{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-10-28","out_of_network":[{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"370663567"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.80,"providers":[{"billed_charge":100.90,"npi":[1629057302]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2317.98,"providers":[{"billed_charge":29252.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7347.35,"providers":[{"billed_charge":25427.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3857.09,"providers":[{"billed_charge":11203.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4843.14,"providers":[{"billed_charge":16075.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7058.91,"providers":[{"billed_charge":14341.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"370661172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1185.29,"providers":[{"billed_charge":3462.00,"npi":[1548278476]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2623.09,"providers":[{"billed_charge":14967.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":923.81,"providers":[{"billed_charge":3920.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14288.00,"providers":[{"billed_charge":50840.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7734.71,"providers":[{"billed_charge":51924.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7743.22,"providers":[{"billed_charge":15016.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3979.56,"providers":[{"billed_charge":26088.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6210.17,"providers":[{"billed_charge":17621.00,"npi":[1588612832]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"237309937"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":60.28,"providers":[{"billed_charge":822.00,"npi":[1649299827]}]},{"allowed_amount":18.94,"providers":[{"billed_charge":88.00,"npi":[1649299827]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":186.81,"providers":[{"billed_charge":2628.00,"npi":[1497859649]}]},{"allowed_amount":3.00,"providers":[{"billed_charge":98.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":560.43,"providers":[{"billed_charge":1887.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":545.89,"providers":[{"billed_charge":2096.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":799.91,"providers":[{"billed_charge":4742.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"370661172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.50,"providers":[{"billed_charge":694.00,"npi":[1548278476]}]}]},{"tin":{"type":"ein","value":"426004813"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11128.71,"providers":[{"billed_charge":72519.00,"npi":[1376544320]}]},{"allowed_amount":2294.14,"providers":[{"billed_charge":6788.00,"npi":[1376544320]}]},{"allowed_amount":146.69,"providers":[{"billed_charge":9696.00,"npi":[1376544320]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.62,"providers":[{"billed_charge":19842.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":628.37,"providers":[{"billed_charge":2236.00,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":343.65,"providers":[{"billed_charge":1208.00,"npi":[1871919381]}]},{"allowed_amount":427.00,"providers":[{"billed_charge":17657.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1672.99,"providers":[{"billed_charge":7501.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"370662561"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":213.50,"providers":[{"billed_charge":1442.40,"npi":[1053481630]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.00,"providers":[{"billed_charge":114.00,"npi":[1003864810]}]},{"allowed_amount":373.62,"providers":[{"billed_charge":4356.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2348.50,"providers":[{"billed_charge":7259.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1188.06,"providers":[{"billed_charge":72082.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"362222696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":498.72,"providers":[{"billed_charge":15254.10,"npi":[1760542732]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":88.51,"providers":[{"billed_charge":3954.46,"npi":[1376521575]}]},{"allowed_amount":333.41,"providers":[{"billed_charge":39461.01,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362604009"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":932.54,"providers":[{"billed_charge":2135.00,"npi":[1588713440]}]}]},{"tin":{"type":"ein","value":"370661208"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1527.24,"providers":[{"billed_charge":3356.81,"npi":[1194705210]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":719.84,"providers":[{"billed_charge":79919.07,"npi":[1831170232]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.54,"providers":[{"billed_charge":44741.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"237309937"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1003.29,"providers":[{"billed_charge":3773.00,"npi":[1649299827]}]},{"allowed_amount":6378.96,"providers":[{"billed_charge":23331.00,"npi":[1649299827]}]}]},{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":125.36,"providers":[{"billed_charge":29038.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":103.45,"providers":[{"billed_charge":1232.00,"npi":[1497859649]}]},{"allowed_amount":96.21,"providers":[{"billed_charge":31615.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.18,"providers":[{"billed_charge":40752.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":230.15,"providers":[{"billed_charge":49532.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.36,"providers":[{"billed_charge":9662.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27.85,"providers":[{"billed_charge":67018.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1292.79,"providers":[{"billed_charge":21234.00,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":254.10,"providers":[{"billed_charge":101782.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":98.53,"providers":[{"billed_charge":54379.00,"npi":[1003864810]}]},{"allowed_amount":187.82,"providers":[{"billed_charge":3071.00,"npi":[1003864810]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":134.89,"providers":[{"billed_charge":9850.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.62,"providers":[{"billed_charge":931.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19.27,"providers":[{"billed_charge":1199.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.22,"providers":[{"billed_charge":4017.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":747.24,"providers":[{"billed_charge":1829.00,"npi":[1124025176]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"237309937"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":368.28,"providers":[{"billed_charge":1138.00,"npi":[1649299827]}]},{"allowed_amount":281.70,"providers":[{"billed_charge":947.00,"npi":[1649299827]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8.63,"providers":[{"billed_charge":285.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":77.94,"providers":[{"billed_charge":4355.00,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":17.26,"providers":[{"billed_charge":262.00,"npi":[1003864810]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.62,"providers":[{"billed_charge":10496.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":344.46,"providers":[{"billed_charge":674.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":64.00,"providers":[{"billed_charge":2201.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1568.43,"providers":[{"billed_charge":22643.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":344.46,"providers":[{"billed_charge":3886.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"370662561"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":70.66,"providers":[{"billed_charge":2954.40,"npi":[1053481630]}]}]}]},{"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":"364015560"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1301.19,"providers":[{"billed_charge":17385.00,"npi":[1376521575]}]},{"allowed_amount":180.62,"providers":[{"billed_charge":7715.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1210.51,"providers":[{"billed_charge":8267.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1995.06,"providers":[{"billed_charge":20160.00,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2247.51,"providers":[{"billed_charge":35381.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":124.74,"providers":[{"billed_charge":2219.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"370662561"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":83.33,"providers":[{"billed_charge":2582.90,"npi":[1053481630]}]},{"allowed_amount":124.74,"providers":[{"billed_charge":2790.50,"npi":[1053481630]}]}]}]},{"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":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":748.44,"providers":[{"billed_charge":3186.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":236.58,"providers":[{"billed_charge":658.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1064.61,"providers":[{"billed_charge":4561.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":354.87,"providers":[{"billed_charge":3657.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":118.29,"providers":[{"billed_charge":768.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2014.87,"providers":[{"billed_charge":17127.00,"npi":[1124025176]}]}]}]},{"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":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6262.14,"providers":[{"billed_charge":83278.00,"npi":[1831170232]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.84,"providers":[{"billed_charge":3763.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":723.32,"providers":[{"billed_charge":44441.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.84,"providers":[{"billed_charge":12293.00,"npi":[1124025176]}]}]}]},{"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":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4289.30,"providers":[{"billed_charge":75776.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":479.75,"providers":[{"billed_charge":17694.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":479.75,"providers":[{"billed_charge":8642.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2110.27,"providers":[{"billed_charge":44172.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":959.50,"providers":[{"billed_charge":46842.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1476.94,"providers":[{"billed_charge":3792.00,"npi":[1588612832]}]},{"allowed_amount":3180.46,"providers":[{"billed_charge":6742.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":479.75,"providers":[{"billed_charge":18975.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1354.32,"providers":[{"billed_charge":23171.00,"npi":[1629057302]}]},{"allowed_amount":228.77,"providers":[{"billed_charge":4763.00,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5422.38,"providers":[{"billed_charge":130360.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2635.69,"providers":[{"billed_charge":84148.00,"npi":[1003864810]}]}]}]},{"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":"362169147"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.90,"providers":[{"billed_charge":44.00,"npi":[1942739396]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81","20"],"billing_class":"professional","payments":[{"allowed_amount":1.28,"providers":[{"billed_charge":10.00,"npi":[1234567893]}]},{"allowed_amount":69.92,"providers":[{"billed_charge":788.44,"npi":[1234567893]}]},{"allowed_amount":20.90,"providers":[{"billed_charge":44.00,"npi":[1234567893]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":214.26,"providers":[{"billed_charge":552.00,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":571.36,"providers":[{"billed_charge":5970.00,"npi":[1124025176]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":45495.50,"providers":[{"billed_charge":107961.00,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"237309937"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":293.00,"providers":[{"billed_charge":293.00,"npi":[1649299827]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12435.34,"providers":[{"billed_charge":85782.00,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":42240.41,"providers":[{"billed_charge":188397.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27315.50,"providers":[{"billed_charge":197076.00,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"370661172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10254.27,"providers":[{"billed_charge":68190.00,"npi":[1548278476]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":51700.57,"providers":[{"billed_charge":246820.00,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40314.53,"providers":[{"billed_charge":380877.00,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"363479824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1461.18,"providers":[{"billed_charge":8471.00,"npi":[1902854623]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30119.19,"providers":[{"billed_charge":115975.00,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10103.78,"providers":[{"billed_charge":24036.00,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":77261.76,"providers":[{"billed_charge":418681.00,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"370662561"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16324.79,"providers":[{"billed_charge":60525.30,"npi":[1053481630]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":54021.15,"providers":[{"billed_charge":247759.00,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370792770"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2427.88,"providers":[{"billed_charge":5269.00,"npi":[1205850690]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49946.43,"providers":[{"billed_charge":324001.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29263.03,"providers":[{"billed_charge":94815.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37883.57,"providers":[{"billed_charge":124835.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":82785.73,"providers":[{"billed_charge":312991.00,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":54146.26,"providers":[{"billed_charge":121267.00,"npi":[1588612832]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"370662561"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":6598.59,"providers":[{"billed_charge":17859.70,"npi":[1053481630]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"364015560"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1701.68,"providers":[{"billed_charge":2016.00,"npi":[1376521575]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"362182095"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":196276.48,"providers":[{"billed_charge":428349.08,"npi":[1508826983]}]}]}]},{"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":"376000511"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":37.04,"providers":[{"billed_charge":13069.18,"npi":[1861431751]}]}]},{"tin":{"type":"ein","value":"237309937"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":209.47,"providers":[{"billed_charge":539.95,"npi":[1649299827]}]}]},{"tin":{"type":"ein","value":"370960170"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14.71,"providers":[{"billed_charge":8060.00,"npi":[1497859649]}]}]},{"tin":{"type":"ein","value":"362338884"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.36,"providers":[{"billed_charge":7803.25,"npi":[1982611281]}]}]},{"tin":{"type":"ein","value":"363484281"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.50,"providers":[{"billed_charge":20293.50,"npi":[1407859655]}]}]},{"tin":{"type":"ein","value":"370661172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":40.40,"providers":[{"billed_charge":519.70,"npi":[1548278476]}]}]},{"tin":{"type":"ein","value":"362169179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":23.56,"providers":[{"billed_charge":14582.75,"npi":[1851386692]}]}]},{"tin":{"type":"ein","value":"362170866"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":42.72,"providers":[{"billed_charge":16878.36,"npi":[1598756686]}]}]},{"tin":{"type":"ein","value":"370663567"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1.50,"providers":[{"billed_charge":694.00,"npi":[1629057302]}]},{"allowed_amount":141.73,"providers":[{"billed_charge":4856.40,"npi":[1629057302]}]}]},{"tin":{"type":"ein","value":"370813229"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14.59,"providers":[{"billed_charge":4158.65,"npi":[1710396932]}]}]},{"tin":{"type":"ein","value":"362179779"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":317.55,"providers":[{"billed_charge":32802.75,"npi":[1124025176]}]}]},{"tin":{"type":"ein","value":"362513909"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34.63,"providers":[{"billed_charge":79625.08,"npi":[1003864810]}]}]},{"tin":{"type":"ein","value":"370662561"},"service_code":["23","20"],"billing_class":"institutional","payments":[{"allowed_amount":16.50,"providers":[{"billed_charge":193.86,"npi":[1053481630]}]},{"allowed_amount":14.60,"providers":[{"billed_charge":4166.35,"npi":[1053481630]}]}]},{"tin":{"type":"ein","value":"370792770"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1.12,"providers":[{"billed_charge":298.00,"npi":[1205850690]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58.39,"providers":[{"billed_charge":1760.95,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9.80,"providers":[{"billed_charge":13458.55,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":21304.40,"providers":[{"billed_charge":48419.84,"npi":[1376521575]}]},{"allowed_amount":18.30,"providers":[{"billed_charge":3477.41,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"366006541"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.52,"providers":[{"billed_charge":1384.84,"npi":[1588612832]}]},{"allowed_amount":211973.90,"providers":[{"billed_charge":350875.58,"npi":[1588612832]}]}]},{"tin":{"type":"ein","value":"362379649"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":60.87,"providers":[{"billed_charge":7531.72,"npi":[1831170232]}]}]},{"tin":{"type":"ein","value":"42768256"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.71,"providers":[{"billed_charge":82.36,"npi":[1578677811]}]}]}]},{"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":"363320227"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":7160.40,"providers":[{"billed_charge":8281.59,"npi":[1811935240]}]}]}]},{"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":"472313900"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":16.02,"providers":[{"billed_charge":42.00,"npi":[1720252315]}]}]}]},{"name":"X-RAY EXAM NECK SPINE 2-3 VW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"72040","description":"RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 2 OR 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":33.92,"providers":[{"billed_charge":125.00,"npi":[1265923494]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"364015560"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":130.35,"providers":[{"billed_charge":555.00,"npi":[1407199250]}]}]},{"tin":{"type":"ein","value":"20715915"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":297.09,"providers":[{"billed_charge":1044.00,"npi":[1679005243]}]},{"allowed_amount":3421.11,"providers":[{"billed_charge":12180.00,"npi":[1932184678]}]}]}]},{"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":"462494918"},"service_code":["22","11","19"],"billing_class":"professional","payments":[{"allowed_amount":41.44,"providers":[{"billed_charge":300.00,"npi":[1093200396]}]},{"allowed_amount":41.06,"providers":[{"billed_charge":300.00,"npi":[1437594843]}]},{"allowed_amount":123.18,"providers":[{"billed_charge":900.00,"npi":[1356367718]}]},{"allowed_amount":62.16,"providers":[{"billed_charge":450.00,"npi":[1093200396]}]},{"allowed_amount":186.48,"providers":[{"billed_charge":1350.00,"npi":[1033451711]}]},{"allowed_amount":82.88,"providers":[{"billed_charge":600.00,"npi":[1093200396,1033451711]}]},{"allowed_amount":287.42,"providers":[{"billed_charge":2100.00,"npi":[1356367718]}]},{"allowed_amount":20.72,"providers":[{"billed_charge":150.00,"npi":[1538190616]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":733.05,"providers":[{"billed_charge":2210.00,"npi":[1234567893]}]}]}]},{"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":"462494918"},"service_code":["22","11","19"],"billing_class":"professional","payments":[{"allowed_amount":52.22,"providers":[{"billed_charge":260.00,"npi":[1437594843]}]},{"allowed_amount":365.54,"providers":[{"billed_charge":1820.00,"npi":[1356367718]}]},{"allowed_amount":26.37,"providers":[{"billed_charge":130.00,"npi":[1093200396,1538190616]}]},{"allowed_amount":158.22,"providers":[{"billed_charge":780.00,"npi":[1093200396,1033451711]}]},{"allowed_amount":52.74,"providers":[{"billed_charge":260.00,"npi":[1093200396]}]},{"allowed_amount":156.66,"providers":[{"billed_charge":780.00,"npi":[1356367718]}]},{"allowed_amount":184.59,"providers":[{"billed_charge":910.00,"npi":[1033451711]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":930.40,"providers":[{"billed_charge":5780.00,"npi":[1234567893]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":550.68,"providers":[{"billed_charge":6589.44,"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":576.63,"providers":[{"billed_charge":6909.24,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":149.46,"providers":[{"billed_charge":1787.88,"npi":[1234567893]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.23,"providers":[{"billed_charge":254.32,"npi":[1234567893]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":276.92,"providers":[{"billed_charge":3315.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81","21"],"billing_class":"professional","payments":[{"allowed_amount":147.56,"providers":[{"billed_charge":1770.72,"npi":[1234567893]}]},{"allowed_amount":3.90,"providers":[{"billed_charge":13.00,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":17.30,"providers":[{"billed_charge":207.20,"npi":[1234567893]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":272.16,"providers":[{"billed_charge":3257.28,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":225.86,"providers":[{"billed_charge":2704.80,"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":272.16,"providers":[{"billed_charge":3262.56,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":87.36,"providers":[{"billed_charge":1045.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.15,"providers":[{"billed_charge":541.20,"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":763.41,"providers":[{"billed_charge":9111.35,"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":"320056775"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":43.06,"providers":[{"billed_charge":52.00,"npi":[1306195920]}]},{"allowed_amount":21.53,"providers":[{"billed_charge":26.00,"npi":[1306195920]}]},{"allowed_amount":32.31,"providers":[{"billed_charge":39.00,"npi":[1306195920]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":395.20,"providers":[{"billed_charge":4724.16,"npi":[1234567893]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":10.01,"providers":[{"billed_charge":119.56,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.16,"providers":[{"billed_charge":456.64,"npi":[1234567893]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":40.50,"providers":[{"billed_charge":371.22,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6.90,"providers":[{"billed_charge":82.64,"npi":[1234567893]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":136.68,"providers":[{"billed_charge":1637.44,"npi":[1234567893]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":808.68,"providers":[{"billed_charge":8970.00,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1089.96,"providers":[{"billed_charge":11224.45,"npi":[1234567893]}]}]}]},{"name":"GARDNER VAG, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87511","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.88,"providers":[{"billed_charge":520.00,"npi":[1234567893]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":269.56,"providers":[{"billed_charge":2990.00,"npi":[1234567893]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":316.44,"providers":[{"billed_charge":3188.51,"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":1078.24,"providers":[{"billed_charge":11193.37,"npi":[1234567893]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":820.40,"providers":[{"billed_charge":11317.97,"npi":[1234567893]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":609.44,"providers":[{"billed_charge":6661.08,"npi":[1234567893]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":738.36,"providers":[{"billed_charge":8301.62,"npi":[1234567893]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":977.90,"providers":[{"billed_charge":9004.56,"npi":[1234567893]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"363947062"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":497.59,"providers":[{"billed_charge":8959.00,"npi":[1457380115]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","81","21"],"billing_class":"professional","payments":[{"allowed_amount":84.94,"providers":[{"billed_charge":1225.10,"npi":[1234567893]}]},{"allowed_amount":425.96,"providers":[{"billed_charge":7159.74,"npi":[1234567893]}]},{"allowed_amount":166.75,"providers":[{"billed_charge":1513.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"364386543"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":722.31,"providers":[{"billed_charge":6885.00,"npi":[1982067807]}]},{"allowed_amount":193.21,"providers":[{"billed_charge":1836.00,"npi":[1336107465]}]},{"allowed_amount":64.21,"providers":[{"billed_charge":612.00,"npi":[1982067807]}]},{"allowed_amount":16.10,"providers":[{"billed_charge":153.00,"npi":[1336107465]}]}]}]},{"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":"363661051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":342.98,"providers":[{"billed_charge":460.00,"npi":[1366181869]}]}]}]},{"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":"362235167"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1800.47,"providers":[{"billed_charge":6195.00,"npi":[1962166892]}]}]}]},{"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":"364249586"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":1143.40,"providers":[{"billed_charge":3528.00,"npi":[1003319146]}]}]},{"tin":{"type":"ein","value":"833023625"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1063680452]}]}]}]},{"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":"821839102"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":618.80,"providers":[{"billed_charge":1200.00,"npi":[1023548062]}]}]},{"tin":{"type":"ein","value":"813973749"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":464.10,"providers":[{"billed_charge":1200.00,"npi":[1598363368]}]},{"allowed_amount":1624.35,"providers":[{"billed_charge":4175.00,"npi":[1598363368]}]},{"allowed_amount":386.75,"providers":[{"billed_charge":1000.00,"npi":[1598363368]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":5803.77,"providers":[{"billed_charge":6090.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"274348005"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":2425.56,"providers":[{"billed_charge":5525.00,"npi":[1922611326]}]}]},{"tin":{"type":"ein","value":"465056572"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":142.69,"providers":[{"billed_charge":225.00,"npi":[1790749620]}]},{"allowed_amount":411.09,"providers":[{"billed_charge":675.00,"npi":[1790749620]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"364249586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":166.28,"providers":[{"billed_charge":1020.00,"npi":[1881078616]}]}]},{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":396.94,"providers":[{"billed_charge":959.42,"npi":[1083662795]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":826.00,"providers":[{"billed_charge":3500.00,"npi":[1265923494]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":543.49,"providers":[{"billed_charge":2093.00,"npi":[1568285120]}]}]},{"tin":{"type":"ein","value":"362169147"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":124.91,"providers":[{"billed_charge":324.00,"npi":[1306093380]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":265.08,"providers":[{"billed_charge":555.84,"npi":[1912674870]}]},{"allowed_amount":971.87,"providers":[{"billed_charge":2038.08,"npi":[1447059423]}]},{"allowed_amount":198.81,"providers":[{"billed_charge":416.88,"npi":[1275607830]}]},{"allowed_amount":132.54,"providers":[{"billed_charge":277.92,"npi":[1114117900]}]},{"allowed_amount":88.36,"providers":[{"billed_charge":185.28,"npi":[1649165184]}]}]},{"tin":{"type":"ein","value":"364333655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1070.55,"providers":[{"billed_charge":6075.00,"npi":[1053334268]}]}]},{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8862.08,"providers":[{"billed_charge":22500.00,"npi":[1265923494]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":236.34,"providers":[{"billed_charge":801.00,"npi":[1568285120]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":466.64,"providers":[{"billed_charge":929.29,"npi":[1114117900]}]},{"allowed_amount":614.00,"providers":[{"billed_charge":1222.75,"npi":[1447059423]}]},{"allowed_amount":49.12,"providers":[{"billed_charge":97.82,"npi":[1649165184]}]},{"allowed_amount":147.36,"providers":[{"billed_charge":293.46,"npi":[1275607830]}]}]}]},{"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":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":245.52,"providers":[{"billed_charge":825.00,"npi":[1568285120]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":104.30,"providers":[{"billed_charge":270.40,"npi":[1912674870]}]},{"allowed_amount":312.95,"providers":[{"billed_charge":811.20,"npi":[1114117900]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"363771769"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":312.40,"providers":[{"billed_charge":880.00,"npi":[1568285120]}]}]},{"tin":{"type":"ein","value":"205145297"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":605.00,"providers":[{"billed_charge":1125.85,"npi":[1114117900,1447059423]}]},{"allowed_amount":78.90,"providers":[{"billed_charge":146.85,"npi":[1275607830]}]},{"allowed_amount":420.87,"providers":[{"billed_charge":783.20,"npi":[1912674870]}]}]}]},{"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":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1578.76,"providers":[{"billed_charge":3480.00,"npi":[1265923494]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":619.20,"providers":[{"billed_charge":944.42,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3539.70,"providers":[{"billed_charge":6300.00,"npi":[1265923494]}]}]}]},{"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":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":695.04,"providers":[{"billed_charge":1080.00,"npi":[1265923494]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"934971906"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":867.45,"providers":[{"billed_charge":1675.00,"npi":[1639707532]}]}]}]},{"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":"364249586"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1672.92,"providers":[{"billed_charge":3600.00,"npi":[1881078616]}]}]},{"tin":{"type":"ein","value":"320115907"},"service_code":["02","50"],"billing_class":"professional","payments":[{"allowed_amount":196.44,"providers":[{"billed_charge":604.08,"npi":[1710564323]}]},{"allowed_amount":687.54,"providers":[{"billed_charge":2114.28,"npi":[1710564323]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","20","10"],"billing_class":"professional","payments":[{"allowed_amount":190.97,"providers":[{"billed_charge":376.00,"npi":[1234567893]}]},{"allowed_amount":2718.50,"providers":[{"billed_charge":5642.00,"npi":[1234567893]}]},{"allowed_amount":93.54,"providers":[{"billed_charge":182.00,"npi":[1234567893]}]},{"allowed_amount":1049.00,"providers":[{"billed_charge":2177.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"363661051"},"service_code":["11","02","20"],"billing_class":"professional","payments":[{"allowed_amount":429.36,"providers":[{"billed_charge":1800.00,"npi":[1871058842]}]},{"allowed_amount":1771.41,"providers":[{"billed_charge":7500.00,"npi":[1366181869]}]},{"allowed_amount":143.12,"providers":[{"billed_charge":600.00,"npi":[1366181869]}]}]}]},{"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":"463370553"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":201.80,"providers":[{"billed_charge":320.06,"npi":[1194015388]}]}]},{"tin":{"type":"ein","value":"270631271"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":593.50,"providers":[{"billed_charge":875.00,"npi":[1780698712]}]}]},{"tin":{"type":"ein","value":"934971906"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3429.14,"providers":[{"billed_charge":6682.00,"npi":[1639707532]}]}]},{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8783.80,"providers":[{"billed_charge":20542.40,"npi":[1083662795]}]}]},{"tin":{"type":"ein","value":"464074961"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":158.27,"providers":[{"billed_charge":200.00,"npi":[1407853435]}]}]},{"tin":{"type":"ein","value":"320115907"},"service_code":["11","02","50"],"billing_class":"professional","payments":[{"allowed_amount":969.36,"providers":[{"billed_charge":3044.72,"npi":[1710564323]}]},{"allowed_amount":2215.68,"providers":[{"billed_charge":6959.36,"npi":[1710564323]}]},{"allowed_amount":138.48,"providers":[{"billed_charge":434.96,"npi":[1710564323]}]}]}]},{"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":"815006445"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":650.60,"providers":[{"billed_charge":1150.00,"npi":[1477616472]}]}]},{"tin":{"type":"ein","value":"363778592"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1373.51,"providers":[{"billed_charge":2128.00,"npi":[1306821053]}]}]},{"tin":{"type":"ein","value":"205287768"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":72.29,"providers":[{"billed_charge":195.00,"npi":[1619390655]}]}]}]},{"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":"270169972"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":651.84,"providers":[{"billed_charge":1272.00,"npi":[1700845260]}]}]},{"tin":{"type":"ein","value":"364371141"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":543.20,"providers":[{"billed_charge":1100.00,"npi":[1215511027]}]}]}]},{"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":"874137742"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1077.60,"providers":[{"billed_charge":3144.00,"npi":[1912444209]}]}]}]},{"name":"PREV VISIT NEW AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99386","description":"INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE AND","allowed_amounts":[{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":410.94,"providers":[{"billed_charge":900.00,"npi":[1083662795]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"208033991"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6627.08,"providers":[{"billed_charge":14500.00,"npi":[1083662795]}]}]}]},{"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":"272791517"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3092.70,"providers":[{"billed_charge":9556.05,"npi":[1710294368]}]}]},{"tin":{"type":"ein","value":"364199315"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":201.30,"providers":[{"billed_charge":1650.00,"npi":[1851343537]}]}]},{"tin":{"type":"ein","value":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26489.25,"providers":[{"billed_charge":122082.00,"npi":[1336107838]}]}]},{"tin":{"type":"ein","value":"371221954"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":101.64,"providers":[{"billed_charge":825.00,"npi":[1013900364]}]}]},{"tin":{"type":"ein","value":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4355.40,"providers":[{"billed_charge":9044.00,"npi":[1376554592]}]}]}]},{"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":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14529.58,"providers":[{"billed_charge":75140.00,"npi":[1336107838]}]}]},{"tin":{"type":"ein","value":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":73615.58,"providers":[{"billed_charge":378188.00,"npi":[1376554592]}]}]}]},{"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":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":26760.21,"providers":[{"billed_charge":154670.00,"npi":[1336107838]}]}]}]},{"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":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3294.13,"providers":[{"billed_charge":13540.00,"npi":[1336107838]}]}]},{"tin":{"type":"ein","value":"366005820"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10177.86,"providers":[{"billed_charge":62326.00,"npi":[1376554592]}]}]}]},{"name":"SPECIALTY CARE TRANSPORT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0434","description":"SPECIALTY CARE TRANSPORT (SCT)","allowed_amounts":[{"tin":{"type":"ein","value":"362688847"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15294.24,"providers":[{"billed_charge":116940.00,"npi":[1336107838]}]}]}]},{"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":"204747232"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7213.50,"providers":[{"billed_charge":13050.00,"npi":[1033142484]}]}]},{"tin":{"type":"ein","value":"261894745"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":480.90,"providers":[{"billed_charge":870.00,"npi":[1285803775]}]}]}]},{"name":"MOLECULAR PATH PROC;PHYS INT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0452","description":"MOLECULAR PATHOLOGY PROCEDURE; PHYSICIAN INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"364386543"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":322.88,"providers":[{"billed_charge":360.00,"npi":[1891157079]}]},{"allowed_amount":40.36,"providers":[{"billed_charge":45.00,"npi":[1891157079]}]}]}]},{"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":107.72,"providers":[{"billed_charge":141.88,"npi":[1234567893]}]}]}]},{"name":"APPL MODAL 1/MORE AREAS; LW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S8948","description":"APPLICATION OF A MODALITY (REQUIRING CONSTANT PROVIDER ATTENDANCE) TO ONE OR MORE AREAS; LOW-LEVEL L","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2574.00,"providers":[{"billed_charge":8580.00,"npi":[1265923494]}]}]}]},{"name":"VERT AXIAL DECOMPRS PER SESS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9090","description":"VERTEBRAL AXIAL DECOMPRESSION, PER SESSION","allowed_amounts":[{"tin":{"type":"ein","value":"364217055"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2211.00,"providers":[{"billed_charge":7370.00,"npi":[1265923494]}]}]}]}]}