi":[1275785511]}]}]},{"tin":{"type":"ein","value":"470996714"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":368.25,"providers":[{"billed_charge":560.00,"npi":[1558117358]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":131.50,"providers":[{"billed_charge":625.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"471993843"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":657.58,"providers":[{"billed_charge":2705.00,"npi":[1316549868]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":25226.43,"providers":[{"billed_charge":64453.28,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"352133454"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":315.62,"providers":[{"billed_charge":789.12,"npi":[1639942568]}]}]},{"tin":{"type":"ein","value":"270550856"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":263.04,"providers":[{"billed_charge":934.00,"npi":[1356022818]}]},{"allowed_amount":447.15,"providers":[{"billed_charge":1587.80,"npi":[1821885930]}]}]}]},{"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":"351579827"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":34.54,"providers":[{"billed_charge":60.00,"npi":[1871330050]}]}]},{"tin":{"type":"ein","value":"204508059"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":155.45,"providers":[{"billed_charge":275.00,"npi":[1659438687]}]}]},{"tin":{"type":"ein","value":"351814334"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.70,"providers":[{"billed_charge":515.00,"npi":[1275530800]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":631.38,"providers":[{"billed_charge":1309.00,"npi":[1801838743]}]},{"allowed_amount":705.66,"providers":[{"billed_charge":1463.00,"npi":[1801887138]}]},{"allowed_amount":891.36,"providers":[{"billed_charge":1848.00,"npi":[1396889788]}]},{"allowed_amount":408.54,"providers":[{"billed_charge":847.00,"npi":[1134219652]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":521.40,"providers":[{"billed_charge":1210.00,"npi":[1396889788]}]},{"allowed_amount":23.70,"providers":[{"billed_charge":55.00,"npi":[1801887138]}]}]}]},{"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":"351302836"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":51.53,"providers":[{"billed_charge":180.00,"npi":[1548945389]}]},{"allowed_amount":142.60,"providers":[{"billed_charge":360.00,"npi":[1548945389]}]}]},{"tin":{"type":"ein","value":"352147791"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":83.88,"providers":[{"billed_charge":125.00,"npi":[1790461390]}]}]},{"tin":{"type":"ein","value":"351097350"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":142.60,"providers":[{"billed_charge":260.00,"npi":[1033539481]}]}]},{"tin":{"type":"ein","value":"351875364"},"service_code":["50","10"],"billing_class":"professional","payments":[{"allowed_amount":1069.50,"providers":[{"billed_charge":2355.00,"npi":[1265021406]}]},{"allowed_amount":103.06,"providers":[{"billed_charge":314.00,"npi":[1265021406]}]}]},{"tin":{"type":"ein","value":"311003977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.90,"providers":[{"billed_charge":537.00,"npi":[1952947574]}]}]},{"tin":{"type":"ein","value":"352152181"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":587.16,"providers":[{"billed_charge":875.00,"npi":[1396248415]}]},{"allowed_amount":530.08,"providers":[{"billed_charge":875.00,"npi":[1073963351]}]},{"allowed_amount":167.76,"providers":[{"billed_charge":250.00,"npi":[1740905488]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":177.90,"providers":[{"billed_charge":364.00,"npi":[1234567893]}]},{"allowed_amount":1423.20,"providers":[{"billed_charge":2912.00,"npi":[1234567893]}]},{"allowed_amount":251.64,"providers":[{"billed_charge":254.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"352020403"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.83,"providers":[{"billed_charge":450.00,"npi":[1669034492]}]}]}]},{"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":"356001532"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":110.46,"providers":[{"billed_charge":160.00,"npi":[1689298622]}]}]},{"tin":{"type":"ein","value":"351516588"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":89.21,"providers":[{"billed_charge":140.00,"npi":[1053394023]}]},{"allowed_amount":4519.82,"providers":[{"billed_charge":5460.00,"npi":[1053394023]}]}]},{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1639.26,"providers":[{"billed_charge":4205.40,"npi":[1083141287]}]}]},{"tin":{"type":"ein","value":"351057889"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":75.83,"providers":[{"billed_charge":125.00,"npi":[1235830043]}]},{"allowed_amount":281.18,"providers":[{"billed_charge":375.00,"npi":[1235830043]}]}]},{"tin":{"type":"ein","value":"311003977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":87.92,"providers":[{"billed_charge":263.00,"npi":[1952947574]}]}]},{"tin":{"type":"ein","value":"350211370"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":178.42,"providers":[{"billed_charge":484.44,"npi":[1821423393]}]},{"allowed_amount":472.56,"providers":[{"billed_charge":968.88,"npi":[1821423393]}]},{"allowed_amount":1427.36,"providers":[{"billed_charge":3875.52,"npi":[1821423393]}]}]}]},{"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":"471628951"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":313.71,"providers":[{"billed_charge":576.00,"npi":[1730426958]}]},{"allowed_amount":145.12,"providers":[{"billed_charge":288.00,"npi":[1760834147]}]}]},{"tin":{"type":"ein","value":"851540000"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":370.02,"providers":[{"billed_charge":936.00,"npi":[1962740365]}]},{"allowed_amount":740.04,"providers":[{"billed_charge":1872.00,"npi":[1083468219]}]}]}]},{"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":"862775542"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":8045.66,"providers":[{"billed_charge":23702.00,"npi":[1689683153]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"851421369"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":729.84,"providers":[{"billed_charge":2133.18,"npi":[1871076471]}]},{"allowed_amount":411.64,"providers":[{"billed_charge":1185.10,"npi":[1871076471]}]}]}]},{"name":"HOME VISIT NEW PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99344","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":557.30,"providers":[{"billed_charge":1805.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99348","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":10029.28,"providers":[{"billed_charge":27722.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99349","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":596.34,"providers":[{"billed_charge":1524.00,"npi":[1669982070]}]},{"allowed_amount":8945.10,"providers":[{"billed_charge":22860.00,"npi":[1770167280]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1137.64,"providers":[{"billed_charge":1137.64,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001134"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":162.00,"providers":[{"billed_charge":162.00,"npi":[1023127206]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2625.41,"providers":[{"billed_charge":2625.41,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40077.00,"providers":[{"billed_charge":77991.49,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"351361390"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":425.00,"providers":[{"billed_charge":425.00,"npi":[1881641504]}]}]},{"tin":{"type":"ein","value":"271130459"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6189.54,"providers":[{"billed_charge":8202.00,"npi":[1952683229]}]}]},{"tin":{"type":"ein","value":"356001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":290.40,"providers":[{"billed_charge":290.40,"npi":[1841418324]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42247.38,"providers":[{"billed_charge":42280.32,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3538.20,"providers":[{"billed_charge":4082.40,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"356000972"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":186.96,"providers":[{"billed_charge":186.96,"npi":[1154325579]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2153.60,"providers":[{"billed_charge":2153.60,"npi":[1114072964]}]}]},{"tin":{"type":"ein","value":"830966826"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":862.27,"providers":[{"billed_charge":4366.00,"npi":[1780338756]}]}]},{"tin":{"type":"ein","value":"351311688"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":900.00,"providers":[{"billed_charge":900.00,"npi":[1841246998]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":99149.40,"providers":[{"billed_charge":100233.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"356000939"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":962.52,"providers":[{"billed_charge":962.52,"npi":[1235137829]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30009.40,"providers":[{"billed_charge":30497.60,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5416.08,"providers":[{"billed_charge":5790.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351549572"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18644.76,"providers":[{"billed_charge":18673.32,"npi":[1215973888]}]}]}]},{"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":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5165.28,"providers":[{"billed_charge":9108.00,"npi":[1578869665]}]}]}]},{"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":"351311688"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1480.00,"providers":[{"billed_charge":1480.00,"npi":[1841246998]}]}]},{"tin":{"type":"ein","value":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1680.00,"providers":[{"billed_charge":1680.00,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3686.97,"providers":[{"billed_charge":3686.97,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8178.24,"providers":[{"billed_charge":10624.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":314862.24,"providers":[{"billed_charge":314862.24,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"356000939"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":501.12,"providers":[{"billed_charge":501.12,"npi":[1235137829]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":71515.04,"providers":[{"billed_charge":71700.00,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9100.00,"providers":[{"billed_charge":9100.00,"npi":[1114072964]}]}]}]},{"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":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53804.00,"providers":[{"billed_charge":72100.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15065.12,"providers":[{"billed_charge":39244.10,"npi":[1174528335]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2742.00,"providers":[{"billed_charge":2742.00,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9474.04,"providers":[{"billed_charge":9474.04,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":220320.00,"providers":[{"billed_charge":220320.00,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"356000939"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7253.12,"providers":[{"billed_charge":7253.12,"npi":[1235137829]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13774.08,"providers":[{"billed_charge":15648.00,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4800.00,"providers":[{"billed_charge":4800.00,"npi":[1114072964]}]}]}]},{"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":144.05,"providers":[{"billed_charge":330.00,"npi":[1234567893]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1226.61,"providers":[{"billed_charge":4576.66,"npi":[1234567893]}]}]}]},{"name":"SPACR BAG/RESRVOR METRD DOSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4627","description":"SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE INHALER","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":18.54,"providers":[{"billed_charge":45.00,"npi":[1669415394]}]}]}]},{"name":"ADMN SET SM VOL NONFLTR NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7005","description":"ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, NONDISPOSABLE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":504.07,"providers":[{"billed_charge":760.00,"npi":[1669415394]}]}]}]},{"name":"AREO MASK USED W/ DME NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7015","description":"AEROSOL MASK, USED WITH DME NEBULIZER","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1.79,"providers":[{"billed_charge":5.00,"npi":[1669415394]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":475.95,"providers":[{"billed_charge":2874.48,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":739.26,"providers":[{"billed_charge":3473.62,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1212.93,"providers":[{"billed_charge":4746.12,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1946.61,"providers":[{"billed_charge":8015.14,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":513.90,"providers":[{"billed_charge":2500.62,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":232.34,"providers":[{"billed_charge":829.51,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1183.27,"providers":[{"billed_charge":3415.20,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":172.75,"providers":[{"billed_charge":1399.36,"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":1237.04,"providers":[{"billed_charge":1487.36,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2106.44,"providers":[{"billed_charge":8976.13,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":925.00,"providers":[{"billed_charge":4080.00,"npi":[1669415394]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3771.00,"providers":[{"billed_charge":57639.60,"npi":[1234567893]}]}]}]},{"name":"BREAST PUMP ELECTRIC ANY TYP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0603","description":"BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":10740.49,"providers":[{"billed_charge":42000.00,"npi":[1669415394]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3494.00,"providers":[{"billed_charge":26375.83,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":45.91,"providers":[{"billed_charge":210.00,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1405.56,"providers":[{"billed_charge":4016.48,"npi":[1811154388]}]}]}]},{"name":"DX DIGTL BRST TOMOSYN UNI/BI","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0279","description":"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":191.20,"providers":[{"billed_charge":478.00,"npi":[1578724894]}]},{"allowed_amount":2868.00,"providers":[{"billed_charge":7170.00,"npi":[1659725323]}]},{"allowed_amount":95.60,"providers":[{"billed_charge":239.00,"npi":[1659725323]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"464126690"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":6273.44,"providers":[{"billed_charge":7015.04,"npi":[1720083082]}]},{"allowed_amount":1176.27,"providers":[{"billed_charge":1315.32,"npi":[1710097571]}]},{"allowed_amount":5581.05,"providers":[{"billed_charge":6933.00,"npi":[1841358017]}]}]}]},{"name":"OFF-B TX OUD;EA ADD 30M BYD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2088","description":"OFF-BASED TX OUD;EA ADD 30 MIN BYD 1ST 120 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"464126690"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":2581.40,"providers":[{"billed_charge":2585.70,"npi":[1841358017]}]},{"allowed_amount":2087.13,"providers":[{"billed_charge":2818.92,"npi":[1720083082]}]}]}]},{"name":"ALCOHL&/RX SRVC; SUB-AC DTOX","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0010","description":"ALCOHOL AND/OR DRUG SERVICES; SUBACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)","allowed_amounts":[{"tin":{"type":"ein","value":"362167910"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":2225.00,"providers":[{"billed_charge":8900.00,"npi":[1659851905]}]}]}]},{"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":"460722516"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":750.00,"providers":[{"billed_charge":3000.00,"npi":[1629085717]}]}]}]},{"name":"BHVAL HLTH; SHRTTRM RES DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0018","description":"BEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NONHOSPITAL RESIDENTIAL TREATMENT PROGRAM), WITHOUT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"932430642"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":6712.00,"providers":[{"billed_charge":16780.00,"npi":[1538329982]}]}]}]},{"name":"SELF-HELP/PEER SVC PER 15MIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0038","description":"SELF-HELP/PEER SERVICES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7.50,"providers":[{"billed_charge":30.00,"npi":[1629085717]}]}]}]},{"name":"ALC &/OTH RX TST: CLCT&HNDL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0048","description":"ALCOHOL AND/OR OTHER DRUG TESTING: COLLECTION AND HANDLING ONLY, SPECIMENS OTHER THAN BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":150.00,"providers":[{"billed_charge":600.00,"npi":[1629085717]}]}]}]},{"name":"KNEE ORTHOSIS ELASTIC W/JNTS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1812","description":"KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":278.04,"providers":[{"billed_charge":476.68,"npi":[1234567893]}]}]}]},{"name":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1821","description":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":344.16,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]}]},{"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":1867.75,"providers":[{"billed_charge":2994.29,"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":348.00,"providers":[{"billed_charge":580.00,"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":1366.56,"providers":[{"billed_charge":2190.60,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOSIS, ACROMIO/C","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3670","description":"SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1085.76,"providers":[{"billed_charge":1740.57,"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":3490.49,"providers":[{"billed_charge":3762.00,"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":3231.60,"providers":[{"billed_charge":4256.40,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":16511.00,"providers":[{"billed_charge":26468.16,"npi":[1234567893]}]}]}]},{"name":"LACTATION CLASS NON-PHYS PRO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9443","description":"LACTATION CLASSES, NONPHYSICIAN PROVIDER, PER SESSION","allowed_amounts":[{"tin":{"type":"ein","value":"850867370"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":720.00,"providers":[{"billed_charge":1800.00,"npi":[1699369124]}]}]}]}]}