{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-09-29","out_of_network":[{"name":"NCNTC R-T FLUOR WND IMG 1ST","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0598T","description":"NONCONTACT R-T FLUOR WND IMG 1ST ANATOMIC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":505.08,"providers":[{"billed_charge":3899.40,"npi":[1083274344]}]},{"allowed_amount":148.56,"providers":[{"billed_charge":1169.82,"npi":[1245821735]}]}]}]},{"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":"874825160"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":188020.00,"providers":[{"billed_charge":932250.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"853039805"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38850.00,"providers":[{"billed_charge":138000.00,"npi":[1215609565]}]}]}]},{"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":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9009982.89,"providers":[{"billed_charge":1606202.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":5672603.53,"providers":[{"billed_charge":1684405.00,"npi":[1558365890]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"621166050"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":344.20,"providers":[{"billed_charge":1589.00,"npi":[1427631662]}]}]}]},{"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":"626001445"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":168944.69,"providers":[{"billed_charge":465024.52,"npi":[1306818265]}]}]},{"tin":{"type":"ein","value":"621113737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":339959.61,"providers":[{"billed_charge":882315.00,"npi":[1023055126]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":67116.00,"providers":[{"billed_charge":397500.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":165541.47,"providers":[{"billed_charge":118071.80,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"853039805"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":16884.00,"providers":[{"billed_charge":81000.00,"npi":[1215609565]}]}]}]},{"name":"ANESTH, LENS SURGERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"142","description":"ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"621560735"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":909.92,"providers":[{"billed_charge":9125.00,"npi":[1346556453]}]}]}]},{"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":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":360379.78,"providers":[{"billed_charge":338549.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":705698.81,"providers":[{"billed_charge":678890.00,"npi":[1558365890]}]}]}]},{"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":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":182127.70,"providers":[{"billed_charge":287756.00,"npi":[1558365890]}]}]}]},{"name":"ICU/TRAMA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"208","description":"INTENSIVE CARE - TRAUMA","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38070.11,"providers":[{"billed_charge":183753.00,"npi":[1538164090]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":102.15,"providers":[{"billed_charge":1120268.63,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":0.19,"providers":[{"billed_charge":18910.13,"npi":[1558365890]}]},{"allowed_amount":204.17,"providers":[{"billed_charge":730498.73,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":501.46,"providers":[{"billed_charge":1671.35,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":250.08,"providers":[{"billed_charge":15940.10,"npi":[1114003175]}]},{"allowed_amount":1856.49,"providers":[{"billed_charge":7046.10,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":147.41,"providers":[{"billed_charge":491.34,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4890.86,"providers":[{"billed_charge":16302.88,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":47.11,"providers":[{"billed_charge":109.88,"npi":[1689011280]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1447.71,"providers":[{"billed_charge":4825.30,"npi":[1811987084]}]},{"allowed_amount":3281.64,"providers":[{"billed_charge":16039.49,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1394.52,"providers":[{"billed_charge":6250.01,"npi":[1417938846]}]},{"allowed_amount":798.34,"providers":[{"billed_charge":2655.35,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.38,"providers":[{"billed_charge":620.96,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":760.02,"providers":[{"billed_charge":20977.87,"npi":[1922319037]}]},{"allowed_amount":5111.59,"providers":[{"billed_charge":17038.57,"npi":[1922319037]}]}]}]},{"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":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":286.88,"providers":[{"billed_charge":77695.88,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":184.47,"providers":[{"billed_charge":614.90,"npi":[1912341439]}]}]}]},{"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":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38.34,"providers":[{"billed_charge":47838.67,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":525.47,"providers":[{"billed_charge":1751.56,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":918.24,"providers":[{"billed_charge":3060.80,"npi":[1114003175]}]},{"allowed_amount":228.12,"providers":[{"billed_charge":10700.50,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32.93,"providers":[{"billed_charge":109.73,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7575.63,"providers":[{"billed_charge":25252.10,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19592.95,"providers":[{"billed_charge":114619.68,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":457.88,"providers":[{"billed_charge":1844.15,"npi":[1811987084]}]},{"allowed_amount":426.15,"providers":[{"billed_charge":1420.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18.21,"providers":[{"billed_charge":60.72,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1503.60,"providers":[{"billed_charge":5012.01,"npi":[1720672934]}]},{"allowed_amount":971.69,"providers":[{"billed_charge":7159.57,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2747.08,"providers":[{"billed_charge":9156.76,"npi":[1922319037]}]},{"allowed_amount":48.78,"providers":[{"billed_charge":2577.43,"npi":[1922319037]}]}]}]},{"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":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":302.67,"providers":[{"billed_charge":1091.02,"npi":[1558365890]}]},{"allowed_amount":149003.17,"providers":[{"billed_charge":279761.61,"npi":[1558365890]}]},{"allowed_amount":299.64,"providers":[{"billed_charge":526829.21,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7762.06,"providers":[{"billed_charge":11986.02,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":499.63,"providers":[{"billed_charge":3396.87,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1659.68,"providers":[{"billed_charge":11664.44,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4023.11,"providers":[{"billed_charge":82521.96,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":315.85,"providers":[{"billed_charge":2701.00,"npi":[1811987084]}]},{"allowed_amount":30443.33,"providers":[{"billed_charge":33760.00,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3079.45,"providers":[{"billed_charge":9461.68,"npi":[1922319037]}]}]}]},{"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":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":336.99,"providers":[{"billed_charge":2162.50,"npi":[1811987084]}]},{"allowed_amount":461.85,"providers":[{"billed_charge":1539.50,"npi":[1811987084]}]}]}]},{"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":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":125.84,"providers":[{"billed_charge":174477.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.64,"providers":[{"billed_charge":32.13,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.90,"providers":[{"billed_charge":3.00,"npi":[1811987084]}]}]}]},{"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":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":15.94,"providers":[{"billed_charge":929183.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":72.72,"providers":[{"billed_charge":242.39,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":648.71,"providers":[{"billed_charge":2162.34,"npi":[1811987084]}]},{"allowed_amount":277.52,"providers":[{"billed_charge":927.51,"npi":[1811987084]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"630997281"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":817.12,"providers":[{"billed_charge":16630.00,"npi":[1780648352]}]},{"allowed_amount":71.32,"providers":[{"billed_charge":8274.00,"npi":[1780648352]}]}]},{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24395.32,"providers":[{"billed_charge":695632.30,"npi":[1538164090]}]},{"allowed_amount":85.48,"providers":[{"billed_charge":1040.50,"npi":[1538164090]}]},{"allowed_amount":580.32,"providers":[{"billed_charge":1710344.20,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":285.26,"providers":[{"billed_charge":967.00,"npi":[1558365890]}]},{"allowed_amount":40.02,"providers":[{"billed_charge":145454.00,"npi":[1558365890]}]},{"allowed_amount":31611.44,"providers":[{"billed_charge":84509.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2208.29,"providers":[{"billed_charge":4798.00,"npi":[1992701429]}]},{"allowed_amount":1744.26,"providers":[{"billed_charge":6683.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":873.35,"providers":[{"billed_charge":972.00,"npi":[1528056066]}]},{"allowed_amount":738.80,"providers":[{"billed_charge":8977.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2024.78,"providers":[{"billed_charge":4847.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1037.57,"providers":[{"billed_charge":3158.35,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15409.17,"providers":[{"billed_charge":19301.00,"npi":[1811987084]}]},{"allowed_amount":1210.00,"providers":[{"billed_charge":6334.45,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":830.99,"providers":[{"billed_charge":4776.04,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2124.45,"providers":[{"billed_charge":5140.30,"npi":[1417938846]}]},{"allowed_amount":242.88,"providers":[{"billed_charge":1199.40,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":355.72,"providers":[{"billed_charge":27151.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":50.28,"providers":[{"billed_charge":52649.33,"npi":[1922319037]}]},{"allowed_amount":33338.96,"providers":[{"billed_charge":167711.44,"npi":[1922319037]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"610600313"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":255.31,"providers":[{"billed_charge":1010.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":637.93,"providers":[{"billed_charge":318229.00,"npi":[1558365890]}]},{"allowed_amount":14.88,"providers":[{"billed_charge":5033.00,"npi":[1558365890]}]},{"allowed_amount":396.07,"providers":[{"billed_charge":595950.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":47513.32,"providers":[{"billed_charge":109927.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1675.47,"providers":[{"billed_charge":3344.00,"npi":[1912341439]}]},{"allowed_amount":11437.82,"providers":[{"billed_charge":17179.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58.14,"providers":[{"billed_charge":153889.68,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12135.49,"providers":[{"billed_charge":16340.60,"npi":[1811987084]}]},{"allowed_amount":1535.81,"providers":[{"billed_charge":7229.70,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1338.47,"providers":[{"billed_charge":3687.25,"npi":[1346297892]}]},{"allowed_amount":229.97,"providers":[{"billed_charge":633.65,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"461481133"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":38.03,"providers":[{"billed_charge":278.00,"npi":[1801990825]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":57.64,"providers":[{"billed_charge":280922.66,"npi":[1639151301]}]},{"allowed_amount":25363.45,"providers":[{"billed_charge":429710.84,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"911631806"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":42.42,"providers":[{"billed_charge":250.14,"npi":[1053359729]}]},{"allowed_amount":600.17,"providers":[{"billed_charge":1217.52,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":605.19,"providers":[{"billed_charge":828.00,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":864.30,"providers":[{"billed_charge":2058.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1328.98,"providers":[{"billed_charge":53798.84,"npi":[1114003175]}]},{"allowed_amount":8809.63,"providers":[{"billed_charge":59754.28,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3238.78,"providers":[{"billed_charge":4584.00,"npi":[1528056066]}]},{"allowed_amount":5952.84,"providers":[{"billed_charge":36750.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34648.21,"providers":[{"billed_charge":258264.52,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1766.03,"providers":[{"billed_charge":8719.50,"npi":[1417938846]}]},{"allowed_amount":16494.57,"providers":[{"billed_charge":26940.80,"npi":[1417938846]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4.75,"providers":[{"billed_charge":1324.00,"npi":[1558365890]}]},{"allowed_amount":17.78,"providers":[{"billed_charge":1947.00,"npi":[1558365890]}]},{"allowed_amount":15.84,"providers":[{"billed_charge":30577.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":961.20,"providers":[{"billed_charge":3636.82,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":993.15,"providers":[{"billed_charge":13330.73,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":93.68,"providers":[{"billed_charge":100.90,"npi":[1417938846]}]}]}]},{"name":"LAB/NR DIALYSIS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"304","description":"LABORATORY - NON-ROUTINE DIALYSIS","allowed_amounts":[{"tin":{"type":"ein","value":"621727146"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":5.71,"providers":[{"billed_charge":6718.36,"npi":[1710099536]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":118.00,"providers":[{"billed_charge":154048.00,"npi":[1558365890]}]},{"allowed_amount":60.12,"providers":[{"billed_charge":92794.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12691.68,"providers":[{"billed_charge":31736.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":367.53,"providers":[{"billed_charge":14867.81,"npi":[1114003175]}]},{"allowed_amount":2525.03,"providers":[{"billed_charge":25401.51,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1200.32,"providers":[{"billed_charge":1804.00,"npi":[1528056066]}]},{"allowed_amount":607.80,"providers":[{"billed_charge":2322.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1915.76,"providers":[{"billed_charge":3388.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7681.66,"providers":[{"billed_charge":79307.96,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6914.42,"providers":[{"billed_charge":11761.80,"npi":[1811987084]}]},{"allowed_amount":993.38,"providers":[{"billed_charge":3751.30,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1950.84,"providers":[{"billed_charge":33730.07,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3820.02,"providers":[{"billed_charge":3829.30,"npi":[1417938846]}]},{"allowed_amount":160.74,"providers":[{"billed_charge":844.70,"npi":[1417938846]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":96.01,"providers":[{"billed_charge":99695.00,"npi":[1558365890]}]},{"allowed_amount":75.78,"providers":[{"billed_charge":116570.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10210.07,"providers":[{"billed_charge":16794.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":70.90,"providers":[{"billed_charge":566.46,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30955.64,"providers":[{"billed_charge":91296.97,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":601.38,"providers":[{"billed_charge":5075.81,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":801.84,"providers":[{"billed_charge":4873.40,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":419.21,"providers":[{"billed_charge":1101.85,"npi":[1811987084]}]},{"allowed_amount":2804.81,"providers":[{"billed_charge":3287.25,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1785.16,"providers":[{"billed_charge":18589.15,"npi":[1639151301]}]},{"allowed_amount":8068.60,"providers":[{"billed_charge":50542.35,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":131.60,"providers":[{"billed_charge":802.50,"npi":[1417938846]}]},{"allowed_amount":4234.89,"providers":[{"billed_charge":8441.60,"npi":[1417938846]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.25,"providers":[{"billed_charge":8038.00,"npi":[1558365890]}]},{"allowed_amount":22.29,"providers":[{"billed_charge":27191.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1419.48,"providers":[{"billed_charge":2531.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1136.27,"providers":[{"billed_charge":3040.05,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12.41,"providers":[{"billed_charge":44.00,"npi":[1912341439]}]},{"allowed_amount":199.56,"providers":[{"billed_charge":256.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2878.60,"providers":[{"billed_charge":24086.04,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4.16,"providers":[{"billed_charge":971.26,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3493.10,"providers":[{"billed_charge":3851.60,"npi":[1811987084]}]},{"allowed_amount":70.58,"providers":[{"billed_charge":233.80,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":295.54,"providers":[{"billed_charge":301.40,"npi":[1417938846]}]},{"allowed_amount":5.70,"providers":[{"billed_charge":19.00,"npi":[1417938846]}]}]}]},{"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":"311626179"},"service_code":["23","19","21"],"billing_class":"institutional","payments":[{"allowed_amount":88.32,"providers":[{"billed_charge":911.00,"npi":[1538164090]}]},{"allowed_amount":33264.09,"providers":[{"billed_charge":260687.00,"npi":[1538164090]}]},{"allowed_amount":48.86,"providers":[{"billed_charge":263341.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":121.00,"providers":[{"billed_charge":46487.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13032.41,"providers":[{"billed_charge":20150.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3189.21,"providers":[{"billed_charge":17487.72,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16316.74,"providers":[{"billed_charge":75243.68,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2831.57,"providers":[{"billed_charge":27829.04,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3998.39,"providers":[{"billed_charge":35564.48,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4910.17,"providers":[{"billed_charge":5266.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":575.74,"providers":[{"billed_charge":3457.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":155.82,"providers":[{"billed_charge":779.10,"npi":[1417938846]}]},{"allowed_amount":7959.37,"providers":[{"billed_charge":11330.90,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6527.20,"providers":[{"billed_charge":26344.76,"npi":[1922319037]}]}]}]},{"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":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28.46,"providers":[{"billed_charge":134578.00,"npi":[1558365890]}]},{"allowed_amount":47888.39,"providers":[{"billed_charge":157476.00,"npi":[1558365890]}]},{"allowed_amount":162.50,"providers":[{"billed_charge":876.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9446.24,"providers":[{"billed_charge":15624.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1131.97,"providers":[{"billed_charge":2190.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5463.26,"providers":[{"billed_charge":12594.48,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8920.80,"providers":[{"billed_charge":29824.51,"npi":[1639151301]}]},{"allowed_amount":1593.00,"providers":[{"billed_charge":7697.13,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":263.73,"providers":[{"billed_charge":612.30,"npi":[1811987084]}]},{"allowed_amount":3038.40,"providers":[{"billed_charge":3038.40,"npi":[1811987084]}]}]}]},{"name":"ECMO/ECLS DAILY MGMT-VENOUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"33948","description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)/EXTRACORPOREAL LIFE SUPPORT (ECLS) PROVIDED BY PHYS; DAIL","allowed_amounts":[{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4593.05,"providers":[{"billed_charge":50400.00,"npi":[1912906660]}]},{"allowed_amount":1263.00,"providers":[{"billed_charge":14400.00,"npi":[1205650124]}]}]}]},{"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":"311626179"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":361.37,"providers":[{"billed_charge":6428.50,"npi":[1538164090]}]},{"allowed_amount":171124.97,"providers":[{"billed_charge":2185029.50,"npi":[1538164090]}]},{"allowed_amount":268.13,"providers":[{"billed_charge":1965381.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12130.32,"providers":[{"billed_charge":12730.40,"npi":[1417938846]}]},{"allowed_amount":989.89,"providers":[{"billed_charge":4171.50,"npi":[1417938846]}]}]}]},{"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":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1679.48,"providers":[{"billed_charge":659112.00,"npi":[1558365890]}]},{"allowed_amount":117368.83,"providers":[{"billed_charge":730290.00,"npi":[1558365890]}]},{"allowed_amount":98.13,"providers":[{"billed_charge":3202.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10473.06,"providers":[{"billed_charge":18306.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":754.23,"providers":[{"billed_charge":5492.11,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6127.38,"providers":[{"billed_charge":29454.60,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":173.64,"providers":[{"billed_charge":368.25,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":802.39,"providers":[{"billed_charge":9941.44,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6050.06,"providers":[{"billed_charge":7299.00,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":514.49,"providers":[{"billed_charge":7900.78,"npi":[1639151301]}]},{"allowed_amount":3545.19,"providers":[{"billed_charge":55569.02,"npi":[1639151301]}]}]}]},{"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":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":79629.42,"providers":[{"billed_charge":1735585.00,"npi":[1558365890]}]},{"allowed_amount":2276.13,"providers":[{"billed_charge":73818.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":80498.59,"providers":[{"billed_charge":242548.00,"npi":[1336841568]}]},{"allowed_amount":611.93,"providers":[{"billed_charge":5362.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10408.73,"providers":[{"billed_charge":93373.54,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17777.61,"providers":[{"billed_charge":74836.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":55946.18,"providers":[{"billed_charge":317951.55,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12373.04,"providers":[{"billed_charge":221489.27,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6828.24,"providers":[{"billed_charge":17710.59,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":26117.28,"providers":[{"billed_charge":542203.65,"npi":[1639151301]}]},{"allowed_amount":8599.79,"providers":[{"billed_charge":118231.89,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":46121.35,"providers":[{"billed_charge":84719.25,"npi":[1811987084]}]},{"allowed_amount":4935.10,"providers":[{"billed_charge":12605.45,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19769.11,"providers":[{"billed_charge":155624.49,"npi":[1922319037]}]}]}]},{"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":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":189475.73,"providers":[{"billed_charge":161471.50,"npi":[1538164090]}]},{"allowed_amount":11865.74,"providers":[{"billed_charge":20854.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18514.71,"providers":[{"billed_charge":35984.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":16640.07,"providers":[{"billed_charge":28529.58,"npi":[1639151301]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":509.69,"providers":[{"billed_charge":1686.00,"npi":[1558365890]}]},{"allowed_amount":78.32,"providers":[{"billed_charge":125730.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","19"],"billing_class":"institutional","payments":[{"allowed_amount":7587.79,"providers":[{"billed_charge":46561.21,"npi":[1639151301]}]},{"allowed_amount":384.47,"providers":[{"billed_charge":2658.87,"npi":[1639151301]}]}]}]},{"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":"626001445"},"service_code":["02","71"],"billing_class":"professional","payments":[{"allowed_amount":104.65,"providers":[{"billed_charge":293.71,"npi":[1417119728]}]},{"allowed_amount":282.10,"providers":[{"billed_charge":791.74,"npi":[1295705564]}]},{"allowed_amount":481.57,"providers":[{"billed_charge":1344.67,"npi":[1316977812]}]},{"allowed_amount":9.10,"providers":[{"billed_charge":25.54,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":201.78,"providers":[{"billed_charge":456.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"626073178"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.86,"providers":[{"billed_charge":25.00,"npi":[1881471340]}]}]},{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.60,"providers":[{"billed_charge":375.00,"npi":[1104316389]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.46,"providers":[{"billed_charge":220.00,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"30417049"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":13.68,"providers":[{"billed_charge":16.00,"npi":[1669134177]}]},{"allowed_amount":205.20,"providers":[{"billed_charge":240.00,"npi":[1669134177]}]}]},{"tin":{"type":"ein","value":"300863554"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31.85,"providers":[{"billed_charge":91.00,"npi":[1124157391]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":13.65,"providers":[{"billed_charge":32.00,"npi":[1234567893]}]},{"allowed_amount":168.43,"providers":[{"billed_charge":795.61,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":92.64,"providers":[{"billed_charge":600.00,"npi":[1093414914]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1362.17,"providers":[{"billed_charge":7096.00,"npi":[1558365890]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":754.85,"providers":[{"billed_charge":3151.00,"npi":[1558365890]}]}]}]},{"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":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6556.14,"providers":[{"billed_charge":37289.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7695.34,"providers":[{"billed_charge":66080.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1121.30,"providers":[{"billed_charge":9792.33,"npi":[1639151301]}]},{"allowed_amount":192.40,"providers":[{"billed_charge":1337.84,"npi":[1639151301]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":889.86,"providers":[{"billed_charge":4689.78,"npi":[1639151301]}]}]}]},{"name":"PET SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"404","description":"POSITION EMISSION TOMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":54765.97,"providers":[{"billed_charge":48945.00,"npi":[1538164090]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1141.48,"providers":[{"billed_charge":28431.00,"npi":[1558365890]}]},{"allowed_amount":67.32,"providers":[{"billed_charge":582724.00,"npi":[1558365890]}]}]}]},{"name":"HYPERBARIC O2","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"413","description":"RESPIRATORY SERVICES - HYPERBARIC OXYGEN THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19853.20,"providers":[{"billed_charge":54692.00,"npi":[1346297892]}]}]}]},{"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":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3166.26,"providers":[{"billed_charge":11549.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":234.96,"providers":[{"billed_charge":49140.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1665.51,"providers":[{"billed_charge":9344.20,"npi":[1639151301]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":80.74,"providers":[{"billed_charge":20679.00,"npi":[1558365890]}]},{"allowed_amount":599.61,"providers":[{"billed_charge":1835.00,"npi":[1558365890]}]}]}]},{"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":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2080.67,"providers":[{"billed_charge":11219.64,"npi":[1639151301]}]}]}]},{"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":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1022.66,"providers":[{"billed_charge":3298.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":981.00,"providers":[{"billed_charge":2136.00,"npi":[1558365890]}]}]}]},{"name":"SPEECH PATHOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"440","description":"SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":149.18,"providers":[{"billed_charge":1042.50,"npi":[1538164090]}]}]}]},{"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":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1286207.65,"providers":[{"billed_charge":2156398.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1177.88,"providers":[{"billed_charge":789976.00,"npi":[1558365890]}]},{"allowed_amount":2683.81,"providers":[{"billed_charge":10837.00,"npi":[1386709871]}]},{"allowed_amount":1326009.39,"providers":[{"billed_charge":3256969.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":319951.54,"providers":[{"billed_charge":470101.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":69466.86,"providers":[{"billed_charge":128468.00,"npi":[1912341439]}]},{"allowed_amount":754.91,"providers":[{"billed_charge":2677.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621757920"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":691.51,"providers":[{"billed_charge":2407.16,"npi":[1619038247]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":150346.98,"providers":[{"billed_charge":559090.30,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":237573.97,"providers":[{"billed_charge":988196.39,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1381.43,"providers":[{"billed_charge":6248.50,"npi":[1811987084]}]},{"allowed_amount":99727.36,"providers":[{"billed_charge":102126.25,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24978.39,"providers":[{"billed_charge":73430.56,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1071.38,"providers":[{"billed_charge":1121.40,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1033.16,"providers":[{"billed_charge":37997.89,"npi":[1114003175]}]},{"allowed_amount":80680.41,"providers":[{"billed_charge":227949.11,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":974.25,"providers":[{"billed_charge":1553.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":215570.62,"providers":[{"billed_charge":431147.82,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":167946.05,"providers":[{"billed_charge":467177.92,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23380.91,"providers":[{"billed_charge":44476.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2038.63,"providers":[{"billed_charge":9827.50,"npi":[1417938846]}]},{"allowed_amount":158581.57,"providers":[{"billed_charge":172341.80,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":876.24,"providers":[{"billed_charge":19225.82,"npi":[1922319037]}]},{"allowed_amount":194633.54,"providers":[{"billed_charge":344833.88,"npi":[1922319037]}]}]}]},{"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":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":270.15,"providers":[{"billed_charge":1587.00,"npi":[1558365890]}]},{"allowed_amount":26.18,"providers":[{"billed_charge":17058.00,"npi":[1558365890]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":680.02,"providers":[{"billed_charge":259369.00,"npi":[1558365890]}]},{"allowed_amount":2975.98,"providers":[{"billed_charge":28103.00,"npi":[1558365890]}]},{"allowed_amount":1364.14,"providers":[{"billed_charge":27083.00,"npi":[1558365890]}]}]}]},{"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":"272910652"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":14911.39,"providers":[{"billed_charge":80303.30,"npi":[1710591060]}]}]}]},{"name":"MRI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"610","description":"MRI - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":296.60,"providers":[{"billed_charge":3837.00,"npi":[1538164090]}]},{"allowed_amount":3531.96,"providers":[{"billed_charge":70032.00,"npi":[1538164090]}]}]}]},{"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":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":417.35,"providers":[{"billed_charge":45661.00,"npi":[1558365890]}]}]}]},{"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":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5328.00,"providers":[{"billed_charge":14202.02,"npi":[1538164090]}]},{"allowed_amount":10957.64,"providers":[{"billed_charge":81300.26,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.01,"providers":[{"billed_charge":255.87,"npi":[1386709871]}]},{"allowed_amount":6275.43,"providers":[{"billed_charge":41388.90,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1912.82,"providers":[{"billed_charge":5371.93,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":532.41,"providers":[{"billed_charge":1638.95,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":168.57,"providers":[{"billed_charge":61892.79,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":20.72,"providers":[{"billed_charge":18440.25,"npi":[1639151301]}]},{"allowed_amount":248.76,"providers":[{"billed_charge":60103.77,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3555.26,"providers":[{"billed_charge":10565.57,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.20,"providers":[{"billed_charge":2490.00,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"610724492"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":131.10,"providers":[{"billed_charge":436.99,"npi":[1871547703]}]}]},{"tin":{"type":"ein","value":"630997281"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1.43,"providers":[{"billed_charge":879.09,"npi":[1780648352]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":128.65,"providers":[{"billed_charge":222.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":246.15,"providers":[{"billed_charge":845.50,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":884.67,"providers":[{"billed_charge":42548.16,"npi":[1114003175]}]},{"allowed_amount":8872.32,"providers":[{"billed_charge":33254.24,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":107.70,"providers":[{"billed_charge":359.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31630.13,"providers":[{"billed_charge":114765.61,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":759.85,"providers":[{"billed_charge":39857.00,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"621727146"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":264.74,"providers":[{"billed_charge":7177.41,"npi":[1710099536]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1108.39,"providers":[{"billed_charge":3144.97,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14.39,"providers":[{"billed_charge":936.15,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12766.25,"providers":[{"billed_charge":46040.56,"npi":[1922319037]}]},{"allowed_amount":170.13,"providers":[{"billed_charge":16282.73,"npi":[1922319037]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4.00,"providers":[{"billed_charge":81054.58,"npi":[1558365890]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"263713065"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":1716.00,"providers":[{"billed_charge":1716.00,"npi":[1407807688]}]}]},{"tin":{"type":"ein","value":"626010402"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":2460.00,"providers":[{"billed_charge":2460.00,"npi":[1104816966]}]}]},{"tin":{"type":"ein","value":"640899562"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":5616.00,"providers":[{"billed_charge":7200.00,"npi":[1346975471]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":371.84,"providers":[{"billed_charge":1568.00,"npi":[1265894380]}]},{"allowed_amount":92.96,"providers":[{"billed_charge":392.00,"npi":[1265894380]}]},{"allowed_amount":1069.04,"providers":[{"billed_charge":4508.00,"npi":[1285628750]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":119.00,"providers":[{"billed_charge":584.00,"npi":[1326023789]}]},{"allowed_amount":59.50,"providers":[{"billed_charge":292.00,"npi":[1326023789]}]},{"allowed_amount":297.50,"providers":[{"billed_charge":1460.00,"npi":[1730107988]}]},{"allowed_amount":29.75,"providers":[{"billed_charge":146.00,"npi":[1730107988]}]},{"allowed_amount":89.25,"providers":[{"billed_charge":438.00,"npi":[1730107988]}]}]},{"tin":{"type":"ein","value":"621203441"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":267.68,"providers":[{"billed_charge":608.00,"npi":[1649807702,1366975955]}]},{"allowed_amount":133.84,"providers":[{"billed_charge":304.00,"npi":[1366975955]}]}]}]},{"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":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":34.30,"providers":[{"billed_charge":160.00,"npi":[1477930337]}]},{"allowed_amount":164.64,"providers":[{"billed_charge":768.00,"npi":[1003301037]}]},{"allowed_amount":68.60,"providers":[{"billed_charge":320.00,"npi":[1003301037]}]},{"allowed_amount":41.16,"providers":[{"billed_charge":192.00,"npi":[1205070851]},{"billed_charge":172.00,"npi":[1003301037]}]},{"allowed_amount":48.02,"providers":[{"billed_charge":224.00,"npi":[1205070851]}]},{"allowed_amount":6.86,"providers":[{"billed_charge":32.00,"npi":[1205070851]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":37.24,"providers":[{"billed_charge":116.76,"npi":[1295760734]}]},{"allowed_amount":9.31,"providers":[{"billed_charge":29.19,"npi":[1538492442]}]},{"allowed_amount":55.86,"providers":[{"billed_charge":175.14,"npi":[1538492442]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":351.40,"providers":[{"billed_charge":1190.00,"npi":[1598793028]}]},{"allowed_amount":90.36,"providers":[{"billed_charge":306.00,"npi":[1285628750]}]},{"allowed_amount":40.16,"providers":[{"billed_charge":136.00,"npi":[1447756960]}]},{"allowed_amount":70.28,"providers":[{"billed_charge":238.00,"npi":[1598793028]}]},{"allowed_amount":60.24,"providers":[{"billed_charge":204.00,"npi":[1265894380,1972000800]}]},{"allowed_amount":10.04,"providers":[{"billed_charge":34.00,"npi":[1265894380,1285628750]}]},{"allowed_amount":1164.64,"providers":[{"billed_charge":3944.00,"npi":[1285628750]}]},{"allowed_amount":401.60,"providers":[{"billed_charge":1360.00,"npi":[1265894380]}]},{"allowed_amount":80.32,"providers":[{"billed_charge":272.00,"npi":[1972000800]}]},{"allowed_amount":130.52,"providers":[{"billed_charge":442.00,"npi":[1447756960]}]},{"allowed_amount":20.08,"providers":[{"billed_charge":68.00,"npi":[1114486057,1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.84,"providers":[{"billed_charge":62.00,"npi":[1689617433]}]},{"allowed_amount":89.88,"providers":[{"billed_charge":434.00,"npi":[1326023789,1720510456]}]},{"allowed_amount":154.08,"providers":[{"billed_charge":744.00,"npi":[1215956008]}]},{"allowed_amount":19.26,"providers":[{"billed_charge":93.00,"npi":[1720510456,1730154261,1376756742,1124480140]}]},{"allowed_amount":57.78,"providers":[{"billed_charge":279.00,"npi":[1326023789,1730154261,1073557831]}]},{"allowed_amount":109.14,"providers":[{"billed_charge":527.00,"npi":[1124480140]}]},{"allowed_amount":237.54,"providers":[{"billed_charge":1147.00,"npi":[1871548818]}]},{"allowed_amount":532.86,"providers":[{"billed_charge":2573.00,"npi":[1730107988]}]},{"allowed_amount":38.52,"providers":[{"billed_charge":186.00,"npi":[1326023789,1689617433,1871548818]}]},{"allowed_amount":6.42,"providers":[{"billed_charge":31.00,"npi":[1215956008]}]},{"allowed_amount":141.24,"providers":[{"billed_charge":682.00,"npi":[1689617433]}]},{"allowed_amount":32.10,"providers":[{"billed_charge":155.00,"npi":[1376756742,1124480140,1073557831,1871548818]}]},{"allowed_amount":166.92,"providers":[{"billed_charge":806.00,"npi":[1720510456,1730107988]}]},{"allowed_amount":64.20,"providers":[{"billed_charge":310.00,"npi":[1730107988]}]},{"allowed_amount":44.94,"providers":[{"billed_charge":217.00,"npi":[1215956008]}]},{"allowed_amount":194.13,"providers":[{"billed_charge":930.00,"npi":[1073557831]}]},{"allowed_amount":173.34,"providers":[{"billed_charge":837.00,"npi":[1376756742]}]}]},{"tin":{"type":"ein","value":"621828139"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":13.64,"providers":[{"billed_charge":352.00,"npi":[1750410452]}]},{"allowed_amount":54.56,"providers":[{"billed_charge":1408.00,"npi":[1750410452]}]},{"allowed_amount":83.46,"providers":[{"billed_charge":2288.00,"npi":[1952563520]}]},{"allowed_amount":6.42,"providers":[{"billed_charge":176.00,"npi":[1952563520]}]}]},{"tin":{"type":"ein","value":"620859738"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":56.21,"providers":[{"billed_charge":252.00,"npi":[1083830749]}]},{"allowed_amount":24.09,"providers":[{"billed_charge":108.00,"npi":[1083830749]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":65.68,"providers":[{"billed_charge":287.00,"npi":[1003301037]}]},{"allowed_amount":24.63,"providers":[{"billed_charge":117.00,"npi":[1003301037]}]},{"allowed_amount":8.21,"providers":[{"billed_charge":39.00,"npi":[1003301037]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":12.01,"providers":[{"billed_charge":41.00,"npi":[1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":38.45,"providers":[{"billed_charge":185.00,"npi":[1730154261]}]},{"allowed_amount":23.07,"providers":[{"billed_charge":111.00,"npi":[1730154261]}]}]}]},{"name":"CT THORAX W/DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71260","description":"COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"843073102"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":378.00,"providers":[{"billed_charge":775.00,"npi":[1932148244]}]}]},{"tin":{"type":"ein","value":"620908836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":182.55,"providers":[{"billed_charge":1050.00,"npi":[1386062511]}]},{"allowed_amount":215.71,"providers":[{"billed_charge":2450.00,"npi":[1134103831]}]}]}]},{"name":"X-RAY EXAM L-S SPINE 2/3 VWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"72100","description":"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":241.24,"providers":[{"billed_charge":658.76,"npi":[1548289416]}]}]}]},{"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":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":44.64,"providers":[{"billed_charge":88815.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":109.62,"providers":[{"billed_charge":1424.00,"npi":[1558365890]}]},{"allowed_amount":78.32,"providers":[{"billed_charge":101816.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9494.29,"providers":[{"billed_charge":23230.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":451.98,"providers":[{"billed_charge":4664.90,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":349.28,"providers":[{"billed_charge":712.00,"npi":[1912341439]}]},{"allowed_amount":1248.08,"providers":[{"billed_charge":2848.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6704.38,"providers":[{"billed_charge":31967.10,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":102.23,"providers":[{"billed_charge":687.25,"npi":[1811987084]}]},{"allowed_amount":2402.50,"providers":[{"billed_charge":2402.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":214.94,"providers":[{"billed_charge":3143.70,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4981.80,"providers":[{"billed_charge":5418.80,"npi":[1417938846]}]},{"allowed_amount":262.20,"providers":[{"billed_charge":1573.20,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":126.51,"providers":[{"billed_charge":2735.36,"npi":[1922319037]}]},{"allowed_amount":1456.63,"providers":[{"billed_charge":4786.88,"npi":[1922319037]}]}]}]},{"name":"X-RAY EXAM ABDOMEN 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74018","description":"RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"620864298"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":12.84,"providers":[{"billed_charge":62.00,"npi":[1730107988]}]},{"allowed_amount":57.78,"providers":[{"billed_charge":279.00,"npi":[1730107988]}]}]}]},{"name":"CT ABD & PELVIS W/O CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74176","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":759.52,"providers":[{"billed_charge":2584.00,"npi":[1285628750]}]},{"allowed_amount":189.88,"providers":[{"billed_charge":646.00,"npi":[1447756960]}]},{"allowed_amount":94.94,"providers":[{"billed_charge":323.00,"npi":[1598793028,1285628750]}]},{"allowed_amount":854.46,"providers":[{"billed_charge":2907.00,"npi":[1598793028]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"843073102"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1134.00,"providers":[{"billed_charge":2913.00,"npi":[1932148244]}]}]},{"tin":{"type":"ein","value":"620908836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":252.13,"providers":[{"billed_charge":2064.00,"npi":[1134103831]}]},{"allowed_amount":268.23,"providers":[{"billed_charge":2064.00,"npi":[1386062511]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":99.70,"providers":[{"billed_charge":530.00,"npi":[1598793028]}]},{"allowed_amount":897.30,"providers":[{"billed_charge":4770.00,"npi":[1265894380]}]},{"allowed_amount":398.80,"providers":[{"billed_charge":2120.00,"npi":[1285628750]}]},{"allowed_amount":299.10,"providers":[{"billed_charge":1590.00,"npi":[1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":127.62,"providers":[{"billed_charge":624.00,"npi":[1730107988]}]},{"allowed_amount":191.43,"providers":[{"billed_charge":936.00,"npi":[1215956008]}]},{"allowed_amount":1467.63,"providers":[{"billed_charge":7176.00,"npi":[1730107988]}]},{"allowed_amount":63.81,"providers":[{"billed_charge":312.00,"npi":[1730107988]}]},{"allowed_amount":255.24,"providers":[{"billed_charge":1248.00,"npi":[1326023789]}]},{"allowed_amount":382.86,"providers":[{"billed_charge":1872.00,"npi":[1215956008,1871548818]}]}]}]},{"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":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4334.11,"providers":[{"billed_charge":14446.95,"npi":[1922319037]}]}]}]},{"name":"US EXAM, ABDOM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76700","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":441.40,"providers":[{"billed_charge":1830.00,"npi":[1598793028]}]}]}]},{"name":"ECHO EXAM OF ABDOMEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76705","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL","allowed_amounts":[{"tin":{"type":"ein","value":"620864298"},"service_code":["11","22","23"],"billing_class":"professional","payments":[{"allowed_amount":41.12,"providers":[{"billed_charge":200.00,"npi":[1326023789]}]},{"allowed_amount":20.56,"providers":[{"billed_charge":100.00,"npi":[1326023789,1871548818]}]},{"allowed_amount":123.36,"providers":[{"billed_charge":600.00,"npi":[1326023789]}]}]}]},{"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":"824944510"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":247.17,"providers":[{"billed_charge":1166.00,"npi":[1902953870]}]},{"allowed_amount":112.35,"providers":[{"billed_charge":530.00,"npi":[1659606788]}]}]},{"tin":{"type":"ein","value":"620818892"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":104.50,"providers":[{"billed_charge":450.00,"npi":[1790778991]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":274.68,"providers":[{"billed_charge":859.50,"npi":[1295760734]}]},{"allowed_amount":286.28,"providers":[{"billed_charge":859.50,"npi":[1295760734]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1874.73,"providers":[{"billed_charge":8550.00,"npi":[1598793028]}]},{"allowed_amount":98.67,"providers":[{"billed_charge":450.00,"npi":[1447756960]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":105.25,"providers":[{"billed_charge":515.00,"npi":[1104851120]}]},{"allowed_amount":1668.21,"providers":[{"billed_charge":8240.00,"npi":[1104851120]}]}]},{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":162.58,"providers":[{"billed_charge":1151.08,"npi":[1326144536]}]}]}]},{"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":"824944510"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":313.83,"providers":[{"billed_charge":1463.00,"npi":[1902953870]}]},{"allowed_amount":142.65,"providers":[{"billed_charge":583.00,"npi":[1659606788]}]}]},{"tin":{"type":"ein","value":"620818892"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":384.78,"providers":[{"billed_charge":1080.00,"npi":[1790778991]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":387.50,"providers":[{"billed_charge":1991.30,"npi":[1295760734]}]},{"allowed_amount":348.75,"providers":[{"billed_charge":1792.17,"npi":[1295760734]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":2379.75,"providers":[{"billed_charge":12255.00,"npi":[1598793028]}]},{"allowed_amount":125.25,"providers":[{"billed_charge":645.00,"npi":[1447756960]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":320.64,"providers":[{"billed_charge":1512.00,"npi":[1104851120]}]},{"allowed_amount":2171.00,"providers":[{"billed_charge":10332.00,"npi":[1104851120]}]}]},{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":391.36,"providers":[{"billed_charge":1132.80,"npi":[1326144536]}]}]}]},{"name":"PET IMAGE W/CT SKULL-THIGH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"78815","description":"POSITRON EMISSION TOMOGRAPHY (PET) W CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION","allowed_amounts":[{"tin":{"type":"ein","value":"620908836"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":1546.09,"providers":[{"billed_charge":9542.00,"npi":[1194227504]}]},{"allowed_amount":237.86,"providers":[{"billed_charge":1468.00,"npi":[1194227504]}]}]}]},{"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":107.22,"providers":[{"billed_charge":415.80,"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":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":63.40,"providers":[{"billed_charge":180.00,"npi":[1104316389]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":52.89,"providers":[{"billed_charge":443.52,"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":107.22,"providers":[{"billed_charge":562.44,"npi":[1234567893]}]}]}]},{"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":"620488046"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":63.00,"providers":[{"billed_charge":100.00,"npi":[1639603640]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":524.79,"providers":[{"billed_charge":980.00,"npi":[1043870157]}]},{"allowed_amount":10.72,"providers":[{"billed_charge":40.00,"npi":[1467995613]}]},{"allowed_amount":921.06,"providers":[{"billed_charge":1720.00,"npi":[1356764088]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":364.14,"providers":[{"billed_charge":1292.00,"npi":[1225648009]}]},{"allowed_amount":214.20,"providers":[{"billed_charge":760.00,"npi":[1881142784]}]}]},{"tin":{"type":"ein","value":"463723510"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1499.40,"providers":[{"billed_charge":22610.00,"npi":[1073569695]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":453.60,"providers":[{"billed_charge":3600.00,"npi":[1538223326]}]}]}]},{"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":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":52.82,"providers":[{"billed_charge":400.00,"npi":[1760111934]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1306.48,"providers":[{"billed_charge":8727.64,"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":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":34.48,"providers":[{"billed_charge":88.80,"npi":[1316977812]}]},{"allowed_amount":129.30,"providers":[{"billed_charge":333.00,"npi":[1295705564]}]},{"allowed_amount":12.93,"providers":[{"billed_charge":33.30,"npi":[1417119728]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"844408280"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":902.00,"providers":[{"billed_charge":8832.00,"npi":[1023774429]}]}]}]},{"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":133.27,"providers":[{"billed_charge":666.00,"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.60,"providers":[{"billed_charge":320.46,"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":56.04,"providers":[{"billed_charge":369.60,"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":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":728.75,"providers":[{"billed_charge":2120.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":96.58,"providers":[{"billed_charge":280.00,"npi":[1104316389]}]}]}]},{"name":"BARTONELLA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87471","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.75,"providers":[{"billed_charge":263.15,"npi":[1164508883]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":205.07,"providers":[{"billed_charge":2132.64,"npi":[1234567893]}]}]}]},{"name":"VANOMYCIN DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87500","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPE","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":52.65,"providers":[{"billed_charge":157.95,"npi":[1164508883]}]}]}]},{"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":240.23,"providers":[{"billed_charge":2522.64,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":199.24,"providers":[{"billed_charge":2210.00,"npi":[1234567893]}]}]}]},{"name":"MR-STAPH DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87641","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTAN","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.55,"providers":[{"billed_charge":52.65,"npi":[1164508883]}]}]}]},{"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":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.75,"providers":[{"billed_charge":263.25,"npi":[1164508883]}]}]}]},{"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":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.75,"providers":[{"billed_charge":263.25,"npi":[1164508883]}]}]}]},{"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":773.52,"providers":[{"billed_charge":8580.00,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"273385100"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":38.70,"providers":[{"billed_charge":210.00,"npi":[1316461460]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88304","description":"LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":127.33,"providers":[{"billed_charge":450.87,"npi":[1770621658]}]}]}]},{"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":"621436754"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1098.28,"providers":[{"billed_charge":5867.72,"npi":[1053392191]}]},{"allowed_amount":1453.62,"providers":[{"billed_charge":7766.10,"npi":[1386867232]}]},{"allowed_amount":1485.92,"providers":[{"billed_charge":7938.68,"npi":[1306997804]}]}]},{"tin":{"type":"ein","value":"621729316"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":161.51,"providers":[{"billed_charge":997.50,"npi":[1073945143]}]}]}]},{"name":"DECALCIFY TISSUE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88311","description":"DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION)","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":62.44,"providers":[{"billed_charge":213.29,"npi":[1770621658]}]}]}]},{"name":"SPECIAL STAINS GROUP 1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88312","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":857.70,"providers":[{"billed_charge":3037.86,"npi":[1770621658]}]}]}]},{"name":"IM ADMIN 1ST/ONLY COMPONENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90460","description":"IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, W COUNSELING BY","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":956.85,"providers":[{"billed_charge":1000.00,"npi":[1316977812]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":205.68,"providers":[{"billed_charge":240.00,"npi":[1295705564]}]},{"allowed_amount":17.14,"providers":[{"billed_charge":20.00,"npi":[1417119728]}]},{"allowed_amount":222.82,"providers":[{"billed_charge":260.00,"npi":[1316977812]}]}]}]},{"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":"874825160"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11195.41,"providers":[{"billed_charge":160500.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":57270.00,"providers":[{"billed_charge":77190.00,"npi":[1336297605]}]},{"allowed_amount":156630.00,"providers":[{"billed_charge":363200.00,"npi":[1487067237]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":49280.73,"providers":[{"billed_charge":282600.00,"npi":[1811144728]}]}]}]},{"name":"TDAP VACCINE 7 YRS/> IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90715","description":"TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":219.22,"providers":[{"billed_charge":225.66,"npi":[1316977812]}]}]}]},{"name":"VAR VACCINE LIVE SUBQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90716","description":"VARICELLA VIRUS VACCINE (VAR), LIVE, FOR SUBCUTANEOUS USE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":806.19,"providers":[{"billed_charge":806.19,"npi":[1316977812]}]}]}]},{"name":"PSYTX COMPLEX INTERACTIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90785","description":"INTERACTIVE COMPLEXITY (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)","allowed_amounts":[{"tin":{"type":"ein","value":"880929018"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":16.76,"providers":[{"billed_charge":40.00,"npi":[1164998027]}]},{"allowed_amount":38.36,"providers":[{"billed_charge":80.00,"npi":[1164998027]}]}]}]},{"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":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":4510.32,"providers":[{"billed_charge":10716.00,"npi":[1275106429]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":5670.00,"providers":[{"billed_charge":21000.00,"npi":[1265892749]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":315.72,"providers":[{"billed_charge":692.00,"npi":[1205405560]}]},{"allowed_amount":394.65,"providers":[{"billed_charge":873.00,"npi":[1316075294]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["02","57"],"billing_class":"professional","payments":[{"allowed_amount":4246.86,"providers":[{"billed_charge":12950.00,"npi":[1407620321]}]},{"allowed_amount":114.78,"providers":[{"billed_charge":350.00,"npi":[1114613874]}]},{"allowed_amount":3140.30,"providers":[{"billed_charge":10850.00,"npi":[1114613874]}]},{"allowed_amount":557.15,"providers":[{"billed_charge":1925.00,"npi":[1407620321]}]}]},{"tin":{"type":"ein","value":"460485169"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":8350.73,"providers":[{"billed_charge":19400.00,"npi":[1649800889]}]},{"allowed_amount":258.27,"providers":[{"billed_charge":600.00,"npi":[1649800889]}]}]},{"tin":{"type":"ein","value":"830589617"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3845.13,"providers":[{"billed_charge":8375.00,"npi":[1760754790]}]},{"allowed_amount":286.95,"providers":[{"billed_charge":625.00,"npi":[1528393550]}]}]}]},{"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":"873095707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":267.90,"providers":[{"billed_charge":705.00,"npi":[1144846767]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":6041.28,"providers":[{"billed_charge":15080.00,"npi":[1225600216]}]},{"allowed_amount":729.12,"providers":[{"billed_charge":1820.00,"npi":[1619192317]}]},{"allowed_amount":4062.24,"providers":[{"billed_charge":10140.00,"npi":[1447955695]}]},{"allowed_amount":4583.04,"providers":[{"billed_charge":11440.00,"npi":[1124803689,1922786755]}]},{"allowed_amount":1249.92,"providers":[{"billed_charge":3120.00,"npi":[1205405560]}]},{"allowed_amount":3437.28,"providers":[{"billed_charge":8580.00,"npi":[1053859504]}]},{"allowed_amount":1979.04,"providers":[{"billed_charge":4940.00,"npi":[1447756333]}]},{"allowed_amount":5312.16,"providers":[{"billed_charge":13260.00,"npi":[1790559938]}]},{"allowed_amount":520.80,"providers":[{"billed_charge":1300.00,"npi":[1952926867]}]}]},{"tin":{"type":"ein","value":"474591265"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1406.16,"providers":[{"billed_charge":3600.00,"npi":[1336584531]}]},{"allowed_amount":1249.92,"providers":[{"billed_charge":3200.00,"npi":[1760581433]}]},{"allowed_amount":2109.24,"providers":[{"billed_charge":5400.00,"npi":[1467629105]}]},{"allowed_amount":156.24,"providers":[{"billed_charge":400.00,"npi":[1760581433]}]},{"allowed_amount":78.12,"providers":[{"billed_charge":200.00,"npi":[1336584531]}]}]},{"tin":{"type":"ein","value":"621538547"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":467.81,"providers":[{"billed_charge":735.00,"npi":[1528425162]}]}]},{"tin":{"type":"ein","value":"460485169"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1590.82,"providers":[{"billed_charge":3150.00,"npi":[1649800889]}]}]},{"tin":{"type":"ein","value":"621420121"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":534.64,"providers":[{"billed_charge":1192.00,"npi":[1508214362]}]},{"allowed_amount":2121.00,"providers":[{"billed_charge":4172.00,"npi":[1508214362]}]}]},{"tin":{"type":"ein","value":"475604312"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1136.25,"providers":[{"billed_charge":1500.00,"npi":[1164649083]}]},{"allowed_amount":66.83,"providers":[{"billed_charge":100.00,"npi":[1164649083]}]}]}]},{"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":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":5091.57,"providers":[{"billed_charge":11583.00,"npi":[1225600216]}]},{"allowed_amount":1388.61,"providers":[{"billed_charge":3159.00,"npi":[1447955695]}]},{"allowed_amount":617.16,"providers":[{"billed_charge":1404.00,"npi":[1124803689]}]},{"allowed_amount":1542.90,"providers":[{"billed_charge":3448.00,"npi":[1447756333]}]}]},{"tin":{"type":"ein","value":"274608696"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":98.90,"providers":[{"billed_charge":200.00,"npi":[1003232968]}]},{"allowed_amount":336.48,"providers":[{"billed_charge":600.00,"npi":[1760965602]}]},{"allowed_amount":197.80,"providers":[{"billed_charge":400.00,"npi":[1760965602]}]},{"allowed_amount":1345.92,"providers":[{"billed_charge":2400.00,"npi":[1003232968]}]}]},{"tin":{"type":"ein","value":"880929018"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1483.50,"providers":[{"billed_charge":2775.00,"npi":[1164998027]}]},{"allowed_amount":5944.48,"providers":[{"billed_charge":9805.00,"npi":[1164998027]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":8005.20,"providers":[{"billed_charge":8400.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"825412020"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2579.68,"providers":[{"billed_charge":3450.00,"npi":[1528459344]}]},{"allowed_amount":2571.40,"providers":[{"billed_charge":3900.00,"npi":[1528459344]}]}]},{"tin":{"type":"ein","value":"461984623"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1233.76,"providers":[{"billed_charge":1320.00,"npi":[1184064644]}]}]},{"tin":{"type":"ein","value":"460485169"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":168.24,"providers":[{"billed_charge":265.00,"npi":[1649800889]}]}]},{"tin":{"type":"ein","value":"873095707"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":2173.79,"providers":[{"billed_charge":5567.80,"npi":[1144846767]}]},{"allowed_amount":686.46,"providers":[{"billed_charge":1800.00,"npi":[1144846767]}]}]}]},{"name":"PSYTX W PT W E/M 60 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90838","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":4492.50,"providers":[{"billed_charge":10000.00,"npi":[1043870157]}]},{"allowed_amount":89.85,"providers":[{"billed_charge":200.00,"npi":[1861602906]}]},{"allowed_amount":7906.80,"providers":[{"billed_charge":17600.00,"npi":[1356764088]}]}]}]},{"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":"832297809"},"service_code":["57","02"],"billing_class":"professional","payments":[{"allowed_amount":122.28,"providers":[{"billed_charge":300.00,"npi":[1861216244]}]},{"allowed_amount":568.64,"providers":[{"billed_charge":1600.00,"npi":[1407620321]}]},{"allowed_amount":124.39,"providers":[{"billed_charge":350.00,"npi":[1861216244]}]},{"allowed_amount":2853.20,"providers":[{"billed_charge":7000.00,"npi":[1407620321]}]},{"allowed_amount":3821.11,"providers":[{"billed_charge":10750.00,"npi":[1114613874]}]}]},{"tin":{"type":"ein","value":"461570381"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":672.54,"providers":[{"billed_charge":1650.00,"npi":[1306090287]}]}]},{"tin":{"type":"ein","value":"582108521"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":323.85,"providers":[{"billed_charge":1088.00,"npi":[1063864171]}]}]},{"tin":{"type":"ein","value":"920286776"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":376.95,"providers":[{"billed_charge":20925.00,"npi":[1760671655]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11475.00,"providers":[{"billed_charge":19800.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"474918169"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2151.84,"providers":[{"billed_charge":10360.00,"npi":[1134596794]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":106110.60,"providers":[{"billed_charge":762200.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":108375.00,"providers":[{"billed_charge":187000.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":36572.10,"providers":[{"billed_charge":127800.00,"npi":[1811144728]}]}]}]},{"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":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6960.65,"providers":[{"billed_charge":34508.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2854.41,"providers":[{"billed_charge":23409.00,"npi":[1558365890]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"620545814"},"service_code":["22","23","19"],"billing_class":"professional","payments":[{"allowed_amount":12.88,"providers":[{"billed_charge":17.57,"npi":[1679563100]}]},{"allowed_amount":8.23,"providers":[{"billed_charge":17.57,"npi":[1679563100]}]}]},{"tin":{"type":"ein","value":"208032568"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":165.92,"providers":[{"billed_charge":355.68,"npi":[1376785410]}]},{"allowed_amount":10.37,"providers":[{"billed_charge":22.23,"npi":[1376785410]}]}]},{"tin":{"type":"ein","value":"264253264"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":222.21,"providers":[{"billed_charge":1215.00,"npi":[1154356764]}]},{"allowed_amount":53.55,"providers":[{"billed_charge":225.00,"npi":[1154356764]}]}]},{"tin":{"type":"ein","value":"620528340"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":16.46,"providers":[{"billed_charge":35.14,"npi":[1992168454,1821087479]}]},{"allowed_amount":41.34,"providers":[{"billed_charge":105.42,"npi":[1407293426]}]},{"allowed_amount":12.88,"providers":[{"billed_charge":17.57,"npi":[1003017963,1821087479]}]},{"allowed_amount":13.78,"providers":[{"billed_charge":35.14,"npi":[1407293426]}]},{"allowed_amount":74.07,"providers":[{"billed_charge":158.13,"npi":[1003017963]}]}]},{"tin":{"type":"ein","value":"621114867"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.88,"providers":[{"billed_charge":17.57,"npi":[1356331805]}]},{"allowed_amount":42.00,"providers":[{"billed_charge":52.71,"npi":[1861873879]}]},{"allowed_amount":331.05,"providers":[{"billed_charge":456.82,"npi":[1861873879]}]},{"allowed_amount":32.92,"providers":[{"billed_charge":70.28,"npi":[1356331805]}]},{"allowed_amount":38.64,"providers":[{"billed_charge":52.71,"npi":[1356331805]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["22","23","51","21"],"billing_class":"professional","payments":[{"allowed_amount":182.00,"providers":[{"billed_charge":228.41,"npi":[1861873879]}]},{"allowed_amount":70.00,"providers":[{"billed_charge":87.85,"npi":[1861873879]}]},{"allowed_amount":14.00,"providers":[{"billed_charge":38.00,"npi":[1861873879]}]},{"allowed_amount":154.00,"providers":[{"billed_charge":193.27,"npi":[1861873879]}]},{"allowed_amount":56.00,"providers":[{"billed_charge":70.28,"npi":[1386006526]}]},{"allowed_amount":112.00,"providers":[{"billed_charge":140.56,"npi":[1386006526]}]},{"allowed_amount":196.00,"providers":[{"billed_charge":245.98,"npi":[1386006526]}]}]},{"tin":{"type":"ein","value":"620790132"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":24.69,"providers":[{"billed_charge":52.71,"npi":[1396944575]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14646.73,"providers":[{"billed_charge":22325.69,"npi":[1922319037]}]},{"allowed_amount":150.87,"providers":[{"billed_charge":4370.99,"npi":[1922319037]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"620863368"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1302.34,"providers":[{"billed_charge":4940.00,"npi":[1710972872]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":204.34,"providers":[{"billed_charge":378.08,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"463723510"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":297.16,"providers":[{"billed_charge":5750.00,"npi":[1073569695]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":312.52,"providers":[{"billed_charge":780.00,"npi":[1538223326]}]}]}]},{"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":"621867012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4764.61,"providers":[{"billed_charge":8760.00,"npi":[1417040312]}]}]},{"tin":{"type":"ein","value":"626000101"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":836.40,"providers":[{"billed_charge":1725.00,"npi":[1437539285]}]}]},{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2288.76,"providers":[{"billed_charge":6325.00,"npi":[1124707823]}]},{"allowed_amount":19.58,"providers":[{"billed_charge":55.00,"npi":[1699910737]}]},{"allowed_amount":332.86,"providers":[{"billed_charge":935.00,"npi":[1003647389]}]},{"allowed_amount":261.07,"providers":[{"billed_charge":715.00,"npi":[1699709204]}]},{"allowed_amount":1037.74,"providers":[{"billed_charge":2915.00,"npi":[1679393987]}]},{"allowed_amount":550.42,"providers":[{"billed_charge":1540.00,"npi":[1730925660]}]},{"allowed_amount":395.96,"providers":[{"billed_charge":1100.00,"npi":[1508606039]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2572.08,"providers":[{"billed_charge":8321.04,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"261286160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":767.97,"providers":[{"billed_charge":3627.00,"npi":[1528811619]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":391.60,"providers":[{"billed_charge":1160.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":237.14,"providers":[{"billed_charge":938.50,"npi":[1962458885]}]},{"allowed_amount":3984.24,"providers":[{"billed_charge":16187.00,"npi":[1972083202]}]},{"allowed_amount":615.33,"providers":[{"billed_charge":2537.00,"npi":[1871511535]}]},{"allowed_amount":704.88,"providers":[{"billed_charge":3093.00,"npi":[1396483558]}]},{"allowed_amount":609.16,"providers":[{"billed_charge":2740.50,"npi":[1306327267]}]},{"allowed_amount":667.90,"providers":[{"billed_charge":2878.00,"npi":[1134594088]}]},{"allowed_amount":732.81,"providers":[{"billed_charge":3089.50,"npi":[1013410562]}]},{"allowed_amount":117.48,"providers":[{"billed_charge":423.00,"npi":[1316488133]},{"billed_charge":460.00,"npi":[1437710167]},{"billed_charge":534.00,"npi":[1164906897]}]},{"allowed_amount":924.61,"providers":[{"billed_charge":3868.50,"npi":[1568108876]}]},{"allowed_amount":1514.20,"providers":[{"billed_charge":6261.00,"npi":[1023056371]}]},{"allowed_amount":352.44,"providers":[{"billed_charge":1417.00,"npi":[1225784812]}]},{"allowed_amount":785.38,"providers":[{"billed_charge":3153.00,"npi":[1376946459]}]},{"allowed_amount":528.66,"providers":[{"billed_charge":2403.00,"npi":[1730685140]}]},{"allowed_amount":763.62,"providers":[{"billed_charge":3138.00,"npi":[1861828816]}]},{"allowed_amount":765.80,"providers":[{"billed_charge":3267.50,"npi":[1285259432]}]},{"allowed_amount":1289.39,"providers":[{"billed_charge":5285.50,"npi":[1427663699]}]},{"allowed_amount":472.10,"providers":[{"billed_charge":2025.00,"npi":[1811496912]}]},{"allowed_amount":19.58,"providers":[{"billed_charge":70.50,"npi":[1134488448]}]},{"allowed_amount":390.89,"providers":[{"billed_charge":1672.50,"npi":[1972333235]}]},{"allowed_amount":726.65,"providers":[{"billed_charge":3015.50,"npi":[1861714099]}]},{"allowed_amount":1161.76,"providers":[{"billed_charge":4603.50,"npi":[1528717071]}]},{"allowed_amount":926.79,"providers":[{"billed_charge":3924.00,"npi":[1467790980]}]},{"allowed_amount":1314.04,"providers":[{"billed_charge":5759.50,"npi":[1578288072]}]},{"allowed_amount":424.25,"providers":[{"billed_charge":1665.50,"npi":[1851902563]}]},{"allowed_amount":5643.39,"providers":[{"billed_charge":23378.50,"npi":[1194391789]}]},{"allowed_amount":567.82,"providers":[{"billed_charge":2544.00,"npi":[1720687460]}]},{"allowed_amount":874.59,"providers":[{"billed_charge":3527.50,"npi":[1972118610]}]},{"allowed_amount":684.59,"providers":[{"billed_charge":2711.50,"npi":[1811591241]}]},{"allowed_amount":432.94,"providers":[{"billed_charge":1884.00,"npi":[1750989943]}]},{"allowed_amount":137.06,"providers":[{"billed_charge":623.00,"npi":[1326638776,1093460115]},{"billed_charge":567.50,"npi":[1629793211]}]},{"allowed_amount":156.64,"providers":[{"billed_charge":693.50,"npi":[1881043917]},{"billed_charge":675.00,"npi":[1659894533]}]},{"allowed_amount":374.20,"providers":[{"billed_charge":1524.50,"npi":[1497142731]}]},{"allowed_amount":824.55,"providers":[{"billed_charge":3423.50,"npi":[1285355107]}]},{"allowed_amount":430.76,"providers":[{"billed_charge":1717.50,"npi":[1790809598]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24.21,"providers":[{"billed_charge":55.00,"npi":[1699709204]}]},{"allowed_amount":363.16,"providers":[{"billed_charge":880.00,"npi":[1508606039]}]},{"allowed_amount":300.21,"providers":[{"billed_charge":715.00,"npi":[1003647389]}]},{"allowed_amount":360.74,"providers":[{"billed_charge":880.00,"npi":[1053002444]}]},{"allowed_amount":1551.88,"providers":[{"billed_charge":3630.00,"npi":[1124707823]}]},{"allowed_amount":329.27,"providers":[{"billed_charge":825.00,"npi":[1730925660,1679393987]}]}]},{"tin":{"type":"ein","value":"262706802"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":108.94,"providers":[{"billed_charge":332.00,"npi":[1699559047]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":148.27,"providers":[{"billed_charge":459.45,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"261286160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":295.37,"providers":[{"billed_charge":1261.00,"npi":[1528811619]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":288.11,"providers":[{"billed_charge":754.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3934.24,"providers":[{"billed_charge":15246.00,"npi":[1194391789]}]},{"allowed_amount":651.27,"providers":[{"billed_charge":2661.00,"npi":[1225784812]}]},{"allowed_amount":1570.28,"providers":[{"billed_charge":6360.00,"npi":[1427663699]}]},{"allowed_amount":1343.71,"providers":[{"billed_charge":5049.00,"npi":[1023056371]}]},{"allowed_amount":409.16,"providers":[{"billed_charge":1722.00,"npi":[1811496912]}]},{"allowed_amount":518.11,"providers":[{"billed_charge":2127.00,"npi":[1285259432]}]},{"allowed_amount":467.27,"providers":[{"billed_charge":1809.00,"npi":[1497142731]}]},{"allowed_amount":381.77,"providers":[{"billed_charge":1494.00,"npi":[1013410562]}]},{"allowed_amount":628.98,"providers":[{"billed_charge":2562.00,"npi":[1972083202]}]},{"allowed_amount":220.84,"providers":[{"billed_charge":891.00,"npi":[1972118610]}]},{"allowed_amount":334.11,"providers":[{"billed_charge":1335.00,"npi":[1861714099]}]},{"allowed_amount":1626.98,"providers":[{"billed_charge":6876.00,"npi":[1467790980]}]},{"allowed_amount":435.80,"providers":[{"billed_charge":1980.00,"npi":[1730685140]}]},{"allowed_amount":87.16,"providers":[{"billed_charge":366.00,"npi":[1881043917]}]},{"allowed_amount":268.49,"providers":[{"billed_charge":1188.00,"npi":[1871511535]}]},{"allowed_amount":1266.24,"providers":[{"billed_charge":5592.00,"npi":[1578288072]}]},{"allowed_amount":1324.34,"providers":[{"billed_charge":5070.00,"npi":[1376946459]}]},{"allowed_amount":329.27,"providers":[{"billed_charge":1425.00,"npi":[1285355107]}]},{"allowed_amount":46.00,"providers":[{"billed_charge":198.00,"npi":[1851902563]}]},{"allowed_amount":48.42,"providers":[{"billed_charge":138.00,"npi":[1316488133]}]},{"allowed_amount":479.38,"providers":[{"billed_charge":1908.00,"npi":[1568108876]}]},{"allowed_amount":65.37,"providers":[{"billed_charge":237.00,"npi":[1629793211]},{"billed_charge":297.00,"npi":[1962458885]}]},{"allowed_amount":1212.95,"providers":[{"billed_charge":4257.00,"npi":[1528717071]}]},{"allowed_amount":21.79,"providers":[{"billed_charge":69.00,"npi":[1134488448]}]},{"allowed_amount":368.53,"providers":[{"billed_charge":1434.00,"npi":[1861828816]}]},{"allowed_amount":108.95,"providers":[{"billed_charge":405.00,"npi":[1659894533]}]},{"allowed_amount":418.85,"providers":[{"billed_charge":1761.00,"npi":[1134594088]}]},{"allowed_amount":305.06,"providers":[{"billed_charge":1326.00,"npi":[1396483558]}]},{"allowed_amount":355.90,"providers":[{"billed_charge":1584.00,"npi":[1306327267]}]},{"allowed_amount":723.91,"providers":[{"billed_charge":2997.00,"npi":[1750989943]}]},{"allowed_amount":266.32,"providers":[{"billed_charge":1128.00,"npi":[1972333235]}]}]}]},{"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":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":665.53,"providers":[{"billed_charge":1980.00,"npi":[1679393987]}]},{"allowed_amount":240.37,"providers":[{"billed_charge":715.00,"npi":[1003647389]}]},{"allowed_amount":55.47,"providers":[{"billed_charge":165.00,"npi":[1699910737]}]},{"allowed_amount":203.36,"providers":[{"billed_charge":605.00,"npi":[1053002444]}]},{"allowed_amount":2056.19,"providers":[{"billed_charge":6105.00,"npi":[1124707823]}]},{"allowed_amount":332.76,"providers":[{"billed_charge":990.00,"npi":[1699709204]}]},{"allowed_amount":281.43,"providers":[{"billed_charge":825.00,"npi":[1508606039]}]},{"allowed_amount":554.64,"providers":[{"billed_charge":1650.00,"npi":[1730925660]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":318.41,"providers":[{"billed_charge":1383.00,"npi":[1285259432]}]},{"allowed_amount":277.32,"providers":[{"billed_charge":1200.00,"npi":[1972118610]}]},{"allowed_amount":129.41,"providers":[{"billed_charge":558.00,"npi":[1285355107]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":513.00,"npi":[1659894533]},{"billed_charge":528.00,"npi":[1861828816]}]},{"allowed_amount":501.28,"providers":[{"billed_charge":2223.00,"npi":[1578288072]}]},{"allowed_amount":55.47,"providers":[{"billed_charge":252.00,"npi":[1093460115]}]},{"allowed_amount":598.93,"providers":[{"billed_charge":2463.00,"npi":[1871511535]}]},{"allowed_amount":1000.44,"providers":[{"billed_charge":3981.00,"npi":[1194391789]}]},{"allowed_amount":112.99,"providers":[{"billed_charge":474.00,"npi":[1568108876]}]},{"allowed_amount":155.24,"providers":[{"billed_charge":657.00,"npi":[1013410562]}]},{"allowed_amount":690.21,"providers":[{"billed_charge":2913.00,"npi":[1528717071]}]},{"allowed_amount":358.61,"providers":[{"billed_charge":1371.00,"npi":[1811591241]}]},{"allowed_amount":18.49,"providers":[{"billed_charge":69.00,"npi":[1437710167,1427663699]}]},{"allowed_amount":499.22,"providers":[{"billed_charge":2148.00,"npi":[1396483558]}]},{"allowed_amount":240.34,"providers":[{"billed_charge":1092.00,"npi":[1720687460]}]},{"allowed_amount":240.33,"providers":[{"billed_charge":1002.00,"npi":[1376946459]}]},{"allowed_amount":794.99,"providers":[{"billed_charge":3372.00,"npi":[1023056371]}]},{"allowed_amount":73.96,"providers":[{"billed_charge":321.00,"npi":[1497142731]}]},{"allowed_amount":2364.70,"providers":[{"billed_charge":9858.00,"npi":[1972083202]}]},{"allowed_amount":221.85,"providers":[{"billed_charge":933.00,"npi":[1811496912]}]},{"allowed_amount":221.88,"providers":[{"billed_charge":963.00,"npi":[1750989943]}]},{"allowed_amount":815.52,"providers":[{"billed_charge":3441.00,"npi":[1467790980]}]},{"allowed_amount":332.81,"providers":[{"billed_charge":1497.00,"npi":[1306327267]}]},{"allowed_amount":332.82,"providers":[{"billed_charge":1452.00,"npi":[1225784812]}]},{"allowed_amount":166.40,"providers":[{"billed_charge":681.00,"npi":[1790809598]}]}]}]},{"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":"883979874"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":26660.06,"providers":[{"billed_charge":255400.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"861811180"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1390.39,"providers":[{"billed_charge":6100.00,"npi":[1265286850]}]}]},{"tin":{"type":"ein","value":"883291014"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":6730.16,"providers":[{"billed_charge":27300.00,"npi":[1366081739]}]},{"allowed_amount":49600.89,"providers":[{"billed_charge":201200.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"844711741"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":22577.89,"providers":[{"billed_charge":29100.00,"npi":[1093224370]}]}]},{"tin":{"type":"ein","value":"824431095"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":10278.60,"providers":[{"billed_charge":11575.00,"npi":[1386152197]}]},{"allowed_amount":9634.80,"providers":[{"billed_charge":10850.00,"npi":[1386152197]}]}]},{"tin":{"type":"ein","value":"872628511"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":2666.16,"providers":[{"billed_charge":8000.00,"npi":[1174924252]}]},{"allowed_amount":3466.01,"providers":[{"billed_charge":10400.00,"npi":[1174924252]}]}]}]},{"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":"883979874"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1616.85,"providers":[{"billed_charge":9375.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"883291014"},"service_code":["99","12","10"],"billing_class":"professional","payments":[{"allowed_amount":7864.19,"providers":[{"billed_charge":39875.00,"npi":[1366081739]}]},{"allowed_amount":246.53,"providers":[{"billed_charge":1250.00,"npi":[1366081739]}]},{"allowed_amount":2588.53,"providers":[{"billed_charge":13125.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"824431095"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":621.60,"providers":[{"billed_charge":980.00,"npi":[1386152197]}]},{"allowed_amount":599.40,"providers":[{"billed_charge":885.00,"npi":[1386152197]}]}]}]},{"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":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":411.81,"providers":[{"billed_charge":880.00,"npi":[1679393987]}]},{"allowed_amount":178.71,"providers":[{"billed_charge":385.00,"npi":[1508606039]}]},{"allowed_amount":217.56,"providers":[{"billed_charge":495.00,"npi":[1124707823]}]},{"allowed_amount":455.84,"providers":[{"billed_charge":990.00,"npi":[1730925660]}]}]},{"tin":{"type":"ein","value":"262706802"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":61.52,"providers":[{"billed_charge":158.00,"npi":[1699559047]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":64.76,"providers":[{"billed_charge":198.84,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":282.31,"providers":[{"billed_charge":638.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3488.73,"providers":[{"billed_charge":13338.50,"npi":[1194391789]}]},{"allowed_amount":559.44,"providers":[{"billed_charge":2354.00,"npi":[1730685140]}]},{"allowed_amount":509.82,"providers":[{"billed_charge":2115.50,"npi":[1720687460]}]},{"allowed_amount":152.81,"providers":[{"billed_charge":544.00,"npi":[1790809598]}]},{"allowed_amount":4324.78,"providers":[{"billed_charge":16689.00,"npi":[1972083202]}]},{"allowed_amount":124.32,"providers":[{"billed_charge":486.00,"npi":[1962458885]},{"billed_charge":535.00,"npi":[1093460115]}]},{"allowed_amount":628.96,"providers":[{"billed_charge":2323.00,"npi":[1871511535]}]},{"allowed_amount":448.07,"providers":[{"billed_charge":1558.50,"npi":[1811591241]}]},{"allowed_amount":468.79,"providers":[{"billed_charge":1763.50,"npi":[1285259432]}]},{"allowed_amount":288.52,"providers":[{"billed_charge":1079.00,"npi":[1013410562]}]},{"allowed_amount":25.90,"providers":[{"billed_charge":82.50,"npi":[1134488448]}]},{"allowed_amount":580.16,"providers":[{"billed_charge":2289.50,"npi":[1285355107]}]},{"allowed_amount":1587.26,"providers":[{"billed_charge":5932.50,"npi":[1023056371]}]},{"allowed_amount":518.00,"providers":[{"billed_charge":2091.00,"npi":[1396483558]}]},{"allowed_amount":725.20,"providers":[{"billed_charge":2760.00,"npi":[1134594088]}]},{"allowed_amount":2315.46,"providers":[{"billed_charge":9608.00,"npi":[1467790980]}]},{"allowed_amount":147.63,"providers":[{"billed_charge":593.00,"npi":[1326638776]}]},{"allowed_amount":1282.05,"providers":[{"billed_charge":5129.50,"npi":[1578288072]},{"billed_charge":4648.50,"npi":[1376946459]}]},{"allowed_amount":383.32,"providers":[{"billed_charge":1409.00,"npi":[1861828816]}]},{"allowed_amount":1038.59,"providers":[{"billed_charge":4215.50,"npi":[1427663699]}]},{"allowed_amount":256.41,"providers":[{"billed_charge":898.50,"npi":[1528717071]}]},{"allowed_amount":75.11,"providers":[{"billed_charge":321.00,"npi":[1861714099]}]},{"allowed_amount":202.02,"providers":[{"billed_charge":807.00,"npi":[1972333235]}]},{"allowed_amount":222.74,"providers":[{"billed_charge":914.00,"npi":[1497142731]}]},{"allowed_amount":251.23,"providers":[{"billed_charge":1070.00,"npi":[1306327267]}]},{"allowed_amount":129.50,"providers":[{"billed_charge":437.00,"npi":[1437710167]}]},{"allowed_amount":305.62,"providers":[{"billed_charge":1137.00,"npi":[1659894533]}]},{"allowed_amount":1245.79,"providers":[{"billed_charge":4982.50,"npi":[1568108876]}]},{"allowed_amount":310.80,"providers":[{"billed_charge":1210.50,"npi":[1225784812]}]},{"allowed_amount":712.25,"providers":[{"billed_charge":2702.00,"npi":[1750989943]}]}]}]},{"name":"RMVL DEVITAL TIS 20 CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97597","description":"DEBRIDEMENT (EG, HIGH PRESSURE WATERJET W/WOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT W SCISSORS, SCAL","allowed_amounts":[{"tin":{"type":"ein","value":"621166050"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":19.78,"providers":[{"billed_charge":106.00,"npi":[1427631662]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"465259447"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":70.32,"providers":[{"billed_charge":180.00,"npi":[1336490366]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"271291725"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2095.32,"providers":[{"billed_charge":2565.00,"npi":[1598090219]}]}]},{"tin":{"type":"ein","value":"465259447"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":957.32,"providers":[{"billed_charge":1680.00,"npi":[1336490366]}]}]},{"tin":{"type":"ein","value":"843725847"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1641.12,"providers":[{"billed_charge":3360.00,"npi":[1508183500]}]},{"allowed_amount":547.04,"providers":[{"billed_charge":1120.00,"npi":[1275914541]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"271291725"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1360.00,"providers":[{"billed_charge":1360.00,"npi":[1598090219]}]}]}]},{"name":"HYPERBARIC OXYGEN THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99183","description":"PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGE","allowed_amounts":[{"tin":{"type":"ein","value":"200027433"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1555.46,"providers":[{"billed_charge":4250.00,"npi":[1942494398]}]},{"allowed_amount":555.43,"providers":[{"billed_charge":1500.00,"npi":[1568860377]}]},{"allowed_amount":2544.91,"providers":[{"billed_charge":8000.00,"npi":[1316040454]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99202","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":259.72,"providers":[{"billed_charge":454.20,"npi":[1295705564]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":800.00,"providers":[{"billed_charge":2336.00,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":1214.76,"providers":[{"billed_charge":2109.84,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3872.25,"providers":[{"billed_charge":13185.00,"npi":[1851636203]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99205","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"871243993"},"service_code":["22","02"],"billing_class":"professional","payments":[{"allowed_amount":140.49,"providers":[{"billed_charge":275.00,"npi":[1780044792]}]},{"allowed_amount":309.08,"providers":[{"billed_charge":550.00,"npi":[1780044792]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":495.84,"providers":[{"billed_charge":1050.00,"npi":[1538223326]}]},{"allowed_amount":402.44,"providers":[{"billed_charge":700.00,"npi":[1538223326]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":250.00,"providers":[{"billed_charge":250.00,"npi":[1234567893]}]}]}]},{"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":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":153.18,"providers":[{"billed_charge":265.86,"npi":[1295705564]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":500.00,"providers":[{"billed_charge":1140.00,"npi":[1234567893]}]}]}]},{"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":"626001445"},"service_code":["02","71","10"],"billing_class":"professional","payments":[{"allowed_amount":165.88,"providers":[{"billed_charge":284.70,"npi":[1295705564]}]},{"allowed_amount":4810.52,"providers":[{"billed_charge":8256.30,"npi":[1316977812]}]},{"allowed_amount":301.65,"providers":[{"billed_charge":711.75,"npi":[1316977812]}]},{"allowed_amount":60.33,"providers":[{"billed_charge":142.35,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2120.86,"providers":[{"billed_charge":4200.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":56.41,"providers":[{"billed_charge":150.00,"npi":[1376237503]}]}]},{"tin":{"type":"ein","value":"262704338"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":51.28,"providers":[{"billed_charge":100.00,"npi":[1639940786]}]},{"allowed_amount":2679.00,"providers":[{"billed_charge":3800.00,"npi":[1639940786]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2256.32,"providers":[{"billed_charge":5896.00,"npi":[1881142784]}]},{"allowed_amount":987.00,"providers":[{"billed_charge":1876.00,"npi":[1881142784]}]},{"allowed_amount":410.24,"providers":[{"billed_charge":1072.00,"npi":[1225648009]}]}]},{"tin":{"type":"ein","value":"851230024"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1078.22,"providers":[{"billed_charge":2795.00,"npi":[1598723645]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4018.50,"providers":[{"billed_charge":11229.00,"npi":[1851636203]}]}]},{"tin":{"type":"ein","value":"833722140"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":282.00,"providers":[{"billed_charge":478.40,"npi":[1073518288]}]}]},{"tin":{"type":"ein","value":"620874165"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1617.89,"providers":[{"billed_charge":3610.29,"npi":[1861762767]}]},{"allowed_amount":1938.44,"providers":[{"billed_charge":5946.36,"npi":[1861762767]}]}]},{"tin":{"type":"ein","value":"621400509"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":551.79,"providers":[{"billed_charge":800.00,"npi":[1689348203]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["57","02"],"billing_class":"professional","payments":[{"allowed_amount":51.28,"providers":[{"billed_charge":200.00,"npi":[1902551682]}]},{"allowed_amount":1128.00,"providers":[{"billed_charge":3200.00,"npi":[1902551682]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1999.92,"providers":[{"billed_charge":9750.00,"npi":[1356764088]}]},{"allowed_amount":1538.40,"providers":[{"billed_charge":7500.00,"npi":[1043870157]}]}]},{"tin":{"type":"ein","value":"621081700"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1043.40,"providers":[{"billed_charge":2400.00,"npi":[1134686116]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":846.00,"providers":[{"billed_charge":1938.48,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"820603989"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1269.00,"providers":[{"billed_charge":3708.00,"npi":[1992376115]}]}]},{"tin":{"type":"ein","value":"621484602"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4512.00,"providers":[{"billed_charge":5440.00,"npi":[1053467589]}]}]},{"tin":{"type":"ein","value":"621307839"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":3566.42,"providers":[{"billed_charge":5590.00,"npi":[1326381856]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["22","02"],"billing_class":"professional","payments":[{"allowed_amount":66.36,"providers":[{"billed_charge":150.00,"npi":[1164083747]}]},{"allowed_amount":331.80,"providers":[{"billed_charge":750.00,"npi":[1164083747]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":9922.90,"providers":[{"billed_charge":21658.00,"npi":[1234567893]}]},{"allowed_amount":622.65,"providers":[{"billed_charge":1274.00,"npi":[1234567893]}]},{"allowed_amount":645.21,"providers":[{"billed_charge":1077.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"824421891"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":141.00,"providers":[{"billed_charge":210.00,"npi":[1114529492]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1410.00,"providers":[{"billed_charge":4968.00,"npi":[1093414914]}]}]},{"tin":{"type":"ein","value":"463000557"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":222.06,"providers":[{"billed_charge":395.00,"npi":[1154351278]}]},{"allowed_amount":296.08,"providers":[{"billed_charge":836.00,"npi":[1154351278]}]}]},{"tin":{"type":"ein","value":"920265597"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1409.98,"providers":[{"billed_charge":12750.00,"npi":[1518940790]}]}]}]},{"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":"626001445"},"service_code":["02","71"],"billing_class":"professional","payments":[{"allowed_amount":88.80,"providers":[{"billed_charge":201.83,"npi":[1316977812]}]},{"allowed_amount":467.64,"providers":[{"billed_charge":807.32,"npi":[1295705564]}]},{"allowed_amount":8534.43,"providers":[{"billed_charge":14733.59,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"261917198"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":298.11,"providers":[{"billed_charge":525.00,"npi":[1801595764]}]}]},{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":429.30,"providers":[{"billed_charge":850.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"621781969"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1936.67,"providers":[{"billed_charge":4598.00,"npi":[1538240130]}]},{"allowed_amount":305.79,"providers":[{"billed_charge":726.00,"npi":[1538240130]}]}]},{"tin":{"type":"ein","value":"621166050"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":447.18,"providers":[{"billed_charge":552.00,"npi":[1851317051]}]}]},{"tin":{"type":"ein","value":"464376962"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":596.28,"providers":[{"billed_charge":1050.00,"npi":[1538908421]}]}]},{"tin":{"type":"ein","value":"452689959"},"service_code":["72","10"],"billing_class":"professional","payments":[{"allowed_amount":150.96,"providers":[{"billed_charge":276.00,"npi":[1861818437]}]},{"allowed_amount":2285.74,"providers":[{"billed_charge":3174.00,"npi":[1861818437]}]}]},{"tin":{"type":"ein","value":"874127862"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":397.52,"providers":[{"billed_charge":620.00,"npi":[1942694641]}]}]},{"tin":{"type":"ein","value":"262704338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1888.22,"providers":[{"billed_charge":2812.00,"npi":[1639940786]}]}]},{"tin":{"type":"ein","value":"851230024"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1753.65,"providers":[{"billed_charge":4590.00,"npi":[1598723645]}]},{"allowed_amount":99.38,"providers":[{"billed_charge":306.00,"npi":[1740838580]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2086.98,"providers":[{"billed_charge":4313.00,"npi":[1851636203]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3279.21,"providers":[{"billed_charge":4422.00,"npi":[1225648009]}]},{"allowed_amount":905.76,"providers":[{"billed_charge":1608.00,"npi":[1225648009]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":18825.60,"providers":[{"billed_charge":42400.00,"npi":[1538223326]}]},{"allowed_amount":12392.46,"providers":[{"billed_charge":21200.00,"npi":[1538223326]}]}]},{"tin":{"type":"ein","value":"990968766"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2285.51,"providers":[{"billed_charge":3450.00,"npi":[1962855445]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":7510.80,"providers":[{"billed_charge":18120.00,"npi":[1457017246]}]},{"allowed_amount":751.08,"providers":[{"billed_charge":1812.00,"npi":[1275106429]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1391.32,"providers":[{"billed_charge":3500.00,"npi":[1902551682]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3677.06,"providers":[{"billed_charge":8791.20,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":515.04,"providers":[{"billed_charge":620.16,"npi":[1982229076]}]},{"allowed_amount":1356.16,"providers":[{"billed_charge":2691.52,"npi":[1467974170]}]}]},{"tin":{"type":"ein","value":"820603989"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1888.22,"providers":[{"billed_charge":5776.00,"npi":[1992376115]}]}]},{"tin":{"type":"ein","value":"621484602"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1490.70,"providers":[{"billed_charge":1875.00,"npi":[1053467589]}]}]},{"tin":{"type":"ein","value":"841737116"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":298.14,"providers":[{"billed_charge":612.00,"npi":[1629846720]}]}]},{"tin":{"type":"ein","value":"621307839"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":4910.22,"providers":[{"billed_charge":5880.00,"npi":[1326381856]}]}]},{"tin":{"type":"ein","value":"621032792"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":298.14,"providers":[{"billed_charge":911.73,"npi":[1104687292]}]}]},{"tin":{"type":"ein","value":"873095707"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":178.88,"providers":[{"billed_charge":468.00,"npi":[1144846767]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1291.94,"providers":[{"billed_charge":4557.00,"npi":[1093414914]}]}]},{"tin":{"type":"ein","value":"626000101"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":1390.62,"providers":[{"billed_charge":2519.00,"npi":[1780048785]}]},{"allowed_amount":193.94,"providers":[{"billed_charge":458.00,"npi":[1780048785]}]}]},{"tin":{"type":"ein","value":"871243993"},"service_code":["22","02"],"billing_class":"professional","payments":[{"allowed_amount":2128.58,"providers":[{"billed_charge":6110.00,"npi":[1780044792]}]},{"allowed_amount":3064.50,"providers":[{"billed_charge":9400.00,"npi":[1780044792]}]}]},{"tin":{"type":"ein","value":"320165938"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.76,"providers":[{"billed_charge":350.00,"npi":[1154832459]}]}]},{"tin":{"type":"ein","value":"473734336"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1660.56,"providers":[{"billed_charge":3300.00,"npi":[1881112308]}]},{"allowed_amount":1093.18,"providers":[{"billed_charge":1650.00,"npi":[1881112308]}]}]},{"tin":{"type":"ein","value":"861707476"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":198.74,"providers":[{"billed_charge":340.00,"npi":[1053905000]}]}]},{"tin":{"type":"ein","value":"621841865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1286.01,"providers":[{"billed_charge":2662.00,"npi":[1659036879]}]}]},{"tin":{"type":"ein","value":"824982979"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1590.08,"providers":[{"billed_charge":3600.00,"npi":[1073121182]}]},{"allowed_amount":226.44,"providers":[{"billed_charge":675.00,"npi":[1073121182]}]}]},{"tin":{"type":"ein","value":"824465091"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":397.48,"providers":[{"billed_charge":578.08,"npi":[1134427644]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["19","10"],"billing_class":"professional","payments":[{"allowed_amount":2822.40,"providers":[{"billed_charge":5000.00,"npi":[1558970517]}]},{"allowed_amount":3386.88,"providers":[{"billed_charge":6000.00,"npi":[1386964641]}]},{"allowed_amount":846.72,"providers":[{"billed_charge":1500.00,"npi":[1386964641]}]},{"allowed_amount":564.48,"providers":[{"billed_charge":1000.00,"npi":[1558970517]}]}]},{"tin":{"type":"ein","value":"620913596"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2057.60,"providers":[{"billed_charge":4368.00,"npi":[1942705637]}]}]},{"tin":{"type":"ein","value":"620488046"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":438.42,"providers":[{"billed_charge":777.00,"npi":[1639603640]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":150.96,"providers":[{"billed_charge":600.00,"npi":[1043870157]}]},{"allowed_amount":3245.64,"providers":[{"billed_charge":12900.00,"npi":[1356764088]}]}]},{"tin":{"type":"ein","value":"30417049"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":2638.35,"providers":[{"billed_charge":4035.00,"npi":[1669134177]}]},{"allowed_amount":175.89,"providers":[{"billed_charge":269.00,"npi":[1669134177]}]}]},{"tin":{"type":"ein","value":"271607836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":496.90,"providers":[{"billed_charge":891.25,"npi":[1073518288]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":140.31,"providers":[{"billed_charge":274.00,"npi":[1386110542]}]}]},{"tin":{"type":"ein","value":"831989830"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":334.98,"providers":[{"billed_charge":451.53,"npi":[1417516469]}]}]},{"tin":{"type":"ein","value":"621302066"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":191.53,"providers":[{"billed_charge":200.00,"npi":[1780690230]}]}]}]},{"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":"471052932"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":221.96,"providers":[{"billed_charge":750.00,"npi":[1992371330]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99223","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"821101530"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":316.86,"providers":[{"billed_charge":924.00,"npi":[1942887500]}]},{"allowed_amount":475.29,"providers":[{"billed_charge":1386.00,"npi":[1316364680]}]},{"allowed_amount":158.43,"providers":[{"billed_charge":462.00,"npi":[1316364680]}]}]},{"tin":{"type":"ein","value":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":15210.78,"providers":[{"billed_charge":27300.00,"npi":[1982199634]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"621400167"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":586.04,"providers":[{"billed_charge":1050.00,"npi":[1861080343]}]}]},{"tin":{"type":"ein","value":"205566098"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":349.20,"providers":[{"billed_charge":600.00,"npi":[1710542303]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":41.86,"providers":[{"billed_charge":75.00,"npi":[1225562747]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":251.16,"providers":[{"billed_charge":450.00,"npi":[1164104543]}]},{"allowed_amount":334.88,"providers":[{"billed_charge":600.00,"npi":[1679235212]}]},{"allowed_amount":544.18,"providers":[{"billed_charge":975.00,"npi":[1205347226]}]},{"allowed_amount":246.25,"providers":[{"billed_charge":375.00,"npi":[1003236837]}]},{"allowed_amount":2093.00,"providers":[{"billed_charge":3750.00,"npi":[1992371330]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1260.86,"providers":[{"billed_charge":2438.00,"npi":[1609694702]}]}]}]},{"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":"934267912"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":361.35,"providers":[{"billed_charge":738.60,"npi":[1235106154]}]}]},{"tin":{"type":"ein","value":"621650705"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1315.30,"providers":[{"billed_charge":1400.00,"npi":[1235247958]}]}]},{"tin":{"type":"ein","value":"832572761"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1115.36,"providers":[{"billed_charge":1869.44,"npi":[1386609055]}]},{"allowed_amount":1254.78,"providers":[{"billed_charge":2103.12,"npi":[1336435551]}]},{"allowed_amount":87.05,"providers":[{"billed_charge":116.84,"npi":[1154764041]}]}]},{"tin":{"type":"ein","value":"883208334"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":574.72,"providers":[{"billed_charge":840.00,"npi":[1215233192]}]}]},{"tin":{"type":"ein","value":"271861450"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":675.73,"providers":[{"billed_charge":2438.37,"npi":[1063160489]}]}]},{"tin":{"type":"ein","value":"320530876"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":557.68,"providers":[{"billed_charge":1280.00,"npi":[1477904241]}]}]},{"tin":{"type":"ein","value":"205291426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":7956.63,"providers":[{"billed_charge":14690.00,"npi":[1013135623]}]}]},{"tin":{"type":"ein","value":"842814288"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1365.00,"providers":[{"billed_charge":2560.00,"npi":[1194448258]}]}]},{"tin":{"type":"ein","value":"810718016"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":69.71,"providers":[{"billed_charge":278.00,"npi":[1467510693]}]}]},{"tin":{"type":"ein","value":"821101530"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2095.83,"providers":[{"billed_charge":6119.00,"npi":[1528621661]}]},{"allowed_amount":1373.13,"providers":[{"billed_charge":4009.00,"npi":[1437737228]}]},{"allowed_amount":627.39,"providers":[{"billed_charge":1899.00,"npi":[1306209689]}]},{"allowed_amount":144.54,"providers":[{"billed_charge":422.00,"npi":[1760010185]}]},{"allowed_amount":216.81,"providers":[{"billed_charge":633.00,"npi":[1538747993]}]},{"allowed_amount":578.16,"providers":[{"billed_charge":1688.00,"npi":[1245893544]}]}]},{"tin":{"type":"ein","value":"821743859"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":2887.21,"providers":[{"billed_charge":8836.00,"npi":[1710692900]}]}]},{"tin":{"type":"ein","value":"922727340"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":2021.59,"providers":[{"billed_charge":4350.00,"npi":[1639631252]}]}]},{"tin":{"type":"ein","value":"822982252"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":69.71,"providers":[{"billed_charge":162.00,"npi":[1588653208]}]}]},{"tin":{"type":"ein","value":"203279920"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":165.84,"providers":[{"billed_charge":744.00,"npi":[1699093286]}]},{"allowed_amount":72.27,"providers":[{"billed_charge":248.00,"npi":[1396785317,1144718677]}]},{"allowed_amount":715.44,"providers":[{"billed_charge":2728.00,"npi":[1144718677]}]},{"allowed_amount":390.24,"providers":[{"billed_charge":1488.00,"npi":[1972164580]}]},{"allowed_amount":354.12,"providers":[{"billed_charge":1240.00,"npi":[1255319067]}]},{"allowed_amount":130.08,"providers":[{"billed_charge":496.00,"npi":[1609255082]},{"billed_charge":584.00,"npi":[1073514022]}]},{"allowed_amount":614.28,"providers":[{"billed_charge":2232.00,"npi":[1285054239]}]},{"allowed_amount":325.20,"providers":[{"billed_charge":1460.00,"npi":[1568091205]}]},{"allowed_amount":109.41,"providers":[{"billed_charge":257.00,"npi":[1184644247]}]}]},{"tin":{"type":"ein","value":"621825715"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1007.25,"providers":[{"billed_charge":2295.00,"npi":[1720302185]}]}]},{"tin":{"type":"ein","value":"256046998"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":278.84,"providers":[{"billed_charge":580.00,"npi":[1427098508]}]}]},{"tin":{"type":"ein","value":"264290352"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":836.52,"providers":[{"billed_charge":1380.00,"npi":[1386609055]}]}]}]},{"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":"203279920"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":389.36,"providers":[{"billed_charge":1424.00,"npi":[1275765950]}]}]},{"tin":{"type":"ein","value":"30417049"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":574.32,"providers":[{"billed_charge":615.00,"npi":[1619550639]}]}]},{"tin":{"type":"ein","value":"205291426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":100.32,"providers":[{"billed_charge":154.00,"npi":[1013135623]}]}]},{"tin":{"type":"ein","value":"821101530"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1189.76,"providers":[{"billed_charge":3487.00,"npi":[1740860022]}]},{"allowed_amount":757.12,"providers":[{"billed_charge":2219.00,"npi":[1477716793]}]},{"allowed_amount":432.64,"providers":[{"billed_charge":1268.00,"npi":[1760010185]}]},{"allowed_amount":324.48,"providers":[{"billed_charge":951.00,"npi":[1942887500]}]}]},{"tin":{"type":"ein","value":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":22070.40,"providers":[{"billed_charge":44000.00,"npi":[1982199634]}]}]}]},{"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":"815117929"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":682.04,"providers":[{"billed_charge":6300.00,"npi":[1497328983]}]},{"allowed_amount":1534.59,"providers":[{"billed_charge":14470.00,"npi":[1265170856]}]},{"allowed_amount":1875.61,"providers":[{"billed_charge":17620.00,"npi":[1487198925]}]},{"allowed_amount":2046.12,"providers":[{"billed_charge":18900.00,"npi":[1336802479]}]},{"allowed_amount":802.40,"providers":[{"billed_charge":5180.00,"npi":[1114546579]}]},{"allowed_amount":1003.00,"providers":[{"billed_charge":8170.00,"npi":[1205465424]}]},{"allowed_amount":200.60,"providers":[{"billed_charge":1870.00,"npi":[1992017875]}]},{"allowed_amount":3209.60,"providers":[{"billed_charge":22900.00,"npi":[1518594761]}]}]},{"tin":{"type":"ein","value":"731723107"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":194.13,"providers":[{"billed_charge":360.00,"npi":[1902078041]}]},{"allowed_amount":647.10,"providers":[{"billed_charge":1500.00,"npi":[1619918851]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1466.46,"providers":[{"billed_charge":4158.00,"npi":[1942625645]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":159.52,"providers":[{"billed_charge":430.00,"npi":[1114785771]}]}]},{"tin":{"type":"ein","value":"824971170"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":531.28,"providers":[{"billed_charge":9996.00,"npi":[1922596410]}]},{"allowed_amount":398.46,"providers":[{"billed_charge":8770.00,"npi":[1861541351]}]}]},{"tin":{"type":"ein","value":"621179254"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1920.48,"providers":[{"billed_charge":12287.00,"npi":[1669009353]}]},{"allowed_amount":4273.02,"providers":[{"billed_charge":27264.00,"npi":[1093396111]}]},{"allowed_amount":3567.97,"providers":[{"billed_charge":20583.00,"npi":[1942760160]}]},{"allowed_amount":2618.41,"providers":[{"billed_charge":15053.00,"npi":[1760126783]}]},{"allowed_amount":1424.34,"providers":[{"billed_charge":9421.00,"npi":[1225591019]}]},{"allowed_amount":12667.11,"providers":[{"billed_charge":79385.00,"npi":[1205413051]}]},{"allowed_amount":9524.08,"providers":[{"billed_charge":56680.00,"npi":[1669052940]}]},{"allowed_amount":2611.29,"providers":[{"billed_charge":15053.00,"npi":[1073183703]}]},{"allowed_amount":712.17,"providers":[{"billed_charge":3303.00,"npi":[1629658752]}]},{"allowed_amount":6919.91,"providers":[{"billed_charge":41343.00,"npi":[1528590346]}]},{"allowed_amount":963.80,"providers":[{"billed_charge":5606.00,"npi":[1548903362]}]},{"allowed_amount":1438.58,"providers":[{"billed_charge":10034.00,"npi":[1790349595,1437646478]},{"billed_charge":8345.00,"npi":[1285088435]}]},{"allowed_amount":244.51,"providers":[{"billed_charge":1689.00,"npi":[1285377267]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"621795045"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3739.77,"providers":[{"billed_charge":9783.00,"npi":[1740763184]}]},{"allowed_amount":1246.59,"providers":[{"billed_charge":3483.00,"npi":[1467195594]}]},{"allowed_amount":831.06,"providers":[{"billed_charge":2174.00,"npi":[1346813888]},{"billed_charge":2294.00,"npi":[1912035635]}]},{"allowed_amount":2077.65,"providers":[{"billed_charge":5695.00,"npi":[1700118411]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2908.71,"providers":[{"billed_charge":6510.00,"npi":[1720580582]},{"billed_charge":8127.00,"npi":[1780004002]},{"billed_charge":6706.00,"npi":[1174085443]}]},{"allowed_amount":6648.48,"providers":[{"billed_charge":14880.00,"npi":[1811255607]},{"billed_charge":15622.00,"npi":[1154673085]}]},{"allowed_amount":10803.78,"providers":[{"billed_charge":30162.00,"npi":[1538789383]}]},{"allowed_amount":4155.30,"providers":[{"billed_charge":11650.00,"npi":[1548458375]}]},{"allowed_amount":3739.77,"providers":[{"billed_charge":10449.00,"npi":[1588472815,1578073219,1235446766]},{"billed_charge":8622.00,"npi":[1487812160]}]},{"allowed_amount":5817.42,"providers":[{"billed_charge":13412.00,"npi":[1396298824,1770196206]},{"billed_charge":16254.00,"npi":[1003904723]}]},{"allowed_amount":10388.25,"providers":[{"billed_charge":29025.00,"npi":[1639416720]}]},{"allowed_amount":6232.95,"providers":[{"billed_charge":13950.00,"npi":[1346858917]},{"billed_charge":17055.00,"npi":[1417580754]},{"billed_charge":16305.00,"npi":[1972371946]},{"billed_charge":17475.00,"npi":[1225324601]},{"billed_charge":14370.00,"npi":[1003400284,1003514894]}]},{"allowed_amount":7064.01,"providers":[{"billed_charge":19737.00,"npi":[1649233305]},{"billed_charge":12988.00,"npi":[1205375623]},{"billed_charge":19329.00,"npi":[1194030809]}]},{"allowed_amount":1662.12,"providers":[{"billed_charge":4182.00,"npi":[1730628603]},{"billed_charge":3832.00,"npi":[1306134986,1275989048,1891479457]},{"billed_charge":4656.00,"npi":[1508813700]},{"billed_charge":4548.00,"npi":[1043283765]}]},{"allowed_amount":831.06,"providers":[{"billed_charge":1986.00,"npi":[1104497932]},{"billed_charge":2274.00,"npi":[1447667423]},{"billed_charge":1860.00,"npi":[1922628882]},{"billed_charge":1916.00,"npi":[1124413455,1659876324]}]},{"allowed_amount":5401.89,"providers":[{"billed_charge":12090.00,"npi":[1598488165]}]},{"allowed_amount":2077.65,"providers":[{"billed_charge":4790.00,"npi":[1174681639,1639633191]},{"billed_charge":5685.00,"npi":[1588001143]},{"billed_charge":5825.00,"npi":[1710173653]},{"billed_charge":3820.00,"npi":[1063458479]},{"billed_charge":4965.00,"npi":[1780612481]}]},{"allowed_amount":415.53,"providers":[{"billed_charge":958.00,"npi":[1770218877]},{"billed_charge":1161.00,"npi":[1982412912,1205026440]},{"billed_charge":1165.00,"npi":[1902623648]}]},{"allowed_amount":1252.44,"providers":[{"billed_charge":2874.00,"npi":[1447294848]}]},{"allowed_amount":1246.59,"providers":[{"billed_charge":3495.00,"npi":[1568402857,1982858312]},{"billed_charge":2874.00,"npi":[1750936076,1306036926,1053995860,1346297686]}]},{"allowed_amount":2493.18,"providers":[{"billed_charge":6822.00,"npi":[1548204951]},{"billed_charge":5748.00,"npi":[1497217608]},{"billed_charge":4584.00,"npi":[1457325755]}]},{"allowed_amount":23685.21,"providers":[{"billed_charge":66405.00,"npi":[1942625645]}]},{"allowed_amount":4986.36,"providers":[{"billed_charge":13780.00,"npi":[1245272400]}]},{"allowed_amount":7479.54,"providers":[{"billed_charge":17244.00,"npi":[1255959425]}]},{"allowed_amount":19529.91,"providers":[{"billed_charge":54755.00,"npi":[1790491298]}]},{"allowed_amount":8726.13,"providers":[{"billed_charge":20118.00,"npi":[1801561279]},{"billed_charge":21550.00,"npi":[1447237110]}]},{"allowed_amount":4570.83,"providers":[{"billed_charge":10230.00,"npi":[1528094471]},{"billed_charge":10538.00,"npi":[1235403999]},{"billed_charge":12507.00,"npi":[1386949022]}]},{"allowed_amount":28671.57,"providers":[{"billed_charge":80385.00,"npi":[1053762732]}]}]},{"tin":{"type":"ein","value":"621130266"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":415.53,"providers":[{"billed_charge":1161.00,"npi":[1265531651]}]},{"allowed_amount":2908.71,"providers":[{"billed_charge":6748.00,"npi":[1952863391,1053038638]},{"billed_charge":8729.00,"npi":[1114298916]},{"billed_charge":7973.00,"npi":[1609189695]},{"billed_charge":8511.00,"npi":[1548622186]}]},{"allowed_amount":4155.30,"providers":[{"billed_charge":11446.00,"npi":[1780682906]}]},{"allowed_amount":3739.77,"providers":[{"billed_charge":10251.00,"npi":[1194259630]}]},{"allowed_amount":2493.18,"providers":[{"billed_charge":6834.00,"npi":[1104355163]}]},{"allowed_amount":1662.12,"providers":[{"billed_charge":3856.00,"npi":[1588333116]},{"billed_charge":4988.00,"npi":[1831400449]}]},{"allowed_amount":4570.83,"providers":[{"billed_charge":12529.00,"npi":[1922628841]}]},{"allowed_amount":2077.65,"providers":[{"billed_charge":5435.00,"npi":[1215275110]}]}]}]},{"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":"621795045"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1209.12,"providers":[{"billed_charge":3232.00,"npi":[1346813888]}]},{"allowed_amount":1813.68,"providers":[{"billed_charge":4848.00,"npi":[1912035635]}]},{"allowed_amount":10277.52,"providers":[{"billed_charge":28016.00,"npi":[1700118411]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":18741.36,"providers":[{"billed_charge":52855.00,"npi":[1710173653]}]},{"allowed_amount":7254.72,"providers":[{"billed_charge":16200.00,"npi":[1720580582]},{"billed_charge":16692.00,"npi":[1447294848,1427678416,1326546664,1487812160]},{"billed_charge":20232.00,"npi":[1285212100]}]},{"allowed_amount":1209.12,"providers":[{"billed_charge":3374.00,"npi":[1316500358]},{"billed_charge":2782.00,"npi":[1346866324,1124413455,1801561279]},{"billed_charge":2700.00,"npi":[1811255607,1821559824,1023294352]},{"billed_charge":3286.00,"npi":[1588622732]},{"billed_charge":2890.00,"npi":[1780612481]}]},{"allowed_amount":33250.80,"providers":[{"billed_charge":93775.00,"npi":[1639433949]}]},{"allowed_amount":5441.04,"providers":[{"billed_charge":15183.00,"npi":[1457779464]},{"billed_charge":12519.00,"npi":[1194768085]},{"billed_charge":15345.00,"npi":[1154663821]}]},{"allowed_amount":4836.48,"providers":[{"billed_charge":8856.00,"npi":[1205375623]},{"billed_charge":13496.00,"npi":[1427373760]}]},{"allowed_amount":4231.92,"providers":[{"billed_charge":8347.00,"npi":[1154673085]},{"billed_charge":11935.00,"npi":[1518914951]},{"billed_charge":9737.00,"npi":[1306134986]},{"billed_charge":11502.00,"npi":[1417392812]}]},{"allowed_amount":23577.84,"providers":[{"billed_charge":54249.00,"npi":[1104867381]}]},{"allowed_amount":9068.40,"providers":[{"billed_charge":20865.00,"npi":[1780030536]},{"billed_charge":19729.00,"npi":[1174681639]}]},{"allowed_amount":14509.44,"providers":[{"billed_charge":33384.00,"npi":[1326676628]}]},{"allowed_amount":21159.60,"providers":[{"billed_charge":52465.00,"npi":[1447237110]}]},{"allowed_amount":6045.60,"providers":[{"billed_charge":16860.00,"npi":[1942363379,1245646850]},{"billed_charge":16936.00,"npi":[1508813700]},{"billed_charge":16870.00,"npi":[1013455104]}]},{"allowed_amount":19345.92,"providers":[{"billed_charge":44512.00,"npi":[1235403999]}]},{"allowed_amount":30228.00,"providers":[{"billed_charge":85250.00,"npi":[1225324601]}]},{"allowed_amount":10882.08,"providers":[{"billed_charge":25038.00,"npi":[1467490805]}]},{"allowed_amount":3022.80,"providers":[{"billed_charge":6955.00,"npi":[1275989048]},{"billed_charge":8430.00,"npi":[1639416720]}]},{"allowed_amount":19950.48,"providers":[{"billed_charge":45903.00,"npi":[1700981271]}]},{"allowed_amount":35064.48,"providers":[{"billed_charge":98890.00,"npi":[1952613408]}]},{"allowed_amount":2418.24,"providers":[{"billed_charge":6820.00,"npi":[1972543536]},{"billed_charge":5564.00,"npi":[1124433107]},{"billed_charge":6744.00,"npi":[1184752024,1538789383]},{"billed_charge":6572.00,"npi":[1548204951]},{"billed_charge":4428.00,"npi":[1063458479]}]},{"allowed_amount":12091.20,"providers":[{"billed_charge":33740.00,"npi":[1003904723]},{"billed_charge":27820.00,"npi":[1497217608]}]},{"allowed_amount":1813.68,"providers":[{"billed_charge":4050.00,"npi":[1215463567]},{"billed_charge":4335.00,"npi":[1235558693]},{"billed_charge":4173.00,"npi":[1770196206]},{"billed_charge":4387.00,"npi":[1730628603]},{"billed_charge":4929.00,"npi":[1942201058,1588001143]},{"billed_charge":5058.00,"npi":[1649233305]}]},{"allowed_amount":10277.52,"providers":[{"billed_charge":28985.00,"npi":[1942625645]},{"billed_charge":28662.00,"npi":[1306378526]}]},{"allowed_amount":6650.16,"providers":[{"billed_charge":15301.00,"npi":[1003514894]},{"billed_charge":18430.00,"npi":[1902212657]}]},{"allowed_amount":3627.36,"providers":[{"billed_charge":8100.00,"npi":[1346858917]},{"billed_charge":9858.00,"npi":[1245272400]},{"billed_charge":10122.00,"npi":[1316502032]},{"billed_charge":8346.00,"npi":[1174588297,1770218877]},{"billed_charge":10116.00,"npi":[1578903662]}]},{"allowed_amount":604.56,"providers":[{"billed_charge":1445.00,"npi":[1538160536]},{"billed_charge":1686.00,"npi":[1902485238,1457355349]},{"billed_charge":1705.00,"npi":[1568402857,1215318951]},{"billed_charge":1643.00,"npi":[1205356441]},{"billed_charge":1391.00,"npi":[1306036926,1659876324]},{"billed_charge":1350.00,"npi":[1598488165]}]},{"allowed_amount":8463.84,"providers":[{"billed_charge":23604.00,"npi":[1538366117]},{"billed_charge":23870.00,"npi":[1982858312]}]},{"allowed_amount":15114.00,"providers":[{"billed_charge":42625.00,"npi":[1942647094]}]},{"allowed_amount":15718.56,"providers":[{"billed_charge":44330.00,"npi":[1790491298]},{"billed_charge":35100.00,"npi":[1184664872]}]},{"allowed_amount":24786.96,"providers":[{"billed_charge":69905.00,"npi":[1053762732]}]}]},{"tin":{"type":"ein","value":"621130266"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4836.48,"providers":[{"billed_charge":13184.00,"npi":[1104355163]}]},{"allowed_amount":6045.60,"providers":[{"billed_charge":16160.00,"npi":[1184787855]}]},{"allowed_amount":604.56,"providers":[{"billed_charge":1616.00,"npi":[1265623342]},{"billed_charge":1686.00,"npi":[1700063351]}]},{"allowed_amount":1209.12,"providers":[{"billed_charge":3232.00,"npi":[1215275110]}]},{"allowed_amount":2418.24,"providers":[{"billed_charge":6744.00,"npi":[1841285228]}]},{"allowed_amount":4231.92,"providers":[{"billed_charge":11536.00,"npi":[1194259630]}]},{"allowed_amount":12695.76,"providers":[{"billed_charge":34128.00,"npi":[1780682906]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"203279920"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1438.98,"providers":[{"billed_charge":6072.00,"npi":[1396188975]}]},{"allowed_amount":297.52,"providers":[{"billed_charge":1518.00,"npi":[1972965275]}]},{"allowed_amount":892.56,"providers":[{"billed_charge":4554.00,"npi":[1093125197]}]}]},{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4424.56,"providers":[{"billed_charge":48400.00,"npi":[1912906660]}]},{"allowed_amount":1208.60,"providers":[{"billed_charge":13200.00,"npi":[1205650124]}]}]}]},{"name":"CRITICAL CARE ADDL 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99292","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; EACH A","allowed_amounts":[{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":23408.86,"providers":[{"billed_charge":278400.00,"npi":[1912906660]}]},{"allowed_amount":8813.76,"providers":[{"billed_charge":105600.00,"npi":[1205650124]}]}]}]},{"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":"270257900"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":591.48,"providers":[{"billed_charge":738.00,"npi":[1407890593]}]}]},{"tin":{"type":"ein","value":"811665429"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":115.26,"providers":[{"billed_charge":164.00,"npi":[1891551784]}]}]},{"tin":{"type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1220.40,"providers":[{"billed_charge":4212.00,"npi":[1518378629]}]}]},{"tin":{"type":"ein","value":"921343519"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":55.86,"providers":[{"billed_charge":234.00,"npi":[1861192858]}]}]},{"tin":{"type":"ein","value":"811562199"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":920.08,"providers":[{"billed_charge":1932.00,"npi":[1548524861]}]}]},{"tin":{"type":"ein","value":"861285321"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":115.26,"providers":[{"billed_charge":232.00,"npi":[1407631229]}]}]}]},{"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":"822171018"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":174.16,"providers":[{"billed_charge":398.00,"npi":[1497498091]}]},{"allowed_amount":74.02,"providers":[{"billed_charge":199.00,"npi":[1699308171]}]},{"allowed_amount":1332.36,"providers":[{"billed_charge":3582.00,"npi":[1699308171]}]}]},{"tin":{"type":"ein","value":"811665429"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":419.20,"providers":[{"billed_charge":598.00,"npi":[1932497674]}]},{"allowed_amount":417.80,"providers":[{"billed_charge":590.00,"npi":[1932497674]}]}]},{"tin":{"type":"ein","value":"921343519"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1044.96,"providers":[{"billed_charge":4056.00,"npi":[1497756258]}]}]},{"tin":{"type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":167.12,"providers":[{"billed_charge":676.00,"npi":[1811343148]}]}]},{"tin":{"type":"ein","value":"460718058"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":888.24,"providers":[{"billed_charge":1248.00,"npi":[1467901058]}]},{"allowed_amount":1554.42,"providers":[{"billed_charge":2184.00,"npi":[1033628284]}]}]},{"tin":{"type":"ein","value":"810712242"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":222.06,"providers":[{"billed_charge":645.00,"npi":[1447742259]}]},{"allowed_amount":444.12,"providers":[{"billed_charge":1290.00,"npi":[1447742259]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99310","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"460718058"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":330.33,"providers":[{"billed_charge":465.00,"npi":[1033628284]}]}]}]},{"name":"BEHAV CHNG SMOKING 3-10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99406","description":"SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI","allowed_amounts":[{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":294.00,"providers":[{"billed_charge":609.00,"npi":[1942647094]}]}]}]},{"name":"PROLNG OFF/OP E/M EA 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99417","description":"PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"621302066"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":131.69,"providers":[{"billed_charge":260.00,"npi":[1780690230]}]}]}]},{"name":"TRANS CARE MGMT 7 DAY DISCH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99496","description":"TRANSITIONAL CARE MANAGEMENT SERVICES W THE FOLLOWING REQUIRED ELEMENTS: COMMUNICATION (DIRECT CONTA","allowed_amounts":[{"tin":{"type":"ein","value":"831989830"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":294.92,"providers":[{"billed_charge":456.10,"npi":[1417516469]}]}]}]},{"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":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49317.35,"providers":[{"billed_charge":163538.02,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"620946367"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":699.56,"providers":[{"billed_charge":1422.00,"npi":[1821071697]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3187.92,"providers":[{"billed_charge":5343.00,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000572"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":580.56,"providers":[{"billed_charge":828.00,"npi":[1801082383]}]}]},{"tin":{"type":"ein","value":"626000890"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2938.66,"providers":[{"billed_charge":3564.00,"npi":[1790760767]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8956.62,"providers":[{"billed_charge":16945.07,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35362.54,"providers":[{"billed_charge":176878.43,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"922991658"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4099.17,"providers":[{"billed_charge":23090.92,"npi":[1770272585]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25413.04,"providers":[{"billed_charge":38161.50,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"900766703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2810.80,"providers":[{"billed_charge":4393.20,"npi":[1629069430]}]}]},{"tin":{"type":"ein","value":"620879009"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10424.75,"providers":[{"billed_charge":16648.70,"npi":[1871538728]}]}]},{"tin":{"type":"ein","value":"626000806"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3182.07,"providers":[{"billed_charge":8465.10,"npi":[1659348209]}]}]},{"tin":{"type":"ein","value":"823967145"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21891.91,"providers":[{"billed_charge":101219.11,"npi":[1861900961]}]}]},{"tin":{"type":"ein","value":"626000604"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9995.84,"providers":[{"billed_charge":17428.80,"npi":[1083624902]}]}]},{"tin":{"type":"ein","value":"626000723"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2797.72,"providers":[{"billed_charge":4929.00,"npi":[1285745356]}]}]},{"tin":{"type":"ein","value":"626000647"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2832.44,"providers":[{"billed_charge":7532.50,"npi":[1689623050]}]}]},{"tin":{"type":"ein","value":"626000446"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3884.66,"providers":[{"billed_charge":6075.80,"npi":[1447217484]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":269580.49,"providers":[{"billed_charge":752898.75,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2583.64,"providers":[{"billed_charge":4620.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"621566628"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2922.06,"providers":[{"billed_charge":5223.22,"npi":[1720176761]}]}]},{"tin":{"type":"ein","value":"626000783"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1586.94,"providers":[{"billed_charge":2390.29,"npi":[1326019480]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":99652.30,"providers":[{"billed_charge":501302.23,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5985.77,"providers":[{"billed_charge":19748.30,"npi":[1407274947]}]}]},{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13044.55,"providers":[{"billed_charge":39779.10,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"882026637"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":147.84,"providers":[{"billed_charge":672.00,"npi":[1972248599]}]}]},{"tin":{"type":"ein","value":"850904868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8289.70,"providers":[{"billed_charge":33698.82,"npi":[1467073338]}]}]},{"tin":{"type":"ein","value":"202864837"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":676.50,"providers":[{"billed_charge":1733.60,"npi":[1245381532]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9958.67,"providers":[{"billed_charge":15721.50,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"626000739"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9.24,"providers":[{"billed_charge":11.09,"npi":[1295736908]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6682.40,"providers":[{"billed_charge":14446.18,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000614"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1144.76,"providers":[{"billed_charge":2018.24,"npi":[1134110042]}]}]},{"tin":{"type":"ein","value":"626000611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1862.50,"providers":[{"billed_charge":3675.00,"npi":[1780675942]}]}]},{"tin":{"type":"ein","value":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10812.35,"providers":[{"billed_charge":35696.97,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22475.22,"providers":[{"billed_charge":63377.25,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"831147798"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9559.26,"providers":[{"billed_charge":29775.20,"npi":[1285113118]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10593.18,"providers":[{"billed_charge":20400.00,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31705.04,"providers":[{"billed_charge":122564.00,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"831033146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12474.09,"providers":[{"billed_charge":64809.44,"npi":[1205318789]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10547.60,"providers":[{"billed_charge":18373.50,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"882472117"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3479.92,"providers":[{"billed_charge":5541.20,"npi":[1487389698]}]}]},{"tin":{"type":"ein","value":"620901553"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":425.92,"providers":[{"billed_charge":774.20,"npi":[1710950704]}]}]},{"tin":{"type":"ein","value":"821436121"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3631.32,"providers":[{"billed_charge":5475.40,"npi":[1154849115]}]}]},{"tin":{"type":"ein","value":"626000703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":803.88,"providers":[{"billed_charge":1293.00,"npi":[1730179250]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13063.98,"providers":[{"billed_charge":16343.22,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7381.95,"providers":[{"billed_charge":13271.75,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000866"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3928.89,"providers":[{"billed_charge":8339.88,"npi":[1487654927]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8238.53,"providers":[{"billed_charge":18666.00,"npi":[1841276300]}]}]},{"tin":{"type":"ein","value":"581468813"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1374.01,"providers":[{"billed_charge":2752.20,"npi":[1992799233]}]}]},{"tin":{"type":"ein","value":"854394625"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3518.62,"providers":[{"billed_charge":13790.00,"npi":[1851974208]}]}]},{"tin":{"type":"ein","value":"626000841"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1595.74,"providers":[{"billed_charge":3640.00,"npi":[1083158570]}]}]},{"tin":{"type":"ein","value":"626000764"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7972.39,"providers":[{"billed_charge":11151.00,"npi":[1053316265]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":43347.61,"providers":[{"billed_charge":99980.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"626000483"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1678.74,"providers":[{"billed_charge":2456.51,"npi":[1215901640]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12999.40,"providers":[{"billed_charge":25251.80,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"621325262"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2266.10,"providers":[{"billed_charge":5386.11,"npi":[1659353761]}]}]},{"tin":{"type":"ein","value":"461615070"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4296.60,"providers":[{"billed_charge":10660.50,"npi":[1215368634]}]}]},{"tin":{"type":"ein","value":"721519591"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6711.64,"providers":[{"billed_charge":12553.60,"npi":[1457322612]}]}]},{"tin":{"type":"ein","value":"621141186"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2864.71,"providers":[{"billed_charge":6501.95,"npi":[1184633679]}]}]},{"tin":{"type":"ein","value":"626000759"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19046.38,"providers":[{"billed_charge":44497.60,"npi":[1417061136]}]}]},{"tin":{"type":"ein","value":"991437440"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":627.09,"providers":[{"billed_charge":669.60,"npi":[1881406908]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15173.58,"providers":[{"billed_charge":40390.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"320434218"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2274.46,"providers":[{"billed_charge":3723.00,"npi":[1376954487]}]}]},{"tin":{"type":"ein","value":"621146791"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3018.00,"providers":[{"billed_charge":4082.50,"npi":[1033182704]}]}]},{"tin":{"type":"ein","value":"621166264"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5674.98,"providers":[{"billed_charge":13110.30,"npi":[1396829081]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":316.61,"providers":[{"billed_charge":1904.00,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2720.09,"providers":[{"billed_charge":8550.00,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9865.83,"providers":[{"billed_charge":116413.44,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":316.61,"providers":[{"billed_charge":621.97,"npi":[1427043702]}]}]}]},{"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":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":38705.54,"providers":[{"billed_charge":106794.31,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21717.00,"providers":[{"billed_charge":71968.28,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":258419.70,"providers":[{"billed_charge":860160.17,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32054.46,"providers":[{"billed_charge":43550.00,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17200.40,"providers":[{"billed_charge":28000.00,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000890"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10124.40,"providers":[{"billed_charge":12000.00,"npi":[1790760767]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":30045.15,"providers":[{"billed_charge":170521.24,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13912.05,"providers":[{"billed_charge":22213.20,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"831033146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1002.60,"providers":[{"billed_charge":4536.00,"npi":[1205318789]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":153098.25,"providers":[{"billed_charge":210600.00,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22148.06,"providers":[{"billed_charge":36800.00,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"900766703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":908.98,"providers":[{"billed_charge":1300.00,"npi":[1629069430]}]}]},{"tin":{"type":"ein","value":"620879009"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9906.40,"providers":[{"billed_charge":15571.92,"npi":[1871538728]}]}]},{"tin":{"type":"ein","value":"882472117"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":402.76,"providers":[{"billed_charge":750.00,"npi":[1487389698]}]}]},{"tin":{"type":"ein","value":"626000806"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5589.88,"providers":[{"billed_charge":15624.00,"npi":[1659348209]}]}]},{"tin":{"type":"ein","value":"626000604"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16901.10,"providers":[{"billed_charge":39100.00,"npi":[1083624902]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24679.16,"providers":[{"billed_charge":31365.00,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8910.00,"providers":[{"billed_charge":13994.83,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000866"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11416.50,"providers":[{"billed_charge":25920.00,"npi":[1487654927]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35914.50,"providers":[{"billed_charge":93220.00,"npi":[1841276300]}]}]},{"tin":{"type":"ein","value":"626000764"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32671.79,"providers":[{"billed_charge":46389.84,"npi":[1053316265]}]}]},{"tin":{"type":"ein","value":"626000841"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7406.10,"providers":[{"billed_charge":18270.28,"npi":[1083158570]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6972.54,"providers":[{"billed_charge":10275.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"621566628"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10401.54,"providers":[{"billed_charge":19210.75,"npi":[1720176761]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":359140.35,"providers":[{"billed_charge":946140.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":184285.20,"providers":[{"billed_charge":1544827.93,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18283.06,"providers":[{"billed_charge":40000.00,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40685.85,"providers":[{"billed_charge":64825.00,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"621141186"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18127.35,"providers":[{"billed_charge":36711.86,"npi":[1184633679]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20930.25,"providers":[{"billed_charge":47124.00,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000759"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15681.74,"providers":[{"billed_charge":24320.00,"npi":[1417061136]}]}]},{"tin":{"type":"ein","value":"626000614"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1800.30,"providers":[{"billed_charge":2819.88,"npi":[1134110042]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":130082.25,"providers":[{"billed_charge":404698.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"621146791"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1311.74,"providers":[{"billed_charge":1800.00,"npi":[1033182704]}]}]},{"tin":{"type":"ein","value":"320434218"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1518.66,"providers":[{"billed_charge":2850.00,"npi":[1376954487]}]}]},{"tin":{"type":"ein","value":"626000611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":506.22,"providers":[{"billed_charge":1028.00,"npi":[1780675942]}]}]},{"tin":{"type":"ein","value":"621166264"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4349.06,"providers":[{"billed_charge":19800.00,"npi":[1396829081]}]}]}]},{"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":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":473.76,"providers":[{"billed_charge":1611.82,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2022.54,"providers":[{"billed_charge":9132.49,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"831147798"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13600.32,"providers":[{"billed_charge":81432.00,"npi":[1285113118]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":445.82,"providers":[{"billed_charge":2250.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27872.80,"providers":[{"billed_charge":315974.91,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6290.46,"providers":[{"billed_charge":48697.74,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1529.12,"providers":[{"billed_charge":4650.00,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13492.48,"providers":[{"billed_charge":190494.72,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"922991658"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5846.88,"providers":[{"billed_charge":38160.00,"npi":[1770272585]}]}]},{"tin":{"type":"ein","value":"831033146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9465.19,"providers":[{"billed_charge":58011.00,"npi":[1205318789]}]}]},{"tin":{"type":"ein","value":"850904868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7585.92,"providers":[{"billed_charge":49651.68,"npi":[1467073338]}]}]},{"tin":{"type":"ein","value":"823967145"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11969.12,"providers":[{"billed_charge":92685.42,"npi":[1861900961]}]}]},{"tin":{"type":"ein","value":"821436121"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12201.33,"providers":[{"billed_charge":13800.00,"npi":[1154849115]}]}]},{"tin":{"type":"ein","value":"991437440"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6416.96,"providers":[{"billed_charge":42000.00,"npi":[1881406908]}]}]},{"tin":{"type":"ein","value":"854394625"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":527.68,"providers":[{"billed_charge":1500.00,"npi":[1851974208]}]}]}]},{"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":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4548.12,"providers":[{"billed_charge":15473.64,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":50460.72,"providers":[{"billed_charge":168224.90,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":319404.07,"providers":[{"billed_charge":1167562.50,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2383.50,"providers":[{"billed_charge":3600.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6385.04,"providers":[{"billed_charge":8800.00,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4941.24,"providers":[{"billed_charge":8100.00,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":53816.39,"providers":[{"billed_charge":153535.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10698.56,"providers":[{"billed_charge":103615.13,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34628.58,"providers":[{"billed_charge":128423.77,"npi":[1407274947]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36011.81,"providers":[{"billed_charge":429976.75,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1765.63,"providers":[{"billed_charge":3109.85,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5619.58,"providers":[{"billed_charge":11900.00,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":100687.32,"providers":[{"billed_charge":163800.00,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":426.29,"providers":[{"billed_charge":600.00,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24111.83,"providers":[{"billed_charge":41675.00,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"721519591"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":426.29,"providers":[{"billed_charge":1050.00,"npi":[1457322612]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":852.58,"providers":[{"billed_charge":1000.00,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4289.28,"providers":[{"billed_charge":7345.32,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11302.52,"providers":[{"billed_charge":24966.12,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1602.32,"providers":[{"billed_charge":4752.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14747.50,"providers":[{"billed_charge":35910.00,"npi":[1841276300]}]}]}]},{"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":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20714.00,"providers":[{"billed_charge":51785.00,"npi":[1942381819]}]}]}]},{"name":"INCONTNCE GARMENT ANY TYPE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4520","description":"INCONTINENCE GARMENT, ANY TYPE, (E.G., BRIEF, DIAPER), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"541818883"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":169.69,"providers":[{"billed_charge":565.63,"npi":[1992070593]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1102.88,"providers":[{"billed_charge":1122.27,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1504.30,"providers":[{"billed_charge":8413.75,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":631.33,"providers":[{"billed_charge":631.33,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4211.75,"providers":[{"billed_charge":28397.61,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1293.84,"providers":[{"billed_charge":1338.02,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5802.76,"providers":[{"billed_charge":25185.42,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":414.96,"providers":[{"billed_charge":4583.84,"npi":[1234567893]}]}]}]},{"name":"PILLW NASL CANNULA TYPE INTF","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7033","description":"PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":474.04,"providers":[{"billed_charge":3476.54,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":465.85,"providers":[{"billed_charge":492.25,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1003.64,"providers":[{"billed_charge":7997.71,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":276.88,"providers":[{"billed_charge":280.67,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":866.97,"providers":[{"billed_charge":4838.22,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":704.10,"providers":[{"billed_charge":3501.56,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":762.10,"providers":[{"billed_charge":1103.70,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":802.86,"providers":[{"billed_charge":6129.16,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":162.36,"providers":[{"billed_charge":1597.83,"npi":[1234567893]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1077.75,"providers":[{"billed_charge":1328.00,"npi":[1234567893]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2237.12,"providers":[{"billed_charge":9644.10,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1287.72,"providers":[{"billed_charge":1361.96,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3810.48,"providers":[{"billed_charge":14944.50,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":460.36,"providers":[{"billed_charge":3449.64,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5378.75,"providers":[{"billed_charge":6700.00,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5346.85,"providers":[{"billed_charge":29561.46,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":11051.00,"providers":[{"billed_charge":60481.55,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":872.40,"providers":[{"billed_charge":5120.00,"npi":[1234567893]}]}]}]},{"name":"PRVS TST MATL&EQUIP HM INR M","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0249","description":"PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WITH EITHER MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12","49"],"billing_class":"professional","payments":[{"allowed_amount":1520.40,"providers":[{"billed_charge":3920.00,"npi":[1234567893]}]},{"allowed_amount":651.60,"providers":[{"billed_charge":1680.00,"npi":[1234567893]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 1-7","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0480","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1604.79,"providers":[{"billed_charge":6600.00,"npi":[1902551682]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1413.04,"providers":[{"billed_charge":9582.28,"npi":[1234567893]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274135289"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":3983.84,"providers":[{"billed_charge":9959.52,"npi":[1497135503]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"463723510"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":166042.02,"providers":[{"billed_charge":181050.00,"npi":[1073569695]}]},{"allowed_amount":14885.22,"providers":[{"billed_charge":17850.00,"npi":[1073569695]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":326.82,"providers":[{"billed_charge":1300.00,"npi":[1225648009]}]},{"allowed_amount":452.52,"providers":[{"billed_charge":1800.00,"npi":[1225648009]}]},{"allowed_amount":238.83,"providers":[{"billed_charge":950.00,"npi":[1881142784]}]},{"allowed_amount":615.93,"providers":[{"billed_charge":2450.00,"npi":[1881142784]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;11","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6013","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"621526296"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2081.07,"providers":[{"billed_charge":6387.93,"npi":[1285869362]}]}]}]},{"name":"INTENS MOD TX DEL 1/MX FLDS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6015","description":"INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM","allowed_amounts":[{"tin":{"type":"ein","value":"621526296"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2163.24,"providers":[{"billed_charge":6565.68,"npi":[1285869362]}]}]}]},{"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":"455381950"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":1170.00,"providers":[{"billed_charge":3900.00,"npi":[1225177710]}]}]}]},{"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":"874825160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":674400.00,"providers":[{"billed_charge":1686000.00,"npi":[1679985105]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97770.00,"providers":[{"billed_charge":246000.00,"npi":[1982684361]}]}]}]},{"name":"MENTAL HLTH PART HOSP TX <24","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0035","description":"MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"472571637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14175.00,"providers":[{"billed_charge":56700.00,"npi":[1982684361]}]}]}]},{"name":"STANDARD WHEELCHAIR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0001","description":"STANDARD WHEELCHAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":508.06,"providers":[{"billed_charge":2619.26,"npi":[1234567893]}]}]}]},{"name":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1821","description":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":293.61,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":930.00,"providers":[{"billed_charge":1448.85,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1062.88,"providers":[{"billed_charge":1703.80,"npi":[1234567893]}]}]}]},{"name":"WHF ORTHO NO JOINTS PREFAB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3809","description":"WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, OFF-THE-SHELF, ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1108.26,"providers":[{"billed_charge":1188.00,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1749.53,"providers":[{"billed_charge":2846.78,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":20979.90,"providers":[{"billed_charge":31835.68,"npi":[1234567893]}]}]}]},{"name":"TRAVL 1 WAY NEC LAB SPEC; TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"P9604","description":"TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F","allowed_amounts":[{"tin":{"type":"ein","value":"650214185"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":100.80,"providers":[{"billed_charge":504.00,"npi":[1295823540]}]}]}]},{"name":"LOCM 300-399 MG/ML I CONC PE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"Q9967","description":"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML","allowed_amounts":[{"tin":{"type":"ein","value":"843073102"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":224.00,"providers":[{"billed_charge":700.00,"npi":[1932148244]}]}]}]},{"name":"INTNSVE OP PSYC SVC PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9480","description":"INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112200.00,"providers":[{"billed_charge":280500.00,"npi":[1679985105]}]}]}]}]}