{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-10-30","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"850959548"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":26988.00,"providers":[{"billed_charge":41600.00,"npi":[1811512262]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":196941.74,"providers":[{"billed_charge":156618.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":181229.17,"providers":[{"billed_charge":79971.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":178947.55,"providers":[{"billed_charge":108800.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2203975.68,"providers":[{"billed_charge":1269577.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":234251.43,"providers":[{"billed_charge":211055.00,"npi":[1427536325]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2398004.16,"providers":[{"billed_charge":937978.00,"npi":[1366436123]}]}]}]},{"name":"OB/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"112","description":"ROOM AND BOARD - PRIVATE -OB","allowed_amounts":[{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":17828.39,"providers":[{"billed_charge":22729.00,"npi":[1285253252]}]}]}]},{"name":"PSTAY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"114","description":"ROOM AND BOARD - PRIVATE -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"726014606"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":43739.70,"providers":[{"billed_charge":64334.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"721025017"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6793.64,"providers":[{"billed_charge":18562.25,"npi":[1619504016]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":228757.15,"providers":[{"billed_charge":71434.00,"npi":[1811973100]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":135748.40,"providers":[{"billed_charge":226250.00,"npi":[1356950398]}]}]},{"tin":{"type":"ein","value":"721272857"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":54384.00,"providers":[{"billed_charge":104500.00,"npi":[1346224847]}]}]},{"tin":{"type":"ein","value":"800544353"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":94461.13,"providers":[{"billed_charge":159900.00,"npi":[1720345663]}]}]},{"tin":{"type":"ein","value":"611679759"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":18419.20,"providers":[{"billed_charge":36800.00,"npi":[1154688315]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":6241.64,"providers":[{"billed_charge":20944.00,"npi":[1164419198]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":302628.67,"providers":[{"billed_charge":419694.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":628642.31,"providers":[{"billed_charge":441320.00,"npi":[1811973100]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":69733.78,"providers":[{"billed_charge":309925.00,"npi":[1811973100]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":174953.30,"providers":[{"billed_charge":134402.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":602970.09,"providers":[{"billed_charge":638280.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":246467.67,"providers":[{"billed_charge":640390.00,"npi":[1811973100]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1694.04,"providers":[{"billed_charge":12373.37,"npi":[1912943184]}]},{"allowed_amount":509.60,"providers":[{"billed_charge":1698.62,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1255.56,"providers":[{"billed_charge":10805.03,"npi":[1477500015]}]},{"allowed_amount":297.27,"providers":[{"billed_charge":990.80,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.40,"providers":[{"billed_charge":18.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":437.11,"providers":[{"billed_charge":2439.44,"npi":[1326485749]}]},{"allowed_amount":224.54,"providers":[{"billed_charge":748.45,"npi":[1326485749]}]},{"allowed_amount":481.43,"providers":[{"billed_charge":2169.27,"npi":[1689011280]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2411.45,"providers":[{"billed_charge":15342.64,"npi":[1548796378]}]},{"allowed_amount":6755.61,"providers":[{"billed_charge":22518.63,"npi":[1548796378]}]},{"allowed_amount":10186.09,"providers":[{"billed_charge":33953.25,"npi":[1629076468]}]},{"allowed_amount":4813.97,"providers":[{"billed_charge":65339.38,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20.51,"providers":[{"billed_charge":68.36,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1838.19,"providers":[{"billed_charge":12307.07,"npi":[1083903744]}]},{"allowed_amount":4787.21,"providers":[{"billed_charge":15968.93,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11575.33,"providers":[{"billed_charge":73891.92,"npi":[1053360651]}]},{"allowed_amount":5225.73,"providers":[{"billed_charge":17418.14,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8010.27,"providers":[{"billed_charge":26703.84,"npi":[1710097936]}]},{"allowed_amount":34783.10,"providers":[{"billed_charge":75175.63,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7733.28,"providers":[{"billed_charge":26532.32,"npi":[1366436123]}]},{"allowed_amount":462.91,"providers":[{"billed_charge":19075.00,"npi":[1164419198]}]},{"allowed_amount":132761.22,"providers":[{"billed_charge":785595.93,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1191.21,"providers":[{"billed_charge":17881.30,"npi":[1144227539]}]},{"allowed_amount":19.50,"providers":[{"billed_charge":64.99,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":78148.72,"providers":[{"billed_charge":461721.79,"npi":[1811973100]}]},{"allowed_amount":33359.69,"providers":[{"billed_charge":111225.93,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10888.51,"providers":[{"billed_charge":78317.54,"npi":[1427536325]}]},{"allowed_amount":3535.66,"providers":[{"billed_charge":11785.03,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"850961512"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":4593.90,"providers":[{"billed_charge":1100.56,"npi":[1356950398]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":310.97,"providers":[{"billed_charge":1036.61,"npi":[1093140600]}]},{"allowed_amount":632.74,"providers":[{"billed_charge":40286.98,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5550.70,"providers":[{"billed_charge":18501.84,"npi":[1578568481]}]},{"allowed_amount":22615.84,"providers":[{"billed_charge":61084.36,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1836.06,"providers":[{"billed_charge":4855.72,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":32.42,"providers":[{"billed_charge":181.94,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":997.77,"providers":[{"billed_charge":4261.86,"npi":[1295716637]}]},{"allowed_amount":7352.49,"providers":[{"billed_charge":15247.71,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13827.52,"providers":[{"billed_charge":57734.58,"npi":[1417950106]}]},{"allowed_amount":6885.21,"providers":[{"billed_charge":22950.48,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"721025017"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":229.67,"providers":[{"billed_charge":797.05,"npi":[1619504016]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1381.37,"providers":[{"billed_charge":4604.41,"npi":[1184373268]}]},{"allowed_amount":2592.47,"providers":[{"billed_charge":5383.18,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13.28,"providers":[{"billed_charge":44.27,"npi":[1639160799]}]},{"allowed_amount":563.67,"providers":[{"billed_charge":10765.70,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":208.53,"providers":[{"billed_charge":578.50,"npi":[]}]},{"allowed_amount":130.39,"providers":[{"billed_charge":916.55,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3764.52,"providers":[{"billed_charge":12168.82,"npi":[1275536799]}]},{"allowed_amount":480.36,"providers":[{"billed_charge":1601.23,"npi":[1275536799]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":591.82,"providers":[{"billed_charge":2784.72,"npi":[1083903744]}]},{"allowed_amount":4967.56,"providers":[{"billed_charge":16617.76,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5187.47,"providers":[{"billed_charge":17291.58,"npi":[1053360651]}]},{"allowed_amount":1013.42,"providers":[{"billed_charge":5643.48,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3609.88,"providers":[{"billed_charge":12032.94,"npi":[1710097936]}]},{"allowed_amount":2496.53,"providers":[{"billed_charge":8470.63,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":735.24,"providers":[{"billed_charge":4353.94,"npi":[1417950106]}]},{"allowed_amount":3623.80,"providers":[{"billed_charge":12079.25,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":200.79,"providers":[{"billed_charge":1367.40,"npi":[1093140600]}]},{"allowed_amount":403.38,"providers":[{"billed_charge":1344.60,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4457.15,"providers":[{"billed_charge":14857.17,"npi":[1548796378]}]},{"allowed_amount":348.20,"providers":[{"billed_charge":7160.86,"npi":[1629076468]}]},{"allowed_amount":6359.81,"providers":[{"billed_charge":21199.38,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13699.87,"providers":[{"billed_charge":84037.14,"npi":[1366436123]}]},{"allowed_amount":31264.75,"providers":[{"billed_charge":106724.43,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":29852.54,"providers":[{"billed_charge":99506.79,"npi":[1811973100]}]},{"allowed_amount":11680.38,"providers":[{"billed_charge":63918.93,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4857.72,"providers":[{"billed_charge":16192.15,"npi":[1427536325]}]},{"allowed_amount":2188.75,"providers":[{"billed_charge":18082.67,"npi":[1427536325]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11827.54,"providers":[{"billed_charge":58369.61,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":315.05,"providers":[{"billed_charge":1050.18,"npi":[1144227539]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"842046902"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10.70,"providers":[{"billed_charge":35.65,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2012.51,"providers":[{"billed_charge":6708.11,"npi":[1417950106]}]},{"allowed_amount":159.97,"providers":[{"billed_charge":1124.81,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13.16,"providers":[{"billed_charge":59.82,"npi":[1639160799]}]},{"allowed_amount":33.83,"providers":[{"billed_charge":112.76,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1404.72,"providers":[{"billed_charge":4682.39,"npi":[1548796378]}]},{"allowed_amount":116.72,"providers":[{"billed_charge":354.55,"npi":[1629076468]}]},{"allowed_amount":24.81,"providers":[{"billed_charge":272.91,"npi":[1548796378]}]},{"allowed_amount":1387.40,"providers":[{"billed_charge":4624.67,"npi":[1629076468]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":317.31,"providers":[{"billed_charge":1621.00,"npi":[1912943184]}]},{"allowed_amount":4633.25,"providers":[{"billed_charge":7455.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":634.42,"providers":[{"billed_charge":905.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2408.55,"providers":[{"billed_charge":6222.00,"npi":[1093140600]}]},{"allowed_amount":19910.35,"providers":[{"billed_charge":36824.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":544.80,"providers":[{"billed_charge":978.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":745.00,"providers":[{"billed_charge":745.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11627.80,"providers":[{"billed_charge":111997.00,"npi":[1578568481]}]},{"allowed_amount":23115.78,"providers":[{"billed_charge":92180.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2857.60,"providers":[{"billed_charge":4175.00,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":52990.72,"providers":[{"billed_charge":173535.00,"npi":[1083903744]}]},{"allowed_amount":5108.06,"providers":[{"billed_charge":30516.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12809.04,"providers":[{"billed_charge":92093.00,"npi":[1427878909]}]},{"allowed_amount":12697.68,"providers":[{"billed_charge":51073.90,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":988.16,"providers":[{"billed_charge":3421.00,"npi":[1902465065]}]},{"allowed_amount":1756.21,"providers":[{"billed_charge":6910.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1436.61,"providers":[{"billed_charge":6901.39,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7494.28,"providers":[{"billed_charge":51082.00,"npi":[1053360651]}]},{"allowed_amount":91080.12,"providers":[{"billed_charge":94712.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4267.55,"providers":[{"billed_charge":12664.00,"npi":[1295716637]}]},{"allowed_amount":11502.05,"providers":[{"billed_charge":22161.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":836.12,"providers":[{"billed_charge":2040.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":238.41,"providers":[{"billed_charge":811.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":45638.30,"providers":[{"billed_charge":92663.00,"npi":[1710097936]}]},{"allowed_amount":15609.99,"providers":[{"billed_charge":48431.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4306.10,"providers":[{"billed_charge":7076.00,"npi":[1184373268]}]},{"allowed_amount":12899.50,"providers":[{"billed_charge":20967.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":320.99,"providers":[{"billed_charge":1333.00,"npi":[1366436123]}]},{"allowed_amount":48803.92,"providers":[{"billed_charge":261076.00,"npi":[1366436123]}]},{"allowed_amount":289695.86,"providers":[{"billed_charge":549632.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1102.50,"providers":[{"billed_charge":5423.65,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13665.38,"providers":[{"billed_charge":34839.00,"npi":[1144227539]}]},{"allowed_amount":1550.52,"providers":[{"billed_charge":19562.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3550.22,"providers":[{"billed_charge":7219.00,"npi":[1275536799]}]},{"allowed_amount":295.60,"providers":[{"billed_charge":12661.00,"npi":[1275536799]}]}]},{"tin":{"type":"ein","value":"800945173"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":140.00,"providers":[{"billed_charge":140.00,"npi":[1215939210]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":405.25,"providers":[{"billed_charge":793.00,"npi":[1811973100]}]},{"allowed_amount":238386.84,"providers":[{"billed_charge":379309.00,"npi":[1811973100]}]},{"allowed_amount":30883.06,"providers":[{"billed_charge":160533.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21419.54,"providers":[{"billed_charge":28806.00,"npi":[1427536325]}]},{"allowed_amount":5610.47,"providers":[{"billed_charge":50578.00,"npi":[1427536325]}]},{"allowed_amount":395.42,"providers":[{"billed_charge":717.00,"npi":[1427536325]}]}]}]},{"name":"IV THERAPY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"269","description":"IV THERAPY - OTHER IV THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"863658746"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":464.88,"providers":[{"billed_charge":2644.76,"npi":[1649849910]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":55.89,"providers":[{"billed_charge":359.23,"npi":[1427878909]}]},{"allowed_amount":164.35,"providers":[{"billed_charge":605.82,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":35.64,"providers":[{"billed_charge":151.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":720.00,"providers":[{"billed_charge":2400.00,"npi":[1710097936]}]},{"allowed_amount":1768.93,"providers":[{"billed_charge":8907.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31.31,"providers":[{"billed_charge":104.37,"npi":[1417950106]}]},{"allowed_amount":1105.92,"providers":[{"billed_charge":5760.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":780.28,"providers":[{"billed_charge":2600.96,"npi":[1366436123]}]},{"allowed_amount":1111.29,"providers":[{"billed_charge":18589.06,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3316.43,"providers":[{"billed_charge":51982.18,"npi":[1144227539]}]},{"allowed_amount":3580.65,"providers":[{"billed_charge":11935.54,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3.90,"providers":[{"billed_charge":13.00,"npi":[1578568481]}]},{"allowed_amount":276.24,"providers":[{"billed_charge":3211.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":465.60,"providers":[{"billed_charge":1552.00,"npi":[1811973100]}]},{"allowed_amount":6682.04,"providers":[{"billed_charge":57538.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1282.02,"providers":[{"billed_charge":2829.00,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5662.26,"providers":[{"billed_charge":42980.06,"npi":[1427536325]}]},{"allowed_amount":385.20,"providers":[{"billed_charge":1284.00,"npi":[1427536325]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24.00,"providers":[{"billed_charge":80.00,"npi":[1811973100]}]},{"allowed_amount":124.04,"providers":[{"billed_charge":29067.00,"npi":[1811973100]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":61.80,"providers":[{"billed_charge":206.00,"npi":[1053360651]}]},{"allowed_amount":706.44,"providers":[{"billed_charge":7611.13,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1850.46,"providers":[{"billed_charge":3679.52,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":365.45,"providers":[{"billed_charge":11299.01,"npi":[1629076468]}]},{"allowed_amount":4916.08,"providers":[{"billed_charge":16386.96,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":66334.75,"providers":[{"billed_charge":384687.64,"npi":[1366436123]}]},{"allowed_amount":12287.12,"providers":[{"billed_charge":47094.29,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8289.69,"providers":[{"billed_charge":55992.61,"npi":[1811973100]}]},{"allowed_amount":6272.16,"providers":[{"billed_charge":20907.21,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":114.00,"providers":[{"billed_charge":498.45,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1009.50,"providers":[{"billed_charge":3365.00,"npi":[1427536325]}]},{"allowed_amount":28.21,"providers":[{"billed_charge":12200.82,"npi":[1427536325]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":53061.85,"providers":[{"billed_charge":225701.51,"npi":[1366436123]}]},{"allowed_amount":13214.36,"providers":[{"billed_charge":44047.86,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1376.31,"providers":[{"billed_charge":4587.69,"npi":[1811973100]}]},{"allowed_amount":4926.08,"providers":[{"billed_charge":212564.14,"npi":[1811973100]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"204670876"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2898.31,"providers":[{"billed_charge":3843.00,"npi":[1396761805]}]},{"allowed_amount":103.50,"providers":[{"billed_charge":2030.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3934.75,"providers":[{"billed_charge":5798.00,"npi":[1306281126]}]},{"allowed_amount":2857.00,"providers":[{"billed_charge":5055.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"480543789"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1307.65,"providers":[{"billed_charge":2893.20,"npi":[1194782409]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5193.17,"providers":[{"billed_charge":7544.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9.09,"providers":[{"billed_charge":377.00,"npi":[1629076468]}]},{"allowed_amount":5717.01,"providers":[{"billed_charge":20717.00,"npi":[1548796378]}]},{"allowed_amount":2231.24,"providers":[{"billed_charge":21544.00,"npi":[1629076468]}]},{"allowed_amount":4105.48,"providers":[{"billed_charge":14181.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6361.09,"providers":[{"billed_charge":14404.00,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3115.35,"providers":[{"billed_charge":18204.00,"npi":[1083903744]}]},{"allowed_amount":52443.05,"providers":[{"billed_charge":105674.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"141958494"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":31.58,"providers":[{"billed_charge":962.00,"npi":[1659082105]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":115901.48,"providers":[{"billed_charge":224164.00,"npi":[1053360651]}]},{"allowed_amount":64.47,"providers":[{"billed_charge":328.00,"npi":[1053360651]}]},{"allowed_amount":15576.89,"providers":[{"billed_charge":135912.26,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59.90,"providers":[{"billed_charge":125.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":45.87,"providers":[{"billed_charge":307.00,"npi":[1710097936]}]},{"allowed_amount":53242.62,"providers":[{"billed_charge":147114.77,"npi":[1710097936]}]},{"allowed_amount":36893.85,"providers":[{"billed_charge":229735.32,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"464958152"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":420.06,"providers":[{"billed_charge":1305.00,"npi":[1669882940]}]},{"allowed_amount":150.20,"providers":[{"billed_charge":576.00,"npi":[1669882940]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21970.36,"providers":[{"billed_charge":86156.00,"npi":[1366436123]}]},{"allowed_amount":17380.51,"providers":[{"billed_charge":109837.00,"npi":[1366436123]}]},{"allowed_amount":798.80,"providers":[{"billed_charge":1627.00,"npi":[1164419198]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":927.96,"providers":[{"billed_charge":8114.00,"npi":[1144227539]}]},{"allowed_amount":3922.28,"providers":[{"billed_charge":16476.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":87179.41,"providers":[{"billed_charge":705792.06,"npi":[1811973100]}]},{"allowed_amount":490.36,"providers":[{"billed_charge":2827.00,"npi":[1811973100]}]},{"allowed_amount":265313.85,"providers":[{"billed_charge":640075.32,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"800945173"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3099.20,"providers":[{"billed_charge":7358.00,"npi":[1215939210]}]},{"allowed_amount":1028.00,"providers":[{"billed_charge":1028.00,"npi":[1215939210]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":57245.22,"providers":[{"billed_charge":92641.00,"npi":[1427536325]}]},{"allowed_amount":724.96,"providers":[{"billed_charge":5857.00,"npi":[1427536325]}]},{"allowed_amount":20101.17,"providers":[{"billed_charge":165098.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3156.00,"providers":[{"billed_charge":3156.00,"npi":[1205900370]}]},{"allowed_amount":198.90,"providers":[{"billed_charge":10196.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":104.26,"providers":[{"billed_charge":1795.00,"npi":[1093140600]}]},{"allowed_amount":1523.75,"providers":[{"billed_charge":6750.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"842237042"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":196.33,"providers":[{"billed_charge":208.00,"npi":[1205482023]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":5022.63,"providers":[{"billed_charge":20994.00,"npi":[1285253252]}]},{"allowed_amount":151.69,"providers":[{"billed_charge":377.00,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":47061.16,"providers":[{"billed_charge":283834.92,"npi":[1578568481]}]},{"allowed_amount":42753.10,"providers":[{"billed_charge":303646.88,"npi":[1578568481]}]},{"allowed_amount":31.41,"providers":[{"billed_charge":2220.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2973.12,"providers":[{"billed_charge":51774.46,"npi":[1427878909]}]},{"allowed_amount":10962.31,"providers":[{"billed_charge":56457.02,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1657.04,"providers":[{"billed_charge":21929.70,"npi":[1649849910]}]},{"allowed_amount":1196.16,"providers":[{"billed_charge":7080.68,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13160.23,"providers":[{"billed_charge":49161.00,"npi":[1295716637]}]},{"allowed_amount":10.56,"providers":[{"billed_charge":747.00,"npi":[1295716637]}]},{"allowed_amount":9287.36,"providers":[{"billed_charge":29533.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1449.12,"providers":[{"billed_charge":6429.00,"npi":[1417950106]}]},{"allowed_amount":5845.19,"providers":[{"billed_charge":9554.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"260154643"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":213.00,"providers":[{"billed_charge":228.00,"npi":[1356552806]}]}]},{"tin":{"type":"ein","value":"721025017"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":60.89,"providers":[{"billed_charge":202.95,"npi":[1619504016]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11227.75,"providers":[{"billed_charge":13796.00,"npi":[1184373268]}]},{"allowed_amount":1883.76,"providers":[{"billed_charge":11254.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8.70,"providers":[{"billed_charge":17.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.71,"providers":[{"billed_charge":88.50,"npi":[]}]},{"allowed_amount":8.97,"providers":[{"billed_charge":117.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":77.09,"providers":[{"billed_charge":697.00,"npi":[1275536799]}]},{"allowed_amount":1399.75,"providers":[{"billed_charge":22366.00,"npi":[1275536799]}]},{"allowed_amount":3569.14,"providers":[{"billed_charge":8986.00,"npi":[1275536799]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":870.00,"providers":[{"billed_charge":9376.00,"npi":[1912943184]}]},{"allowed_amount":4513.16,"providers":[{"billed_charge":8368.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":153.90,"providers":[{"billed_charge":865.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":65.00,"providers":[{"billed_charge":65.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":179.70,"providers":[{"billed_charge":669.03,"npi":[1477500015]}]},{"allowed_amount":96.00,"providers":[{"billed_charge":1535.47,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":212.76,"providers":[{"billed_charge":275.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":307.00,"providers":[{"billed_charge":307.00,"npi":[1326485749]}]},{"allowed_amount":983.00,"providers":[{"billed_charge":983.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11041.03,"providers":[{"billed_charge":39622.00,"npi":[1548796378]}]},{"allowed_amount":10443.03,"providers":[{"billed_charge":47845.00,"npi":[1629076468]}]},{"allowed_amount":20336.08,"providers":[{"billed_charge":82105.00,"npi":[1629076468]}]},{"allowed_amount":502.00,"providers":[{"billed_charge":5239.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":633.28,"providers":[{"billed_charge":1029.00,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1784.98,"providers":[{"billed_charge":7449.00,"npi":[1083903744]}]},{"allowed_amount":15070.58,"providers":[{"billed_charge":26450.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":137.83,"providers":[{"billed_charge":683.00,"npi":[1053360651]}]},{"allowed_amount":23885.90,"providers":[{"billed_charge":33854.00,"npi":[1053360651]}]},{"allowed_amount":9368.06,"providers":[{"billed_charge":32599.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2152.43,"providers":[{"billed_charge":5776.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15169.49,"providers":[{"billed_charge":40655.00,"npi":[1710097936]}]},{"allowed_amount":23745.70,"providers":[{"billed_charge":66672.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":306179.17,"providers":[{"billed_charge":917700.00,"npi":[1366436123]}]},{"allowed_amount":3488.15,"providers":[{"billed_charge":13604.00,"npi":[1164419198]}]},{"allowed_amount":146017.09,"providers":[{"billed_charge":849810.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9470.58,"providers":[{"billed_charge":102177.00,"npi":[1144227539]}]},{"allowed_amount":29956.64,"providers":[{"billed_charge":78223.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":38223.47,"providers":[{"billed_charge":174907.00,"npi":[1811973100]}]},{"allowed_amount":67039.22,"providers":[{"billed_charge":108288.00,"npi":[1811973100]}]},{"allowed_amount":279.49,"providers":[{"billed_charge":1927.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"720408970"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1150.23,"providers":[{"billed_charge":3849.00,"npi":[1295723229]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3644.65,"providers":[{"billed_charge":19866.00,"npi":[1427536325]}]},{"allowed_amount":12570.72,"providers":[{"billed_charge":16840.00,"npi":[1427536325]}]},{"allowed_amount":110.57,"providers":[{"billed_charge":987.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"800948632"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":18.99,"providers":[{"billed_charge":61.00,"npi":[1104252030]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2214.84,"providers":[{"billed_charge":21167.00,"npi":[1093140600]}]},{"allowed_amount":23540.03,"providers":[{"billed_charge":56947.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":56.31,"providers":[{"billed_charge":5595.00,"npi":[1568403111]}]}]},{"tin":{"type":"ein","value":"751301362"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16.47,"providers":[{"billed_charge":3355.00,"npi":[1821087164]}]}]},{"tin":{"type":"ein","value":"450310462"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":715.33,"providers":[{"billed_charge":1630.00,"npi":[1154346161]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20145.45,"providers":[{"billed_charge":90673.00,"npi":[1578568481]}]},{"allowed_amount":35521.06,"providers":[{"billed_charge":150283.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2898.04,"providers":[{"billed_charge":45042.00,"npi":[1902465065]}]},{"allowed_amount":4535.83,"providers":[{"billed_charge":10835.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"726013916"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":90.76,"providers":[{"billed_charge":259.00,"npi":[1689676835]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5686.54,"providers":[{"billed_charge":15194.00,"npi":[1295716637]}]},{"allowed_amount":28.28,"providers":[{"billed_charge":505.00,"npi":[1295716637]}]},{"allowed_amount":3976.21,"providers":[{"billed_charge":13695.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1318.58,"providers":[{"billed_charge":1627.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9130.08,"providers":[{"billed_charge":32184.00,"npi":[1417950106]}]},{"allowed_amount":47176.40,"providers":[{"billed_charge":70375.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"721025017"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":173.90,"providers":[{"billed_charge":579.65,"npi":[1619504016]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1116.80,"providers":[{"billed_charge":1935.00,"npi":[1184373268]}]},{"allowed_amount":2500.45,"providers":[{"billed_charge":3178.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1054.17,"providers":[{"billed_charge":3976.00,"npi":[1639160799]}]},{"allowed_amount":569.14,"providers":[{"billed_charge":8805.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":328.39,"providers":[{"billed_charge":3843.19,"npi":[]}]},{"allowed_amount":1186.06,"providers":[{"billed_charge":21334.92,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":494.91,"providers":[{"billed_charge":2827.00,"npi":[1275536799]}]},{"allowed_amount":594.82,"providers":[{"billed_charge":1041.00,"npi":[1275536799]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":150.90,"providers":[{"billed_charge":290.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":204.69,"providers":[{"billed_charge":450.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":978.96,"providers":[{"billed_charge":9899.00,"npi":[1053360651]}]},{"allowed_amount":543.36,"providers":[{"billed_charge":1437.00,"npi":[1053360651]}]},{"allowed_amount":118.52,"providers":[{"billed_charge":232.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":322.51,"providers":[{"billed_charge":1848.00,"npi":[1710097936]}]},{"allowed_amount":1811.77,"providers":[{"billed_charge":5316.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":200.37,"providers":[{"billed_charge":582.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":123.09,"providers":[{"billed_charge":460.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4381.73,"providers":[{"billed_charge":41698.00,"npi":[1366436123]}]},{"allowed_amount":5105.31,"providers":[{"billed_charge":17024.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":803.36,"providers":[{"billed_charge":4728.00,"npi":[1144227539]}]},{"allowed_amount":705.28,"providers":[{"billed_charge":3118.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":64.13,"providers":[{"billed_charge":385.00,"npi":[1811973100]}]},{"allowed_amount":2934.20,"providers":[{"billed_charge":28571.00,"npi":[1811973100]}]},{"allowed_amount":7674.88,"providers":[{"billed_charge":87481.53,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":312.54,"providers":[{"billed_charge":985.00,"npi":[1427536325]}]},{"allowed_amount":248.32,"providers":[{"billed_charge":394.00,"npi":[1427536325]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":848.10,"providers":[{"billed_charge":2444.00,"npi":[1912943184]}]},{"allowed_amount":152.00,"providers":[{"billed_charge":684.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4151.99,"providers":[{"billed_charge":10702.00,"npi":[1093140600]}]},{"allowed_amount":338.98,"providers":[{"billed_charge":3252.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6.47,"providers":[{"billed_charge":226.00,"npi":[1629076468]}]},{"allowed_amount":3486.64,"providers":[{"billed_charge":18231.00,"npi":[1629076468]}]},{"allowed_amount":1657.51,"providers":[{"billed_charge":8341.00,"npi":[1629076468]}]},{"allowed_amount":238.00,"providers":[{"billed_charge":1190.00,"npi":[1548796378]}]},{"allowed_amount":2178.63,"providers":[{"billed_charge":11521.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3064.14,"providers":[{"billed_charge":24790.00,"npi":[1578568481]}]},{"allowed_amount":9955.69,"providers":[{"billed_charge":24674.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":569.71,"providers":[{"billed_charge":1228.00,"npi":[1902465065]}]},{"allowed_amount":1796.68,"providers":[{"billed_charge":5975.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":480.24,"providers":[{"billed_charge":3845.81,"npi":[1649849910]}]},{"allowed_amount":447.12,"providers":[{"billed_charge":1347.18,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":228.11,"providers":[{"billed_charge":876.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":95.55,"providers":[{"billed_charge":118.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7429.40,"providers":[{"billed_charge":20546.00,"npi":[1417950106]}]},{"allowed_amount":2379.46,"providers":[{"billed_charge":9633.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":175.31,"providers":[{"billed_charge":811.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37073.22,"providers":[{"billed_charge":172370.00,"npi":[1366436123]}]},{"allowed_amount":35654.06,"providers":[{"billed_charge":183241.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":84.52,"providers":[{"billed_charge":1343.30,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3934.59,"providers":[{"billed_charge":9188.00,"npi":[1144227539]}]},{"allowed_amount":1106.95,"providers":[{"billed_charge":8011.00,"npi":[1144227539]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4953.05,"providers":[{"billed_charge":8177.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6412.48,"providers":[{"billed_charge":18741.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3200.63,"providers":[{"billed_charge":16796.00,"npi":[1629076468]}]},{"allowed_amount":5726.65,"providers":[{"billed_charge":21623.00,"npi":[1629076468]}]},{"allowed_amount":7844.07,"providers":[{"billed_charge":38825.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2758.23,"providers":[{"billed_charge":11805.00,"npi":[1578568481]}]},{"allowed_amount":3182.48,"providers":[{"billed_charge":20750.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1447.86,"providers":[{"billed_charge":2481.00,"npi":[1083903744]}]},{"allowed_amount":1365.81,"providers":[{"billed_charge":1827.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3213.44,"providers":[{"billed_charge":10693.00,"npi":[1053360651]}]},{"allowed_amount":9145.19,"providers":[{"billed_charge":21699.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":74.93,"providers":[{"billed_charge":471.00,"npi":[1295716637]}]},{"allowed_amount":444.00,"providers":[{"billed_charge":1480.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9791.32,"providers":[{"billed_charge":22489.00,"npi":[1710097936]}]},{"allowed_amount":4669.16,"providers":[{"billed_charge":13817.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4688.10,"providers":[{"billed_charge":11408.00,"npi":[1417950106]}]},{"allowed_amount":616.71,"providers":[{"billed_charge":3949.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36744.71,"providers":[{"billed_charge":254764.00,"npi":[1366436123]}]},{"allowed_amount":71694.28,"providers":[{"billed_charge":176266.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8.07,"providers":[{"billed_charge":16.45,"npi":[]}]},{"allowed_amount":311.68,"providers":[{"billed_charge":4950.55,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1931.13,"providers":[{"billed_charge":6889.00,"npi":[1144227539]}]},{"allowed_amount":2829.33,"providers":[{"billed_charge":16777.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13433.70,"providers":[{"billed_charge":52679.00,"npi":[1811973100]}]},{"allowed_amount":13088.35,"providers":[{"billed_charge":27891.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":260.99,"providers":[{"billed_charge":347.00,"npi":[1427536325]}]},{"allowed_amount":675.05,"providers":[{"billed_charge":12007.00,"npi":[1427536325]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3735.64,"providers":[{"billed_charge":5835.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":281.08,"providers":[{"billed_charge":864.00,"npi":[1417950106]}]},{"allowed_amount":7924.50,"providers":[{"billed_charge":13117.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2651.38,"providers":[{"billed_charge":4972.00,"npi":[1093140600]}]},{"allowed_amount":137.44,"providers":[{"billed_charge":342.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":320.22,"providers":[{"billed_charge":1110.00,"npi":[1629076468]}]},{"allowed_amount":2000.64,"providers":[{"billed_charge":10923.00,"npi":[1548796378]}]},{"allowed_amount":1373.96,"providers":[{"billed_charge":5423.00,"npi":[1629076468]}]},{"allowed_amount":55.00,"providers":[{"billed_charge":215.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4160.67,"providers":[{"billed_charge":19844.00,"npi":[1366436123]}]},{"allowed_amount":13107.46,"providers":[{"billed_charge":51730.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":46.61,"providers":[{"billed_charge":1411.00,"npi":[]}]},{"allowed_amount":3.17,"providers":[{"billed_charge":86.35,"npi":[]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13.13,"providers":[{"billed_charge":630.00,"npi":[1144227539]}]},{"allowed_amount":1040.52,"providers":[{"billed_charge":1313.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":387.99,"providers":[{"billed_charge":3780.00,"npi":[1578568481]}]},{"allowed_amount":311.11,"providers":[{"billed_charge":1680.00,"npi":[1578568481]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17971.25,"providers":[{"billed_charge":54538.00,"npi":[1811973100]}]},{"allowed_amount":2780.33,"providers":[{"billed_charge":9353.00,"npi":[1811973100]}]},{"allowed_amount":525.98,"providers":[{"billed_charge":1448.00,"npi":[1811973100]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":827.03,"providers":[{"billed_charge":3096.00,"npi":[1811973100]}]},{"allowed_amount":1624.50,"providers":[{"billed_charge":17853.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":861.52,"providers":[{"billed_charge":1226.00,"npi":[1427536325]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"463123178"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":80.08,"providers":[{"billed_charge":198.00,"npi":[1093140600]}]},{"allowed_amount":7076.51,"providers":[{"billed_charge":14158.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":397.06,"providers":[{"billed_charge":777.00,"npi":[1629076468]}]},{"allowed_amount":1950.45,"providers":[{"billed_charge":5476.00,"npi":[1629076468]}]},{"allowed_amount":3787.89,"providers":[{"billed_charge":10398.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17361.60,"providers":[{"billed_charge":39567.00,"npi":[1578568481]}]},{"allowed_amount":2423.82,"providers":[{"billed_charge":11544.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12925.08,"providers":[{"billed_charge":17853.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":29755.29,"providers":[{"billed_charge":34691.00,"npi":[1053360651]}]},{"allowed_amount":97.78,"providers":[{"billed_charge":349.00,"npi":[1053360651]}]},{"allowed_amount":649.88,"providers":[{"billed_charge":3601.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":126.95,"providers":[{"billed_charge":216.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":864.65,"providers":[{"billed_charge":28823.00,"npi":[1710097936]}]},{"allowed_amount":13398.07,"providers":[{"billed_charge":21485.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22867.01,"providers":[{"billed_charge":32948.00,"npi":[1417950106]}]},{"allowed_amount":2826.27,"providers":[{"billed_charge":5299.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":406.00,"providers":[{"billed_charge":406.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21407.96,"providers":[{"billed_charge":154495.00,"npi":[1366436123]}]},{"allowed_amount":195.56,"providers":[{"billed_charge":1313.00,"npi":[1366436123]}]},{"allowed_amount":108670.04,"providers":[{"billed_charge":223348.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1101.94,"providers":[{"billed_charge":4780.00,"npi":[1144227539]}]},{"allowed_amount":366.95,"providers":[{"billed_charge":1358.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":259.32,"providers":[{"billed_charge":1394.00,"npi":[1811973100]}]},{"allowed_amount":7316.00,"providers":[{"billed_charge":53595.00,"npi":[1811973100]}]},{"allowed_amount":78763.38,"providers":[{"billed_charge":108378.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3572.07,"providers":[{"billed_charge":177311.00,"npi":[1427536325]}]},{"allowed_amount":82.62,"providers":[{"billed_charge":1645.00,"npi":[1427536325]}]},{"allowed_amount":35017.83,"providers":[{"billed_charge":45854.00,"npi":[1427536325]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5104.11,"providers":[{"billed_charge":14133.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":81.36,"providers":[{"billed_charge":638.00,"npi":[1629076468]}]},{"allowed_amount":5029.20,"providers":[{"billed_charge":22792.00,"npi":[1629076468]}]},{"allowed_amount":1656.90,"providers":[{"billed_charge":7492.00,"npi":[1548796378]}]},{"allowed_amount":728.84,"providers":[{"billed_charge":6216.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":80.57,"providers":[{"billed_charge":296.00,"npi":[1578568481]}]},{"allowed_amount":2468.15,"providers":[{"billed_charge":16493.00,"npi":[1578568481]}]},{"allowed_amount":9176.06,"providers":[{"billed_charge":28805.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9023.33,"providers":[{"billed_charge":23406.00,"npi":[1083903744]}]},{"allowed_amount":338.65,"providers":[{"billed_charge":2988.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19257.00,"providers":[{"billed_charge":19257.00,"npi":[1053360651]}]},{"allowed_amount":1425.92,"providers":[{"billed_charge":9350.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":699.43,"providers":[{"billed_charge":1288.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6822.10,"providers":[{"billed_charge":11799.00,"npi":[1710097936]}]},{"allowed_amount":2343.78,"providers":[{"billed_charge":7866.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10536.71,"providers":[{"billed_charge":20095.00,"npi":[1417950106]}]},{"allowed_amount":591.74,"providers":[{"billed_charge":4118.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":120.43,"providers":[{"billed_charge":135.00,"npi":[1184373268]}]},{"allowed_amount":40.50,"providers":[{"billed_charge":135.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14704.34,"providers":[{"billed_charge":83966.00,"npi":[1366436123]}]},{"allowed_amount":119962.61,"providers":[{"billed_charge":148599.00,"npi":[1366436123]}]},{"allowed_amount":80.96,"providers":[{"billed_charge":383.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":175.30,"providers":[{"billed_charge":4566.00,"npi":[1144227539]}]},{"allowed_amount":1607.28,"providers":[{"billed_charge":8716.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":80.84,"providers":[{"billed_charge":208.00,"npi":[1811973100]}]},{"allowed_amount":5059.03,"providers":[{"billed_charge":46046.00,"npi":[1811973100]}]},{"allowed_amount":49118.09,"providers":[{"billed_charge":82215.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18710.37,"providers":[{"billed_charge":24857.00,"npi":[1427536325]}]},{"allowed_amount":3180.38,"providers":[{"billed_charge":30639.00,"npi":[1427536325]}]},{"allowed_amount":82.62,"providers":[{"billed_charge":833.00,"npi":[1427536325]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2568.46,"providers":[{"billed_charge":7840.00,"npi":[1083903744]}]},{"allowed_amount":31407.94,"providers":[{"billed_charge":43884.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":70367.39,"providers":[{"billed_charge":79429.00,"npi":[1053360651]}]},{"allowed_amount":9792.22,"providers":[{"billed_charge":32484.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":30095.32,"providers":[{"billed_charge":43328.00,"npi":[1710097936]}]},{"allowed_amount":6482.87,"providers":[{"billed_charge":11402.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":801.05,"providers":[{"billed_charge":1160.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":173945.76,"providers":[{"billed_charge":406291.00,"npi":[1811973100]}]},{"allowed_amount":97.64,"providers":[{"billed_charge":745.00,"npi":[1811973100]}]},{"allowed_amount":39410.83,"providers":[{"billed_charge":179676.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":52095.52,"providers":[{"billed_charge":220437.00,"npi":[1578568481]}]},{"allowed_amount":6228.83,"providers":[{"billed_charge":89178.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7855.00,"providers":[{"billed_charge":7855.00,"npi":[1427536325]}]},{"allowed_amount":99.79,"providers":[{"billed_charge":996.00,"npi":[1427536325]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3191.42,"providers":[{"billed_charge":4128.00,"npi":[1083903744]}]},{"allowed_amount":24003.22,"providers":[{"billed_charge":32002.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":63361.00,"providers":[{"billed_charge":63361.00,"npi":[1053360651]}]},{"allowed_amount":97.78,"providers":[{"billed_charge":772.00,"npi":[1053360651]}]},{"allowed_amount":7254.20,"providers":[{"billed_charge":27327.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17144.46,"providers":[{"billed_charge":25470.00,"npi":[1710097936]}]},{"allowed_amount":7900.95,"providers":[{"billed_charge":17603.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":512.64,"providers":[{"billed_charge":2670.00,"npi":[1417950106]}]},{"allowed_amount":6331.00,"providers":[{"billed_charge":7778.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2683.32,"providers":[{"billed_charge":11346.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":769.64,"providers":[{"billed_charge":8496.00,"npi":[1629076468]}]},{"allowed_amount":8075.35,"providers":[{"billed_charge":21504.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":75631.80,"providers":[{"billed_charge":306455.00,"npi":[1366436123]}]},{"allowed_amount":386320.84,"providers":[{"billed_charge":548120.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1658.34,"providers":[{"billed_charge":6147.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":103648.68,"providers":[{"billed_charge":270493.00,"npi":[1811973100]}]},{"allowed_amount":20548.24,"providers":[{"billed_charge":177656.00,"npi":[1811973100]}]},{"allowed_amount":261.09,"providers":[{"billed_charge":2804.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":240.25,"providers":[{"billed_charge":1834.00,"npi":[1578568481]}]},{"allowed_amount":5308.93,"providers":[{"billed_charge":21788.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6735.19,"providers":[{"billed_charge":46646.00,"npi":[1427536325]}]},{"allowed_amount":41524.40,"providers":[{"billed_charge":51354.00,"npi":[1427536325]}]},{"allowed_amount":99.79,"providers":[{"billed_charge":1232.00,"npi":[1427536325]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":487.69,"providers":[{"billed_charge":5728.00,"npi":[1083903744]}]},{"allowed_amount":10901.66,"providers":[{"billed_charge":20836.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3308.22,"providers":[{"billed_charge":13194.00,"npi":[1053360651]}]},{"allowed_amount":26037.05,"providers":[{"billed_charge":37480.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7153.19,"providers":[{"billed_charge":14067.00,"npi":[1710097936]}]},{"allowed_amount":4986.66,"providers":[{"billed_charge":12752.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3417.00,"providers":[{"billed_charge":13002.00,"npi":[1093140600]}]},{"allowed_amount":15866.12,"providers":[{"billed_charge":60210.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9194.15,"providers":[{"billed_charge":27532.00,"npi":[1417950106]}]},{"allowed_amount":86215.66,"providers":[{"billed_charge":120464.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7584.11,"providers":[{"billed_charge":37004.00,"npi":[1629076468]}]},{"allowed_amount":28457.88,"providers":[{"billed_charge":112650.00,"npi":[1629076468]}]},{"allowed_amount":30728.38,"providers":[{"billed_charge":117648.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":122755.58,"providers":[{"billed_charge":878004.00,"npi":[1366436123]}]},{"allowed_amount":719563.73,"providers":[{"billed_charge":1746075.00,"npi":[1366436123]}]},{"allowed_amount":97.78,"providers":[{"billed_charge":2013.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1930.99,"providers":[{"billed_charge":16114.00,"npi":[1144227539]}]},{"allowed_amount":1449.62,"providers":[{"billed_charge":16519.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12482.71,"providers":[{"billed_charge":44204.00,"npi":[1578568481]}]},{"allowed_amount":2365.22,"providers":[{"billed_charge":27263.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":97266.26,"providers":[{"billed_charge":308550.00,"npi":[1811973100]}]},{"allowed_amount":97.64,"providers":[{"billed_charge":1730.00,"npi":[1811973100]}]},{"allowed_amount":37511.49,"providers":[{"billed_charge":238422.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":40971.37,"providers":[{"billed_charge":53360.00,"npi":[1427536325]}]},{"allowed_amount":4268.62,"providers":[{"billed_charge":26286.00,"npi":[1427536325]}]},{"allowed_amount":99.79,"providers":[{"billed_charge":1223.00,"npi":[1427536325]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":173851.03,"providers":[{"billed_charge":1032685.00,"npi":[1366436123]}]},{"allowed_amount":92591.87,"providers":[{"billed_charge":164832.00,"npi":[1366436123]}]},{"allowed_amount":2981.94,"providers":[{"billed_charge":6466.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11344.62,"providers":[{"billed_charge":121433.00,"npi":[1811973100]}]},{"allowed_amount":43361.13,"providers":[{"billed_charge":2237947.00,"npi":[1811973100]}]},{"allowed_amount":64370.16,"providers":[{"billed_charge":447167.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3984.29,"providers":[{"billed_charge":21958.00,"npi":[1427536325]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":849.37,"providers":[{"billed_charge":12177.00,"npi":[1053360651]}]},{"allowed_amount":2240.32,"providers":[{"billed_charge":4117.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1431.00,"providers":[{"billed_charge":1431.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2862.63,"providers":[{"billed_charge":9925.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1042.39,"providers":[{"billed_charge":5232.00,"npi":[1811973100]}]},{"allowed_amount":13597.31,"providers":[{"billed_charge":31758.00,"npi":[1811973100]}]},{"allowed_amount":12148.45,"providers":[{"billed_charge":205895.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":311.25,"providers":[{"billed_charge":489.00,"npi":[1427536325]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.75,"providers":[{"billed_charge":55.00,"npi":[1558758730]}]},{"allowed_amount":109.20,"providers":[{"billed_charge":264.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":640.28,"providers":[{"billed_charge":7225.05,"npi":[1234567893]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":891.60,"providers":[{"billed_charge":2972.00,"npi":[1053360651]}]},{"allowed_amount":2577.69,"providers":[{"billed_charge":12860.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":282.92,"providers":[{"billed_charge":1643.00,"npi":[1710097936]}]},{"allowed_amount":672.00,"providers":[{"billed_charge":2240.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11189.40,"providers":[{"billed_charge":40538.00,"npi":[1366436123]}]},{"allowed_amount":40434.22,"providers":[{"billed_charge":235253.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":337.50,"providers":[{"billed_charge":1125.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9983.40,"providers":[{"billed_charge":32410.00,"npi":[1811973100]}]},{"allowed_amount":22059.45,"providers":[{"billed_charge":145069.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1564.00,"providers":[{"billed_charge":12132.00,"npi":[1427536325]}]}]}]},{"name":"BLOOD/STOR-PROC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"390","description":"BLOOD STORAGE AND PROCESSING - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6890.43,"providers":[{"billed_charge":37150.00,"npi":[1366436123]}]},{"allowed_amount":2947.50,"providers":[{"billed_charge":9825.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":360.00,"providers":[{"billed_charge":1200.00,"npi":[1811973100]}]},{"allowed_amount":1846.26,"providers":[{"billed_charge":14130.00,"npi":[1811973100]}]}]}]},{"name":"BLOOD/ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"391","description":"BLOOD STORAGE AND PROCESSING - BLOOD ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":702.98,"providers":[{"billed_charge":3145.00,"npi":[1811973100]}]},{"allowed_amount":1341.88,"providers":[{"billed_charge":106930.00,"npi":[1811973100]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14617.79,"providers":[{"billed_charge":23343.00,"npi":[1912943184]}]},{"allowed_amount":212.18,"providers":[{"billed_charge":515.00,"npi":[1912943184]}]},{"allowed_amount":95.88,"providers":[{"billed_charge":718.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":463.00,"providers":[{"billed_charge":5546.00,"npi":[1053360651]}]},{"allowed_amount":5098.24,"providers":[{"billed_charge":5897.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6136.24,"providers":[{"billed_charge":13534.00,"npi":[1710097936]}]},{"allowed_amount":972.94,"providers":[{"billed_charge":4057.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4712.55,"providers":[{"billed_charge":44617.00,"npi":[1366436123]}]},{"allowed_amount":26717.77,"providers":[{"billed_charge":64038.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":35639.51,"providers":[{"billed_charge":98500.00,"npi":[1811973100]}]},{"allowed_amount":244.10,"providers":[{"billed_charge":1445.00,"npi":[1811973100]}]},{"allowed_amount":2928.29,"providers":[{"billed_charge":42150.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4627.58,"providers":[{"billed_charge":13027.00,"npi":[1578568481]}]},{"allowed_amount":1803.75,"providers":[{"billed_charge":10183.00,"npi":[1578568481]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":225.26,"providers":[{"billed_charge":318.00,"npi":[1083903744]}]},{"allowed_amount":43.25,"providers":[{"billed_charge":159.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1096.37,"providers":[{"billed_charge":12558.00,"npi":[1053360651]}]},{"allowed_amount":912.33,"providers":[{"billed_charge":1971.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7316.50,"providers":[{"billed_charge":13684.00,"npi":[1710097936]}]},{"allowed_amount":1013.67,"providers":[{"billed_charge":1341.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6940.03,"providers":[{"billed_charge":17955.00,"npi":[1366436123]}]},{"allowed_amount":16578.17,"providers":[{"billed_charge":196414.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":563.15,"providers":[{"billed_charge":1215.00,"npi":[1578568481]}]},{"allowed_amount":12453.90,"providers":[{"billed_charge":42615.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23698.86,"providers":[{"billed_charge":208311.00,"npi":[1811973100]}]},{"allowed_amount":8976.59,"providers":[{"billed_charge":17934.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":852.62,"providers":[{"billed_charge":65008.00,"npi":[1427536325]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":111.97,"providers":[{"billed_charge":528.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":287.86,"providers":[{"billed_charge":1689.00,"npi":[1710097936]}]},{"allowed_amount":1248.41,"providers":[{"billed_charge":2747.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3356.39,"providers":[{"billed_charge":7307.00,"npi":[1366436123]}]},{"allowed_amount":11489.87,"providers":[{"billed_charge":60762.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":123.14,"providers":[{"billed_charge":339.00,"npi":[1811973100]}]},{"allowed_amount":5147.28,"providers":[{"billed_charge":41740.00,"npi":[1811973100]}]},{"allowed_amount":2070.93,"providers":[{"billed_charge":15067.00,"npi":[1811973100]}]}]}]},{"name":"PHYS THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"421","description":"PHYSICAL THERAPY/VISIT","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2013.26,"providers":[{"billed_charge":15786.00,"npi":[1366436123]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":459.82,"providers":[{"billed_charge":876.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4834.34,"providers":[{"billed_charge":30093.00,"npi":[1811973100]}]},{"allowed_amount":1069.86,"providers":[{"billed_charge":2305.00,"npi":[1811973100]}]},{"allowed_amount":95.16,"providers":[{"billed_charge":461.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":262.49,"providers":[{"billed_charge":1192.00,"npi":[1427536325]}]},{"allowed_amount":329.08,"providers":[{"billed_charge":596.00,"npi":[1427536325]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37.32,"providers":[{"billed_charge":176.00,"npi":[1053360651]}]},{"allowed_amount":178.45,"providers":[{"billed_charge":3264.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4499.55,"providers":[{"billed_charge":8487.00,"npi":[1366436123]}]},{"allowed_amount":8477.41,"providers":[{"billed_charge":58777.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":163.28,"providers":[{"billed_charge":925.00,"npi":[1811973100]}]},{"allowed_amount":3397.52,"providers":[{"billed_charge":48878.00,"npi":[1811973100]}]}]}]},{"name":"OCCUP THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"431","description":"OCCUPATIONAL THERAPY - VISIT CHARGE","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":130.85,"providers":[{"billed_charge":1223.00,"npi":[1366436123]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":277.94,"providers":[{"billed_charge":1413.00,"npi":[1053360651]}]},{"allowed_amount":227.70,"providers":[{"billed_charge":471.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5311.11,"providers":[{"billed_charge":32990.00,"npi":[1811973100]}]},{"allowed_amount":1015.52,"providers":[{"billed_charge":1980.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":373.50,"providers":[{"billed_charge":638.00,"npi":[1427536325]}]},{"allowed_amount":442.13,"providers":[{"billed_charge":957.00,"npi":[1427536325]}]},{"allowed_amount":94.68,"providers":[{"billed_charge":319.00,"npi":[1427536325]}]}]}]},{"name":"SPEECH PATH/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"444","description":"SPEECH-LANGUAGE PATHOLOGY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":616.89,"providers":[{"billed_charge":888.00,"npi":[1366436123]}]},{"allowed_amount":3592.78,"providers":[{"billed_charge":8639.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":464.74,"providers":[{"billed_charge":1818.00,"npi":[1811973100]}]},{"allowed_amount":1698.15,"providers":[{"billed_charge":11542.00,"npi":[1811973100]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":832.24,"providers":[{"billed_charge":8080.00,"npi":[1912943184]}]},{"allowed_amount":73332.20,"providers":[{"billed_charge":88959.00,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7110.08,"providers":[{"billed_charge":9619.00,"npi":[1396761805]}]},{"allowed_amount":202.80,"providers":[{"billed_charge":1851.00,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11630.32,"providers":[{"billed_charge":16364.00,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":639.14,"providers":[{"billed_charge":2572.00,"npi":[1326485749]}]},{"allowed_amount":16905.00,"providers":[{"billed_charge":16905.00,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":177592.95,"providers":[{"billed_charge":448154.00,"npi":[1548796378]}]},{"allowed_amount":7864.29,"providers":[{"billed_charge":48271.00,"npi":[1629076468]}]},{"allowed_amount":160066.04,"providers":[{"billed_charge":435109.00,"npi":[1629076468]}]},{"allowed_amount":240.85,"providers":[{"billed_charge":11050.00,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22793.81,"providers":[{"billed_charge":41511.75,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":421725.72,"providers":[{"billed_charge":557580.00,"npi":[1083903744]}]},{"allowed_amount":4275.92,"providers":[{"billed_charge":38568.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":901583.18,"providers":[{"billed_charge":1082671.00,"npi":[1053360651]}]},{"allowed_amount":22836.15,"providers":[{"billed_charge":162027.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6352.63,"providers":[{"billed_charge":10544.00,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20172.55,"providers":[{"billed_charge":82160.00,"npi":[1710097936]}]},{"allowed_amount":496190.58,"providers":[{"billed_charge":631859.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"760591590"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8477.88,"providers":[{"billed_charge":50839.00,"npi":[1679557888]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":75881.62,"providers":[{"billed_charge":570348.00,"npi":[1366436123]}]},{"allowed_amount":1906644.23,"providers":[{"billed_charge":2888825.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2907.83,"providers":[{"billed_charge":69366.00,"npi":[1144227539]}]},{"allowed_amount":64321.16,"providers":[{"billed_charge":272450.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":77806.45,"providers":[{"billed_charge":567728.00,"npi":[1811973100]}]},{"allowed_amount":2295890.11,"providers":[{"billed_charge":4490590.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"800945173"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5964.04,"providers":[{"billed_charge":8522.00,"npi":[1215939210]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":263680.80,"providers":[{"billed_charge":666614.00,"npi":[1427536325]}]},{"allowed_amount":17576.97,"providers":[{"billed_charge":119711.00,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":532.95,"providers":[{"billed_charge":1275.00,"npi":[1205900370]}]},{"allowed_amount":3858.31,"providers":[{"billed_charge":5526.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"721495500"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2056.37,"providers":[{"billed_charge":2269.00,"npi":[1609860360]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3360.45,"providers":[{"billed_charge":23607.00,"npi":[1093140600]}]},{"allowed_amount":122705.20,"providers":[{"billed_charge":193574.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"751301362"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":867.95,"providers":[{"billed_charge":6485.00,"npi":[1821087164]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":391859.95,"providers":[{"billed_charge":480384.88,"npi":[1578568481]}]},{"allowed_amount":15590.59,"providers":[{"billed_charge":123587.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2666.56,"providers":[{"billed_charge":8530.00,"npi":[1902465065]}]},{"allowed_amount":12043.50,"providers":[{"billed_charge":15614.00,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4837.00,"providers":[{"billed_charge":20173.44,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":94148.14,"providers":[{"billed_charge":100973.00,"npi":[1295716637]}]},{"allowed_amount":1730.57,"providers":[{"billed_charge":6757.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12856.38,"providers":[{"billed_charge":18788.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4176.89,"providers":[{"billed_charge":30827.00,"npi":[1417950106]}]},{"allowed_amount":192101.42,"providers":[{"billed_charge":408007.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3374.56,"providers":[{"billed_charge":14856.00,"npi":[1184373268]}]},{"allowed_amount":68594.18,"providers":[{"billed_charge":98102.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8236.41,"providers":[{"billed_charge":16338.00,"npi":[1639160799]}]},{"allowed_amount":1106.82,"providers":[{"billed_charge":11497.00,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11602.01,"providers":[{"billed_charge":54892.61,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15626.19,"providers":[{"billed_charge":27131.00,"npi":[1275536799]}]},{"allowed_amount":1185.01,"providers":[{"billed_charge":11878.00,"npi":[1275536799]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":789.22,"providers":[{"billed_charge":2958.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":157.50,"providers":[{"billed_charge":220.00,"npi":[1710097936]}]},{"allowed_amount":6566.22,"providers":[{"billed_charge":12857.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9597.98,"providers":[{"billed_charge":55846.00,"npi":[1366436123]}]},{"allowed_amount":1309.55,"providers":[{"billed_charge":2646.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":11930.64,"providers":[{"billed_charge":56920.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":236.25,"providers":[{"billed_charge":714.00,"npi":[1811973100]}]},{"allowed_amount":22896.08,"providers":[{"billed_charge":136136.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":315.78,"providers":[{"billed_charge":2122.00,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":992.75,"providers":[{"billed_charge":2266.00,"npi":[1427536325]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4930.41,"providers":[{"billed_charge":17128.00,"npi":[1053360651]}]},{"allowed_amount":1350.86,"providers":[{"billed_charge":2141.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2008.07,"providers":[{"billed_charge":3822.00,"npi":[1710097936]}]},{"allowed_amount":6434.20,"providers":[{"billed_charge":15736.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":29723.70,"providers":[{"billed_charge":66424.00,"npi":[1366436123]}]},{"allowed_amount":27022.16,"providers":[{"billed_charge":187395.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19696.80,"providers":[{"billed_charge":29759.00,"npi":[1811973100]}]},{"allowed_amount":33981.45,"providers":[{"billed_charge":180395.00,"npi":[1811973100]}]},{"allowed_amount":503.43,"providers":[{"billed_charge":5743.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1662.00,"providers":[{"billed_charge":1662.00,"npi":[1427536325]}]},{"allowed_amount":8549.02,"providers":[{"billed_charge":28208.00,"npi":[1427536325]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21021.11,"providers":[{"billed_charge":38709.00,"npi":[1366436123]}]}]}]},{"name":"RURAL/CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"521","description":"FREE-STANDING CLINIC - RURAL HEALTH-CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"141958494"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":72686.15,"providers":[{"billed_charge":138694.98,"npi":[1659082105]}]}]},{"tin":{"type":"ein","value":"721395500"},"service_code":["50"],"billing_class":"institutional","payments":[{"allowed_amount":1147.80,"providers":[{"billed_charge":3292.00,"npi":[1962154542]}]}]}]},{"name":"AMBULANCE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"540","description":"AMBULANCE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"726014606"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11272.31,"providers":[{"billed_charge":40596.00,"npi":[1295716637]}]}]}]},{"name":"MRI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"610","description":"MRI - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":327.90,"providers":[{"billed_charge":3778.00,"npi":[1811973100]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9827.89,"providers":[{"billed_charge":45120.00,"npi":[1366436123]}]},{"allowed_amount":6334.00,"providers":[{"billed_charge":11380.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12169.04,"providers":[{"billed_charge":69084.00,"npi":[1811973100]}]},{"allowed_amount":12542.84,"providers":[{"billed_charge":32151.00,"npi":[1811973100]}]}]}]},{"name":"MRI-SPINE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"612","description":"MRI - SPINAL CORD (INCLUDING SPINE)","allowed_amounts":[{"tin":{"type":"ein","value":"720423651"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5273.94,"providers":[{"billed_charge":7448.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":7829.10,"providers":[{"billed_charge":62252.00,"npi":[1811973100]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"720652905"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":48964.52,"providers":[{"billed_charge":199983.23,"npi":[1912943184]}]},{"allowed_amount":1168.11,"providers":[{"billed_charge":3893.49,"npi":[1912943184]}]}]},{"tin":{"type":"ein","value":"204670876"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96.86,"providers":[{"billed_charge":322.84,"npi":[1396761805]}]}]},{"tin":{"type":"ein","value":"611267229"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2446.53,"providers":[{"billed_charge":127722.30,"npi":[1477500015]}]},{"allowed_amount":1413.67,"providers":[{"billed_charge":4712.26,"npi":[1477500015]}]}]},{"tin":{"type":"ein","value":"462605366"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":63.86,"providers":[{"billed_charge":212.88,"npi":[1306281126]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":777.39,"providers":[{"billed_charge":2849.52,"npi":[1326485749]}]},{"allowed_amount":153.10,"providers":[{"billed_charge":510.31,"npi":[1326485749]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15141.02,"providers":[{"billed_charge":87406.25,"npi":[1629076468]}]},{"allowed_amount":8234.83,"providers":[{"billed_charge":29439.78,"npi":[1629076468]}]},{"allowed_amount":1.00,"providers":[{"billed_charge":996.16,"npi":[1629076468]}]},{"allowed_amount":8363.24,"providers":[{"billed_charge":29884.73,"npi":[1548796378]}]},{"allowed_amount":40.93,"providers":[{"billed_charge":3266.13,"npi":[1548796378]}]}]},{"tin":{"type":"ein","value":"720880258"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":299.30,"providers":[{"billed_charge":997.70,"npi":[1518924109]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1121.36,"providers":[{"billed_charge":13764.89,"npi":[1083903744]}]},{"allowed_amount":31242.99,"providers":[{"billed_charge":103296.11,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19058.01,"providers":[{"billed_charge":57829.77,"npi":[1053360651]}]},{"allowed_amount":12056.38,"providers":[{"billed_charge":141376.76,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423635"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":68.69,"providers":[{"billed_charge":228.96,"npi":[1598766495]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6570.37,"providers":[{"billed_charge":21244.93,"npi":[1710097936]}]},{"allowed_amount":22851.50,"providers":[{"billed_charge":124624.90,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":165.11,"providers":[{"billed_charge":225.62,"npi":[1366436123]}]},{"allowed_amount":148410.02,"providers":[{"billed_charge":654518.47,"npi":[1366436123]}]},{"allowed_amount":52977.05,"providers":[{"billed_charge":159544.34,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4445.79,"providers":[{"billed_charge":14173.12,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":847.75,"providers":[{"billed_charge":3975.64,"npi":[1811973100]}]},{"allowed_amount":65417.25,"providers":[{"billed_charge":214392.95,"npi":[1811973100]}]},{"allowed_amount":39593.54,"providers":[{"billed_charge":581815.88,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"800945173"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6.08,"providers":[{"billed_charge":20.26,"npi":[1215939210]}]},{"allowed_amount":184.22,"providers":[{"billed_charge":818.84,"npi":[1215939210]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6021.12,"providers":[{"billed_charge":140663.27,"npi":[1427536325]}]},{"allowed_amount":24438.19,"providers":[{"billed_charge":134720.19,"npi":[1427536325]}]},{"allowed_amount":3702.03,"providers":[{"billed_charge":7330.79,"npi":[1427536325]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3368.37,"providers":[{"billed_charge":10476.66,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"450310462"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15.00,"providers":[{"billed_charge":50.00,"npi":[1154346161]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11562.30,"providers":[{"billed_charge":369916.56,"npi":[1578568481]}]},{"allowed_amount":8.11,"providers":[{"billed_charge":2246.03,"npi":[1578568481]}]},{"allowed_amount":38497.83,"providers":[{"billed_charge":128822.63,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1894.21,"providers":[{"billed_charge":9811.89,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"994947730"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3049.57,"providers":[{"billed_charge":26277.88,"npi":[1427878909]}]},{"allowed_amount":4034.58,"providers":[{"billed_charge":16500.51,"npi":[1427878909]}]}]},{"tin":{"type":"ein","value":"842046902"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":301.45,"providers":[{"billed_charge":1004.70,"npi":[1902465065]}]}]},{"tin":{"type":"ein","value":"863658746"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":148.00,"providers":[{"billed_charge":4581.41,"npi":[1649849910]}]},{"allowed_amount":9116.34,"providers":[{"billed_charge":30263.22,"npi":[1649849910]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1752.58,"providers":[{"billed_charge":11249.35,"npi":[1295716637]}]},{"allowed_amount":2068.51,"providers":[{"billed_charge":6577.84,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"726010747"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":283.50,"providers":[{"billed_charge":945.00,"npi":[1588654966]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1616.41,"providers":[{"billed_charge":16328.25,"npi":[1417950106]}]},{"allowed_amount":5328.27,"providers":[{"billed_charge":18347.24,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2937.36,"providers":[{"billed_charge":9109.73,"npi":[1184373268]}]},{"allowed_amount":1144.84,"providers":[{"billed_charge":7763.32,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720408984"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":55.11,"providers":[{"billed_charge":183.68,"npi":[1639160799]}]}]},{"tin":{"type":"ein","value":"271287287"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":128.78,"providers":[{"billed_charge":629.88,"npi":[]}]},{"allowed_amount":209.35,"providers":[{"billed_charge":1566.50,"npi":[]}]}]},{"tin":{"type":"ein","value":"720535375"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1569.71,"providers":[{"billed_charge":17054.47,"npi":[1275536799]}]},{"allowed_amount":966.42,"providers":[{"billed_charge":3173.39,"npi":[1275536799]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":718.80,"providers":[{"billed_charge":2396.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9019.50,"providers":[{"billed_charge":31885.00,"npi":[1366436123]}]},{"allowed_amount":21095.52,"providers":[{"billed_charge":120534.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17287.46,"providers":[{"billed_charge":78830.00,"npi":[1811973100]}]},{"allowed_amount":5721.30,"providers":[{"billed_charge":19071.00,"npi":[1811973100]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"741740101"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":58.59,"providers":[{"billed_charge":1584.00,"npi":[1538100805]}]},{"allowed_amount":6.51,"providers":[{"billed_charge":176.00,"npi":[1538100805]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":24.75,"providers":[{"billed_charge":87.00,"npi":[1447703103]}]},{"allowed_amount":16.44,"providers":[{"billed_charge":58.00,"npi":[1871819250]}]},{"allowed_amount":74.61,"providers":[{"billed_charge":261.00,"npi":[1124033055]}]},{"allowed_amount":16.26,"providers":[{"billed_charge":58.00,"npi":[1871819250]}]},{"allowed_amount":33.24,"providers":[{"billed_charge":116.00,"npi":[1871819250]}]},{"allowed_amount":41.19,"providers":[{"billed_charge":145.00,"npi":[1124033055]}]},{"allowed_amount":49.68,"providers":[{"billed_charge":174.00,"npi":[1447703103]}]},{"allowed_amount":8.31,"providers":[{"billed_charge":29.00,"npi":[1982830063,1447703103]}]},{"allowed_amount":24.93,"providers":[{"billed_charge":87.00,"npi":[1982830063]}]}]}]},{"name":"DELIVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"722","description":"LABOR ROOM/DELIVERY - DELIVERY","allowed_amounts":[{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":990.40,"providers":[{"billed_charge":5867.00,"npi":[1811973100]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"463123178"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4043.29,"providers":[{"billed_charge":6730.00,"npi":[1093140600]}]},{"allowed_amount":149.00,"providers":[{"billed_charge":464.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720411322"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1869.88,"providers":[{"billed_charge":9894.00,"npi":[1629076468]}]},{"allowed_amount":2094.73,"providers":[{"billed_charge":5786.00,"npi":[1548796378]}]},{"allowed_amount":9331.07,"providers":[{"billed_charge":28518.00,"npi":[1629076468]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2970.95,"providers":[{"billed_charge":11484.00,"npi":[1578568481]}]},{"allowed_amount":9725.52,"providers":[{"billed_charge":25578.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"261576974"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":515.68,"providers":[{"billed_charge":2672.00,"npi":[1083903744]}]},{"allowed_amount":10320.96,"providers":[{"billed_charge":17368.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17515.00,"providers":[{"billed_charge":17515.00,"npi":[1053360651]}]},{"allowed_amount":1675.68,"providers":[{"billed_charge":6554.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"726014606"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":282.48,"providers":[{"billed_charge":708.00,"npi":[1295716637]}]},{"allowed_amount":1190.88,"providers":[{"billed_charge":1416.00,"npi":[1295716637]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12405.00,"providers":[{"billed_charge":17500.00,"npi":[1710097936]}]},{"allowed_amount":3522.20,"providers":[{"billed_charge":8909.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"720408982"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4982.12,"providers":[{"billed_charge":13364.00,"npi":[1417950106]}]},{"allowed_amount":510.62,"providers":[{"billed_charge":2570.00,"npi":[1417950106]}]}]},{"tin":{"type":"ein","value":"880907240"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":752.24,"providers":[{"billed_charge":952.00,"npi":[1184373268]}]},{"allowed_amount":35.70,"providers":[{"billed_charge":238.00,"npi":[1184373268]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13374.96,"providers":[{"billed_charge":76560.00,"npi":[1366436123]}]},{"allowed_amount":145.87,"providers":[{"billed_charge":580.00,"npi":[1164419198]}]},{"allowed_amount":129507.21,"providers":[{"billed_charge":184426.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"451834769"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":616.06,"providers":[{"billed_charge":3465.00,"npi":[1144227539]}]},{"allowed_amount":2468.34,"providers":[{"billed_charge":5390.00,"npi":[1144227539]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":68277.12,"providers":[{"billed_charge":81302.00,"npi":[1811973100]}]},{"allowed_amount":14712.52,"providers":[{"billed_charge":35872.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1360.59,"providers":[{"billed_charge":7089.00,"npi":[1427536325]}]},{"allowed_amount":55.74,"providers":[{"billed_charge":417.00,"npi":[1427536325]}]},{"allowed_amount":9868.43,"providers":[{"billed_charge":14317.00,"npi":[1427536325]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":180.14,"providers":[{"billed_charge":454.00,"npi":[1053360651]}]},{"allowed_amount":2808.47,"providers":[{"billed_charge":17077.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19200.17,"providers":[{"billed_charge":119730.00,"npi":[1366436123]}]},{"allowed_amount":712.51,"providers":[{"billed_charge":3632.00,"npi":[1366436123]}]},{"allowed_amount":12947.33,"providers":[{"billed_charge":27103.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":16160.23,"providers":[{"billed_charge":85574.00,"npi":[1811973100]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"261576974"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2652.00,"providers":[{"billed_charge":8840.00,"npi":[1083903744]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2019.23,"providers":[{"billed_charge":16037.00,"npi":[1053360651]}]},{"allowed_amount":12608.40,"providers":[{"billed_charge":42028.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"205432782"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2986.80,"providers":[{"billed_charge":9956.00,"npi":[1710097936]}]},{"allowed_amount":311.34,"providers":[{"billed_charge":2204.00,"npi":[1710097936]}]}]},{"tin":{"type":"ein","value":"463123178"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":471.60,"providers":[{"billed_charge":1572.00,"npi":[1093140600]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22083.34,"providers":[{"billed_charge":147405.00,"npi":[1366436123]}]},{"allowed_amount":172271.40,"providers":[{"billed_charge":574451.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14464.72,"providers":[{"billed_charge":149032.00,"npi":[1811973100]}]},{"allowed_amount":107689.50,"providers":[{"billed_charge":358965.00,"npi":[1811973100]}]},{"allowed_amount":2431.04,"providers":[{"billed_charge":12007.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4935.00,"providers":[{"billed_charge":16450.00,"npi":[1578568481]}]},{"allowed_amount":1436.45,"providers":[{"billed_charge":11150.00,"npi":[1578568481]}]}]},{"tin":{"type":"ein","value":"831173631"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1250.64,"providers":[{"billed_charge":22005.00,"npi":[1427536325]}]},{"allowed_amount":14256.00,"providers":[{"billed_charge":47520.00,"npi":[1427536325]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"741740101"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":362.10,"providers":[{"billed_charge":3383.00,"npi":[1679872568]}]},{"allowed_amount":21.30,"providers":[{"billed_charge":199.00,"npi":[1104809011]}]},{"allowed_amount":340.80,"providers":[{"billed_charge":3184.00,"npi":[1104809011]}]},{"allowed_amount":42.60,"providers":[{"billed_charge":398.00,"npi":[1679872568]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":886.49,"providers":[{"billed_charge":2475.00,"npi":[1609195312]}]},{"allowed_amount":298.98,"providers":[{"billed_charge":825.00,"npi":[1265751259]}]},{"allowed_amount":611.56,"providers":[{"billed_charge":1800.00,"npi":[1871598474]}]},{"allowed_amount":81.54,"providers":[{"billed_charge":225.00,"npi":[1104892363]}]},{"allowed_amount":239.67,"providers":[{"billed_charge":675.00,"npi":[1861724080]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"741740101"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":54.14,"providers":[{"billed_charge":590.00,"npi":[1679872568]}]},{"allowed_amount":460.19,"providers":[{"billed_charge":5015.00,"npi":[1679872568]}]},{"allowed_amount":412.82,"providers":[{"billed_charge":4720.00,"npi":[1104809011]}]},{"allowed_amount":27.07,"providers":[{"billed_charge":295.00,"npi":[1104809011]}]}]},{"tin":{"type":"ein","value":"204722218"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":103.65,"providers":[{"billed_charge":342.00,"npi":[1104892363]}]},{"allowed_amount":1129.35,"providers":[{"billed_charge":3762.00,"npi":[1609195312]}]},{"allowed_amount":304.47,"providers":[{"billed_charge":1026.00,"npi":[1861724080]}]},{"allowed_amount":837.84,"providers":[{"billed_charge":2850.00,"npi":[1871598474]}]},{"allowed_amount":380.05,"providers":[{"billed_charge":1254.00,"npi":[1265751259]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":506.61,"providers":[{"billed_charge":657.00,"npi":[1053360651]}]},{"allowed_amount":16.71,"providers":[{"billed_charge":292.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1801.28,"providers":[{"billed_charge":3201.00,"npi":[1366436123]}]},{"allowed_amount":26.48,"providers":[{"billed_charge":97.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":58.38,"providers":[{"billed_charge":1018.00,"npi":[1811973100]}]},{"allowed_amount":1685.95,"providers":[{"billed_charge":2660.00,"npi":[1811973100]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":744.65,"providers":[{"billed_charge":7447.56,"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":473.02,"providers":[{"billed_charge":5660.16,"npi":[1234567893]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":13.40,"providers":[{"billed_charge":90.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":375.48,"providers":[{"billed_charge":4499.04,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":80.34,"providers":[{"billed_charge":738.00,"npi":[1124580535]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"611810471"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":60.24,"providers":[{"billed_charge":88.44,"npi":[1497781611]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"463417600"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2299.18,"providers":[{"billed_charge":7400.00,"npi":[1033166962]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18944.75,"providers":[{"billed_charge":170201.46,"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":87.98,"providers":[{"billed_charge":1052.44,"npi":[1234567893]}]}]}]},{"name":"NFCT DS BV&VAGINITIS DNA ALG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81514","description":"NFCT DS BCT VAGINOSIS&VAGINITIS DNA VAG FLU ALG","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1317.60,"providers":[{"billed_charge":15000.00,"npi":[1234567893]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.51,"providers":[{"billed_charge":161.84,"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":563.73,"providers":[{"billed_charge":6748.80,"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":211.68,"providers":[{"billed_charge":2533.44,"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":137.48,"providers":[{"billed_charge":1646.40,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":148.80,"providers":[{"billed_charge":1785.60,"npi":[1234567893]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"721111417"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.16,"providers":[{"billed_charge":240.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":294.84,"providers":[{"billed_charge":3534.44,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.71,"providers":[{"billed_charge":46.00,"npi":[1124580535]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2.16,"providers":[{"billed_charge":25.88,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15.68,"providers":[{"billed_charge":187.60,"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":96.32,"providers":[{"billed_charge":1154.56,"npi":[1234567893]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.32,"providers":[{"billed_charge":806.40,"npi":[1234567893]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.66,"providers":[{"billed_charge":510.48,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":343.20,"providers":[{"billed_charge":4102.56,"npi":[1234567893]}]}]}]},{"name":"TB TEST CELL IMMUN MEASURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86480","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":103.50,"providers":[{"billed_charge":2000.00,"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":225.94,"providers":[{"billed_charge":2698.64,"npi":[1234567893]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":478.38,"providers":[{"billed_charge":5735.80,"npi":[1234567893]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":437.98,"providers":[{"billed_charge":5241.12,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":496.80,"providers":[{"billed_charge":5947.20,"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":705.96,"providers":[{"billed_charge":8447.84,"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":43.20,"providers":[{"billed_charge":451.92,"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":465.75,"providers":[{"billed_charge":5578.20,"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":1302.48,"providers":[{"billed_charge":15603.84,"npi":[1234567893]}]}]}]},{"name":"CORONAVIRUS AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87426","description":"IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":123.69,"providers":[{"billed_charge":420.00,"npi":[1780875039]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":293.00,"providers":[{"billed_charge":3076.89,"npi":[1234567893]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2351.03,"providers":[{"billed_charge":3386.85,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"741100163"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":149.10,"providers":[{"billed_charge":1500.00,"npi":[1316145345]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3281.60,"providers":[{"billed_charge":33061.45,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87502","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); INFLUENZA VIRUS, FOR MULTIPLE TYPES OR SUB-","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":287.40,"providers":[{"billed_charge":900.00,"npi":[1780875039]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":300.51,"providers":[{"billed_charge":2698.92,"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":410.20,"providers":[{"billed_charge":4500.54,"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":1453.28,"providers":[{"billed_charge":15996.35,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2421.21,"providers":[{"billed_charge":3487.95,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"741100163"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":149.10,"providers":[{"billed_charge":1500.00,"npi":[1316145345]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3281.60,"providers":[{"billed_charge":33011.99,"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":503.96,"providers":[{"billed_charge":6921.62,"npi":[1234567893]}]}]}]},{"name":"RSV DNA/RNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87634","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY SYNCYTIAL VIRUS, AMPLIFIED PROB","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":210.60,"providers":[{"billed_charge":960.00,"npi":[1780875039]}]}]}]},{"name":"STAPH A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87640","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":351.60,"providers":[{"billed_charge":3776.35,"npi":[1234567893]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":105.30,"providers":[{"billed_charge":480.00,"npi":[1780875039]}]}]}]},{"name":"STREP B, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87653","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":597.72,"providers":[{"billed_charge":6432.16,"npi":[1234567893]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"726000821"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1579.05,"providers":[{"billed_charge":5805.00,"npi":[1942221098]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2683.88,"providers":[{"billed_charge":26555.10,"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":597.72,"providers":[{"billed_charge":6630.00,"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":"300876536"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":267.33,"providers":[{"billed_charge":380.00,"npi":[1265078166]}]}]},{"tin":{"type":"ein","value":"463353218"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":98.49,"providers":[{"billed_charge":413.00,"npi":[1235918533]}]}]},{"tin":{"type":"ein","value":"134205269"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":126.63,"providers":[{"billed_charge":234.00,"npi":[1952706897]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":488.95,"providers":[{"billed_charge":4313.64,"npi":[1234567893]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"743038198"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":240.17,"providers":[{"billed_charge":1288.00,"npi":[1114151578]}]},{"allowed_amount":1852.74,"providers":[{"billed_charge":9936.00,"npi":[1114151578]}]},{"allowed_amount":34.31,"providers":[{"billed_charge":184.00,"npi":[1114151578]}]}]},{"tin":{"type":"ein","value":"720679679"},"service_code":["81","21"],"billing_class":"professional","payments":[{"allowed_amount":33.70,"providers":[{"billed_charge":88.00,"npi":[1366647646]}]},{"allowed_amount":30.52,"providers":[{"billed_charge":127.00,"npi":[1366647646]}]}]},{"tin":{"type":"ein","value":"720423889"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":301.93,"providers":[{"billed_charge":648.00,"npi":[1255367132]}]},{"allowed_amount":1773.80,"providers":[{"billed_charge":3807.00,"npi":[1255367132]}]}]},{"tin":{"type":"ein","value":"720933293"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4934.59,"providers":[{"billed_charge":11980.76,"npi":[1699236992]}]},{"allowed_amount":5719.64,"providers":[{"billed_charge":13886.79,"npi":[1043579709]}]}]}]},{"name":"IMMUNOHISTO ANTB 1ST STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88342","description":"IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE","allowed_amounts":[{"tin":{"type":"ein","value":"720423889"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":176.50,"providers":[{"billed_charge":380.00,"npi":[1255367132]}]},{"allowed_amount":141.20,"providers":[{"billed_charge":304.00,"npi":[1255367132]}]}]}]},{"name":"PSTAY TREATMENT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"900","description":"PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1898.50,"providers":[{"billed_charge":7810.00,"npi":[1568403111]}]}]}]},{"name":"BH/INTENS OP/PSYCH","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"905","description":"INTENSIVE OUTPATIENT SERVICES - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"850961512"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3855.78,"providers":[{"billed_charge":7950.00,"npi":[1356950398]}]}]}]},{"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":"371852529"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6120.00,"providers":[{"billed_charge":13050.00,"npi":[1154855781]}]}]},{"tin":{"type":"ein","value":"726000628"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5192.00,"providers":[{"billed_charge":38350.00,"npi":[1689033839]}]}]},{"tin":{"type":"ein","value":"882656603"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6480.00,"providers":[{"billed_charge":21600.00,"npi":[1114655834]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56"],"billing_class":"professional","payments":[{"allowed_amount":105.00,"providers":[{"billed_charge":105.00,"npi":[1124889829]}]},{"allowed_amount":945.00,"providers":[{"billed_charge":945.00,"npi":[1336680719]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"932778825"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":124.21,"providers":[{"billed_charge":134.39,"npi":[1912517848]}]}]},{"tin":{"type":"ein","value":"815146293"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":762.30,"providers":[{"billed_charge":1120.00,"npi":[1841882875]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"991484769"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2390.16,"providers":[{"billed_charge":3000.00,"npi":[1225893340]}]},{"allowed_amount":225.26,"providers":[{"billed_charge":250.00,"npi":[1225893340]}]}]},{"tin":{"type":"ein","value":"333583756"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":100.52,"providers":[{"billed_charge":120.00,"npi":[1689119422]}]},{"allowed_amount":114.35,"providers":[{"billed_charge":120.00,"npi":[1689119422]}]}]},{"tin":{"type":"ein","value":"461612422"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":531.12,"providers":[{"billed_charge":640.00,"npi":[1497063473]}]},{"allowed_amount":300.34,"providers":[{"billed_charge":320.00,"npi":[1497063473]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"462411016"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":222.56,"providers":[{"billed_charge":306.16,"npi":[1285769471]}]},{"allowed_amount":626.10,"providers":[{"billed_charge":1148.10,"npi":[1881779320]}]}]}]},{"name":"PSTAY/INDIV RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"914","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - INDIVIDUAL THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"251925187"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":18898.19,"providers":[{"billed_charge":69415.00,"npi":[1568403111]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"850672191"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":253.92,"providers":[{"billed_charge":1611.00,"npi":[1285253252]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3051.28,"providers":[{"billed_charge":4596.00,"npi":[1811973100]}]},{"allowed_amount":2829.51,"providers":[{"billed_charge":6384.00,"npi":[1811973100]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"201729674"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4762.28,"providers":[{"billed_charge":4900.00,"npi":[1053360651]}]},{"allowed_amount":178.18,"providers":[{"billed_charge":1510.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"720423651"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9687.16,"providers":[{"billed_charge":52890.00,"npi":[1366436123]}]},{"allowed_amount":26097.59,"providers":[{"billed_charge":46433.00,"npi":[1366436123]}]}]},{"tin":{"type":"ein","value":"720502505"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15977.98,"providers":[{"billed_charge":19990.00,"npi":[1811973100]}]},{"allowed_amount":3730.54,"providers":[{"billed_charge":19826.00,"npi":[1811973100]}]}]},{"tin":{"type":"ein","value":"726014895"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2045.89,"providers":[{"billed_charge":4050.00,"npi":[1578568481]}]},{"allowed_amount":626.43,"providers":[{"billed_charge":4782.00,"npi":[1578568481]}]}]}]},{"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":"364774713"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":14.51,"providers":[{"billed_charge":26.00,"npi":[1992238695]}]}]}]},{"name":"SLEEP STUDY UNATT&RESP EFFT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95806","description":"SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFL","allowed_amounts":[{"tin":{"type":"ein","value":"450538779"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2231.32,"providers":[{"billed_charge":17550.00,"npi":[1295786655]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1273.84,"providers":[{"billed_charge":3575.00,"npi":[1053622274]}]}]}]},{"name":"AQUATIC THERAPY/EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97113","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; AQUATIC THERAPY WITH THERAPEUTIC EXERCISES","allowed_amounts":[{"tin":{"type":"ein","value":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":894.32,"providers":[{"billed_charge":1815.00,"npi":[1053622274]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.60,"providers":[{"billed_charge":440.00,"npi":[1053622274]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"881774824"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1065.00,"providers":[{"billed_charge":1065.00,"npi":[1811527823]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"721425916"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1525.99,"providers":[{"billed_charge":3410.00,"npi":[1053622274]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"300876536"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1218.86,"providers":[{"billed_charge":2155.95,"npi":[1265078166]}]}]},{"tin":{"type":"ein","value":"463353218"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":407.76,"providers":[{"billed_charge":1083.00,"npi":[1235918533]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"720743677"},"service_code":["02","50"],"billing_class":"professional","payments":[{"allowed_amount":114.20,"providers":[{"billed_charge":150.60,"npi":[1396326955]}]},{"allowed_amount":263.55,"providers":[{"billed_charge":263.55,"npi":[1396326955]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"741100163"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":220.17,"providers":[{"billed_charge":375.00,"npi":[1316145345]}]}]},{"tin":{"type":"ein","value":"263958456"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1358.50,"providers":[{"billed_charge":5469.88,"npi":[1184971673]}]},{"allowed_amount":156.75,"providers":[{"billed_charge":631.14,"npi":[1124370838]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","02","10"],"billing_class":"professional","payments":[{"allowed_amount":711.60,"providers":[{"billed_charge":1456.00,"npi":[1234567893]}]},{"allowed_amount":206.57,"providers":[{"billed_charge":655.00,"npi":[1234567893]}]},{"allowed_amount":939.50,"providers":[{"billed_charge":2002.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":878.85,"providers":[{"billed_charge":1085.00,"npi":[1124580535]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1752.52,"providers":[{"billed_charge":4188.00,"npi":[1134555790]}]}]},{"tin":{"type":"ein","value":"460944751"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":366.45,"providers":[{"billed_charge":960.00,"npi":[1780875039]}]}]},{"tin":{"type":"ein","value":"932778825"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":236.70,"providers":[{"billed_charge":274.81,"npi":[1912517848]}]}]},{"tin":{"type":"ein","value":"134205269"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":622.98,"providers":[{"billed_charge":840.00,"npi":[1952706897]}]}]},{"tin":{"type":"ein","value":"721111417"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2233.28,"providers":[{"billed_charge":2422.00,"npi":[1558758730]}]},{"allowed_amount":2392.80,"providers":[{"billed_charge":2595.00,"npi":[1407433592]}]},{"allowed_amount":122.20,"providers":[{"billed_charge":173.00,"npi":[1407433592]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6557.88,"providers":[{"billed_charge":6845.00,"npi":[1124580535]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99222","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"843374531"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1865.85,"providers":[{"billed_charge":3750.00,"npi":[1407309479]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"872539640"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":200.98,"providers":[{"billed_charge":300.00,"npi":[1063734069]}]}]},{"tin":{"type":"ein","value":"270586364"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":1513.00,"providers":[{"billed_charge":2100.00,"npi":[1013485887]}]},{"allowed_amount":2057.60,"providers":[{"billed_charge":3360.00,"npi":[1306329263]}]},{"allowed_amount":756.50,"providers":[{"billed_charge":1050.00,"npi":[1265968853]}]}]},{"tin":{"type":"ein","value":"721450954"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":8018.90,"providers":[{"billed_charge":11660.00,"npi":[1194887125]}]}]},{"tin":{"type":"ein","value":"800325677"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":838.27,"providers":[{"billed_charge":1950.00,"npi":[1124635164]}]}]},{"tin":{"type":"ein","value":"371432688"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":1003.68,"providers":[{"billed_charge":2320.00,"npi":[1346799459]}]}]},{"tin":{"type":"ein","value":"433735670"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":919.40,"providers":[{"billed_charge":1100.00,"npi":[1558751651]}]}]},{"tin":{"type":"ein","value":"810608560"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":1437.35,"providers":[{"billed_charge":1900.00,"npi":[1679501712]}]}]},{"tin":{"type":"ein","value":"464568405"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1392.00,"providers":[{"billed_charge":2720.00,"npi":[1437342615]}]}]},{"tin":{"type":"ein","value":"815146293"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":450.10,"providers":[{"billed_charge":1225.00,"npi":[1841882875]}]}]},{"tin":{"type":"ein","value":"720276883"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":832.15,"providers":[{"billed_charge":1760.00,"npi":[1063860641]}]}]},{"tin":{"type":"ein","value":"721245632"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":664.20,"providers":[{"billed_charge":798.00,"npi":[1396107975]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"720423889"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2851.77,"providers":[{"billed_charge":6187.00,"npi":[1427403989]}]}]},{"tin":{"type":"ein","value":"720687735"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2028.96,"providers":[{"billed_charge":3600.00,"npi":[1831314905]}]}]},{"tin":{"type":"ein","value":"813930652"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":225.44,"providers":[{"billed_charge":530.00,"npi":[1942418421]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"812574422"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":235.71,"providers":[{"billed_charge":1248.00,"npi":[1124522172]}]}]},{"tin":{"type":"ein","value":"822400811"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":239.12,"providers":[{"billed_charge":1620.00,"npi":[1598346504]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"812574422"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2142.36,"providers":[{"billed_charge":4520.00,"npi":[1124522172]}]}]},{"tin":{"type":"ein","value":"822400811"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1778.28,"providers":[{"billed_charge":7068.00,"npi":[1598346504]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"030417452"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1048.50,"providers":[{"billed_charge":2376.00,"npi":[1861026049]}]},{"allowed_amount":291.25,"providers":[{"billed_charge":660.00,"npi":[1861026049]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"030417452"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1184.96,"providers":[{"billed_charge":2436.00,"npi":[1104349950]}]},{"allowed_amount":2116.00,"providers":[{"billed_charge":4350.00,"npi":[1104349950]}]}]},{"tin":{"type":"ein","value":"462453627"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":507.84,"providers":[{"billed_charge":1008.00,"npi":[1083269542]}]},{"allowed_amount":677.12,"providers":[{"billed_charge":1344.00,"npi":[1083269542]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":168129.72,"providers":[{"billed_charge":168376.00,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20525.38,"providers":[{"billed_charge":20525.38,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"201167146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21015.75,"providers":[{"billed_charge":21033.00,"npi":[1114952751]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":51022.75,"providers":[{"billed_charge":61480.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":79629.62,"providers":[{"billed_charge":79630.26,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"721185789"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1205.40,"providers":[{"billed_charge":1205.40,"npi":[1912087578]}]}]},{"tin":{"type":"ein","value":"472104991"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4990.00,"providers":[{"billed_charge":4990.00,"npi":[1821837535]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":194431.67,"providers":[{"billed_charge":201656.50,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":608880.14,"providers":[{"billed_charge":656747.55,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"726000179"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5699.20,"providers":[{"billed_charge":5699.20,"npi":[1548340144]}]}]},{"tin":{"type":"ein","value":"726001499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":161.00,"providers":[{"billed_charge":161.00,"npi":[1689835001]}]}]},{"tin":{"type":"ein","value":"726000499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2914.27,"providers":[{"billed_charge":3444.00,"npi":[1053373670]}]}]},{"tin":{"type":"ein","value":"721315055"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32454.49,"providers":[{"billed_charge":32550.00,"npi":[1063533610]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":266000.00,"providers":[{"billed_charge":266000.00,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":921155.51,"providers":[{"billed_charge":938000.00,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"201167146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34158.39,"providers":[{"billed_charge":43984.50,"npi":[1114952751]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":212284.00,"providers":[{"billed_charge":215964.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":521268.40,"providers":[{"billed_charge":546304.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":811892.81,"providers":[{"billed_charge":827750.06,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"721185789"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4500.00,"providers":[{"billed_charge":4500.00,"npi":[1912087578]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":867002.71,"providers":[{"billed_charge":970903.80,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"726000179"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35437.60,"providers":[{"billed_charge":38500.00,"npi":[1548340144]}]}]},{"tin":{"type":"ein","value":"726000499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12800.00,"providers":[{"billed_charge":12800.00,"npi":[1053373670]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":34718.95,"providers":[{"billed_charge":42956.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":27392.00,"providers":[{"billed_charge":27392.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":95319.46,"providers":[{"billed_charge":153235.00,"npi":[1316943566]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"472104991"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5425.80,"providers":[{"billed_charge":5800.00,"npi":[1821837535]}]}]},{"tin":{"type":"ein","value":"726001326"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31500.00,"providers":[{"billed_charge":31500.00,"npi":[1396861415]}]}]},{"tin":{"type":"ein","value":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":593536.69,"providers":[{"billed_charge":610500.00,"npi":[1760408926]}]}]},{"tin":{"type":"ein","value":"200817213"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":365824.63,"providers":[{"billed_charge":399510.00,"npi":[1285630459]}]}]},{"tin":{"type":"ein","value":"472667968"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":69325.55,"providers":[{"billed_charge":70658.00,"npi":[1285464578]}]}]},{"tin":{"type":"ein","value":"726000969"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":280995.00,"providers":[{"billed_charge":280995.00,"npi":[1982671202]}]}]},{"tin":{"type":"ein","value":"720701964"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":592651.63,"providers":[{"billed_charge":678962.70,"npi":[1316943566]}]}]},{"tin":{"type":"ein","value":"721315055"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":70380.00,"providers":[{"billed_charge":70380.00,"npi":[1063533610]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"726000137"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13200.00,"providers":[{"billed_charge":33000.00,"npi":[1760408926]}]}]}]},{"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":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1261.26,"providers":[{"billed_charge":11328.57,"npi":[1234567893]}]}]}]},{"name":"ALCOHL&/RX SRVC;AC DTOX RES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0011","description":"ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)","allowed_amounts":[{"tin":{"type":"ein","value":"720743677"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":10715.50,"providers":[{"billed_charge":12106.05,"npi":[1245729045]}]}]}]},{"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":"474572658"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":371.25,"providers":[{"billed_charge":1350.00,"npi":[1407978455]}]}]},{"tin":{"type":"ein","value":"831183200"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1080.00,"providers":[{"billed_charge":4200.00,"npi":[1790255388]}]}]}]},{"name":"INJ MEDROXYPROGESTERNE ACETA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1050","description":"INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"741100163"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":30.60,"providers":[{"billed_charge":120.00,"npi":[1437548641]}]}]}]},{"name":"CRISIS INTRVNT MNTL HLTH SVC","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9485","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"711018775"},"service_code":["56"],"billing_class":"professional","payments":[{"allowed_amount":1300.00,"providers":[{"billed_charge":5200.00,"npi":[1497378764]}]}]}]}]}