{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-10-03","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"850959548"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38925.00,"providers":[{"billed_charge":60000.00,"npi":[1811512262]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":109581.85,"providers":[{"billed_charge":137634.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":122133.70,"providers":[{"billed_charge":110837.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":47868.05,"providers":[{"billed_charge":57800.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1073177.61,"providers":[{"billed_charge":1165673.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":37590.04,"providers":[{"billed_charge":58446.00,"npi":[1427536325]}]}]}]},{"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":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1213266.35,"providers":[{"billed_charge":682022.00,"npi":[1366436123]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":33030.26,"providers":[{"billed_charge":77928.00,"npi":[1811973100]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":151528.78,"providers":[{"billed_charge":232500.00,"npi":[1356950398]}]}]},{"tin":{"type":"ein","value":"721272857"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":51040.00,"providers":[{"billed_charge":97900.00,"npi":[1346224847]}]}]},{"tin":{"type":"ein","value":"800544353"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":69048.39,"providers":[{"billed_charge":123500.00,"npi":[1720345663]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":51807.52,"providers":[{"billed_charge":112496.00,"npi":[1164419198]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":252663.86,"providers":[{"billed_charge":527268.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":88116.03,"providers":[{"billed_charge":194700.00,"npi":[1811973100]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":50655.71,"providers":[{"billed_charge":96600.00,"npi":[1811973100]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":59530.25,"providers":[{"billed_charge":150348.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":634997.17,"providers":[{"billed_charge":459462.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":260868.77,"providers":[{"billed_charge":568817.00,"npi":[1811973100]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6472.46,"providers":[{"billed_charge":4432.67,"npi":[1356950398]}]}]},{"tin":{"type":"ein","value":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":454.89,"providers":[{"billed_charge":1516.28,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":89.67,"providers":[{"billed_charge":879.12,"npi":[1477500015]}]},{"allowed_amount":315.73,"providers":[{"billed_charge":1052.36,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.88,"providers":[{"billed_charge":46.26,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":444.17,"providers":[{"billed_charge":1480.59,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":153.83,"providers":[{"billed_charge":512.76,"npi":[1326485749]}]},{"allowed_amount":358.50,"providers":[{"billed_charge":1902.55,"npi":[1689011280]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7547.76,"providers":[{"billed_charge":25158.93,"npi":[1629076468]}]},{"allowed_amount":5921.13,"providers":[{"billed_charge":19736.97,"npi":[1548796378]}]},{"allowed_amount":5556.15,"providers":[{"billed_charge":52325.33,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":667.88,"providers":[{"billed_charge":1002.30,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":25245.66,"providers":[{"billed_charge":77688.61,"npi":[1578568481]}]},{"allowed_amount":5149.28,"providers":[{"billed_charge":17459.25,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3527.09,"providers":[{"billed_charge":10268.32,"npi":[1083903744]}]},{"allowed_amount":4458.55,"providers":[{"billed_charge":14873.33,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3961.09,"providers":[{"billed_charge":13203.09,"npi":[1053360651]}]},{"allowed_amount":15178.50,"providers":[{"billed_charge":54540.55,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":993.54,"providers":[{"billed_charge":4247.87,"npi":[1295716637]}]},{"allowed_amount":5689.04,"providers":[{"billed_charge":11337.93,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6042.92,"providers":[{"billed_charge":20146.03,"npi":[1710097936]}]},{"allowed_amount":36029.75,"providers":[{"billed_charge":83718.75,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5350.74,"providers":[{"billed_charge":17835.66,"npi":[1417950106]}]},{"allowed_amount":9727.18,"providers":[{"billed_charge":54477.29,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1630.31,"providers":[{"billed_charge":3652.98,"npi":[1184373268]}]},{"allowed_amount":1088.18,"providers":[{"billed_charge":3627.12,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":694.08,"providers":[{"billed_charge":17141.57,"npi":[1164419198]}]},{"allowed_amount":136796.51,"providers":[{"billed_charge":918483.89,"npi":[1366436123]}]},{"allowed_amount":8035.89,"providers":[{"billed_charge":27602.40,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":208.53,"providers":[{"billed_charge":617.00,"npi":[]}]},{"allowed_amount":500.14,"providers":[{"billed_charge":1970.44,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10891.99,"providers":[{"billed_charge":72846.30,"npi":[1144227539]}]},{"allowed_amount":556.39,"providers":[{"billed_charge":1854.64,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7443.38,"providers":[{"billed_charge":15427.18,"npi":[1275536799]}]},{"allowed_amount":538.06,"providers":[{"billed_charge":1793.56,"npi":[1275536799]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":79322.08,"providers":[{"billed_charge":341210.03,"npi":[1811973100]}]},{"allowed_amount":29509.87,"providers":[{"billed_charge":98396.82,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3278.97,"providers":[{"billed_charge":10929.45,"npi":[1427536325]}]},{"allowed_amount":14257.85,"providers":[{"billed_charge":36430.93,"npi":[1427536325]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3715.21,"providers":[{"billed_charge":12384.08,"npi":[1083903744]}]},{"allowed_amount":137.21,"providers":[{"billed_charge":1267.84,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4636.53,"providers":[{"billed_charge":15455.10,"npi":[1053360651]}]},{"allowed_amount":1118.42,"providers":[{"billed_charge":5475.45,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1541.39,"providers":[{"billed_charge":7178.28,"npi":[1710097936]}]},{"allowed_amount":2391.82,"providers":[{"billed_charge":7972.74,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4278.04,"providers":[{"billed_charge":14260.05,"npi":[1417950106]}]},{"allowed_amount":441.74,"providers":[{"billed_charge":3008.34,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":284.70,"providers":[{"billed_charge":949.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6159.69,"providers":[{"billed_charge":20532.30,"npi":[1629076468]}]},{"allowed_amount":4829.91,"providers":[{"billed_charge":16099.70,"npi":[1548796378]}]},{"allowed_amount":282.00,"providers":[{"billed_charge":3638.10,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13657.22,"providers":[{"billed_charge":86153.25,"npi":[1366436123]}]},{"allowed_amount":31072.09,"providers":[{"billed_charge":105243.74,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10719.87,"providers":[{"billed_charge":53586.03,"npi":[1811973100]}]},{"allowed_amount":23559.82,"providers":[{"billed_charge":78531.39,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2639.57,"providers":[{"billed_charge":9879.73,"npi":[1427536325]}]},{"allowed_amount":3420.96,"providers":[{"billed_charge":11403.06,"npi":[1427536325]}]}]}]},{"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":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9784.33,"providers":[{"billed_charge":53545.03,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2218.95,"providers":[{"billed_charge":17514.96,"npi":[1144227539]}]},{"allowed_amount":688.56,"providers":[{"billed_charge":2295.21,"npi":[1144227539]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"842046902"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49.47,"providers":[{"billed_charge":164.85,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":172.70,"providers":[{"billed_charge":868.91,"npi":[1417950106]}]},{"allowed_amount":2348.85,"providers":[{"billed_charge":7829.24,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36.06,"providers":[{"billed_charge":572.01,"npi":[1629076468]}]},{"allowed_amount":1260.80,"providers":[{"billed_charge":4202.69,"npi":[1629076468]}]},{"allowed_amount":1585.35,"providers":[{"billed_charge":5284.44,"npi":[1548796378]}]}]}]},{"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":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2644.74,"providers":[{"billed_charge":3899.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":437.25,"providers":[{"billed_charge":650.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18514.35,"providers":[{"billed_charge":33507.00,"npi":[1093140600]}]},{"allowed_amount":515.20,"providers":[{"billed_charge":5125.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":518.04,"providers":[{"billed_charge":550.25,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20163.05,"providers":[{"billed_charge":82894.00,"npi":[1578568481]}]},{"allowed_amount":9064.95,"providers":[{"billed_charge":88886.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":46253.58,"providers":[{"billed_charge":154281.00,"npi":[1083903744]}]},{"allowed_amount":3680.96,"providers":[{"billed_charge":30162.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10102.68,"providers":[{"billed_charge":37671.30,"npi":[1427878909]}]},{"allowed_amount":7788.48,"providers":[{"billed_charge":25961.60,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1405.38,"providers":[{"billed_charge":5509.00,"npi":[1902465065]}]},{"allowed_amount":1867.48,"providers":[{"billed_charge":7737.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1376.55,"providers":[{"billed_charge":6534.27,"npi":[1649849910]}]},{"allowed_amount":3853.40,"providers":[{"billed_charge":6474.68,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7366.46,"providers":[{"billed_charge":46228.00,"npi":[1053360651]}]},{"allowed_amount":71012.48,"providers":[{"billed_charge":74095.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":867.05,"providers":[{"billed_charge":1543.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11894.50,"providers":[{"billed_charge":23459.00,"npi":[1295716637]}]},{"allowed_amount":4267.55,"providers":[{"billed_charge":12664.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":42913.45,"providers":[{"billed_charge":88189.00,"npi":[1710097936]}]},{"allowed_amount":386.90,"providers":[{"billed_charge":1624.00,"npi":[1710097936]}]},{"allowed_amount":8510.41,"providers":[{"billed_charge":50665.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":668.14,"providers":[{"billed_charge":3685.00,"npi":[1184373268]}]},{"allowed_amount":12507.65,"providers":[{"billed_charge":19879.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3047.44,"providers":[{"billed_charge":15565.16,"npi":[]}]},{"allowed_amount":574.99,"providers":[{"billed_charge":1965.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31822.46,"providers":[{"billed_charge":246409.00,"npi":[1366436123]}]},{"allowed_amount":236.15,"providers":[{"billed_charge":895.00,"npi":[1366436123]}]},{"allowed_amount":275371.06,"providers":[{"billed_charge":531573.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":495.53,"providers":[{"billed_charge":14774.00,"npi":[1275536799]}]},{"allowed_amount":3880.20,"providers":[{"billed_charge":7353.00,"npi":[1275536799]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2812.92,"providers":[{"billed_charge":23018.00,"npi":[1144227539]}]},{"allowed_amount":21979.12,"providers":[{"billed_charge":53993.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28108.71,"providers":[{"billed_charge":164016.00,"npi":[1811973100]}]},{"allowed_amount":216024.57,"providers":[{"billed_charge":344547.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6418.35,"providers":[{"billed_charge":42059.00,"npi":[1427536325]}]},{"allowed_amount":18501.24,"providers":[{"billed_charge":24495.00,"npi":[1427536325]}]}]}]},{"name":"IV THERAPY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"269","description":"IV THERAPY - OTHER IV THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":371.16,"providers":[{"billed_charge":1937.60,"npi":[1649849910]}]},{"allowed_amount":636.44,"providers":[{"billed_charge":2121.48,"npi":[1649849910]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":35.64,"providers":[{"billed_charge":834.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1077.87,"providers":[{"billed_charge":14086.00,"npi":[1710097936]}]},{"allowed_amount":720.00,"providers":[{"billed_charge":2400.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":195.11,"providers":[{"billed_charge":650.37,"npi":[1366436123]}]},{"allowed_amount":894.29,"providers":[{"billed_charge":18828.68,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8641.54,"providers":[{"billed_charge":28805.18,"npi":[1144227539]}]},{"allowed_amount":19511.81,"providers":[{"billed_charge":136462.79,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.80,"providers":[{"billed_charge":26.00,"npi":[1578568481]}]},{"allowed_amount":510.16,"providers":[{"billed_charge":1964.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":323.40,"providers":[{"billed_charge":1078.00,"npi":[1811973100]}]},{"allowed_amount":5629.61,"providers":[{"billed_charge":46430.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":284.10,"providers":[{"billed_charge":947.00,"npi":[1427536325]}]},{"allowed_amount":2046.45,"providers":[{"billed_charge":9496.00,"npi":[1427536325]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":325.68,"providers":[{"billed_charge":4400.00,"npi":[1811973100]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":291.80,"providers":[{"billed_charge":972.65,"npi":[1053360651]}]},{"allowed_amount":769.86,"providers":[{"billed_charge":12336.71,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18.15,"providers":[{"billed_charge":60.50,"npi":[1710097936]}]},{"allowed_amount":459.24,"providers":[{"billed_charge":3508.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6394.80,"providers":[{"billed_charge":21315.99,"npi":[1629076468]}]},{"allowed_amount":48.12,"providers":[{"billed_charge":32711.69,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":64361.45,"providers":[{"billed_charge":338770.71,"npi":[1366436123]}]},{"allowed_amount":10570.97,"providers":[{"billed_charge":41373.81,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":457.37,"providers":[{"billed_charge":7193.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3801.22,"providers":[{"billed_charge":12670.74,"npi":[1811973100]}]},{"allowed_amount":8130.68,"providers":[{"billed_charge":43198.04,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":168.19,"providers":[{"billed_charge":395.99,"npi":[1427536325]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"205432782"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":539.50,"providers":[{"billed_charge":33657.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":44148.29,"providers":[{"billed_charge":163378.40,"npi":[1366436123]}]},{"allowed_amount":7093.91,"providers":[{"billed_charge":31333.86,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7197.10,"providers":[{"billed_charge":241725.51,"npi":[1811973100]}]},{"allowed_amount":1156.19,"providers":[{"billed_charge":3853.94,"npi":[1811973100]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"446005747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":105.28,"providers":[{"billed_charge":229.00,"npi":[1629062799]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3901.77,"providers":[{"billed_charge":4751.00,"npi":[1396761805]}]},{"allowed_amount":103.50,"providers":[{"billed_charge":345.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3340.70,"providers":[{"billed_charge":5434.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"480543789"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1129.46,"providers":[{"billed_charge":2781.09,"npi":[1194782409]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5102.27,"providers":[{"billed_charge":7253.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":408.00,"npi":[1629076468]}]},{"allowed_amount":4412.02,"providers":[{"billed_charge":15676.00,"npi":[1548796378]}]},{"allowed_amount":1338.37,"providers":[{"billed_charge":19768.00,"npi":[1629076468]}]},{"allowed_amount":3194.04,"providers":[{"billed_charge":11007.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4068.19,"providers":[{"billed_charge":8784.50,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3352.26,"providers":[{"billed_charge":17100.00,"npi":[1083903744]}]},{"allowed_amount":51467.98,"providers":[{"billed_charge":102743.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"141958494"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":91.55,"providers":[{"billed_charge":802.00,"npi":[1659082105]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":13.00,"npi":[1053360651]}]},{"allowed_amount":9539.73,"providers":[{"billed_charge":132216.26,"npi":[1053360651]}]},{"allowed_amount":105351.97,"providers":[{"billed_charge":206951.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":208.86,"providers":[{"billed_charge":16869.00,"npi":[1598766495]}]},{"allowed_amount":23.96,"providers":[{"billed_charge":50.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":48434.89,"providers":[{"billed_charge":133108.00,"npi":[1710097936]}]},{"allowed_amount":17075.85,"providers":[{"billed_charge":238652.26,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21924.75,"providers":[{"billed_charge":85270.00,"npi":[1366436123]}]},{"allowed_amount":13070.51,"providers":[{"billed_charge":106976.00,"npi":[1366436123]}]},{"allowed_amount":116.20,"providers":[{"billed_charge":693.00,"npi":[1164419198]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4556.74,"providers":[{"billed_charge":18038.00,"npi":[1144227539]}]},{"allowed_amount":3187.03,"providers":[{"billed_charge":18844.52,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":60440.29,"providers":[{"billed_charge":542813.56,"npi":[1811973100]}]},{"allowed_amount":598.51,"providers":[{"billed_charge":4125.00,"npi":[1811973100]}]},{"allowed_amount":237404.94,"providers":[{"billed_charge":577086.32,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"800945173"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1520.47,"providers":[{"billed_charge":4282.00,"npi":[1215939210]}]},{"allowed_amount":137.06,"providers":[{"billed_charge":965.00,"npi":[1215939210]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8499.99,"providers":[{"billed_charge":75154.00,"npi":[1427536325]}]},{"allowed_amount":44570.03,"providers":[{"billed_charge":71469.00,"npi":[1427536325]}]},{"allowed_amount":536.75,"providers":[{"billed_charge":3218.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8.57,"providers":[{"billed_charge":17.00,"npi":[1356950398]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.97,"providers":[{"billed_charge":10152.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1475.22,"providers":[{"billed_charge":7036.00,"npi":[1093140600]}]},{"allowed_amount":43.01,"providers":[{"billed_charge":3099.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"842237042"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":364.33,"providers":[{"billed_charge":376.00,"npi":[1205482023]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":127.90,"providers":[{"billed_charge":576.00,"npi":[1285253252]}]},{"allowed_amount":239.72,"providers":[{"billed_charge":11644.00,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23800.20,"providers":[{"billed_charge":308234.84,"npi":[1578568481]}]},{"allowed_amount":40450.43,"providers":[{"billed_charge":286645.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6632.09,"providers":[{"billed_charge":22106.94,"npi":[1427878909]}]},{"allowed_amount":3466.74,"providers":[{"billed_charge":20641.26,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1708.80,"providers":[{"billed_charge":11686.10,"npi":[1649849910]}]},{"allowed_amount":1625.05,"providers":[{"billed_charge":19871.75,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37.20,"providers":[{"billed_charge":1519.00,"npi":[1295716637]}]},{"allowed_amount":6053.30,"providers":[{"billed_charge":22539.00,"npi":[1295716637]}]},{"allowed_amount":9719.08,"providers":[{"billed_charge":38719.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":785.00,"providers":[{"billed_charge":5388.00,"npi":[1417950106]}]},{"allowed_amount":4409.90,"providers":[{"billed_charge":8532.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1566.08,"providers":[{"billed_charge":11526.00,"npi":[1184373268]}]},{"allowed_amount":67.74,"providers":[{"billed_charge":820.00,"npi":[1184373268]}]},{"allowed_amount":9706.72,"providers":[{"billed_charge":12194.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":250.35,"providers":[{"billed_charge":1555.60,"npi":[]}]},{"allowed_amount":118.85,"providers":[{"billed_charge":1362.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3887.57,"providers":[{"billed_charge":9184.00,"npi":[1275536799]}]},{"allowed_amount":4051.09,"providers":[{"billed_charge":25642.00,"npi":[1275536799]}]},{"allowed_amount":2.25,"providers":[{"billed_charge":895.00,"npi":[1275536799]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":204.35,"providers":[{"billed_charge":7026.00,"npi":[1912943184]}]},{"allowed_amount":4568.34,"providers":[{"billed_charge":8235.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":69.71,"providers":[{"billed_charge":344.69,"npi":[1477500015]}]},{"allowed_amount":758.97,"providers":[{"billed_charge":6348.10,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":187.58,"providers":[{"billed_charge":305.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":430.32,"providers":[{"billed_charge":488.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":117.00,"providers":[{"billed_charge":117.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11120.40,"providers":[{"billed_charge":40201.00,"npi":[1548796378]}]},{"allowed_amount":6484.91,"providers":[{"billed_charge":38969.00,"npi":[1629076468]}]},{"allowed_amount":17774.18,"providers":[{"billed_charge":72660.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14660.15,"providers":[{"billed_charge":25729.00,"npi":[1083903744]}]},{"allowed_amount":1660.42,"providers":[{"billed_charge":5632.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11743.16,"providers":[{"billed_charge":34491.00,"npi":[1053360651]}]},{"allowed_amount":22768.98,"providers":[{"billed_charge":33836.00,"npi":[1053360651]}]},{"allowed_amount":63.64,"providers":[{"billed_charge":282.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1880.50,"providers":[{"billed_charge":4884.00,"npi":[1598766495]}]},{"allowed_amount":1545.90,"providers":[{"billed_charge":24824.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14073.59,"providers":[{"billed_charge":37490.00,"npi":[1710097936]}]},{"allowed_amount":21224.43,"providers":[{"billed_charge":72771.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":296568.30,"providers":[{"billed_charge":859972.00,"npi":[1366436123]}]},{"allowed_amount":110986.56,"providers":[{"billed_charge":767415.00,"npi":[1366436123]}]},{"allowed_amount":1684.56,"providers":[{"billed_charge":16630.00,"npi":[1164419198]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":26048.01,"providers":[{"billed_charge":165164.00,"npi":[1144227539]}]},{"allowed_amount":34043.07,"providers":[{"billed_charge":87459.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":175.20,"providers":[{"billed_charge":1163.00,"npi":[1811973100]}]},{"allowed_amount":58082.37,"providers":[{"billed_charge":94735.00,"npi":[1811973100]}]},{"allowed_amount":38151.76,"providers":[{"billed_charge":128933.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10598.42,"providers":[{"billed_charge":14507.00,"npi":[1427536325]}]},{"allowed_amount":163.46,"providers":[{"billed_charge":1100.00,"npi":[1427536325]}]},{"allowed_amount":3389.86,"providers":[{"billed_charge":9514.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"720408970"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1565.17,"providers":[{"billed_charge":4369.00,"npi":[1295723229]}]}]},{"tin":{"type":"ein","value":"800948632"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9.20,"providers":[{"billed_charge":47.00,"npi":[1104252030]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":25777.06,"providers":[{"billed_charge":62463.00,"npi":[1093140600]}]},{"allowed_amount":2967.10,"providers":[{"billed_charge":23692.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"751301362"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16.47,"providers":[{"billed_charge":2887.00,"npi":[1821087164]}]}]},{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":85.89,"providers":[{"billed_charge":1792.00,"npi":[1568403111]}]}]},{"tin":{"type":"ein","value":"311480941"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38.47,"providers":[{"billed_charge":100.53,"npi":[1598868655]}]}]},{"tin":{"type":"ein","value":"450310462"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":504.93,"providers":[{"billed_charge":787.00,"npi":[1154346161]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17964.77,"providers":[{"billed_charge":83994.00,"npi":[1578568481]}]},{"allowed_amount":21037.94,"providers":[{"billed_charge":155840.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3486.37,"providers":[{"billed_charge":9064.00,"npi":[1902465065]}]},{"allowed_amount":4521.58,"providers":[{"billed_charge":48462.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3909.02,"providers":[{"billed_charge":11144.00,"npi":[1295716637]}]},{"allowed_amount":34.06,"providers":[{"billed_charge":722.00,"npi":[1295716637]}]},{"allowed_amount":2687.54,"providers":[{"billed_charge":10203.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":775.33,"providers":[{"billed_charge":1128.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"741180155"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20.22,"providers":[{"billed_charge":7421.00,"npi":[1548387418]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37547.63,"providers":[{"billed_charge":57048.00,"npi":[1417950106]}]},{"allowed_amount":6109.70,"providers":[{"billed_charge":34096.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20.28,"providers":[{"billed_charge":242.00,"npi":[1184373268]}]},{"allowed_amount":2381.44,"providers":[{"billed_charge":3162.00,"npi":[1184373268]}]},{"allowed_amount":777.30,"providers":[{"billed_charge":1690.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":569.14,"providers":[{"billed_charge":14670.00,"npi":[1639160799]}]},{"allowed_amount":1608.70,"providers":[{"billed_charge":5256.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3051.15,"providers":[{"billed_charge":46395.96,"npi":[]}]},{"allowed_amount":597.06,"providers":[{"billed_charge":6599.46,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":417.28,"providers":[{"billed_charge":867.00,"npi":[1275536799]}]},{"allowed_amount":810.47,"providers":[{"billed_charge":1442.00,"npi":[1275536799]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":211.26,"providers":[{"billed_charge":406.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":190.32,"providers":[{"billed_charge":470.00,"npi":[1912943184]}]},{"allowed_amount":81.58,"providers":[{"billed_charge":968.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":695.37,"providers":[{"billed_charge":10189.00,"npi":[1053360651]}]},{"allowed_amount":474.49,"providers":[{"billed_charge":864.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1494.44,"providers":[{"billed_charge":4556.00,"npi":[1710097936]}]},{"allowed_amount":222.48,"providers":[{"billed_charge":1288.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":158.83,"providers":[{"billed_charge":706.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2673.86,"providers":[{"billed_charge":23823.00,"npi":[1366436123]}]},{"allowed_amount":3963.13,"providers":[{"billed_charge":12753.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":727.58,"providers":[{"billed_charge":3252.00,"npi":[1144227539]}]},{"allowed_amount":3449.87,"providers":[{"billed_charge":18322.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":58.46,"providers":[{"billed_charge":354.00,"npi":[1811973100]}]},{"allowed_amount":6260.57,"providers":[{"billed_charge":52730.92,"npi":[1811973100]}]},{"allowed_amount":3094.17,"providers":[{"billed_charge":29549.53,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":31.92,"providers":[{"billed_charge":614.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":58.67,"providers":[{"billed_charge":152.00,"npi":[1427536325]}]},{"allowed_amount":32.00,"providers":[{"billed_charge":32.00,"npi":[1427536325]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":724.13,"providers":[{"billed_charge":2144.00,"npi":[1912943184]}]},{"allowed_amount":106.30,"providers":[{"billed_charge":1246.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":94.98,"providers":[{"billed_charge":3543.00,"npi":[1093140600]}]},{"allowed_amount":4228.33,"providers":[{"billed_charge":10664.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3443.44,"providers":[{"billed_charge":18050.00,"npi":[1629076468]}]},{"allowed_amount":2348.61,"providers":[{"billed_charge":12480.00,"npi":[1548796378]}]},{"allowed_amount":6.47,"providers":[{"billed_charge":226.00,"npi":[1629076468]}]},{"allowed_amount":1114.29,"providers":[{"billed_charge":6826.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2838.90,"providers":[{"billed_charge":22755.00,"npi":[1578568481]}]},{"allowed_amount":7952.56,"providers":[{"billed_charge":28004.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":688.76,"providers":[{"billed_charge":1550.00,"npi":[1902465065]}]},{"allowed_amount":1796.68,"providers":[{"billed_charge":5535.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":538.08,"providers":[{"billed_charge":4266.07,"npi":[1649849910]}]},{"allowed_amount":298.08,"providers":[{"billed_charge":898.12,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.53,"providers":[{"billed_charge":31.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":267.84,"providers":[{"billed_charge":991.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1608.50,"providers":[{"billed_charge":8477.00,"npi":[1417950106]}]},{"allowed_amount":5825.44,"providers":[{"billed_charge":16456.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":277.87,"providers":[{"billed_charge":1368.00,"npi":[1639160799]}]},{"allowed_amount":17.82,"providers":[{"billed_charge":409.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36360.65,"providers":[{"billed_charge":165302.00,"npi":[1366436123]}]},{"allowed_amount":33563.59,"providers":[{"billed_charge":177229.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":269.75,"providers":[{"billed_charge":4740.95,"npi":[]}]},{"allowed_amount":54.76,"providers":[{"billed_charge":999.15,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4998.21,"providers":[{"billed_charge":11675.00,"npi":[1144227539]}]},{"allowed_amount":3864.28,"providers":[{"billed_charge":16129.00,"npi":[1144227539]}]}]}]},{"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":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4398.13,"providers":[{"billed_charge":7494.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5979.56,"providers":[{"billed_charge":17246.00,"npi":[1093140600]}]},{"allowed_amount":197.57,"providers":[{"billed_charge":4408.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6342.62,"providers":[{"billed_charge":22997.00,"npi":[1629076468]}]},{"allowed_amount":458.39,"providers":[{"billed_charge":15348.00,"npi":[1629076468]}]},{"allowed_amount":7971.24,"providers":[{"billed_charge":37275.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2852.89,"providers":[{"billed_charge":12263.00,"npi":[1578568481]}]},{"allowed_amount":3154.87,"providers":[{"billed_charge":22844.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":413.96,"providers":[{"billed_charge":1732.00,"npi":[1083903744]}]},{"allowed_amount":2286.98,"providers":[{"billed_charge":3225.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45.38,"providers":[{"billed_charge":106.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3418.01,"providers":[{"billed_charge":11148.00,"npi":[1053360651]}]},{"allowed_amount":8694.28,"providers":[{"billed_charge":20917.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":99.75,"providers":[{"billed_charge":251.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":74.93,"providers":[{"billed_charge":185.00,"npi":[1295716637]}]},{"allowed_amount":113.45,"providers":[{"billed_charge":356.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3289.09,"providers":[{"billed_charge":10500.00,"npi":[1710097936]}]},{"allowed_amount":4412.09,"providers":[{"billed_charge":13140.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3655.90,"providers":[{"billed_charge":8172.00,"npi":[1417950106]}]},{"allowed_amount":185.39,"providers":[{"billed_charge":2272.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":109.83,"providers":[{"billed_charge":1134.95,"npi":[]}]},{"allowed_amount":762.89,"providers":[{"billed_charge":9237.71,"npi":[]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1865.94,"providers":[{"billed_charge":5798.00,"npi":[1366436123]}]},{"allowed_amount":68712.40,"providers":[{"billed_charge":162886.00,"npi":[1366436123]}]},{"allowed_amount":27622.72,"providers":[{"billed_charge":188289.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2827.66,"providers":[{"billed_charge":12231.00,"npi":[1144227539]}]},{"allowed_amount":3467.25,"providers":[{"billed_charge":36746.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12074.70,"providers":[{"billed_charge":48316.00,"npi":[1811973100]}]},{"allowed_amount":11343.64,"providers":[{"billed_charge":24560.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":33.31,"providers":[{"billed_charge":54.00,"npi":[1427536325]}]},{"allowed_amount":126.22,"providers":[{"billed_charge":327.00,"npi":[1427536325]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3301.33,"providers":[{"billed_charge":4998.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2652.98,"providers":[{"billed_charge":4780.00,"npi":[1093140600]}]},{"allowed_amount":13.44,"providers":[{"billed_charge":214.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6700.92,"providers":[{"billed_charge":10908.00,"npi":[1417950106]}]},{"allowed_amount":162.92,"providers":[{"billed_charge":906.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1328.44,"providers":[{"billed_charge":5297.00,"npi":[1629076468]}]},{"allowed_amount":2008.88,"providers":[{"billed_charge":10787.00,"npi":[1548796378]}]},{"allowed_amount":197.36,"providers":[{"billed_charge":1047.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.51,"providers":[{"billed_charge":32.71,"npi":[]}]},{"allowed_amount":154.64,"providers":[{"billed_charge":3042.85,"npi":[]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12903.76,"providers":[{"billed_charge":49561.00,"npi":[1366436123]}]},{"allowed_amount":3156.28,"providers":[{"billed_charge":18101.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1486.95,"providers":[{"billed_charge":2177.00,"npi":[1144227539]}]},{"allowed_amount":321.05,"providers":[{"billed_charge":1112.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":287.40,"providers":[{"billed_charge":2800.00,"npi":[1578568481]}]},{"allowed_amount":271.09,"providers":[{"billed_charge":2100.00,"npi":[1578568481]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3078.90,"providers":[{"billed_charge":10263.00,"npi":[1811973100]}]},{"allowed_amount":262.99,"providers":[{"billed_charge":724.00,"npi":[1811973100]}]},{"allowed_amount":4616.01,"providers":[{"billed_charge":31776.00,"npi":[1811973100]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":736.24,"providers":[{"billed_charge":6110.00,"npi":[1811973100]}]},{"allowed_amount":483.04,"providers":[{"billed_charge":2148.00,"npi":[1811973100]}]}]}]},{"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":"463123178"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":80.08,"providers":[{"billed_charge":198.00,"npi":[1093140600]}]},{"allowed_amount":5149.62,"providers":[{"billed_charge":9997.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2990.66,"providers":[{"billed_charge":7842.00,"npi":[1629076468]}]},{"allowed_amount":3308.15,"providers":[{"billed_charge":9704.00,"npi":[1548796378]}]},{"allowed_amount":147.53,"providers":[{"billed_charge":734.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13407.52,"providers":[{"billed_charge":30653.00,"npi":[1578568481]}]},{"allowed_amount":2700.57,"providers":[{"billed_charge":10179.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11363.87,"providers":[{"billed_charge":15502.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23614.27,"providers":[{"billed_charge":27267.00,"npi":[1053360651]}]},{"allowed_amount":80.96,"providers":[{"billed_charge":305.00,"npi":[1053360651]}]},{"allowed_amount":1172.33,"providers":[{"billed_charge":4524.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":729.15,"providers":[{"billed_charge":1292.00,"npi":[1295716637]}]},{"allowed_amount":92.34,"providers":[{"billed_charge":228.00,"npi":[1295716637]}]},{"allowed_amount":163.45,"providers":[{"billed_charge":629.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10622.37,"providers":[{"billed_charge":17109.00,"npi":[1710097936]}]},{"allowed_amount":2549.73,"providers":[{"billed_charge":9708.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":233.27,"providers":[{"billed_charge":1238.00,"npi":[1417950106]}]},{"allowed_amount":15986.42,"providers":[{"billed_charge":22256.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":407.00,"providers":[{"billed_charge":407.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1333.54,"providers":[{"billed_charge":6088.00,"npi":[]}]},{"allowed_amount":676.87,"providers":[{"billed_charge":1267.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19320.17,"providers":[{"billed_charge":125029.00,"npi":[1366436123]}]},{"allowed_amount":116339.84,"providers":[{"billed_charge":235902.00,"npi":[1366436123]}]},{"allowed_amount":293.34,"providers":[{"billed_charge":1980.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1269.24,"providers":[{"billed_charge":5200.00,"npi":[1144227539]}]},{"allowed_amount":2216.99,"providers":[{"billed_charge":14399.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9667.03,"providers":[{"billed_charge":104020.00,"npi":[1811973100]}]},{"allowed_amount":8668.31,"providers":[{"billed_charge":55826.00,"npi":[1811973100]}]},{"allowed_amount":68696.14,"providers":[{"billed_charge":94473.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2509.67,"providers":[{"billed_charge":7903.00,"npi":[1427536325]}]},{"allowed_amount":19299.64,"providers":[{"billed_charge":25672.00,"npi":[1427536325]}]}]}]},{"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":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":732.62,"providers":[{"billed_charge":3984.00,"npi":[1083903744]}]},{"allowed_amount":9074.80,"providers":[{"billed_charge":23904.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18261.00,"providers":[{"billed_charge":18261.00,"npi":[1053360651]}]},{"allowed_amount":2034.24,"providers":[{"billed_charge":7650.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6413.81,"providers":[{"billed_charge":10944.00,"npi":[1710097936]}]},{"allowed_amount":2319.75,"providers":[{"billed_charge":7353.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5554.70,"providers":[{"billed_charge":11207.00,"npi":[1417950106]}]},{"allowed_amount":455.07,"providers":[{"billed_charge":3723.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4923.08,"providers":[{"billed_charge":13930.00,"npi":[1093140600]}]},{"allowed_amount":172.03,"providers":[{"billed_charge":1920.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":603.94,"providers":[{"billed_charge":8806.00,"npi":[1629076468]}]},{"allowed_amount":4686.30,"providers":[{"billed_charge":21238.00,"npi":[1629076468]}]},{"allowed_amount":81.36,"providers":[{"billed_charge":638.00,"npi":[1629076468]}]},{"allowed_amount":1371.60,"providers":[{"billed_charge":6216.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14872.64,"providers":[{"billed_charge":82009.00,"npi":[1366436123]}]},{"allowed_amount":113628.45,"providers":[{"billed_charge":140799.00,"npi":[1366436123]}]},{"allowed_amount":80.96,"providers":[{"billed_charge":383.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1464.93,"providers":[{"billed_charge":6849.00,"npi":[1144227539]}]},{"allowed_amount":2707.18,"providers":[{"billed_charge":14521.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6503.44,"providers":[{"billed_charge":37423.00,"npi":[1811973100]}]},{"allowed_amount":44963.41,"providers":[{"billed_charge":75685.00,"npi":[1811973100]}]},{"allowed_amount":80.84,"providers":[{"billed_charge":208.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8448.21,"providers":[{"billed_charge":26615.00,"npi":[1578568481]}]},{"allowed_amount":80.57,"providers":[{"billed_charge":296.00,"npi":[1578568481]}]},{"allowed_amount":3310.48,"providers":[{"billed_charge":21300.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3984.33,"providers":[{"billed_charge":13650.00,"npi":[1427536325]}]},{"allowed_amount":13310.82,"providers":[{"billed_charge":17682.00,"npi":[1427536325]}]}]}]},{"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":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1000.46,"providers":[{"billed_charge":4704.00,"npi":[1083903744]}]},{"allowed_amount":22556.05,"providers":[{"billed_charge":31488.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9435.48,"providers":[{"billed_charge":26292.00,"npi":[1053360651]}]},{"allowed_amount":63433.87,"providers":[{"billed_charge":70157.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3765.75,"providers":[{"billed_charge":7220.00,"npi":[1710097936]}]},{"allowed_amount":18556.43,"providers":[{"billed_charge":26014.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":97.64,"providers":[{"billed_charge":1619.00,"npi":[1811973100]}]},{"allowed_amount":34373.44,"providers":[{"billed_charge":163504.00,"npi":[1811973100]}]},{"allowed_amount":143592.34,"providers":[{"billed_charge":343792.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":41323.47,"providers":[{"billed_charge":177700.00,"npi":[1578568481]}]},{"allowed_amount":8981.59,"providers":[{"billed_charge":93325.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1571.00,"providers":[{"billed_charge":1571.00,"npi":[1427536325]}]},{"allowed_amount":2652.00,"providers":[{"billed_charge":6971.00,"npi":[1427536325]}]},{"allowed_amount":99.79,"providers":[{"billed_charge":1524.00,"npi":[1427536325]}]}]}]},{"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":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":442.26,"providers":[{"billed_charge":2710.00,"npi":[1083903744]}]},{"allowed_amount":20870.03,"providers":[{"billed_charge":27683.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":54710.00,"providers":[{"billed_charge":54710.00,"npi":[1053360651]}]},{"allowed_amount":5587.77,"providers":[{"billed_charge":19481.00,"npi":[1053360651]}]},{"allowed_amount":97.78,"providers":[{"billed_charge":772.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":97.64,"providers":[{"billed_charge":1018.00,"npi":[1710097936]}]},{"allowed_amount":6246.10,"providers":[{"billed_charge":22916.00,"npi":[1710097936]}]},{"allowed_amount":11146.40,"providers":[{"billed_charge":25785.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6316.62,"providers":[{"billed_charge":7918.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3709.94,"providers":[{"billed_charge":11312.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6837.17,"providers":[{"billed_charge":18845.00,"npi":[1629076468]}]},{"allowed_amount":426.92,"providers":[{"billed_charge":11453.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":342249.07,"providers":[{"billed_charge":483463.00,"npi":[1366436123]}]},{"allowed_amount":65901.36,"providers":[{"billed_charge":299088.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2288.41,"providers":[{"billed_charge":14932.00,"npi":[1144227539]}]},{"allowed_amount":4422.24,"providers":[{"billed_charge":16392.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":396.28,"providers":[{"billed_charge":7646.00,"npi":[1578568481]}]},{"allowed_amount":3466.42,"providers":[{"billed_charge":16782.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":92440.13,"providers":[{"billed_charge":242449.00,"npi":[1811973100]}]},{"allowed_amount":25576.38,"providers":[{"billed_charge":146713.00,"npi":[1811973100]}]},{"allowed_amount":261.09,"providers":[{"billed_charge":2804.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5245.69,"providers":[{"billed_charge":16030.00,"npi":[1427536325]}]},{"allowed_amount":31921.82,"providers":[{"billed_charge":39642.00,"npi":[1427536325]}]}]}]},{"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":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":864.41,"providers":[{"billed_charge":8244.00,"npi":[1083903744]}]},{"allowed_amount":9265.73,"providers":[{"billed_charge":16221.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3424.70,"providers":[{"billed_charge":9998.00,"npi":[1053360651]}]},{"allowed_amount":28913.79,"providers":[{"billed_charge":37569.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8759.35,"providers":[{"billed_charge":17324.00,"npi":[1710097936]}]},{"allowed_amount":2951.05,"providers":[{"billed_charge":10254.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13929.13,"providers":[{"billed_charge":51710.00,"npi":[1093140600]}]},{"allowed_amount":2381.12,"providers":[{"billed_charge":8535.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":100.51,"providers":[{"billed_charge":239.00,"npi":[1417950106]}]},{"allowed_amount":72821.12,"providers":[{"billed_charge":102816.00,"npi":[1417950106]}]},{"allowed_amount":973.47,"providers":[{"billed_charge":18244.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":33832.39,"providers":[{"billed_charge":127028.00,"npi":[1548796378]}]},{"allowed_amount":28959.34,"providers":[{"billed_charge":116407.00,"npi":[1629076468]}]},{"allowed_amount":4537.07,"providers":[{"billed_charge":23586.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":129738.78,"providers":[{"billed_charge":932598.00,"npi":[1366436123]}]},{"allowed_amount":328.37,"providers":[{"billed_charge":5315.00,"npi":[1366436123]}]},{"allowed_amount":717932.30,"providers":[{"billed_charge":1689980.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3075.71,"providers":[{"billed_charge":30629.00,"npi":[1144227539]}]},{"allowed_amount":6620.58,"providers":[{"billed_charge":39127.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31067.65,"providers":[{"billed_charge":184637.00,"npi":[1811973100]}]},{"allowed_amount":78277.46,"providers":[{"billed_charge":250261.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8629.19,"providers":[{"billed_charge":54455.00,"npi":[1578568481]}]},{"allowed_amount":11713.51,"providers":[{"billed_charge":40703.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":27981.19,"providers":[{"billed_charge":37372.00,"npi":[1427536325]}]},{"allowed_amount":4921.39,"providers":[{"billed_charge":13873.00,"npi":[1427536325]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3058.40,"providers":[{"billed_charge":6549.00,"npi":[1366436123]}]},{"allowed_amount":106751.83,"providers":[{"billed_charge":201403.50,"npi":[1366436123]}]},{"allowed_amount":189220.32,"providers":[{"billed_charge":919803.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":50802.80,"providers":[{"billed_charge":935172.00,"npi":[1811973100]}]},{"allowed_amount":68554.63,"providers":[{"billed_charge":450753.34,"npi":[1811973100]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":849.37,"providers":[{"billed_charge":11564.00,"npi":[1053360651]}]},{"allowed_amount":701.55,"providers":[{"billed_charge":1329.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1263.36,"providers":[{"billed_charge":13724.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2118.61,"providers":[{"billed_charge":5927.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2287.41,"providers":[{"billed_charge":8816.00,"npi":[1811973100]}]},{"allowed_amount":8896.69,"providers":[{"billed_charge":17535.00,"npi":[1811973100]}]},{"allowed_amount":17968.22,"providers":[{"billed_charge":154309.00,"npi":[1811973100]}]}]}]},{"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":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":18.20,"providers":[{"billed_charge":44.00,"npi":[1558758730]}]},{"allowed_amount":95.55,"providers":[{"billed_charge":231.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":615.96,"providers":[{"billed_charge":6950.81,"npi":[1234567893]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1099.52,"providers":[{"billed_charge":9226.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":148.95,"providers":[{"billed_charge":154.00,"npi":[1710097936]}]},{"allowed_amount":2538.00,"providers":[{"billed_charge":2538.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24552.28,"providers":[{"billed_charge":189493.00,"npi":[1366436123]}]},{"allowed_amount":14094.04,"providers":[{"billed_charge":49111.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17062.24,"providers":[{"billed_charge":105129.00,"npi":[1811973100]}]},{"allowed_amount":5649.90,"providers":[{"billed_charge":18042.00,"npi":[1811973100]}]}]}]},{"name":"BLOOD/STOR-PROC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"390","description":"BLOOD STORAGE AND PROCESSING - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2889.60,"providers":[{"billed_charge":9632.00,"npi":[1366436123]}]},{"allowed_amount":10346.22,"providers":[{"billed_charge":22704.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1734.86,"providers":[{"billed_charge":5156.00,"npi":[1811973100]}]},{"allowed_amount":720.00,"providers":[{"billed_charge":2400.00,"npi":[1811973100]}]}]}]},{"name":"BLOOD/ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"391","description":"BLOOD STORAGE AND PROCESSING - BLOOD ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":601.97,"providers":[{"billed_charge":9261.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2108.94,"providers":[{"billed_charge":9435.00,"npi":[1811973100]}]},{"allowed_amount":3009.16,"providers":[{"billed_charge":15725.00,"npi":[1811973100]}]}]}]},{"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":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12676.91,"providers":[{"billed_charge":20612.00,"npi":[1912943184]}]},{"allowed_amount":334.54,"providers":[{"billed_charge":812.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2924.33,"providers":[{"billed_charge":3608.00,"npi":[1053360651]}]},{"allowed_amount":975.77,"providers":[{"billed_charge":2905.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5104.43,"providers":[{"billed_charge":10695.00,"npi":[1710097936]}]},{"allowed_amount":1114.50,"providers":[{"billed_charge":6058.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":100.51,"providers":[{"billed_charge":786.00,"npi":[1417950106]}]},{"allowed_amount":344.54,"providers":[{"billed_charge":753.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28272.81,"providers":[{"billed_charge":65838.00,"npi":[1366436123]}]},{"allowed_amount":6572.73,"providers":[{"billed_charge":44882.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":46.90,"providers":[{"billed_charge":606.00,"npi":[]}]},{"allowed_amount":844.16,"providers":[{"billed_charge":3374.34,"npi":[]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4804.54,"providers":[{"billed_charge":13322.00,"npi":[1578568481]}]},{"allowed_amount":546.14,"providers":[{"billed_charge":12686.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4794.41,"providers":[{"billed_charge":38014.00,"npi":[1811973100]}]},{"allowed_amount":30080.70,"providers":[{"billed_charge":82595.00,"npi":[1811973100]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":648.72,"providers":[{"billed_charge":2385.00,"npi":[1083903744]}]},{"allowed_amount":112.63,"providers":[{"billed_charge":159.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1259.61,"providers":[{"billed_charge":8924.00,"npi":[1053360651]}]},{"allowed_amount":506.85,"providers":[{"billed_charge":1095.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20778.11,"providers":[{"billed_charge":38163.00,"npi":[1710097936]}]},{"allowed_amount":675.78,"providers":[{"billed_charge":894.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7021.20,"providers":[{"billed_charge":16259.00,"npi":[1366436123]}]},{"allowed_amount":22540.77,"providers":[{"billed_charge":222652.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8900.57,"providers":[{"billed_charge":17878.00,"npi":[1811973100]}]},{"allowed_amount":30702.22,"providers":[{"billed_charge":130586.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":788.41,"providers":[{"billed_charge":1701.00,"npi":[1578568481]}]},{"allowed_amount":3993.27,"providers":[{"billed_charge":54377.00,"npi":[1578568481]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":34.69,"providers":[{"billed_charge":147.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4378.21,"providers":[{"billed_charge":8942.00,"npi":[1366436123]}]},{"allowed_amount":9626.60,"providers":[{"billed_charge":57715.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1234.57,"providers":[{"billed_charge":9083.00,"npi":[1811973100]}]},{"allowed_amount":6264.80,"providers":[{"billed_charge":27533.00,"npi":[1811973100]}]},{"allowed_amount":123.14,"providers":[{"billed_charge":339.00,"npi":[1811973100]}]}]}]},{"name":"PHYS THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"421","description":"PHYSICAL THERAPY/VISIT","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1635.69,"providers":[{"billed_charge":8982.00,"npi":[1366436123]}]},{"allowed_amount":31.82,"providers":[{"billed_charge":94.00,"npi":[1366436123]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":181.80,"providers":[{"billed_charge":1314.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1069.86,"providers":[{"billed_charge":2305.00,"npi":[1811973100]}]},{"allowed_amount":4958.64,"providers":[{"billed_charge":23470.00,"npi":[1811973100]}]},{"allowed_amount":95.16,"providers":[{"billed_charge":461.00,"npi":[1811973100]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":702.16,"providers":[{"billed_charge":3133.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4413.79,"providers":[{"billed_charge":8119.00,"npi":[1366436123]}]},{"allowed_amount":9676.33,"providers":[{"billed_charge":53736.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5146.18,"providers":[{"billed_charge":31366.00,"npi":[1811973100]}]},{"allowed_amount":94.89,"providers":[{"billed_charge":555.00,"npi":[1811973100]}]}]}]},{"name":"OCCUP THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"431","description":"OCCUPATIONAL THERAPY - VISIT CHARGE","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":294.47,"providers":[{"billed_charge":2824.00,"npi":[1366436123]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":268.95,"providers":[{"billed_charge":942.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4252.41,"providers":[{"billed_charge":25274.00,"npi":[1811973100]}]},{"allowed_amount":1015.52,"providers":[{"billed_charge":1980.00,"npi":[1811973100]}]}]}]},{"name":"SPEECH PATH/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"444","description":"SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2465.47,"providers":[{"billed_charge":9701.00,"npi":[1366436123]}]},{"allowed_amount":411.26,"providers":[{"billed_charge":592.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1166.58,"providers":[{"billed_charge":10023.00,"npi":[1811973100]}]},{"allowed_amount":464.74,"providers":[{"billed_charge":1818.00,"npi":[1811973100]}]}]}]},{"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":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":61802.72,"providers":[{"billed_charge":74458.90,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7174.71,"providers":[{"billed_charge":9120.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8503.91,"providers":[{"billed_charge":11873.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12968.09,"providers":[{"billed_charge":12971.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":187894.52,"providers":[{"billed_charge":474890.00,"npi":[1548796378]}]},{"allowed_amount":6142.33,"providers":[{"billed_charge":32502.00,"npi":[1629076468]}]},{"allowed_amount":150810.14,"providers":[{"billed_charge":410077.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9134.97,"providers":[{"billed_charge":16234.25,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":389169.76,"providers":[{"billed_charge":515045.00,"npi":[1083903744]}]},{"allowed_amount":5783.80,"providers":[{"billed_charge":33594.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28249.69,"providers":[{"billed_charge":147512.00,"npi":[1053360651]}]},{"allowed_amount":787348.87,"providers":[{"billed_charge":948661.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2770.31,"providers":[{"billed_charge":4836.00,"npi":[1598766495]}]},{"allowed_amount":872.70,"providers":[{"billed_charge":5115.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":440608.92,"providers":[{"billed_charge":558181.00,"npi":[1710097936]}]},{"allowed_amount":23498.86,"providers":[{"billed_charge":84506.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"760591590"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5572.46,"providers":[{"billed_charge":37247.00,"npi":[1679557888]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1815032.57,"providers":[{"billed_charge":2692856.00,"npi":[1366436123]}]},{"allowed_amount":76307.55,"providers":[{"billed_charge":491722.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":71470.33,"providers":[{"billed_charge":291295.00,"npi":[1144227539]}]},{"allowed_amount":17536.56,"providers":[{"billed_charge":138492.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":94484.29,"providers":[{"billed_charge":534247.00,"npi":[1811973100]}]},{"allowed_amount":2047980.58,"providers":[{"billed_charge":4008391.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":201204.83,"providers":[{"billed_charge":527979.00,"npi":[1427536325]}]},{"allowed_amount":16955.24,"providers":[{"billed_charge":77303.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4267.75,"providers":[{"billed_charge":5937.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"721495500"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":628.34,"providers":[{"billed_charge":699.00,"npi":[1609860360]}]}]},{"tin":{"type":"ein","value":"751301362"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":159.85,"providers":[{"billed_charge":1949.00,"npi":[1821087164]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1684.03,"providers":[{"billed_charge":33482.00,"npi":[1093140600]}]},{"allowed_amount":120837.51,"providers":[{"billed_charge":185865.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19847.39,"providers":[{"billed_charge":125257.00,"npi":[1578568481]}]},{"allowed_amount":355114.70,"providers":[{"billed_charge":430220.88,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10952.67,"providers":[{"billed_charge":14359.00,"npi":[1902465065]}]},{"allowed_amount":1801.84,"providers":[{"billed_charge":4618.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1610.38,"providers":[{"billed_charge":6390.81,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8540.85,"providers":[{"billed_charge":12484.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2554.02,"providers":[{"billed_charge":6757.00,"npi":[1295716637]}]},{"allowed_amount":72219.20,"providers":[{"billed_charge":77213.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":160260.68,"providers":[{"billed_charge":333859.00,"npi":[1417950106]}]},{"allowed_amount":3675.77,"providers":[{"billed_charge":24940.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":62380.57,"providers":[{"billed_charge":92423.00,"npi":[1184373268]}]},{"allowed_amount":1991.13,"providers":[{"billed_charge":9924.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":412.72,"providers":[{"billed_charge":8342.00,"npi":[1639160799]}]},{"allowed_amount":7602.05,"providers":[{"billed_charge":13600.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29588.13,"providers":[{"billed_charge":127253.10,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15720.80,"providers":[{"billed_charge":27378.00,"npi":[1275536799]}]},{"allowed_amount":933.32,"providers":[{"billed_charge":9909.00,"npi":[1275536799]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":486.41,"providers":[{"billed_charge":3792.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":78.75,"providers":[{"billed_charge":110.00,"npi":[1710097936]}]},{"allowed_amount":3570.15,"providers":[{"billed_charge":9182.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":652.93,"providers":[{"billed_charge":1253.00,"npi":[1366436123]}]},{"allowed_amount":6667.32,"providers":[{"billed_charge":47164.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20398.65,"providers":[{"billed_charge":106387.00,"npi":[1811973100]}]},{"allowed_amount":393.75,"providers":[{"billed_charge":1190.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6864.54,"providers":[{"billed_charge":63429.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":116.00,"providers":[{"billed_charge":707.00,"npi":[1427536325]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":504.15,"providers":[{"billed_charge":2141.00,"npi":[1053360651]}]},{"allowed_amount":6238.02,"providers":[{"billed_charge":23551.00,"npi":[1053360651]}]},{"allowed_amount":1350.86,"providers":[{"billed_charge":2141.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3598.00,"providers":[{"billed_charge":5397.00,"npi":[1710097936]}]},{"allowed_amount":539.70,"providers":[{"billed_charge":1799.00,"npi":[1710097936]}]},{"allowed_amount":503.43,"providers":[{"billed_charge":2023.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28003.31,"providers":[{"billed_charge":150776.00,"npi":[1366436123]}]},{"allowed_amount":20697.63,"providers":[{"billed_charge":47679.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1006.86,"providers":[{"billed_charge":5963.00,"npi":[1811973100]}]},{"allowed_amount":21340.37,"providers":[{"billed_charge":32012.00,"npi":[1811973100]}]},{"allowed_amount":31167.43,"providers":[{"billed_charge":155149.00,"npi":[1811973100]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15416.63,"providers":[{"billed_charge":25900.00,"npi":[1366436123]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"271287287"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":473.00,"providers":[{"billed_charge":1999.00,"npi":[]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"141958494"},"service_code":["22","50"],"billing_class":"institutional","payments":[{"allowed_amount":62342.93,"providers":[{"billed_charge":121488.38,"npi":[1659082105]}]},{"allowed_amount":45.00,"providers":[{"billed_charge":25.00,"npi":[1659082105]}]}]},{"tin":{"type":"ein","value":"721395500"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":2682.13,"providers":[{"billed_charge":7860.00,"npi":[1962154542]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"726014606"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10721.55,"providers":[{"billed_charge":37573.00,"npi":[1295716637]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5067.20,"providers":[{"billed_charge":9060.00,"npi":[1366436123]}]},{"allowed_amount":9865.47,"providers":[{"billed_charge":60763.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14108.03,"providers":[{"billed_charge":35572.00,"npi":[1811973100]}]},{"allowed_amount":327.90,"providers":[{"billed_charge":3034.00,"npi":[1811973100]}]},{"allowed_amount":6860.31,"providers":[{"billed_charge":44469.00,"npi":[1811973100]}]}]}]},{"name":"MRI-SPINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"612","description":"MRI - SPINAL CORD (INCLUDING SPINE)","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9740.46,"providers":[{"billed_charge":23300.00,"npi":[1366436123]}]},{"allowed_amount":1837.13,"providers":[{"billed_charge":4157.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4493.06,"providers":[{"billed_charge":17551.00,"npi":[1811973100]}]}]}]},{"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":"760545192"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":269.74,"providers":[{"billed_charge":1756.50,"npi":[1083937593]}]}]},{"tin":{"type":"ein","value":"720652905"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":23739.60,"providers":[{"billed_charge":95473.76,"npi":[1912943184]}]},{"allowed_amount":603.00,"providers":[{"billed_charge":2009.88,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":773.10,"providers":[{"billed_charge":2577.02,"npi":[1477500015]}]},{"allowed_amount":1936.22,"providers":[{"billed_charge":106281.31,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":95.71,"providers":[{"billed_charge":319.02,"npi":[1396761805]}]},{"allowed_amount":2.40,"providers":[{"billed_charge":8.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":244.70,"providers":[{"billed_charge":487.02,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7762.89,"providers":[{"billed_charge":27729.33,"npi":[1629076468]}]},{"allowed_amount":13144.00,"providers":[{"billed_charge":71704.90,"npi":[1629076468]}]},{"allowed_amount":1.00,"providers":[{"billed_charge":946.06,"npi":[1629076468]}]},{"allowed_amount":8515.49,"providers":[{"billed_charge":31734.34,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43.14,"providers":[{"billed_charge":143.82,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4330.69,"providers":[{"billed_charge":22590.96,"npi":[1083903744]}]},{"allowed_amount":19671.48,"providers":[{"billed_charge":64602.06,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10679.44,"providers":[{"billed_charge":68100.60,"npi":[1053360651]}]},{"allowed_amount":16854.16,"providers":[{"billed_charge":52383.54,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":86.16,"providers":[{"billed_charge":287.18,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1677.75,"providers":[{"billed_charge":17765.38,"npi":[1710097936]}]},{"allowed_amount":18161.95,"providers":[{"billed_charge":98229.49,"npi":[1710097936]}]},{"allowed_amount":6028.66,"providers":[{"billed_charge":19571.65,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":165.11,"providers":[{"billed_charge":225.62,"npi":[1366436123]}]},{"allowed_amount":59271.74,"providers":[{"billed_charge":171076.48,"npi":[1366436123]}]},{"allowed_amount":146852.57,"providers":[{"billed_charge":628881.68,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6814.88,"providers":[{"billed_charge":21639.31,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":647.80,"providers":[{"billed_charge":1936.41,"npi":[1811973100]}]},{"allowed_amount":45764.52,"providers":[{"billed_charge":445066.68,"npi":[1811973100]}]},{"allowed_amount":47062.67,"providers":[{"billed_charge":153308.94,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3358.75,"providers":[{"billed_charge":6975.25,"npi":[1427536325]}]},{"allowed_amount":7057.78,"providers":[{"billed_charge":41764.98,"npi":[1427536325]}]},{"allowed_amount":33457.91,"providers":[{"billed_charge":165267.91,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3480.53,"providers":[{"billed_charge":10850.48,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"450310462"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15.00,"providers":[{"billed_charge":50.00,"npi":[1154346161]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22114.75,"providers":[{"billed_charge":485474.01,"npi":[1578568481]}]},{"allowed_amount":51748.28,"providers":[{"billed_charge":174563.45,"npi":[1578568481]}]},{"allowed_amount":8.11,"providers":[{"billed_charge":1799.16,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1441.46,"providers":[{"billed_charge":4050.88,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2690.97,"providers":[{"billed_charge":8970.04,"npi":[1427878909]}]},{"allowed_amount":2147.00,"providers":[{"billed_charge":9579.00,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":240.80,"providers":[{"billed_charge":802.50,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10498.94,"providers":[{"billed_charge":34747.34,"npi":[1649849910]}]},{"allowed_amount":74.00,"providers":[{"billed_charge":1036.27,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1707.40,"providers":[{"billed_charge":5551.45,"npi":[1295716637]}]},{"allowed_amount":2527.37,"providers":[{"billed_charge":9664.92,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":174.83,"providers":[{"billed_charge":403.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"741180155"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":388.70,"providers":[{"billed_charge":4138.50,"npi":[1548387418]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4956.58,"providers":[{"billed_charge":16727.71,"npi":[1417950106]}]},{"allowed_amount":1428.32,"providers":[{"billed_charge":17210.78,"npi":[1417950106]}]},{"allowed_amount":516.86,"providers":[{"billed_charge":16664.08,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2517.30,"providers":[{"billed_charge":7936.65,"npi":[1184373268]}]},{"allowed_amount":1172.30,"providers":[{"billed_charge":9604.02,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":30.74,"providers":[{"billed_charge":501.50,"npi":[]}]},{"allowed_amount":401.44,"providers":[{"billed_charge":2012.24,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":931.11,"providers":[{"billed_charge":3055.71,"npi":[1275536799]}]},{"allowed_amount":1914.94,"providers":[{"billed_charge":15974.08,"npi":[1275536799]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8703.90,"providers":[{"billed_charge":31067.00,"npi":[1366436123]}]},{"allowed_amount":21576.14,"providers":[{"billed_charge":93350.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5157.51,"providers":[{"billed_charge":56118.00,"npi":[1811973100]}]},{"allowed_amount":4589.10,"providers":[{"billed_charge":15297.00,"npi":[1811973100]}]}]}]},{"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":"741740101"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":26.04,"providers":[{"billed_charge":704.00,"npi":[1538100805]}]},{"allowed_amount":6.51,"providers":[{"billed_charge":176.00,"npi":[1871021527,1538100805]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":16.44,"providers":[{"billed_charge":58.00,"npi":[1124033055,1871819250]}]},{"allowed_amount":33.06,"providers":[{"billed_charge":116.00,"npi":[1871819250]}]},{"allowed_amount":41.37,"providers":[{"billed_charge":145.00,"npi":[1447703103]}]},{"allowed_amount":8.31,"providers":[{"billed_charge":29.00,"npi":[1447703103]}]},{"allowed_amount":90.87,"providers":[{"billed_charge":319.00,"npi":[1124033055]}]}]}]},{"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":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":223.10,"providers":[{"billed_charge":1145.00,"npi":[1093140600]}]},{"allowed_amount":3573.14,"providers":[{"billed_charge":6121.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2285.16,"providers":[{"billed_charge":6137.00,"npi":[1548796378]}]},{"allowed_amount":811.58,"providers":[{"billed_charge":9312.00,"npi":[1629076468]}]},{"allowed_amount":7617.20,"providers":[{"billed_charge":23159.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8832.36,"providers":[{"billed_charge":23229.00,"npi":[1578568481]}]},{"allowed_amount":2879.93,"providers":[{"billed_charge":12789.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":326.26,"providers":[{"billed_charge":2171.00,"npi":[1083903744]}]},{"allowed_amount":9427.80,"providers":[{"billed_charge":15865.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16837.00,"providers":[{"billed_charge":16837.00,"npi":[1053360651]}]},{"allowed_amount":1804.52,"providers":[{"billed_charge":6102.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":312.93,"providers":[{"billed_charge":472.00,"npi":[1295716637]}]},{"allowed_amount":694.68,"providers":[{"billed_charge":826.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2216.96,"providers":[{"billed_charge":6720.00,"npi":[1710097936]}]},{"allowed_amount":11611.08,"providers":[{"billed_charge":16380.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":306.34,"providers":[{"billed_charge":1028.00,"npi":[1417950106]}]},{"allowed_amount":3736.59,"providers":[{"billed_charge":10023.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":564.18,"providers":[{"billed_charge":714.00,"npi":[1184373268]}]},{"allowed_amount":35.70,"providers":[{"billed_charge":238.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":437.61,"providers":[{"billed_charge":1450.00,"npi":[1164419198]}]},{"allowed_amount":123273.17,"providers":[{"billed_charge":172398.00,"npi":[1366436123]}]},{"allowed_amount":11095.86,"providers":[{"billed_charge":62350.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":137.37,"providers":[{"billed_charge":378.00,"npi":[]}]},{"allowed_amount":307.91,"providers":[{"billed_charge":780.60,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":526.81,"providers":[{"billed_charge":5005.00,"npi":[1144227539]}]},{"allowed_amount":3349.89,"providers":[{"billed_charge":7315.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":62491.78,"providers":[{"billed_charge":74576.00,"npi":[1811973100]}]},{"allowed_amount":14454.51,"providers":[{"billed_charge":30680.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":996.49,"providers":[{"billed_charge":5699.00,"npi":[1427536325]}]},{"allowed_amount":8335.47,"providers":[{"billed_charge":12093.00,"npi":[1427536325]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3787.11,"providers":[{"billed_charge":28849.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":97.64,"providers":[{"billed_charge":197.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17424.06,"providers":[{"billed_charge":89076.00,"npi":[1366436123]}]},{"allowed_amount":951.04,"providers":[{"billed_charge":4788.00,"npi":[1366436123]}]},{"allowed_amount":11683.26,"providers":[{"billed_charge":22808.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":213.00,"providers":[{"billed_charge":213.00,"npi":[1578568481]}]},{"allowed_amount":1145.68,"providers":[{"billed_charge":16064.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8137.53,"providers":[{"billed_charge":67155.00,"npi":[1811973100]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3505.84,"providers":[{"billed_charge":11765.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":988.13,"providers":[{"billed_charge":17459.00,"npi":[1053360651]}]},{"allowed_amount":12015.90,"providers":[{"billed_charge":40053.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1254.00,"providers":[{"billed_charge":4180.00,"npi":[1710097936]}]},{"allowed_amount":890.24,"providers":[{"billed_charge":7013.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20945.93,"providers":[{"billed_charge":153978.00,"npi":[1366436123]}]},{"allowed_amount":169425.42,"providers":[{"billed_charge":565986.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5340.00,"providers":[{"billed_charge":17800.00,"npi":[1578568481]}]},{"allowed_amount":1348.61,"providers":[{"billed_charge":11850.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11492.34,"providers":[{"billed_charge":122711.00,"npi":[1811973100]}]},{"allowed_amount":2431.04,"providers":[{"billed_charge":7822.00,"npi":[1811973100]}]},{"allowed_amount":99353.88,"providers":[{"billed_charge":332100.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8262.00,"providers":[{"billed_charge":27540.00,"npi":[1427536325]}]},{"allowed_amount":3894.92,"providers":[{"billed_charge":19170.00,"npi":[1427536325]}]}]}]},{"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":"741740101"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":346.13,"providers":[{"billed_charge":3383.00,"npi":[1104809011]}]},{"allowed_amount":362.10,"providers":[{"billed_charge":3383.00,"npi":[1679872568]}]},{"allowed_amount":42.60,"providers":[{"billed_charge":398.00,"npi":[1104809011]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":557.20,"providers":[{"billed_charge":1650.00,"npi":[1871598474]}]},{"allowed_amount":88.34,"providers":[{"billed_charge":300.00,"npi":[1265751259]}]},{"allowed_amount":213.04,"providers":[{"billed_charge":600.00,"npi":[1861724080]}]},{"allowed_amount":217.44,"providers":[{"billed_charge":600.00,"npi":[1104892363]}]},{"allowed_amount":485.39,"providers":[{"billed_charge":1350.00,"npi":[1609195312]}]}]}]},{"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":"741740101"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":439.89,"providers":[{"billed_charge":5015.00,"npi":[1104809011]}]},{"allowed_amount":54.14,"providers":[{"billed_charge":590.00,"npi":[1104809011]}]},{"allowed_amount":433.12,"providers":[{"billed_charge":4720.00,"npi":[1679872568]}]},{"allowed_amount":27.07,"providers":[{"billed_charge":295.00,"npi":[1679872568]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":138.20,"providers":[{"billed_charge":456.00,"npi":[1265751259]}]},{"allowed_amount":276.40,"providers":[{"billed_charge":912.00,"npi":[1104892363]}]},{"allowed_amount":614.70,"providers":[{"billed_charge":2052.00,"npi":[1609195312]}]},{"allowed_amount":270.64,"providers":[{"billed_charge":912.00,"npi":[1861724080]}]},{"allowed_amount":768.74,"providers":[{"billed_charge":2622.00,"npi":[1871598474]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":281.45,"providers":[{"billed_charge":365.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1895.15,"providers":[{"billed_charge":3298.00,"npi":[1366436123]}]},{"allowed_amount":26.48,"providers":[{"billed_charge":97.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19.46,"providers":[{"billed_charge":760.00,"npi":[1811973100]}]},{"allowed_amount":1541.44,"providers":[{"billed_charge":2432.00,"npi":[1811973100]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":730.60,"providers":[{"billed_charge":7307.04,"npi":[1234567893]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":434.19,"providers":[{"billed_charge":5195.52,"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":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.70,"providers":[{"billed_charge":45.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":371.01,"providers":[{"billed_charge":4445.48,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.39,"providers":[{"billed_charge":123.00,"npi":[1124580535]}]}]}]},{"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":"475386675"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":203.49,"providers":[{"billed_charge":2850.00,"npi":[1740626225]}]}]}]},{"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":"463417600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2205.97,"providers":[{"billed_charge":7100.00,"npi":[1033166962]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15002.25,"providers":[{"billed_charge":134781.66,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":73.14,"providers":[{"billed_charge":874.92,"npi":[1234567893]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"134205269"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":7.32,"providers":[{"billed_charge":18.00,"npi":[1952706897]}]}]}]},{"name":"NFCT DS BV&VAGINITIS DNA ALG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81514","description":"NFCT DS BCT VAGINOSIS&VAGINITIS DNA VAG FLU ALG","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1054.08,"providers":[{"billed_charge":12000.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.58,"providers":[{"billed_charge":138.72,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":534.06,"providers":[{"billed_charge":6393.60,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":196.56,"providers":[{"billed_charge":2352.48,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":132.57,"providers":[{"billed_charge":1587.60,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":115.20,"providers":[{"billed_charge":1382.40,"npi":[1234567893]}]}]}]},{"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":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.44,"providers":[{"billed_charge":160.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":291.60,"providers":[{"billed_charge":3495.60,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.16,"providers":[{"billed_charge":25.88,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.20,"providers":[{"billed_charge":134.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":99.33,"providers":[{"billed_charge":1190.64,"npi":[1234567893]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.32,"providers":[{"billed_charge":806.40,"npi":[1234567893]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.40,"providers":[{"billed_charge":567.20,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":309.40,"providers":[{"billed_charge":3698.52,"npi":[1234567893]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":203.06,"providers":[{"billed_charge":2425.36,"npi":[1234567893]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":418.08,"providers":[{"billed_charge":5012.80,"npi":[1234567893]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":380.54,"providers":[{"billed_charge":4553.76,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":434.70,"providers":[{"billed_charge":5203.80,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":629.64,"providers":[{"billed_charge":7534.56,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.00,"providers":[{"billed_charge":282.45,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":414.00,"providers":[{"billed_charge":4958.40,"npi":[1234567893]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1189.92,"providers":[{"billed_charge":14255.36,"npi":[1234567893]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":141.36,"providers":[{"billed_charge":480.00,"npi":[1780875039]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":140.64,"providers":[{"billed_charge":1560.00,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2596.66,"providers":[{"billed_charge":3740.70,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3001.25,"providers":[{"billed_charge":29996.25,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":335.30,"providers":[{"billed_charge":1050.00,"npi":[1780875039]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":228.96,"providers":[{"billed_charge":2056.32,"npi":[1234567893]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":375.04,"providers":[{"billed_charge":4160.00,"npi":[1234567893]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1277.48,"providers":[{"billed_charge":14071.08,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2491.39,"providers":[{"billed_charge":3589.05,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3001.25,"providers":[{"billed_charge":30045.71,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":515.68,"providers":[{"billed_charge":6832.70,"npi":[1234567893]}]}]}]},{"name":"RSV DNA/RNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87634","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY SYNCYTIAL VIRUS, AMPLIFIED PROB","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":245.70,"providers":[{"billed_charge":1120.00,"npi":[1780875039]}]}]}]},{"name":"STAPH A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87640","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":328.16,"providers":[{"billed_charge":3491.62,"npi":[1234567893]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":122.85,"providers":[{"billed_charge":560.00,"npi":[1780875039]}]}]}]},{"name":"STREP B, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87653","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":527.40,"providers":[{"billed_charge":5751.08,"npi":[1234567893]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1508.87,"providers":[{"billed_charge":5547.00,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2332.28,"providers":[{"billed_charge":23050.78,"npi":[1234567893]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":621.16,"providers":[{"billed_charge":6741.62,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"300876536"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":42.21,"providers":[{"billed_charge":60.00,"npi":[1265078166]}]}]},{"tin":{"type":"ein","value":"463353218"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":98.49,"providers":[{"billed_charge":413.00,"npi":[1235918533]}]}]},{"tin":{"type":"ein","value":"134205269"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":154.77,"providers":[{"billed_charge":286.00,"npi":[1952706897]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":488.95,"providers":[{"billed_charge":4407.96,"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":"743038198"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":2504.63,"providers":[{"billed_charge":13432.00,"npi":[1114151578]}]},{"allowed_amount":205.86,"providers":[{"billed_charge":1104.00,"npi":[1114151578]}]},{"allowed_amount":34.31,"providers":[{"billed_charge":184.00,"npi":[1114151578]}]}]},{"tin":{"type":"ein","value":"720423889"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":150.96,"providers":[{"billed_charge":324.00,"npi":[1255367132]}]},{"allowed_amount":1924.76,"providers":[{"billed_charge":4131.00,"npi":[1255367132]}]}]},{"tin":{"type":"ein","value":"720933293"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2355.15,"providers":[{"billed_charge":5718.09,"npi":[1699236992]}]},{"allowed_amount":6168.25,"providers":[{"billed_charge":14975.95,"npi":[1043579709]}]}]}]},{"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":"743038198"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":96.27,"providers":[{"billed_charge":333.00,"npi":[1114151578]}]}]},{"tin":{"type":"ein","value":"720423889"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":282.40,"providers":[{"billed_charge":608.00,"npi":[1255367132]}]},{"allowed_amount":35.30,"providers":[{"billed_charge":76.00,"npi":[1255367132]}]}]}]},{"name":"PSTAY TREATMENT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"900","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":759.40,"providers":[{"billed_charge":3124.00,"npi":[1568403111]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"882656603"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":7740.00,"providers":[{"billed_charge":25800.00,"npi":[1114655834]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56"],"billing_class":"professional","payments":[{"allowed_amount":840.00,"providers":[{"billed_charge":840.00,"npi":[1336680719]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"932778825"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":202.85,"providers":[{"billed_charge":223.21,"npi":[1912517848]}]}]}]},{"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":"991484769"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":3286.47,"providers":[{"billed_charge":4125.00,"npi":[1225893340]}]},{"allowed_amount":112.63,"providers":[{"billed_charge":125.00,"npi":[1225893340]}]}]},{"tin":{"type":"ein","value":"461612422"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":531.12,"providers":[{"billed_charge":640.00,"npi":[1497063473]}]},{"allowed_amount":600.68,"providers":[{"billed_charge":640.00,"npi":[1497063473]}]}]}]},{"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":"462411016"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":333.84,"providers":[{"billed_charge":459.24,"npi":[1285769471]}]},{"allowed_amount":208.70,"providers":[{"billed_charge":382.70,"npi":[1881779320]}]}]}]},{"name":"PSTAY/INDIV RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"914","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - INDIVIDUAL THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":17466.20,"providers":[{"billed_charge":65097.00,"npi":[1568403111]}]}]}]},{"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":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4686.61,"providers":[{"billed_charge":10500.00,"npi":[1356950398]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1760.30,"providers":[{"billed_charge":5018.00,"npi":[1811973100]}]},{"allowed_amount":3051.28,"providers":[{"billed_charge":4596.00,"npi":[1811973100]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4471.58,"providers":[{"billed_charge":4900.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5607.19,"providers":[{"billed_charge":49334.00,"npi":[1366436123]}]},{"allowed_amount":28157.40,"providers":[{"billed_charge":50043.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2087.62,"providers":[{"billed_charge":13680.00,"npi":[1811973100]}]},{"allowed_amount":12793.58,"providers":[{"billed_charge":16338.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3007.08,"providers":[{"billed_charge":5818.00,"npi":[1578568481]}]},{"allowed_amount":417.62,"providers":[{"billed_charge":7080.00,"npi":[1578568481]}]}]}]},{"name":"EDUC/TRAINING","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"942","description":"OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING","allowed_amounts":[{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3.41,"providers":[{"billed_charge":26.00,"npi":[1578568481]}]}]}]},{"name":"SLEEP STUDY UNATT&RESP EFFT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95806","description":"SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFL","allowed_amounts":[{"tin":{"type":"ein","value":"450538779"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2488.78,"providers":[{"billed_charge":19575.00,"npi":[1295786655]}]}]}]},{"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":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1280.37,"providers":[{"billed_charge":3575.00,"npi":[1053622274]}]}]}]},{"name":"AQUATIC THERAPY/EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97113","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES","allowed_amounts":[{"tin":{"type":"ein","value":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":190.86,"providers":[{"billed_charge":385.00,"npi":[1053622274]}]}]}]},{"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":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":73.80,"providers":[{"billed_charge":220.00,"npi":[1053622274]}]}]}]},{"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":"881774824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4893.00,"providers":[{"billed_charge":4893.00,"npi":[1811527823]}]}]}]},{"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":"881774824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":134.37,"providers":[{"billed_charge":150.00,"npi":[1811527823]}]}]}]},{"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":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1162.48,"providers":[{"billed_charge":2585.00,"npi":[1053622274]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"300876536"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":135.92,"providers":[{"billed_charge":239.55,"npi":[1265078166]}]}]},{"tin":{"type":"ein","value":"463353218"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":271.84,"providers":[{"billed_charge":722.00,"npi":[1235918533]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"720743677"},"service_code":["02","50"],"billing_class":"professional","payments":[{"allowed_amount":85.65,"providers":[{"billed_charge":112.95,"npi":[1396326955]}]},{"allowed_amount":112.95,"providers":[{"billed_charge":112.95,"npi":[1396326955]}]}]}]},{"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":"263958456"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1567.50,"providers":[{"billed_charge":6311.40,"npi":[1184971673]}]},{"allowed_amount":261.25,"providers":[{"billed_charge":1051.90,"npi":[1124370838]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":138.95,"providers":[{"billed_charge":364.00,"npi":[1234567893]}]},{"allowed_amount":88.95,"providers":[{"billed_charge":182.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1129.95,"providers":[{"billed_charge":1395.00,"npi":[1124580535]}]}]}]},{"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":"463417600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":236.32,"providers":[{"billed_charge":708.96,"npi":[1225761471]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":876.26,"providers":[{"billed_charge":2074.00,"npi":[1134555790]}]}]},{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":488.60,"providers":[{"billed_charge":1280.00,"npi":[1780875039]}]}]},{"tin":{"type":"ein","value":"932778825"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":367.26,"providers":[{"billed_charge":425.64,"npi":[1912517848]}]}]},{"tin":{"type":"ein","value":"134205269"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1038.30,"providers":[{"billed_charge":1400.00,"npi":[1952706897]}]}]},{"tin":{"type":"ein","value":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1914.24,"providers":[{"billed_charge":2076.00,"npi":[1558758730]}]},{"allowed_amount":2552.32,"providers":[{"billed_charge":2769.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2304.12,"providers":[{"billed_charge":2405.00,"npi":[1235767302]}]},{"allowed_amount":6912.36,"providers":[{"billed_charge":7215.00,"npi":[1124580535]}]},{"allowed_amount":1949.64,"providers":[{"billed_charge":2035.00,"npi":[1457081549]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"843374531"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":995.12,"providers":[{"billed_charge":2000.00,"npi":[1407309479]}]}]}]},{"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":"872539640"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":200.98,"providers":[{"billed_charge":300.00,"npi":[1063734069]}]}]},{"tin":{"type":"ein","value":"270586364"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":2042.55,"providers":[{"billed_charge":2835.00,"npi":[1265968853]}]},{"allowed_amount":2379.10,"providers":[{"billed_charge":3885.00,"npi":[1306329263]}]},{"allowed_amount":2420.80,"providers":[{"billed_charge":3360.00,"npi":[1013485887]}]}]},{"tin":{"type":"ein","value":"721450954"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4009.45,"providers":[{"billed_charge":5830.00,"npi":[1194887125]}]}]},{"tin":{"type":"ein","value":"800325677"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":501.84,"providers":[{"billed_charge":1200.00,"npi":[1124635164]}]}]},{"tin":{"type":"ein","value":"371432688"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":940.95,"providers":[{"billed_charge":2175.00,"npi":[1346799459]}]}]},{"tin":{"type":"ein","value":"433735670"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1155.39,"providers":[{"billed_charge":1500.00,"npi":[1558751651]}]}]},{"tin":{"type":"ein","value":"810608560"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1891.25,"providers":[{"billed_charge":2500.00,"npi":[1679501712]}]}]},{"tin":{"type":"ein","value":"721216841"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":369.00,"providers":[{"billed_charge":553.50,"npi":[1134121999]}]}]},{"tin":{"type":"ein","value":"720276883"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":832.15,"providers":[{"billed_charge":1760.00,"npi":[1063860641]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"720423889"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":247.98,"providers":[{"billed_charge":538.00,"npi":[1114480027]}]},{"allowed_amount":2355.81,"providers":[{"billed_charge":5111.00,"npi":[1427403989]}]}]},{"tin":{"type":"ein","value":"720687735"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2705.28,"providers":[{"billed_charge":4800.00,"npi":[1831314905]}]}]},{"tin":{"type":"ein","value":"813930652"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":338.16,"providers":[{"billed_charge":795.00,"npi":[1942418421]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"721425772"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":133.62,"providers":[{"billed_charge":1108.00,"npi":[1134177645]}]}]},{"tin":{"type":"ein","value":"822400811"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":239.12,"providers":[{"billed_charge":2356.00,"npi":[1598346504]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"812574422"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2531.88,"providers":[{"billed_charge":5310.00,"npi":[1124522172]}]}]},{"tin":{"type":"ein","value":"822400811"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1185.52,"providers":[{"billed_charge":4712.00,"npi":[1598346504]}]},{"allowed_amount":592.76,"providers":[{"billed_charge":2356.00,"npi":[1184183345]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"030417452"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1223.25,"providers":[{"billed_charge":2772.00,"npi":[1861026049]}]},{"allowed_amount":407.75,"providers":[{"billed_charge":924.00,"npi":[1861026049]}]}]}]},{"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":"030417452"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1946.72,"providers":[{"billed_charge":4002.00,"npi":[1104349950]}]},{"allowed_amount":677.12,"providers":[{"billed_charge":1392.00,"npi":[1104349950]}]}]},{"tin":{"type":"ein","value":"462453627"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":338.56,"providers":[{"billed_charge":672.00,"npi":[1083269542]}]},{"allowed_amount":592.48,"providers":[{"billed_charge":1176.00,"npi":[1083269542]}]}]}]},{"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":"352456982"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":200.46,"providers":[{"billed_charge":490.00,"npi":[1013626498]}]}]}]},{"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":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":121137.92,"providers":[{"billed_charge":121336.80,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"472104991"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3392.50,"providers":[{"billed_charge":3392.50,"npi":[1821837535]}]}]},{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13713.38,"providers":[{"billed_charge":13713.38,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"201167146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8129.70,"providers":[{"billed_charge":8129.70,"npi":[1114952751]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":151346.14,"providers":[{"billed_charge":156313.18,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38111.45,"providers":[{"billed_charge":45880.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54249.62,"providers":[{"billed_charge":54250.26,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":457677.58,"providers":[{"billed_charge":497069.78,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"726000179"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2480.40,"providers":[{"billed_charge":2480.40,"npi":[1548340144]}]}]},{"tin":{"type":"ein","value":"726000499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1724.76,"providers":[{"billed_charge":2068.50,"npi":[1053373670]}]}]},{"tin":{"type":"ein","value":"721315055"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17972.80,"providers":[{"billed_charge":18030.00,"npi":[1063533610]}]}]}]},{"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":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":656212.00,"providers":[{"billed_charge":665000.00,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":178500.00,"providers":[{"billed_charge":178500.00,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"201167146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8132.95,"providers":[{"billed_charge":10743.50,"npi":[1114952751]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":367596.80,"providers":[{"billed_charge":382709.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":158503.20,"providers":[{"billed_charge":161116.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":550599.00,"providers":[{"billed_charge":561597.00,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":626376.01,"providers":[{"billed_charge":705579.80,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"726000179"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12886.40,"providers":[{"billed_charge":14000.00,"npi":[1548340144]}]}]},{"tin":{"type":"ein","value":"726000499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3200.00,"providers":[{"billed_charge":3200.00,"npi":[1053373670]}]}]}]},{"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":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26523.10,"providers":[{"billed_charge":32501.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13696.00,"providers":[{"billed_charge":13696.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":88265.33,"providers":[{"billed_charge":145278.40,"npi":[1316943566]}]}]}]},{"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":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":436809.79,"providers":[{"billed_charge":447000.00,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13500.00,"providers":[{"billed_charge":13500.00,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38193.75,"providers":[{"billed_charge":38934.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":256618.51,"providers":[{"billed_charge":274978.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":180595.00,"providers":[{"billed_charge":180595.00,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":399454.92,"providers":[{"billed_charge":455872.50,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"721315055"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34500.00,"providers":[{"billed_charge":34500.00,"npi":[1063533610]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3600.00,"providers":[{"billed_charge":9000.00,"npi":[1760408926]}]}]}]},{"name":"ALCOHL&/RX SRVC;AC DTOX RES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0011","description":"ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)","allowed_amounts":[{"tin":{"type":"ein","value":"720743677"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":14601.50,"providers":[{"billed_charge":16540.15,"npi":[1245729045]}]}]},{"tin":{"type":"ein","value":"450718634"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":1856.00,"providers":[{"billed_charge":1856.00,"npi":[1437751807]}]}]}]},{"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":"932537590"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":810.00,"providers":[{"billed_charge":1080.00,"npi":[1093105801]}]}]},{"tin":{"type":"ein","value":"900948147"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":810.00,"providers":[{"billed_charge":1080.00,"npi":[1467293670]}]}]},{"tin":{"type":"ein","value":"831183200"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":4266.00,"providers":[{"billed_charge":16800.00,"npi":[1790255388]}]}]}]},{"name":"ALCOHOL &/OR DRUG SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0049","description":"ALCOHOL AND/OR DRUG SCREENING","allowed_amounts":[{"tin":{"type":"ein","value":"412114148"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":25.76,"providers":[{"billed_charge":120.00,"npi":[1588421986]}]}]}]},{"name":"CRISIS INTRVNT MNTL HLTH SVC","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9485","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56"],"billing_class":"professional","payments":[{"allowed_amount":650.00,"providers":[{"billed_charge":2600.00,"npi":[1497378764]}]}]}]}]}