{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-10-28","out_of_network":[{"name":"RESIDENTIAL TREATMENT - CHEM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1002","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":168980.00,"providers":[{"billed_charge":848250.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"833203254"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":12852.00,"providers":[{"billed_charge":150120.00,"npi":[1710443940]}]}]},{"tin":{"type":"ein","value":"731697900"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8092.00,"providers":[{"billed_charge":16150.00,"npi":[1144549551]}]}]}]},{"name":"ROOM-BOARD/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"110","description":"ROOM AND BOARD - PRIVATE -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9001190.72,"providers":[{"billed_charge":1701139.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":5634830.93,"providers":[{"billed_charge":1610782.00,"npi":[1558365890]}]}]}]},{"name":"DEB SUBQ TISSUE 20 SQ CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"11042","description":"DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LE","allowed_amounts":[{"tin":{"type":"ein","value":"621166050"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":587.76,"providers":[{"billed_charge":2724.00,"npi":[1427631662]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":154737.98,"providers":[{"billed_charge":420228.58,"npi":[1306818265]}]}]},{"tin":{"type":"ein","value":"621113737"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":263894.64,"providers":[{"billed_charge":798285.00,"npi":[1023055126]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":46648.00,"providers":[{"billed_charge":278250.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":267630.05,"providers":[{"billed_charge":180327.84,"npi":[1841388519]}]}]}]},{"name":"ANESTH, LENS SURGERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"142","description":"ANESTHESIA FOR PROCEDURES ON EYE; LENS SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"621560735"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":1277.76,"providers":[{"billed_charge":12875.00,"npi":[1346556453]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":490144.98,"providers":[{"billed_charge":349391.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":371063.36,"providers":[{"billed_charge":407334.00,"npi":[1558365890]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":146082.47,"providers":[{"billed_charge":391482.00,"npi":[1558365890]}]}]}]},{"name":"ICU/TRAMA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"208","description":"INTENSIVE CARE - TRAUMA","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":77469.03,"providers":[{"billed_charge":154932.00,"npi":[1538164090]}]}]}]},{"name":"CORONARY CARE (CCU)","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"210","description":"CORONARY CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":19714.81,"providers":[{"billed_charge":29101.50,"npi":[1538164090]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":102.15,"providers":[{"billed_charge":1211998.76,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.19,"providers":[{"billed_charge":17509.36,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":699.90,"providers":[{"billed_charge":2332.75,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2172.42,"providers":[{"billed_charge":8349.80,"npi":[1114003175]}]},{"allowed_amount":250.08,"providers":[{"billed_charge":9773.00,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":66.00,"providers":[{"billed_charge":219.94,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4716.44,"providers":[{"billed_charge":15721.48,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"462743282"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":33.68,"providers":[{"billed_charge":103.86,"npi":[1689011280]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":961.19,"providers":[{"billed_charge":3203.70,"npi":[1811987084]}]},{"allowed_amount":1943.83,"providers":[{"billed_charge":15249.74,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1307.35,"providers":[{"billed_charge":4901.31,"npi":[1417938846]}]},{"allowed_amount":530.92,"providers":[{"billed_charge":1764.04,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4834.56,"providers":[{"billed_charge":16115.07,"npi":[1922319037]}]},{"allowed_amount":760.02,"providers":[{"billed_charge":17969.21,"npi":[1922319037]}]}]}]},{"name":"DRUGS/INCIDNT RAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"255","description":"PHARMACY - DRUGS INCIDENT TO RADIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":276.67,"providers":[{"billed_charge":72233.09,"npi":[1558365890]}]}]}]},{"name":"IV SOLUTIONS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"258","description":"PHARMACY - IV SOLUTIONS","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":38.34,"providers":[{"billed_charge":48899.02,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":638.99,"providers":[{"billed_charge":2129.96,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":542.46,"providers":[{"billed_charge":2539.20,"npi":[1114003175]}]},{"allowed_amount":228.12,"providers":[{"billed_charge":11697.40,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15.68,"providers":[{"billed_charge":52.25,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8421.24,"providers":[{"billed_charge":28070.80,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18000.76,"providers":[{"billed_charge":98152.98,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":207.98,"providers":[{"billed_charge":1190.05,"npi":[1811987084]}]},{"allowed_amount":345.60,"providers":[{"billed_charge":1152.00,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1663.41,"providers":[{"billed_charge":9664.02,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1931.21,"providers":[{"billed_charge":6437.24,"npi":[1922319037]}]}]}]},{"name":"IV THERAPY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"260","description":"IV THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":152399.62,"providers":[{"billed_charge":295595.45,"npi":[1558365890]}]},{"allowed_amount":1093.21,"providers":[{"billed_charge":3482.03,"npi":[1558365890]}]},{"allowed_amount":78.32,"providers":[{"billed_charge":515200.19,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4025.29,"providers":[{"billed_charge":7429.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9004.76,"providers":[{"billed_charge":14161.01,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1777.81,"providers":[{"billed_charge":10326.87,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2319.15,"providers":[{"billed_charge":18328.76,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3679.07,"providers":[{"billed_charge":76590.47,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1143.57,"providers":[{"billed_charge":4233.66,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":486.24,"providers":[{"billed_charge":3816.25,"npi":[1811987084]}]},{"allowed_amount":24313.10,"providers":[{"billed_charge":26894.00,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4809.43,"providers":[{"billed_charge":13329.16,"npi":[1922319037]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":14.02,"providers":[{"billed_charge":296535.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36.70,"providers":[{"billed_charge":122.34,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":299.55,"providers":[{"billed_charge":998.50,"npi":[1811987084]}]},{"allowed_amount":6.75,"providers":[{"billed_charge":105.00,"npi":[1811987084]}]}]}]},{"name":"NON-STER SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"271","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON-STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30.57,"providers":[{"billed_charge":101.90,"npi":[1528056066]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":15.94,"providers":[{"billed_charge":1108413.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":117.08,"providers":[{"billed_charge":390.26,"npi":[1528056066]}]},{"allowed_amount":531.04,"providers":[{"billed_charge":30403.37,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":481.80,"providers":[{"billed_charge":1605.98,"npi":[1811987084]}]},{"allowed_amount":22.35,"providers":[{"billed_charge":2113.44,"npi":[1811987084]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28043.55,"providers":[{"billed_charge":714536.40,"npi":[1538164090]}]},{"allowed_amount":85.48,"providers":[{"billed_charge":2211.50,"npi":[1538164090]}]},{"allowed_amount":580.32,"providers":[{"billed_charge":1817907.20,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31524.10,"providers":[{"billed_charge":91039.00,"npi":[1558365890]}]},{"allowed_amount":20.22,"providers":[{"billed_charge":164276.00,"npi":[1558365890]}]},{"allowed_amount":142.63,"providers":[{"billed_charge":757.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"611345363"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":411.42,"providers":[{"billed_charge":1186.00,"npi":[1871588772]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2304.59,"providers":[{"billed_charge":4987.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"301205721"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":245.32,"providers":[{"billed_charge":11962.88,"npi":[1588215461]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.77,"providers":[{"billed_charge":941.04,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":920.09,"providers":[{"billed_charge":5354.44,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11425.97,"providers":[{"billed_charge":14308.05,"npi":[1811987084]}]},{"allowed_amount":818.16,"providers":[{"billed_charge":5660.15,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"237098532"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":424.28,"providers":[{"billed_charge":559.00,"npi":[1669564662]}]}]},{"tin":{"type":"ein","value":"630997281"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":582.57,"providers":[{"billed_charge":12159.00,"npi":[1780648352]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":857.70,"providers":[{"billed_charge":1988.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"201729674"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":158.22,"providers":[{"billed_charge":314.00,"npi":[1053360651]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2405.00,"providers":[{"billed_charge":2644.00,"npi":[1528056066]}]},{"allowed_amount":622.72,"providers":[{"billed_charge":15155.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":794.07,"providers":[{"billed_charge":2539.10,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1583.53,"providers":[{"billed_charge":3786.70,"npi":[1417938846]}]},{"allowed_amount":242.88,"providers":[{"billed_charge":1199.40,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":355.72,"providers":[{"billed_charge":28085.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":50.28,"providers":[{"billed_charge":71093.38,"npi":[1922319037]}]},{"allowed_amount":38442.38,"providers":[{"billed_charge":194470.89,"npi":[1922319037]}]}]},{"tin":{"type":"ein","value":"562112733"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":491.16,"providers":[{"billed_charge":640.35,"npi":[1053375253]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"610600313"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":293.82,"providers":[{"billed_charge":696.00,"npi":[1346244126]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":637.93,"providers":[{"billed_charge":330017.00,"npi":[1558365890]}]},{"allowed_amount":38.50,"providers":[{"billed_charge":7122.00,"npi":[1558365890]}]},{"allowed_amount":254.61,"providers":[{"billed_charge":600964.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59895.98,"providers":[{"billed_charge":142038.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10943.35,"providers":[{"billed_charge":16939.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":216.67,"providers":[{"billed_charge":162651.13,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24655.66,"providers":[{"billed_charge":430725.72,"npi":[1639151301]}]},{"allowed_amount":32.87,"providers":[{"billed_charge":299576.72,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8607.60,"providers":[{"billed_charge":11881.65,"npi":[1811987084]}]},{"allowed_amount":566.63,"providers":[{"billed_charge":5502.70,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"560529945"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1073.17,"providers":[{"billed_charge":2956.40,"npi":[1346297892]}]},{"allowed_amount":214.11,"providers":[{"billed_charge":589.95,"npi":[1346297892]}]}]},{"tin":{"type":"ein","value":"461481133"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":57.26,"providers":[{"billed_charge":663.00,"npi":[1801990825]}]}]},{"tin":{"type":"ein","value":"911631806"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1592.39,"providers":[{"billed_charge":3369.62,"npi":[1053359729]}]},{"allowed_amount":63.84,"providers":[{"billed_charge":402.76,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":350.49,"providers":[{"billed_charge":452.00,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1050.00,"providers":[{"billed_charge":5367.00,"npi":[1427055821]}]},{"allowed_amount":1362.57,"providers":[{"billed_charge":3073.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1328.98,"providers":[{"billed_charge":36628.54,"npi":[1114003175]}]},{"allowed_amount":7549.29,"providers":[{"billed_charge":65747.19,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4756.60,"providers":[{"billed_charge":6813.00,"npi":[1528056066]}]},{"allowed_amount":731.04,"providers":[{"billed_charge":46274.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":34178.87,"providers":[{"billed_charge":253486.83,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":173.64,"providers":[{"billed_charge":35650.93,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"560510824"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.66,"providers":[{"billed_charge":205.00,"npi":[1205859766]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13165.68,"providers":[{"billed_charge":23225.30,"npi":[1417938846]}]},{"allowed_amount":469.89,"providers":[{"billed_charge":2995.20,"npi":[1417938846]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.78,"providers":[{"billed_charge":2019.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1487.16,"providers":[{"billed_charge":4934.03,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24.49,"providers":[{"billed_charge":1732.11,"npi":[1639151301]}]},{"allowed_amount":1074.90,"providers":[{"billed_charge":14171.75,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31.10,"providers":[{"billed_charge":31.10,"npi":[1417938846]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":50.46,"providers":[{"billed_charge":158436.00,"npi":[1558365890]}]},{"allowed_amount":60.12,"providers":[{"billed_charge":96768.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15934.26,"providers":[{"billed_charge":40111.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":367.53,"providers":[{"billed_charge":10796.53,"npi":[1114003175]}]},{"allowed_amount":2378.55,"providers":[{"billed_charge":26171.80,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1770.84,"providers":[{"billed_charge":3010.00,"npi":[1528056066]}]},{"allowed_amount":1522.70,"providers":[{"billed_charge":7347.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1808.20,"providers":[{"billed_charge":3141.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8057.36,"providers":[{"billed_charge":83752.60,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":51.12,"providers":[{"billed_charge":57552.56,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5418.32,"providers":[{"billed_charge":9205.00,"npi":[1811987084]}]},{"allowed_amount":406.35,"providers":[{"billed_charge":3088.40,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2016.92,"providers":[{"billed_charge":35312.79,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":69.90,"providers":[{"billed_charge":574.40,"npi":[1417938846]}]},{"allowed_amount":2957.04,"providers":[{"billed_charge":2964.00,"npi":[1417938846]}]}]}]},{"name":"LAB/BACT-MIRCO","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"306","description":"LABORATORY - BACTERIOLOGY & MICROBIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21.66,"providers":[{"billed_charge":125931.00,"npi":[1558365890]}]},{"allowed_amount":96.01,"providers":[{"billed_charge":115669.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14181.65,"providers":[{"billed_charge":21578.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":41.64,"providers":[{"billed_charge":1244.69,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":28734.30,"providers":[{"billed_charge":92230.19,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":601.38,"providers":[{"billed_charge":4320.15,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":200.46,"providers":[{"billed_charge":3857.17,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2143.02,"providers":[{"billed_charge":2559.80,"npi":[1811987084]}]},{"allowed_amount":157.46,"providers":[{"billed_charge":524.85,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1199.86,"providers":[{"billed_charge":18050.68,"npi":[1639151301]}]},{"allowed_amount":8216.20,"providers":[{"billed_charge":54147.86,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4257.45,"providers":[{"billed_charge":8810.30,"npi":[1417938846]}]},{"allowed_amount":37.14,"providers":[{"billed_charge":123.80,"npi":[1417938846]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7.25,"providers":[{"billed_charge":7872.00,"npi":[1558365890]}]},{"allowed_amount":22.29,"providers":[{"billed_charge":28956.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2057.07,"providers":[{"billed_charge":3769.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1352.74,"providers":[{"billed_charge":7189.50,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":478.93,"providers":[{"billed_charge":691.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":277.34,"providers":[{"billed_charge":362.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3116.00,"providers":[{"billed_charge":25910.64,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":10.02,"providers":[{"billed_charge":2067.43,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20.96,"providers":[{"billed_charge":154.90,"npi":[1811987084]}]},{"allowed_amount":2192.93,"providers":[{"billed_charge":2415.20,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":188.98,"providers":[{"billed_charge":200.70,"npi":[1417938846]}]}]}]},{"name":"DX X-RAY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"320","description":"RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":32663.04,"providers":[{"billed_charge":254779.50,"npi":[1538164090]}]},{"allowed_amount":48.86,"providers":[{"billed_charge":276514.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":121.00,"providers":[{"billed_charge":44039.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14876.34,"providers":[{"billed_charge":22393.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3482.51,"providers":[{"billed_charge":22262.52,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16584.73,"providers":[{"billed_charge":75496.93,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2516.96,"providers":[{"billed_charge":22603.50,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6048.59,"providers":[{"billed_charge":49967.56,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3396.54,"providers":[{"billed_charge":3635.80,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7742.28,"providers":[{"billed_charge":10606.40,"npi":[1417938846]}]},{"allowed_amount":77.91,"providers":[{"billed_charge":519.40,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":290.02,"providers":[{"billed_charge":2639.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7351.52,"providers":[{"billed_charge":29119.57,"npi":[1922319037]}]}]}]},{"name":"DX X-RAY/CHEST","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"324","description":"RADIOLOGY - DIAGNOSTIC - CHEST X-RAY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":28.46,"providers":[{"billed_charge":131950.00,"npi":[1558365890]}]},{"allowed_amount":51436.11,"providers":[{"billed_charge":167764.00,"npi":[1558365890]}]},{"allowed_amount":162.50,"providers":[{"billed_charge":876.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13067.72,"providers":[{"billed_charge":21204.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":435.56,"providers":[{"billed_charge":876.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4313.10,"providers":[{"billed_charge":11185.50,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1666.50,"providers":[{"billed_charge":1666.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1752.30,"providers":[{"billed_charge":8418.74,"npi":[1639151301]}]},{"allowed_amount":11151.00,"providers":[{"billed_charge":36558.80,"npi":[1639151301]}]}]}]},{"name":"ECMO/ECLS DAILY MGMT-VENOUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"33948","description":"EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)/EXTRACORPOREAL LIFE SUPPORT (ECLS) PROVIDED BY PHYS; DAIL","allowed_amounts":[{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":842.00,"providers":[{"billed_charge":9600.00,"npi":[1205650124]}]},{"allowed_amount":4593.05,"providers":[{"billed_charge":50400.00,"npi":[1912906660]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":361.37,"providers":[{"billed_charge":6428.50,"npi":[1538164090]}]},{"allowed_amount":268.13,"providers":[{"billed_charge":1907077.00,"npi":[1538164090]}]},{"allowed_amount":165715.21,"providers":[{"billed_charge":2157741.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6439.46,"providers":[{"billed_charge":6739.50,"npi":[1417938846]}]}]}]},{"name":"CT SCAN/HEAD","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"351","description":"CT SCAN - HEAD SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":704.44,"providers":[{"billed_charge":709824.00,"npi":[1558365890]}]},{"allowed_amount":110378.16,"providers":[{"billed_charge":732246.00,"npi":[1558365890]}]},{"allowed_amount":98.13,"providers":[{"billed_charge":3202.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":15014.07,"providers":[{"billed_charge":24549.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7686.47,"providers":[{"billed_charge":38546.53,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":540.30,"providers":[{"billed_charge":736.50,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8878.66,"providers":[{"billed_charge":118696.08,"npi":[1639151301]}]},{"allowed_amount":384.80,"providers":[{"billed_charge":7687.72,"npi":[1639151301]}]}]}]},{"name":"CT SCAN/BODY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"352","description":"CT SCAN - BODY SCAN","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2019.56,"providers":[{"billed_charge":64954.00,"npi":[1558365890]}]},{"allowed_amount":90059.35,"providers":[{"billed_charge":1921775.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":99534.75,"providers":[{"billed_charge":309715.00,"npi":[1336841568]}]},{"allowed_amount":709.48,"providers":[{"billed_charge":5712.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8604.05,"providers":[{"billed_charge":88879.13,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":14199.76,"providers":[{"billed_charge":59573.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":52035.40,"providers":[{"billed_charge":298014.79,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5663.72,"providers":[{"billed_charge":17615.17,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12129.85,"providers":[{"billed_charge":222786.96,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":29776.38,"providers":[{"billed_charge":712562.35,"npi":[1639151301]}]},{"allowed_amount":8846.66,"providers":[{"billed_charge":129107.85,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":33489.32,"providers":[{"billed_charge":60924.85,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22164.83,"providers":[{"billed_charge":179163.80,"npi":[1922319037]}]},{"allowed_amount":1831.65,"providers":[{"billed_charge":18480.15,"npi":[1922319037]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":224926.20,"providers":[{"billed_charge":170632.33,"npi":[1538164090]}]},{"allowed_amount":16778.70,"providers":[{"billed_charge":23600.33,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2035.78,"providers":[{"billed_charge":7400.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10555.58,"providers":[{"billed_charge":16382.35,"npi":[1639151301]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12758.51,"providers":[{"billed_charge":19390.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","19"],"billing_class":"institutional","payments":[{"allowed_amount":1231.31,"providers":[{"billed_charge":5317.74,"npi":[1639151301]}]},{"allowed_amount":18789.73,"providers":[{"billed_charge":81806.75,"npi":[1639151301]}]}]}]},{"name":"ROUTINE VENIPUNCTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"36415","description":"COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":200.20,"providers":[{"billed_charge":561.88,"npi":[1295705564]}]},{"allowed_amount":495.22,"providers":[{"billed_charge":1397.50,"npi":[1316977812]}]},{"allowed_amount":188.05,"providers":[{"billed_charge":538.76,"npi":[1417119728]}]}]},{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":143.37,"providers":[{"billed_charge":324.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":141.65,"providers":[{"billed_charge":420.00,"npi":[1104316389]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":38.60,"providers":[{"billed_charge":200.00,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"30417049"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":82.08,"providers":[{"billed_charge":96.00,"npi":[1669134177]}]},{"allowed_amount":13.68,"providers":[{"billed_charge":16.00,"npi":[1669134177,1497577357]}]}]},{"tin":{"type":"ein","value":"300863554"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":40.95,"providers":[{"billed_charge":117.00,"npi":[1124157391]}]}]},{"tin":{"type":"ein","value":"473734336"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.58,"providers":[{"billed_charge":30.00,"npi":[1881112308]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":20.69,"providers":[{"billed_charge":42.00,"npi":[1234567893]}]},{"allowed_amount":166.92,"providers":[{"billed_charge":816.64,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":65.62,"providers":[{"billed_charge":425.00,"npi":[1093414914]}]}]}]},{"name":"BLOOD/STOR-PROC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"390","description":"BLOOD STORAGE AND PROCESSING - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2043.27,"providers":[{"billed_charge":17740.00,"npi":[1558365890]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5693.49,"providers":[{"billed_charge":35711.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5341.60,"providers":[{"billed_charge":56579.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":192.40,"providers":[{"billed_charge":2264.84,"npi":[1639151301]},{"billed_charge":2244.08,"npi":[1639151301]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":889.86,"providers":[{"billed_charge":4689.78,"npi":[1639151301]}]}]}]},{"name":"PET SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"404","description":"POSITION EMISSION TOMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":36510.62,"providers":[{"billed_charge":35893.00,"npi":[1538164090]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1141.48,"providers":[{"billed_charge":37790.00,"npi":[1558365890]}]},{"allowed_amount":67.32,"providers":[{"billed_charge":539322.00,"npi":[1558365890]}]}]}]},{"name":"HYPERBARIC O2","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"413","description":"RESPIRATORY SERVICES - HYPERBARIC OXYGEN THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"560529945"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":13897.24,"providers":[{"billed_charge":38284.40,"npi":[1346297892]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3128.41,"providers":[{"billed_charge":11411.50,"npi":[1538164090]}]},{"allowed_amount":81.54,"providers":[{"billed_charge":259.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":368.87,"providers":[{"billed_charge":1862.16,"npi":[1639151301]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":717.25,"providers":[{"billed_charge":2202.00,"npi":[1558365890]}]},{"allowed_amount":80.74,"providers":[{"billed_charge":19211.00,"npi":[1558365890]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2494.36,"providers":[{"billed_charge":13239.96,"npi":[1639151301]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1194.83,"providers":[{"billed_charge":3880.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":653.29,"providers":[{"billed_charge":1424.00,"npi":[1558365890]}]}]}]},{"name":"EMERG ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"450","description":"EMERGENCY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1290687.80,"providers":[{"billed_charge":2113225.00,"npi":[1538164090]}]},{"allowed_amount":289.15,"providers":[{"billed_charge":996219.50,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":588.94,"providers":[{"billed_charge":778794.00,"npi":[1558365890]}]},{"allowed_amount":5081.23,"providers":[{"billed_charge":21898.00,"npi":[1386709871]}]},{"allowed_amount":1345653.93,"providers":[{"billed_charge":3337888.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":407478.57,"providers":[{"billed_charge":591402.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":70149.24,"providers":[{"billed_charge":119562.00,"npi":[1912341439]}]},{"allowed_amount":754.91,"providers":[{"billed_charge":2677.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621757920"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":539.09,"providers":[{"billed_charge":1805.37,"npi":[1619038247]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":146281.68,"providers":[{"billed_charge":547068.98,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":77433.01,"providers":[{"billed_charge":79183.25,"npi":[1811987084]}]},{"allowed_amount":441.09,"providers":[{"billed_charge":3607.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":247508.06,"providers":[{"billed_charge":1030948.71,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":25857.71,"providers":[{"billed_charge":75934.49,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":956.00,"providers":[{"billed_charge":956.00,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1033.16,"providers":[{"billed_charge":25229.79,"npi":[1114003175]}]},{"allowed_amount":77270.29,"providers":[{"billed_charge":233437.35,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6754.83,"providers":[{"billed_charge":11948.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":211368.00,"providers":[{"billed_charge":416627.39,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":169893.99,"providers":[{"billed_charge":436894.98,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":137018.45,"providers":[{"billed_charge":148307.40,"npi":[1417938846]}]},{"allowed_amount":1662.84,"providers":[{"billed_charge":7378.80,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21722.36,"providers":[{"billed_charge":49620.00,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":225025.29,"providers":[{"billed_charge":403598.85,"npi":[1922319037]}]},{"allowed_amount":876.24,"providers":[{"billed_charge":26867.76,"npi":[1922319037]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":270.15,"providers":[{"billed_charge":2301.00,"npi":[1558365890]}]},{"allowed_amount":26.18,"providers":[{"billed_charge":33059.00,"npi":[1558365890]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":455.36,"providers":[{"billed_charge":2083.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":680.02,"providers":[{"billed_charge":284374.00,"npi":[1558365890]}]},{"allowed_amount":2799.57,"providers":[{"billed_charge":23887.00,"npi":[1558365890]}]},{"allowed_amount":1364.14,"providers":[{"billed_charge":36850.00,"npi":[1558365890]}]}]}]},{"name":"AMBUL SURG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"490","description":"AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"272910652"},"service_code":["24"],"billing_class":"institutional","payments":[{"allowed_amount":17599.77,"providers":[{"billed_charge":94651.65,"npi":[1710591060]}]}]}]},{"name":"MRI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"610","description":"MRI - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2171.13,"providers":[{"billed_charge":107202.50,"npi":[1538164090]}]},{"allowed_amount":593.20,"providers":[{"billed_charge":8101.00,"npi":[1538164090]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":417.35,"providers":[{"billed_charge":51863.00,"npi":[1558365890]}]}]}]},{"name":"DRUG/DETAIL CODE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"636","description":"DRUGS REQ SPEC IDENTIFICATION - DRUGS REQ DETAILED CODING*","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":24285.80,"providers":[{"billed_charge":96327.50,"npi":[1538164090]}]},{"allowed_amount":0.75,"providers":[{"billed_charge":1051.63,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7.23,"providers":[{"billed_charge":91.07,"npi":[1386709871]}]},{"allowed_amount":6437.05,"providers":[{"billed_charge":44434.75,"npi":[1558365890]}]},{"allowed_amount":3.43,"providers":[{"billed_charge":846.38,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2684.67,"providers":[{"billed_charge":7108.27,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":570.16,"providers":[{"billed_charge":1629.06,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.11,"providers":[{"billed_charge":71039.46,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2429.52,"providers":[{"billed_charge":6465.13,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5210.13,"providers":[{"billed_charge":81897.53,"npi":[1639151301]}]},{"allowed_amount":21.37,"providers":[{"billed_charge":21153.46,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"560952955"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10.50,"providers":[{"billed_charge":35.00,"npi":[1760479331]}]}]},{"tin":{"type":"ein","value":"853679546"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.51,"providers":[{"billed_charge":3082.00,"npi":[1720672934]}]}]},{"tin":{"type":"ein","value":"611334601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.60,"providers":[{"billed_charge":2.00,"npi":[1992701429]}]}]},{"tin":{"type":"ein","value":"586025393"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96.90,"providers":[{"billed_charge":373.00,"npi":[1487684122]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":884.67,"providers":[{"billed_charge":43809.84,"npi":[1114003175]}]},{"allowed_amount":7039.01,"providers":[{"billed_charge":32849.35,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"581519911"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":484.80,"providers":[{"billed_charge":1616.00,"npi":[1528056066]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":30086.12,"providers":[{"billed_charge":109618.89,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"421557533"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":731.40,"providers":[{"billed_charge":39139.00,"npi":[1255302923]}]}]},{"tin":{"type":"ein","value":"626002604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.51,"providers":[{"billed_charge":836.84,"npi":[1760476659]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1067.01,"providers":[{"billed_charge":2915.32,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":170.13,"providers":[{"billed_charge":32220.20,"npi":[1922319037]}]},{"allowed_amount":14618.74,"providers":[{"billed_charge":51828.02,"npi":[1922319037]}]}]}]},{"name":"SELF-ADMINISTRABLE DRUGS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"637","description":"SELF-ADMINISTRABLE DRUGS","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":0.37,"providers":[{"billed_charge":74818.06,"npi":[1558365890]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"50583027"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":3742.00,"providers":[{"billed_charge":3742.00,"npi":[1326811100]}]}]},{"tin":{"type":"ein","value":"626010402"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":2050.00,"providers":[{"billed_charge":2050.00,"npi":[1104816966]}]}]},{"tin":{"type":"ein","value":"640899562"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":14040.00,"providers":[{"billed_charge":18000.00,"npi":[1346975471]}]}]}]},{"name":"CT HEAD/BRAIN W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"70450","description":"COMPUTED TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":604.24,"providers":[{"billed_charge":2548.00,"npi":[1265894380]}]},{"allowed_amount":46.48,"providers":[{"billed_charge":196.00,"npi":[1285628750]}]},{"allowed_amount":976.08,"providers":[{"billed_charge":4116.00,"npi":[1285628750]}]},{"allowed_amount":232.40,"providers":[{"billed_charge":980.00,"npi":[1265894380]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":119.00,"providers":[{"billed_charge":584.00,"npi":[1326023789]}]},{"allowed_amount":148.75,"providers":[{"billed_charge":730.00,"npi":[1730107988]}]},{"allowed_amount":208.25,"providers":[{"billed_charge":1022.00,"npi":[1730107988]}]},{"allowed_amount":29.75,"providers":[{"billed_charge":146.00,"npi":[1326023789]}]}]},{"tin":{"type":"ein","value":"621203441"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":535.36,"providers":[{"billed_charge":1216.00,"npi":[1649807702]}]},{"allowed_amount":66.92,"providers":[{"billed_charge":152.00,"npi":[1366975955]}]},{"allowed_amount":334.60,"providers":[{"billed_charge":760.00,"npi":[1366975955]}]}]}]},{"name":"X-RAY EXAM CHEST 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71045","description":"RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":34.30,"providers":[{"billed_charge":160.00,"npi":[1205070851]}]},{"allowed_amount":20.58,"providers":[{"billed_charge":96.00,"npi":[1356389597]}]},{"allowed_amount":205.80,"providers":[{"billed_charge":960.00,"npi":[1003301037]}]},{"allowed_amount":48.02,"providers":[{"billed_charge":224.00,"npi":[1003301037]}]},{"allowed_amount":54.88,"providers":[{"billed_charge":256.00,"npi":[1205070851]}]},{"allowed_amount":13.72,"providers":[{"billed_charge":64.00,"npi":[1205070851]}]},{"allowed_amount":6.86,"providers":[{"billed_charge":32.00,"npi":[1356389597,1477930337]}]},{"allowed_amount":82.32,"providers":[{"billed_charge":384.00,"npi":[1003301037]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":90.36,"providers":[{"billed_charge":306.00,"npi":[1285628750]}]},{"allowed_amount":40.16,"providers":[{"billed_charge":136.00,"npi":[1770558496,1265894380,1972000800]}]},{"allowed_amount":1014.04,"providers":[{"billed_charge":3434.00,"npi":[1285628750]}]},{"allowed_amount":552.20,"providers":[{"billed_charge":1870.00,"npi":[1265894380]}]},{"allowed_amount":291.16,"providers":[{"billed_charge":986.00,"npi":[1598793028]}]},{"allowed_amount":110.44,"providers":[{"billed_charge":374.00,"npi":[1447756960]}]},{"allowed_amount":60.24,"providers":[{"billed_charge":204.00,"npi":[1114486057,1598793028]}]},{"allowed_amount":10.04,"providers":[{"billed_charge":34.00,"npi":[1265894380]}]},{"allowed_amount":20.08,"providers":[{"billed_charge":68.00,"npi":[1114486057,1447756960,1598793028]}]},{"allowed_amount":130.52,"providers":[{"billed_charge":442.00,"npi":[1972000800]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.84,"providers":[{"billed_charge":62.00,"npi":[1730154261]}]},{"allowed_amount":154.08,"providers":[{"billed_charge":744.00,"npi":[1730107988]}]},{"allowed_amount":121.98,"providers":[{"billed_charge":589.00,"npi":[1376756742]}]},{"allowed_amount":231.12,"providers":[{"billed_charge":1116.00,"npi":[1871548818]}]},{"allowed_amount":147.66,"providers":[{"billed_charge":713.00,"npi":[1689617433]}]},{"allowed_amount":57.78,"providers":[{"billed_charge":279.00,"npi":[1215956008]}]},{"allowed_amount":109.14,"providers":[{"billed_charge":527.00,"npi":[1720510456]}]},{"allowed_amount":70.62,"providers":[{"billed_charge":341.00,"npi":[1326023789,1124480140]}]},{"allowed_amount":38.52,"providers":[{"billed_charge":186.00,"npi":[1376756742,1124480140]}]},{"allowed_amount":142.77,"providers":[{"billed_charge":682.00,"npi":[1073557831]}]},{"allowed_amount":6.42,"providers":[{"billed_charge":31.00,"npi":[1215956008,1720510456]}]},{"allowed_amount":77.04,"providers":[{"billed_charge":372.00,"npi":[1326023789]}]},{"allowed_amount":134.82,"providers":[{"billed_charge":651.00,"npi":[1215956008]}]},{"allowed_amount":25.68,"providers":[{"billed_charge":124.00,"npi":[1376756742,1073557831,1689617433]}]},{"allowed_amount":32.10,"providers":[{"billed_charge":155.00,"npi":[1326023789,1689617433,1871548818]}]},{"allowed_amount":64.20,"providers":[{"billed_charge":310.00,"npi":[1124480140]}]},{"allowed_amount":44.94,"providers":[{"billed_charge":217.00,"npi":[1730107988]}]},{"allowed_amount":526.44,"providers":[{"billed_charge":2542.00,"npi":[1730107988]}]},{"allowed_amount":192.60,"providers":[{"billed_charge":930.00,"npi":[1720510456]}]}]},{"tin":{"type":"ein","value":"621828139"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.84,"providers":[{"billed_charge":352.00,"npi":[1952563520]}]},{"allowed_amount":141.24,"providers":[{"billed_charge":3872.00,"npi":[1952563520]}]},{"allowed_amount":40.92,"providers":[{"billed_charge":1056.00,"npi":[1750410452]}]},{"allowed_amount":68.20,"providers":[{"billed_charge":1760.00,"npi":[1750410452]}]},{"allowed_amount":6.42,"providers":[{"billed_charge":176.00,"npi":[1952563520]}]}]},{"tin":{"type":"ein","value":"621203441"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":72.25,"providers":[{"billed_charge":165.00,"npi":[1649807702]}]},{"allowed_amount":86.70,"providers":[{"billed_charge":198.00,"npi":[1649807702]}]}]},{"tin":{"type":"ein","value":"620859738"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":8.03,"providers":[{"billed_charge":36.00,"npi":[1083830749]}]},{"allowed_amount":16.06,"providers":[{"billed_charge":72.00,"npi":[1083830749]}]},{"allowed_amount":40.15,"providers":[{"billed_charge":180.00,"npi":[1083830749]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":49.26,"providers":[{"billed_charge":234.00,"npi":[1003301037]}]},{"allowed_amount":32.84,"providers":[{"billed_charge":156.00,"npi":[1003301037]}]},{"allowed_amount":8.21,"providers":[{"billed_charge":39.00,"npi":[1003301037]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":30.76,"providers":[{"billed_charge":148.00,"npi":[1730154261]}]}]}]},{"name":"CT THORAX W/DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71260","description":"COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"843073102"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":378.00,"providers":[{"billed_charge":775.00,"npi":[1932148244]}]}]},{"tin":{"type":"ein","value":"620908836"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":76.03,"providers":[{"billed_charge":350.00,"npi":[1134103831]}]},{"allowed_amount":25.81,"providers":[{"billed_charge":350.00,"npi":[1134103831]}]},{"allowed_amount":60.85,"providers":[{"billed_charge":350.00,"npi":[1386062511]}]}]}]},{"name":"X-RAY EXAM L-S SPINE 2/3 VWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"72100","description":"RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; 2 OR 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":180.93,"providers":[{"billed_charge":494.07,"npi":[1548289416]}]}]}]},{"name":"EKG/ECG","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"730","description":"EKG/ECG - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":44.64,"providers":[{"billed_charge":82770.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":54.81,"providers":[{"billed_charge":1068.00,"npi":[1558365890]}]},{"allowed_amount":78.32,"providers":[{"billed_charge":107156.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"883616696"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12560.37,"providers":[{"billed_charge":31310.00,"npi":[1336841568]}]}]},{"tin":{"type":"ein","value":"621762364"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":451.98,"providers":[{"billed_charge":4664.90,"npi":[1114003175]}]}]},{"tin":{"type":"ein","value":"640889822"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1248.08,"providers":[{"billed_charge":2848.00,"npi":[1912341439]}]}]},{"tin":{"type":"ein","value":"621762419"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7344.68,"providers":[{"billed_charge":34808.62,"npi":[1396760542]}]}]},{"tin":{"type":"ein","value":"626014528"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1848.00,"providers":[{"billed_charge":1848.00,"npi":[1811987084]}]},{"allowed_amount":34.65,"providers":[{"billed_charge":115.50,"npi":[1811987084]}]}]},{"tin":{"type":"ein","value":"452528273"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":107.47,"providers":[{"billed_charge":3143.70,"npi":[1639151301]}]}]},{"tin":{"type":"ein","value":"620988604"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3106.10,"providers":[{"billed_charge":3324.60,"npi":[1417938846]}]}]},{"tin":{"type":"ein","value":"621762469"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3121.35,"providers":[{"billed_charge":10257.60,"npi":[1922319037]}]},{"allowed_amount":126.51,"providers":[{"billed_charge":2051.52,"npi":[1922319037]}]}]}]},{"name":"X-RAY EXAM ABDOMEN 1 VIEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74018","description":"RADIOLOGIC EXAMINATION, ABDOMEN; 1 VIEW","allowed_amounts":[{"tin":{"type":"ein","value":"620864298"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":77.04,"providers":[{"billed_charge":372.00,"npi":[1730107988]}]},{"allowed_amount":19.26,"providers":[{"billed_charge":93.00,"npi":[1730107988]}]}]}]},{"name":"CT ABD & PELVIS W/O CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74176","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":759.52,"providers":[{"billed_charge":2584.00,"npi":[1285628750]}]},{"allowed_amount":1139.28,"providers":[{"billed_charge":3876.00,"npi":[1598793028]}]}]}]},{"name":"CT ABD & PELV W/CONTRAST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"74177","description":"COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S)","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":340.50,"providers":[{"billed_charge":1600.00,"npi":[1003301037]}]},{"allowed_amount":204.30,"providers":[{"billed_charge":960.00,"npi":[1003301037]}]}]},{"tin":{"type":"ein","value":"620908836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":89.41,"providers":[{"billed_charge":688.00,"npi":[1386062511]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":1495.50,"providers":[{"billed_charge":7950.00,"npi":[1265894380]}]},{"allowed_amount":99.70,"providers":[{"billed_charge":530.00,"npi":[1265894380,1598793028]}]},{"allowed_amount":897.30,"providers":[{"billed_charge":4770.00,"npi":[1285628750]}]},{"allowed_amount":199.40,"providers":[{"billed_charge":1060.00,"npi":[1972000800,1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":127.62,"providers":[{"billed_charge":624.00,"npi":[1215956008,1730107988,1871548818]}]},{"allowed_amount":510.48,"providers":[{"billed_charge":2496.00,"npi":[1215956008]}]},{"allowed_amount":63.81,"providers":[{"billed_charge":312.00,"npi":[1215956008,1326023789,1730107988,1871548818]}]},{"allowed_amount":1403.82,"providers":[{"billed_charge":6864.00,"npi":[1730107988]}]},{"allowed_amount":446.67,"providers":[{"billed_charge":2184.00,"npi":[1326023789]}]}]},{"tin":{"type":"ein","value":"621203441"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":287.14,"providers":[{"billed_charge":654.00,"npi":[1649807702]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4383.35,"providers":[{"billed_charge":14611.10,"npi":[1922319037]}]}]}]},{"name":"US EXAM, ABDOM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76700","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE","allowed_amounts":[{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":529.68,"providers":[{"billed_charge":2196.00,"npi":[1598793028]}]}]}]},{"name":"ECHO EXAM OF ABDOMEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76705","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL","allowed_amounts":[{"tin":{"type":"ein","value":"620864298"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":41.12,"providers":[{"billed_charge":200.00,"npi":[1326023789]}]}]}]},{"name":"CT SCAN FOR THERAPY GUIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77014","description":"COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS","allowed_amounts":[{"tin":{"type":"ein","value":"30417049"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":370.10,"providers":[{"billed_charge":405.00,"npi":[1669616132]}]}]}]},{"name":"BREAST TOMOSYNTHESIS BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77063","description":"SCREENING DIGITAL BREAST TOMOSYNTHESIS, BILATERAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY P","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":134.82,"providers":[{"billed_charge":636.00,"npi":[1831517770]}]},{"allowed_amount":112.35,"providers":[{"billed_charge":464.00,"npi":[1659606788]}]},{"allowed_amount":292.11,"providers":[{"billed_charge":1378.00,"npi":[1902953870]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":274.68,"providers":[{"billed_charge":859.50,"npi":[1295760734]}]},{"allowed_amount":427.28,"providers":[{"billed_charge":1337.00,"npi":[1295760734]}]}]},{"tin":{"type":"ein","value":"620818892"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":16.69,"providers":[{"billed_charge":75.00,"npi":[1790778991]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1545.83,"providers":[{"billed_charge":7050.00,"npi":[1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":21.05,"providers":[{"billed_charge":103.00,"npi":[1104851120]}]},{"allowed_amount":1305.10,"providers":[{"billed_charge":6386.00,"npi":[1104851120]}]}]},{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":406.45,"providers":[{"billed_charge":2877.70,"npi":[1326144536]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":171.18,"providers":[{"billed_charge":798.00,"npi":[1831517770]}]},{"allowed_amount":370.89,"providers":[{"billed_charge":1729.00,"npi":[1902953870]}]},{"allowed_amount":142.65,"providers":[{"billed_charge":665.00,"npi":[1659606788]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":465.00,"providers":[{"billed_charge":2389.56,"npi":[1295760734]}]},{"allowed_amount":478.38,"providers":[{"billed_charge":2389.56,"npi":[1295760734]}]}]},{"tin":{"type":"ein","value":"620818892"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":64.13,"providers":[{"billed_charge":180.00,"npi":[1790778991]}]}]},{"tin":{"type":"ein","value":"620963389"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1962.25,"providers":[{"billed_charge":10105.00,"npi":[1598793028]}]}]},{"tin":{"type":"ein","value":"620864298"},"service_code":["11","22","23"],"billing_class":"professional","payments":[{"allowed_amount":213.76,"providers":[{"billed_charge":1008.00,"npi":[1104851120]}]},{"allowed_amount":26.72,"providers":[{"billed_charge":126.00,"npi":[1104851120]}]},{"allowed_amount":1736.80,"providers":[{"billed_charge":8190.00,"npi":[1104851120]}]}]},{"tin":{"type":"ein","value":"10570490"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":587.04,"providers":[{"billed_charge":1699.20,"npi":[1902953870]}]},{"allowed_amount":978.40,"providers":[{"billed_charge":2832.00,"npi":[1326144536]}]}]}]},{"name":"PET IMAGE W/CT SKULL-THIGH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"78815","description":"POSITRON EMISSION TOMOGRAPHY (PET) W CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION","allowed_amounts":[{"tin":{"type":"ein","value":"620908836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":356.79,"providers":[{"billed_charge":2202.00,"npi":[1194227504]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":142.96,"providers":[{"billed_charge":554.40,"npi":[1234567893]}]}]}]},{"name":"COMPREHEN METABOLIC PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80053","description":"COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA","allowed_amounts":[{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.78,"providers":[{"billed_charge":216.00,"npi":[1104316389]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.91,"providers":[{"billed_charge":638.88,"npi":[1234567893]}]}]}]},{"name":"LIPID PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80061","description":"LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":163.06,"providers":[{"billed_charge":810.19,"npi":[1234567893]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"621162462"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.30,"providers":[{"billed_charge":55.00,"npi":[1356392567]}]}]},{"tin":{"type":"ein","value":"620488046"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15.75,"providers":[{"billed_charge":25.00,"npi":[1639603640]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":546.21,"providers":[{"billed_charge":1020.00,"npi":[1043870157]}]},{"allowed_amount":31.50,"providers":[{"billed_charge":100.00,"npi":[1023157195]}]},{"allowed_amount":942.48,"providers":[{"billed_charge":1760.00,"npi":[1356764088]}]},{"allowed_amount":37.50,"providers":[{"billed_charge":100.00,"npi":[1467995613]}]},{"allowed_amount":192.78,"providers":[{"billed_charge":360.00,"npi":[1770079675]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":396.27,"providers":[{"billed_charge":1406.00,"npi":[1225648009]}]},{"allowed_amount":107.10,"providers":[{"billed_charge":380.00,"npi":[1881142784]}]}]},{"tin":{"type":"ein","value":"463723510"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1228.50,"providers":[{"billed_charge":18525.00,"npi":[1073569695]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":6.30,"providers":[{"billed_charge":50.00,"npi":[1538223326]}]},{"allowed_amount":384.30,"providers":[{"billed_charge":3050.00,"npi":[1538223326]}]}]}]},{"name":"DRUG TEST PRSMV CHEM ANLYZR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80307","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR","allowed_amounts":[{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":818.71,"providers":[{"billed_charge":6200.00,"npi":[1760111934]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1067.69,"providers":[{"billed_charge":6092.97,"npi":[1234567893]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":25.86,"providers":[{"billed_charge":66.60,"npi":[1316977812]}]},{"allowed_amount":77.58,"providers":[{"billed_charge":199.80,"npi":[1295705564]}]},{"allowed_amount":51.72,"providers":[{"billed_charge":133.20,"npi":[1417119728]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"844408280"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":902.00,"providers":[{"billed_charge":8832.00,"npi":[1023774429]}]}]}]},{"name":"VITAMIN D 25 HYDROXY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82306","description":"VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":93.78,"providers":[{"billed_charge":458.80,"npi":[1234567893]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":74.52,"providers":[{"billed_charge":456.42,"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":78.45,"providers":[{"billed_charge":487.20,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85025","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE","allowed_amounts":[{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":536.25,"providers":[{"billed_charge":1560.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":105.90,"providers":[{"billed_charge":308.00,"npi":[1104316389]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11.69,"providers":[{"billed_charge":104.90,"npi":[1234567893]}]}]}]},{"name":"BARTONELLA DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87471","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); BARTONELLA HENSELAE AND BARTONELLA QUINTANA","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":228.15,"providers":[{"billed_charge":684.19,"npi":[1164508883]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":234.40,"providers":[{"billed_charge":2600.00,"npi":[1234567893]}]}]}]},{"name":"VANOMYCIN DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87500","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); VANCOMYCIN RESISTANCE (EG, ENTEROCOCCUS SPE","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":193.05,"providers":[{"billed_charge":579.15,"npi":[1164508883]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":298.83,"providers":[{"billed_charge":3172.64,"npi":[1234567893]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":240.23,"providers":[{"billed_charge":2522.64,"npi":[1234567893]}]}]}]},{"name":"MR-STAPH DNA AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87641","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTAN","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":52.65,"providers":[{"billed_charge":157.95,"npi":[1164508883]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":228.15,"providers":[{"billed_charge":684.45,"npi":[1164508883]}]}]}]},{"name":"STREP B, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87653","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":228.15,"providers":[{"billed_charge":684.45,"npi":[1164508883]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":931.29,"providers":[{"billed_charge":8484.32,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"273385100"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":69.66,"providers":[{"billed_charge":378.00,"npi":[1316461460]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88304","description":"LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION, INDUCED ABSCESS ANEURYSM","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":145.52,"providers":[{"billed_charge":515.28,"npi":[1770621658]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"621436754"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1001.35,"providers":[{"billed_charge":5349.98,"npi":[1386867232]}]},{"allowed_amount":807.56,"providers":[{"billed_charge":4314.50,"npi":[1306997804]}]},{"allowed_amount":549.14,"providers":[{"billed_charge":2933.86,"npi":[1053392191]}]}]},{"tin":{"type":"ein","value":"621729316"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":290.73,"providers":[{"billed_charge":1795.50,"npi":[1073945143]}]}]}]},{"name":"DECALCIFY TISSUE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88311","description":"DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION)","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":80.28,"providers":[{"billed_charge":274.23,"npi":[1770621658]}]}]}]},{"name":"SPECIAL STAINS GROUP 1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88312","description":"SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT; GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN","allowed_amounts":[{"tin":{"type":"ein","value":"872266063"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":857.70,"providers":[{"billed_charge":3037.86,"npi":[1770621658]}]}]}]},{"name":"IM ADMIN 1ST/ONLY COMPONENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90460","description":"IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, W COUNSELING BY","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":995.13,"providers":[{"billed_charge":1040.00,"npi":[1316977812]}]},{"allowed_amount":114.82,"providers":[{"billed_charge":120.00,"npi":[1417119728]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":274.24,"providers":[{"billed_charge":320.00,"npi":[1316977812]}]},{"allowed_amount":68.56,"providers":[{"billed_charge":80.00,"npi":[1295705564]}]},{"allowed_amount":157.12,"providers":[{"billed_charge":180.00,"npi":[1417119728]}]}]}]},{"name":"BH/INTENS OP/CHEM DEP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"906","description":"INTENSIVE OUTPATIENT SERVICES - CHEMICAL DEPENDENCY","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":21449.15,"providers":[{"billed_charge":307500.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":67620.00,"providers":[{"billed_charge":91140.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":83180.85,"providers":[{"billed_charge":477000.00,"npi":[1811144728]}]}]}]},{"name":"TDAP VACCINE 7 YRS/> IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90715","description":"TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE (TDAP), WHEN ADMINISTERED TO INDIVIDUALS","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":150.50,"providers":[{"billed_charge":158.16,"npi":[1417119728]}]},{"allowed_amount":407.33,"providers":[{"billed_charge":421.43,"npi":[1316977812]}]}]}]},{"name":"VAR VACCINE LIVE SUBQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90716","description":"VARICELLA VIRUS VACCINE (VAR), LIVE, FOR SUBCUTANEOUS USE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":691.02,"providers":[{"billed_charge":691.02,"npi":[1316977812]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":5637.90,"providers":[{"billed_charge":12576.00,"npi":[1275106429]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":5535.00,"providers":[{"billed_charge":20500.00,"npi":[1265892749]}]}]}]},{"name":"PSYTX W PT 30 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90832","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":78.93,"providers":[{"billed_charge":181.00,"npi":[1205405560]}]},{"allowed_amount":552.51,"providers":[{"billed_charge":1267.00,"npi":[1316075294]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["02","57","10"],"billing_class":"professional","payments":[{"allowed_amount":3386.01,"providers":[{"billed_charge":10325.00,"npi":[1407620321]}]},{"allowed_amount":50.65,"providers":[{"billed_charge":175.00,"npi":[1861216244]}]},{"allowed_amount":114.78,"providers":[{"billed_charge":350.00,"npi":[1114613874]}]},{"allowed_amount":607.80,"providers":[{"billed_charge":2100.00,"npi":[1407620321]}]},{"allowed_amount":286.95,"providers":[{"billed_charge":875.00,"npi":[1861216244]}]},{"allowed_amount":3140.30,"providers":[{"billed_charge":10850.00,"npi":[1114613874]}]}]},{"tin":{"type":"ein","value":"621538547"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":354.55,"providers":[{"billed_charge":539.00,"npi":[1023645645]}]}]},{"tin":{"type":"ein","value":"460485169"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":172.18,"providers":[{"billed_charge":400.00,"npi":[1649800889]}]},{"allowed_amount":6628.93,"providers":[{"billed_charge":15400.00,"npi":[1649800889]}]}]},{"tin":{"type":"ein","value":"830589617"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3558.18,"providers":[{"billed_charge":7750.00,"npi":[1760754790]}]},{"allowed_amount":1377.36,"providers":[{"billed_charge":3000.00,"npi":[1528393550]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"922040476"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":53.13,"providers":[{"billed_charge":80.00,"npi":[1578074480]}]}]}]},{"name":"PSYTX W PT 45 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90834","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":208.32,"providers":[{"billed_charge":520.00,"npi":[1568790913]}]},{"allowed_amount":1666.56,"providers":[{"billed_charge":4160.00,"npi":[1447756333]}]},{"allowed_amount":3645.60,"providers":[{"billed_charge":9100.00,"npi":[1447955695]}]},{"allowed_amount":4166.40,"providers":[{"billed_charge":10400.00,"npi":[1225600216]}]},{"allowed_amount":2812.32,"providers":[{"billed_charge":7020.00,"npi":[1053859504]}]},{"allowed_amount":1249.92,"providers":[{"billed_charge":3120.00,"npi":[1205405560,1619192317]}]},{"allowed_amount":4687.20,"providers":[{"billed_charge":11700.00,"npi":[1124803689]}]},{"allowed_amount":2604.00,"providers":[{"billed_charge":6500.00,"npi":[1790559938]}]},{"allowed_amount":5208.00,"providers":[{"billed_charge":13000.00,"npi":[1922786755]}]}]},{"tin":{"type":"ein","value":"474591265"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":2343.60,"providers":[{"billed_charge":6000.00,"npi":[1467629105]}]},{"allowed_amount":1718.64,"providers":[{"billed_charge":4400.00,"npi":[1336584531]}]},{"allowed_amount":390.60,"providers":[{"billed_charge":1000.00,"npi":[1336584531]}]},{"allowed_amount":78.12,"providers":[{"billed_charge":200.00,"npi":[1467629105]}]}]},{"tin":{"type":"ein","value":"621538547"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":601.47,"providers":[{"billed_charge":945.00,"npi":[1528425162]}]}]},{"tin":{"type":"ein","value":"460485169"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1818.08,"providers":[{"billed_charge":3600.00,"npi":[1649800889]}]}]},{"tin":{"type":"ein","value":"621420121"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1666.50,"providers":[{"billed_charge":3278.00,"npi":[1508214362]}]},{"allowed_amount":467.81,"providers":[{"billed_charge":1043.00,"npi":[1508214362]}]}]},{"tin":{"type":"ein","value":"475604312"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":757.50,"providers":[{"billed_charge":1000.00,"npi":[1164649083]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1388.61,"providers":[{"billed_charge":3159.00,"npi":[1124803689]}]},{"allowed_amount":3085.80,"providers":[{"billed_charge":6958.00,"npi":[1447756333]}]},{"allowed_amount":8794.53,"providers":[{"billed_charge":20007.00,"npi":[1225600216]}]},{"allowed_amount":925.74,"providers":[{"billed_charge":2106.00,"npi":[1053859504]}]},{"allowed_amount":617.16,"providers":[{"billed_charge":1404.00,"npi":[1790559938]}]},{"allowed_amount":3857.25,"providers":[{"billed_charge":8775.00,"npi":[1639963119]}]},{"allowed_amount":3548.67,"providers":[{"billed_charge":8073.00,"npi":[1447955695]}]},{"allowed_amount":1851.48,"providers":[{"billed_charge":4212.00,"npi":[1922786755]}]}]},{"tin":{"type":"ein","value":"274608696"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":98.90,"providers":[{"billed_charge":200.00,"npi":[1760965602]}]},{"allowed_amount":224.32,"providers":[{"billed_charge":400.00,"npi":[1003232968]}]},{"allowed_amount":336.48,"providers":[{"billed_charge":600.00,"npi":[1760965602]}]},{"allowed_amount":197.80,"providers":[{"billed_charge":400.00,"npi":[1760965602]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":7404.81,"providers":[{"billed_charge":7770.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"880929018"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1087.90,"providers":[{"billed_charge":2035.00,"npi":[1164998027]}]},{"allowed_amount":4486.40,"providers":[{"billed_charge":7400.00,"npi":[1164998027]}]}]},{"tin":{"type":"ein","value":"825412020"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2175.80,"providers":[{"billed_charge":3300.00,"npi":[1528459344]}]},{"allowed_amount":2131.04,"providers":[{"billed_charge":2850.00,"npi":[1528459344]}]}]},{"tin":{"type":"ein","value":"461984623"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1345.92,"providers":[{"billed_charge":1440.00,"npi":[1184064644]}]}]},{"tin":{"type":"ein","value":"873095707"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":1601.74,"providers":[{"billed_charge":4200.00,"npi":[1144846767]}]},{"allowed_amount":228.82,"providers":[{"billed_charge":600.00,"npi":[1144846767]}]}]}]},{"name":"PSYTX W PT W E/M 60 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90838","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":8176.35,"providers":[{"billed_charge":18200.00,"npi":[1356764088]}]},{"allowed_amount":2066.55,"providers":[{"billed_charge":4600.00,"npi":[1770079675]}]},{"allowed_amount":4762.05,"providers":[{"billed_charge":10600.00,"npi":[1043870157]}]},{"allowed_amount":634.20,"providers":[{"billed_charge":1200.00,"npi":[1023157195]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"832297809"},"service_code":["57","02"],"billing_class":"professional","payments":[{"allowed_amount":2669.78,"providers":[{"billed_charge":6550.00,"npi":[1407620321]}]},{"allowed_amount":244.56,"providers":[{"billed_charge":600.00,"npi":[1861216244]}]},{"allowed_amount":337.63,"providers":[{"billed_charge":950.00,"npi":[1861216244]}]},{"allowed_amount":4140.69,"providers":[{"billed_charge":11650.00,"npi":[1114613874]}]},{"allowed_amount":426.48,"providers":[{"billed_charge":1200.00,"npi":[1407620321]}]}]},{"tin":{"type":"ein","value":"461570381"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":774.44,"providers":[{"billed_charge":1900.00,"npi":[1306090287]}]}]},{"tin":{"type":"ein","value":"582108521"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":400.05,"providers":[{"billed_charge":1344.00,"npi":[1063864171]}]}]},{"tin":{"type":"ein","value":"920286776"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":376.95,"providers":[{"billed_charge":20925.00,"npi":[1760671655]}]}]}]},{"name":"TCRANIAL MAGN STIM TX DELI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90868","description":"THERAPEUTIC REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) TREATMENT; SUBSEQUENT DELIVERY AND MA","allowed_amounts":[{"tin":{"type":"ein","value":"473095365"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1080.00,"providers":[{"billed_charge":4000.00,"npi":[1518154566]}]}]}]},{"name":"PSTAY/PARTIAL HOSP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"912","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - PARTIAL HOSPITALIZATION","allowed_amounts":[{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11475.00,"providers":[{"billed_charge":19800.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"474918169"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2151.84,"providers":[{"billed_charge":10360.00,"npi":[1134596794]}]}]}]},{"name":"PSYCHIATRIC CARE INTENSIVE 4","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"913","description":"PSYCHIATRIC CARE INTENSIVE 4-6 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":84218.85,"providers":[{"billed_charge":604950.00,"npi":[1477335008]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":31875.00,"providers":[{"billed_charge":55000.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":78552.75,"providers":[{"billed_charge":274500.00,"npi":[1811144728]}]}]}]},{"name":"PERI VASCUL LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"921","description":"OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB","allowed_amounts":[{"tin":{"type":"ein","value":"311626179"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6007.68,"providers":[{"billed_charge":31281.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3138.28,"providers":[{"billed_charge":26031.00,"npi":[1558365890]}]}]}]},{"name":"ELECTROCARDIOGRAM REPORT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93010","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; INTERPRETATION AND REPORT ONLY","allowed_amounts":[{"tin":{"type":"ein","value":"620545814"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":24.69,"providers":[{"billed_charge":52.71,"npi":[1679563100]}]},{"allowed_amount":8.23,"providers":[{"billed_charge":17.57,"npi":[1174502298]}]},{"allowed_amount":38.64,"providers":[{"billed_charge":52.71,"npi":[1679563100]}]}]},{"tin":{"type":"ein","value":"208032568"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":31.11,"providers":[{"billed_charge":66.69,"npi":[1376785410]}]}]},{"tin":{"type":"ein","value":"264253264"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":120.46,"providers":[{"billed_charge":540.00,"npi":[1154356764]}]},{"allowed_amount":205.75,"providers":[{"billed_charge":1125.00,"npi":[1154356764]}]}]},{"tin":{"type":"ein","value":"620528340"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":57.61,"providers":[{"billed_charge":122.99,"npi":[1003017963]}]}]},{"tin":{"type":"ein","value":"621114867"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":12.88,"providers":[{"billed_charge":17.57,"npi":[1356331805]}]},{"allowed_amount":41.15,"providers":[{"billed_charge":87.85,"npi":[1356331805]}]},{"allowed_amount":252.00,"providers":[{"billed_charge":316.26,"npi":[1861873879]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["22","23","51","21"],"billing_class":"professional","payments":[{"allowed_amount":14.00,"providers":[{"billed_charge":38.00,"npi":[1861873879]}]},{"allowed_amount":56.00,"providers":[{"billed_charge":70.28,"npi":[1386006526,1861873879]}]},{"allowed_amount":112.00,"providers":[{"billed_charge":140.56,"npi":[1386006526]}]},{"allowed_amount":266.00,"providers":[{"billed_charge":333.83,"npi":[1861873879]}]},{"allowed_amount":168.00,"providers":[{"billed_charge":210.84,"npi":[1386006526]}]},{"allowed_amount":224.00,"providers":[{"billed_charge":281.12,"npi":[1861873879]}]}]}]},{"name":"CARDIOVASCULAR STRESS TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93016","description":"CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELE","allowed_amounts":[{"tin":{"type":"ein","value":"581897274"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":21.71,"providers":[{"billed_charge":44.46,"npi":[1699762252]}]}]}]},{"name":"OTHER RX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"940","description":"OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"621762469"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16633.41,"providers":[{"billed_charge":24679.50,"npi":[1922319037]}]}]}]},{"name":"IMMUNOTHERAPY INJECTIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95117","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; 2 O","allowed_amounts":[{"tin":{"type":"ein","value":"620863368"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":858.69,"providers":[{"billed_charge":3306.00,"npi":[1710972872]}]}]}]},{"name":"THER/PROPH/DIAG IV INF INIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96365","description":"INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); INITIAL, U","allowed_amounts":[{"tin":{"type":"ein","value":"621647259"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.56,"providers":[{"billed_charge":216.00,"npi":[1104316389]}]}]}]},{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96372","description":"THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC INJECTION (SPECIFY SUBSTANCE OR DRUG); SUBCUTANEOUS OR INTR","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":36.06,"providers":[{"billed_charge":66.72,"npi":[1417119728]}]},{"allowed_amount":216.35,"providers":[{"billed_charge":404.12,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10.21,"providers":[{"billed_charge":35.00,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"463723510"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":219.64,"providers":[{"billed_charge":4250.00,"npi":[1073569695]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":12.02,"providers":[{"billed_charge":30.00,"npi":[1538223326]}]},{"allowed_amount":264.44,"providers":[{"billed_charge":660.00,"npi":[1538223326]}]}]}]},{"name":"THERAPEUTIC EXERCISES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97110","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH A","allowed_amounts":[{"tin":{"type":"ein","value":"621867012"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4460.03,"providers":[{"billed_charge":8200.00,"npi":[1417040312]}]}]},{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2367.08,"providers":[{"billed_charge":6545.00,"npi":[1124707823]}]},{"allowed_amount":437.30,"providers":[{"billed_charge":1210.00,"npi":[1699709204]}]},{"allowed_amount":652.68,"providers":[{"billed_charge":1815.00,"npi":[1508606039]}]},{"allowed_amount":195.80,"providers":[{"billed_charge":550.00,"npi":[1003647389]}]},{"allowed_amount":530.84,"providers":[{"billed_charge":1485.00,"npi":[1730925660]}]},{"allowed_amount":139.24,"providers":[{"billed_charge":385.00,"npi":[1699910737]}]},{"allowed_amount":628.74,"providers":[{"billed_charge":1760.00,"npi":[1679393987]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2879.33,"providers":[{"billed_charge":9201.15,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"261286160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":411.18,"providers":[{"billed_charge":1953.00,"npi":[1528811619]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":606.98,"providers":[{"billed_charge":1798.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":369.13,"providers":[{"billed_charge":1491.00,"npi":[1861828816]}]},{"allowed_amount":1000.05,"providers":[{"billed_charge":4024.50,"npi":[1528717071]}]},{"allowed_amount":772.32,"providers":[{"billed_charge":3249.00,"npi":[1497142731]}]},{"allowed_amount":665.72,"providers":[{"billed_charge":2804.00,"npi":[1871511535]}]},{"allowed_amount":39.16,"providers":[{"billed_charge":141.00,"npi":[1316488133]}]},{"allowed_amount":411.18,"providers":[{"billed_charge":1869.00,"npi":[1750989943]}]},{"allowed_amount":197.99,"providers":[{"billed_charge":779.00,"npi":[1164906897]}]},{"allowed_amount":511.26,"providers":[{"billed_charge":2203.00,"npi":[1134594088]}]},{"allowed_amount":796.25,"providers":[{"billed_charge":3375.00,"npi":[1972118610]}]},{"allowed_amount":576.17,"providers":[{"billed_charge":2507.00,"npi":[1013410562]}]},{"allowed_amount":464.14,"providers":[{"billed_charge":1902.50,"npi":[1972333235]}]},{"allowed_amount":787.57,"providers":[{"billed_charge":3356.50,"npi":[1285259432]}]},{"allowed_amount":1277.05,"providers":[{"billed_charge":5618.50,"npi":[1568108876]}]},{"allowed_amount":509.08,"providers":[{"billed_charge":2314.00,"npi":[1730685140]}]},{"allowed_amount":763.62,"providers":[{"billed_charge":3415.50,"npi":[1396483558]}]},{"allowed_amount":1378.95,"providers":[{"billed_charge":5730.50,"npi":[1427663699]}]},{"allowed_amount":43.51,"providers":[{"billed_charge":178.00,"npi":[1881043917]}]},{"allowed_amount":234.96,"providers":[{"billed_charge":1068.00,"npi":[1851902563]}]},{"allowed_amount":176.22,"providers":[{"billed_charge":801.00,"npi":[1326638776]}]},{"allowed_amount":1612.10,"providers":[{"billed_charge":6928.00,"npi":[1023056371]}]},{"allowed_amount":959.42,"providers":[{"billed_charge":4361.00,"npi":[1861714099]}]},{"allowed_amount":850.65,"providers":[{"billed_charge":3586.50,"npi":[1467790980]}]},{"allowed_amount":685.30,"providers":[{"billed_charge":2967.00,"npi":[1376946459]}]},{"allowed_amount":315.46,"providers":[{"billed_charge":1350.00,"npi":[1811591241]}]},{"allowed_amount":3942.90,"providers":[{"billed_charge":16360.50,"npi":[1972083202]}]},{"allowed_amount":295.88,"providers":[{"billed_charge":1261.00,"npi":[1790809598]}]},{"allowed_amount":1311.15,"providers":[{"billed_charge":5763.00,"npi":[1578288072]}]},{"allowed_amount":606.98,"providers":[{"billed_charge":2740.50,"npi":[1306327267]}]},{"allowed_amount":5915.38,"providers":[{"billed_charge":25412.00,"npi":[1194391789]}]},{"allowed_amount":97.90,"providers":[{"billed_charge":352.50,"npi":[1629793211]}]},{"allowed_amount":1006.93,"providers":[{"billed_charge":4372.50,"npi":[1720687460]}]},{"allowed_amount":1000.76,"providers":[{"billed_charge":4372.50,"npi":[1285355107]}]},{"allowed_amount":137.06,"providers":[{"billed_charge":586.00,"npi":[1306891684]},{"billed_charge":623.00,"npi":[1841681855,1962458885]}]},{"allowed_amount":430.76,"providers":[{"billed_charge":1958.00,"npi":[1093460115]}]},{"allowed_amount":469.92,"providers":[{"billed_charge":2043.50,"npi":[1811496912]},{"billed_charge":2025.00,"npi":[1225784812]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":533.51,"providers":[{"billed_charge":1903.00,"npi":[1234567893]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":164.63,"providers":[{"billed_charge":385.00,"npi":[1699709204]}]},{"allowed_amount":208.21,"providers":[{"billed_charge":495.00,"npi":[1730925660]}]},{"allowed_amount":1459.88,"providers":[{"billed_charge":3410.00,"npi":[1124707823]}]},{"allowed_amount":159.79,"providers":[{"billed_charge":385.00,"npi":[1699910737]}]},{"allowed_amount":581.06,"providers":[{"billed_charge":1430.00,"npi":[1508606039]}]},{"allowed_amount":656.11,"providers":[{"billed_charge":1595.00,"npi":[1053002444]}]},{"allowed_amount":89.58,"providers":[{"billed_charge":220.00,"npi":[1679393987]}]},{"allowed_amount":179.16,"providers":[{"billed_charge":440.00,"npi":[1003647389]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":202.73,"providers":[{"billed_charge":643.23,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"261286160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":116.21,"providers":[{"billed_charge":485.00,"npi":[1528811619]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":394.64,"providers":[{"billed_charge":1044.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":232.42,"providers":[{"billed_charge":810.00,"npi":[1972118610]}]},{"allowed_amount":684.92,"providers":[{"billed_charge":2979.00,"npi":[1972083202]}]},{"allowed_amount":43.58,"providers":[{"billed_charge":198.00,"npi":[1356901359]}]},{"allowed_amount":460.01,"providers":[{"billed_charge":2079.00,"npi":[1750989943]}]},{"allowed_amount":476.95,"providers":[{"billed_charge":1839.00,"npi":[1285259432]}]},{"allowed_amount":162.21,"providers":[{"billed_charge":693.00,"npi":[1861828816]}]},{"allowed_amount":818.33,"providers":[{"billed_charge":3453.00,"npi":[1225784812]}]},{"allowed_amount":292.95,"providers":[{"billed_charge":1287.00,"npi":[1811496912]}]},{"allowed_amount":4432.48,"providers":[{"billed_charge":18654.00,"npi":[1194391789]}]},{"allowed_amount":87.16,"providers":[{"billed_charge":366.00,"npi":[1841681855]}]},{"allowed_amount":374.51,"providers":[{"billed_charge":1584.00,"npi":[1871511535]}]},{"allowed_amount":338.95,"providers":[{"billed_charge":1485.00,"npi":[1013410562]}]},{"allowed_amount":975.70,"providers":[{"billed_charge":4146.00,"npi":[1497142731]}]},{"allowed_amount":1714.14,"providers":[{"billed_charge":7362.00,"npi":[1467790980]}]},{"allowed_amount":1844.37,"providers":[{"billed_charge":7587.00,"npi":[1427663699]}]},{"allowed_amount":457.08,"providers":[{"billed_charge":1980.00,"npi":[1306327267]}]},{"allowed_amount":479.38,"providers":[{"billed_charge":1998.00,"npi":[1285355107]}]},{"allowed_amount":990.21,"providers":[{"billed_charge":3747.00,"npi":[1528717071]}]},{"allowed_amount":152.53,"providers":[{"billed_charge":693.00,"npi":[1720687460]}]},{"allowed_amount":65.37,"providers":[{"billed_charge":297.00,"npi":[1093460115]}]},{"allowed_amount":21.79,"providers":[{"billed_charge":99.00,"npi":[1326638776]},{"billed_charge":69.00,"npi":[1881043917,1659894533,1629793211]}]},{"allowed_amount":348.64,"providers":[{"billed_charge":1524.00,"npi":[1396483558]}]},{"allowed_amount":181.58,"providers":[{"billed_charge":672.00,"npi":[1962458885]}]},{"allowed_amount":1145.18,"providers":[{"billed_charge":4638.00,"npi":[1376946459]}]},{"allowed_amount":273.33,"providers":[{"billed_charge":1158.00,"npi":[1972333235]}]},{"allowed_amount":462.43,"providers":[{"billed_charge":1959.00,"npi":[1861714099]}]},{"allowed_amount":326.85,"providers":[{"billed_charge":1455.00,"npi":[1568108876]}]},{"allowed_amount":355.90,"providers":[{"billed_charge":1494.00,"npi":[1134594088]}]},{"allowed_amount":1229.67,"providers":[{"billed_charge":5484.00,"npi":[1578288072]}]},{"allowed_amount":67.79,"providers":[{"billed_charge":267.00,"npi":[1306891684]}]},{"allowed_amount":522.96,"providers":[{"billed_charge":2376.00,"npi":[1730685140]}]},{"allowed_amount":1302.55,"providers":[{"billed_charge":5241.00,"npi":[1023056371]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":506.19,"providers":[{"billed_charge":1851.00,"npi":[1234567893]}]}]}]},{"name":"MANUAL THERAPY 1/> REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97140","description":"MANUAL THERAPY TECHNIQUES (EG, MOBILIZATION/ MANIPULATION, MANUAL LYMPHATIC DRAINAGE, MANUAL TRACTIO","allowed_amounts":[{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.91,"providers":[{"billed_charge":440.00,"npi":[1699910737]}]},{"allowed_amount":166.41,"providers":[{"billed_charge":495.00,"npi":[1003647389]}]},{"allowed_amount":406.72,"providers":[{"billed_charge":1210.00,"npi":[1679393987]}]},{"allowed_amount":2115.73,"providers":[{"billed_charge":6270.00,"npi":[1124707823]}]},{"allowed_amount":517.67,"providers":[{"billed_charge":1540.00,"npi":[1508606039]}]},{"allowed_amount":634.71,"providers":[{"billed_charge":1870.00,"npi":[1699709204]}]},{"allowed_amount":517.66,"providers":[{"billed_charge":1540.00,"npi":[1730925660]}]},{"allowed_amount":462.16,"providers":[{"billed_charge":1375.00,"npi":[1053002444]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":556.74,"providers":[{"billed_charge":2490.00,"npi":[1578288072]}]},{"allowed_amount":390.32,"providers":[{"billed_charge":1659.00,"npi":[1194391789]}]},{"allowed_amount":517.69,"providers":[{"billed_charge":2247.00,"npi":[1396483558]}]},{"allowed_amount":513.87,"providers":[{"billed_charge":2268.00,"npi":[1720687460]}]},{"allowed_amount":99.79,"providers":[{"billed_charge":405.00,"npi":[1811591241]}]},{"allowed_amount":129.43,"providers":[{"billed_charge":573.00,"npi":[1811496912]}]},{"allowed_amount":487.99,"providers":[{"billed_charge":2034.00,"npi":[1871511535]}]},{"allowed_amount":735.72,"providers":[{"billed_charge":3141.00,"npi":[1528717071]}]},{"allowed_amount":628.59,"providers":[{"billed_charge":2796.00,"npi":[1467790980]}]},{"allowed_amount":388.27,"providers":[{"billed_charge":1734.00,"npi":[1497142731]}]},{"allowed_amount":304.03,"providers":[{"billed_charge":1314.00,"npi":[1285259432]}]},{"allowed_amount":110.93,"providers":[{"billed_charge":504.00,"npi":[1013410562]}]},{"allowed_amount":414.12,"providers":[{"billed_charge":1803.00,"npi":[1225784812]}]},{"allowed_amount":155.26,"providers":[{"billed_charge":657.00,"npi":[1861828816]}]},{"allowed_amount":240.34,"providers":[{"billed_charge":1017.00,"npi":[1568108876]}]},{"allowed_amount":240.35,"providers":[{"billed_charge":1092.00,"npi":[1093460115]}]},{"allowed_amount":168.45,"providers":[{"billed_charge":711.00,"npi":[1972118610]}]},{"allowed_amount":36.98,"providers":[{"billed_charge":168.00,"npi":[1861714099]}]},{"allowed_amount":794.98,"providers":[{"billed_charge":3462.00,"npi":[1023056371]}]},{"allowed_amount":73.95,"providers":[{"billed_charge":291.00,"npi":[1790809598]}]},{"allowed_amount":184.90,"providers":[{"billed_charge":840.00,"npi":[1750989943]}]},{"allowed_amount":166.41,"providers":[{"billed_charge":741.00,"npi":[1285355107]}]},{"allowed_amount":221.87,"providers":[{"billed_charge":993.00,"npi":[1376946459]}]},{"allowed_amount":2438.63,"providers":[{"billed_charge":10329.00,"npi":[1972083202]}]},{"allowed_amount":377.14,"providers":[{"billed_charge":1665.00,"npi":[1306327267]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":41.35,"providers":[{"billed_charge":203.00,"npi":[1234567893]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"883979874"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":27199.01,"providers":[{"billed_charge":297300.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"883291014"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":28991.38,"providers":[{"billed_charge":117600.00,"npi":[1366081739]}]},{"allowed_amount":5275.65,"providers":[{"billed_charge":21400.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"844711741"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":24383.47,"providers":[{"billed_charge":31080.00,"npi":[1093224370]}]}]},{"tin":{"type":"ein","value":"824431095"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":9546.00,"providers":[{"billed_charge":10750.00,"npi":[1386152197]}]},{"allowed_amount":14785.20,"providers":[{"billed_charge":16650.00,"npi":[1386152197]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"883979874"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":862.32,"providers":[{"billed_charge":12000.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"883291014"},"service_code":["99","12"],"billing_class":"professional","payments":[{"allowed_amount":221.87,"providers":[{"billed_charge":1125.00,"npi":[1366081739]}]},{"allowed_amount":4585.40,"providers":[{"billed_charge":23250.00,"npi":[1366081739]}]}]},{"tin":{"type":"ein","value":"824431095"},"service_code":["11","03"],"billing_class":"professional","payments":[{"allowed_amount":688.20,"providers":[{"billed_charge":965.00,"npi":[1386152197]}]},{"allowed_amount":133.20,"providers":[{"billed_charge":150.00,"npi":[1386152197]}]}]}]},{"name":"PT EVAL MOD COMPLEX 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97162","description":"PHYSICAL THERAPY EVALUATION: MODERATE COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY OF PRESENT P","allowed_amounts":[{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":148.06,"providers":[{"billed_charge":604.00,"npi":[1194391789]}]}]}]},{"name":"THERAPEUTIC ACTIVITIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97530","description":"THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FU","allowed_amounts":[{"tin":{"type":"ein","value":"263392940"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":284.90,"providers":[{"billed_charge":605.00,"npi":[1679393987]}]},{"allowed_amount":199.43,"providers":[{"billed_charge":440.00,"npi":[1124707823,1730925660]}]},{"allowed_amount":533.54,"providers":[{"billed_charge":1155.00,"npi":[1508606039]}]}]},{"tin":{"type":"ein","value":"473001395"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":291.42,"providers":[{"billed_charge":894.78,"npi":[1023672292]}]}]},{"tin":{"type":"ein","value":"851009969"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":435.12,"providers":[{"billed_charge":986.00,"npi":[1811503287]}]}]},{"tin":{"type":"ein","value":"371349655"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1209.53,"providers":[{"billed_charge":4915.50,"npi":[1427663699]}]},{"allowed_amount":218.59,"providers":[{"billed_charge":856.00,"npi":[1972333235]}]},{"allowed_amount":857.29,"providers":[{"billed_charge":3613.50,"npi":[1720687460]}]},{"allowed_amount":124.32,"providers":[{"billed_charge":535.00,"npi":[1326638776]}]},{"allowed_amount":1535.87,"providers":[{"billed_charge":6086.00,"npi":[1023056371]}]},{"allowed_amount":145.04,"providers":[{"billed_charge":593.00,"npi":[1659894533]}]},{"allowed_amount":459.87,"providers":[{"billed_charge":1926.00,"npi":[1093460115]}]},{"allowed_amount":411.81,"providers":[{"billed_charge":1663.00,"npi":[1225784812]}]},{"allowed_amount":326.34,"providers":[{"billed_charge":1342.00,"npi":[1306327267]}]},{"allowed_amount":25.90,"providers":[{"billed_charge":107.00,"npi":[1811591241]},{"billed_charge":82.50,"npi":[1528717071]}]},{"allowed_amount":610.42,"providers":[{"billed_charge":2289.50,"npi":[1871511535]}]},{"allowed_amount":385.91,"providers":[{"billed_charge":1605.00,"npi":[1750989943]}]},{"allowed_amount":3418.80,"providers":[{"billed_charge":13556.50,"npi":[1194391789]}]},{"allowed_amount":409.22,"providers":[{"billed_charge":1712.00,"npi":[1861714099]},{"billed_charge":1565.00,"npi":[1134594088]}]},{"allowed_amount":2375.03,"providers":[{"billed_charge":10076.00,"npi":[1467790980]}]},{"allowed_amount":1033.41,"providers":[{"billed_charge":4068.50,"npi":[1376946459]}]},{"allowed_amount":1258.74,"providers":[{"billed_charge":5169.50,"npi":[1578288072]}]},{"allowed_amount":77.70,"providers":[{"billed_charge":321.00,"npi":[1164906897,1356901359]}]},{"allowed_amount":4347.07,"providers":[{"billed_charge":17090.00,"npi":[1972083202]}]},{"allowed_amount":1566.96,"providers":[{"billed_charge":6643.00,"npi":[1568108876]}]},{"allowed_amount":593.11,"providers":[{"billed_charge":2436.50,"npi":[1396483558]}]},{"allowed_amount":103.60,"providers":[{"billed_charge":428.00,"npi":[1841681855]}]},{"allowed_amount":611.24,"providers":[{"billed_charge":2568.00,"npi":[1730685140]}]},{"allowed_amount":538.72,"providers":[{"billed_charge":2084.50,"npi":[1285259432]}]},{"allowed_amount":438.74,"providers":[{"billed_charge":1819.00,"npi":[1013410562]}]},{"allowed_amount":808.08,"providers":[{"billed_charge":3277.00,"npi":[1285355107]}]},{"allowed_amount":528.36,"providers":[{"billed_charge":2149.00,"npi":[1497142731]}]},{"allowed_amount":49.21,"providers":[{"billed_charge":214.00,"npi":[1962458885]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":416.85,"providers":[{"billed_charge":1463.00,"npi":[1234567893]}]}]}]},{"name":"RMVL DEVITAL TIS 20 CM/<","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97597","description":"DEBRIDEMENT (EG, HIGH PRESSURE WATERJET W/WOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT W SCISSORS, SCAL","allowed_amounts":[{"tin":{"type":"ein","value":"621166050"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":61.63,"providers":[{"billed_charge":322.00,"npi":[1427631662]}]}]}]},{"name":"CHIROPRACT MANJ 1-2 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98940","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 1-2 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"465259447"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.44,"providers":[{"billed_charge":60.00,"npi":[1336490366]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"271291725"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2757.00,"providers":[{"billed_charge":3375.00,"npi":[1598090219]}]}]},{"tin":{"type":"ein","value":"843725847"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":376.09,"providers":[{"billed_charge":770.00,"npi":[1275914541]}]},{"allowed_amount":1606.93,"providers":[{"billed_charge":3285.00,"npi":[1508183500]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"271291725"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1760.00,"providers":[{"billed_charge":1760.00,"npi":[1598090219]}]}]}]},{"name":"HYPERBARIC OXYGEN THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99183","description":"PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGE","allowed_amounts":[{"tin":{"type":"ein","value":"200027433"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":2489.76,"providers":[{"billed_charge":7000.00,"npi":[1942494398]}]},{"allowed_amount":1155.96,"providers":[{"billed_charge":3250.00,"npi":[1568860377]}]},{"allowed_amount":3530.93,"providers":[{"billed_charge":11500.00,"npi":[1316040454]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99202","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":650.00,"providers":[{"billed_charge":1898.00,"npi":[1234567893]}]},{"allowed_amount":152.00,"providers":[{"billed_charge":438.00,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99203","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":1214.76,"providers":[{"billed_charge":2136.94,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3269.90,"providers":[{"billed_charge":11134.00,"npi":[1851636203]}]}]}]},{"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":"205277615"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":129.52,"providers":[{"billed_charge":309.80,"npi":[1366201964]}]}]},{"tin":{"type":"ein","value":"992676245"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":647.60,"providers":[{"billed_charge":1675.00,"npi":[1336976570]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["02","17","10"],"billing_class":"professional","payments":[{"allowed_amount":300.00,"providers":[{"billed_charge":300.00,"npi":[1234567893]}]},{"allowed_amount":50.00,"providers":[{"billed_charge":50.00,"npi":[1234567893]}]},{"allowed_amount":18.70,"providers":[{"billed_charge":70.56,"npi":[1234567893]}]}]}]},{"name":"OFFICE OR OTH OUTPATIENT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99212","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71"],"billing_class":"professional","payments":[{"allowed_amount":51.06,"providers":[{"billed_charge":88.62,"npi":[1417119728]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":550.00,"providers":[{"billed_charge":1254.00,"npi":[1234567893]}]},{"allowed_amount":51.00,"providers":[{"billed_charge":114.00,"npi":[1234567893]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99213","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["71","10"],"billing_class":"professional","payments":[{"allowed_amount":4644.64,"providers":[{"billed_charge":8009.91,"npi":[1316977812]}]},{"allowed_amount":60.33,"providers":[{"billed_charge":142.35,"npi":[1316977812]}]}]},{"tin":{"type":"ein","value":"842055057"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":423.00,"providers":[{"billed_charge":780.00,"npi":[1972335131]}]}]},{"tin":{"type":"ein","value":"621619239"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1211.92,"providers":[{"billed_charge":2400.00,"npi":[1104924232]}]}]},{"tin":{"type":"ein","value":"262704338"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2467.50,"providers":[{"billed_charge":3500.00,"npi":[1639940786]}]},{"allowed_amount":153.84,"providers":[{"billed_charge":300.00,"npi":[1639940786]}]}]},{"tin":{"type":"ein","value":"851230024"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1244.10,"providers":[{"billed_charge":3225.00,"npi":[1598723645]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":846.00,"providers":[{"billed_charge":1608.00,"npi":[1881142784]}]},{"allowed_amount":564.08,"providers":[{"billed_charge":1474.00,"npi":[1225648009]}]},{"allowed_amount":70.50,"providers":[{"billed_charge":134.00,"npi":[1225648009]}]},{"allowed_amount":1589.68,"providers":[{"billed_charge":4154.00,"npi":[1881142784]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2961.00,"providers":[{"billed_charge":8274.00,"npi":[1851636203]}]}]},{"tin":{"type":"ein","value":"621841865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":248.82,"providers":[{"billed_charge":570.00,"npi":[1659036879]}]}]},{"tin":{"type":"ein","value":"620874165"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1592.29,"providers":[{"billed_charge":4884.51,"npi":[1861762767]}]},{"allowed_amount":1332.38,"providers":[{"billed_charge":2973.18,"npi":[1861762767]}]}]},{"tin":{"type":"ein","value":"621400509"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":622.29,"providers":[{"billed_charge":900.00,"npi":[1689348203]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":361.98,"providers":[{"billed_charge":1500.00,"npi":[1023157195]}]},{"allowed_amount":1589.68,"providers":[{"billed_charge":7750.00,"npi":[1043870157]}]},{"allowed_amount":1999.92,"providers":[{"billed_charge":9750.00,"npi":[1356764088]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":846.00,"providers":[{"billed_charge":2400.00,"npi":[1902551682]}]}]},{"tin":{"type":"ein","value":"621081700"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":317.25,"providers":[{"billed_charge":750.00,"npi":[1134686116]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":916.50,"providers":[{"billed_charge":2100.02,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"820603989"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1551.00,"providers":[{"billed_charge":4532.00,"npi":[1992376115]}]}]},{"tin":{"type":"ein","value":"621484602"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3807.00,"providers":[{"billed_charge":4590.00,"npi":[1053467589]}]}]},{"tin":{"type":"ein","value":"621307839"},"service_code":["72","10"],"billing_class":"professional","payments":[{"allowed_amount":1907.62,"providers":[{"billed_charge":2990.00,"npi":[1326381856]}]},{"allowed_amount":60.33,"providers":[{"billed_charge":130.00,"npi":[1326381856]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":199.08,"providers":[{"billed_charge":450.00,"npi":[1164083747]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":450.88,"providers":[{"billed_charge":657.00,"npi":[1234567893]}]},{"allowed_amount":11179.25,"providers":[{"billed_charge":24388.00,"npi":[1234567893]}]},{"allowed_amount":7838.65,"providers":[{"billed_charge":16198.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1269.00,"providers":[{"billed_charge":4482.00,"npi":[1093414914]}]}]},{"tin":{"type":"ein","value":"920265597"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":331.76,"providers":[{"billed_charge":3000.00,"npi":[1518940790]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99214","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"626001445"},"service_code":["02","71"],"billing_class":"professional","payments":[{"allowed_amount":88.80,"providers":[{"billed_charge":201.83,"npi":[1316977812]}]},{"allowed_amount":8651.34,"providers":[{"billed_charge":15036.34,"npi":[1316977812]}]},{"allowed_amount":116.91,"providers":[{"billed_charge":201.83,"npi":[1295705564]}]}]},{"tin":{"type":"ein","value":"261917198"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":99.37,"providers":[{"billed_charge":175.00,"npi":[1801595764]}]}]},{"tin":{"type":"ein","value":"621781969"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":917.37,"providers":[{"billed_charge":2178.00,"npi":[1538240130]}]},{"allowed_amount":407.72,"providers":[{"billed_charge":968.00,"npi":[1538240130]}]}]},{"tin":{"type":"ein","value":"464376962"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":596.28,"providers":[{"billed_charge":1050.00,"npi":[1538908421]}]}]},{"tin":{"type":"ein","value":"452689959"},"service_code":["72","10"],"billing_class":"professional","payments":[{"allowed_amount":301.92,"providers":[{"billed_charge":552.00,"npi":[1861818437]}]},{"allowed_amount":2186.36,"providers":[{"billed_charge":3036.00,"npi":[1861818437]}]}]},{"tin":{"type":"ein","value":"874127862"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1192.56,"providers":[{"billed_charge":1860.00,"npi":[1942694641]}]}]},{"tin":{"type":"ein","value":"262704338"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1490.70,"providers":[{"billed_charge":2220.00,"npi":[1639940786]}]}]},{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":3477.95,"providers":[{"billed_charge":4690.00,"npi":[1225648009]}]},{"allowed_amount":1132.20,"providers":[{"billed_charge":2010.00,"npi":[1225648009]}]}]},{"tin":{"type":"ein","value":"851230024"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1519.83,"providers":[{"billed_charge":3978.00,"npi":[1598723645]}]}]},{"tin":{"type":"ein","value":"461115240"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1689.46,"providers":[{"billed_charge":3601.00,"npi":[1851636203]}]}]},{"tin":{"type":"ein","value":"881104491"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":10755.72,"providers":[{"billed_charge":18400.00,"npi":[1538223326]}]},{"allowed_amount":15273.60,"providers":[{"billed_charge":34400.00,"npi":[1538223326]}]}]},{"tin":{"type":"ein","value":"990968766"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2384.88,"providers":[{"billed_charge":3600.00,"npi":[1962855445]}]}]},{"tin":{"type":"ein","value":"832104126"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":12893.54,"providers":[{"billed_charge":31106.00,"npi":[1457017246]}]},{"allowed_amount":2503.60,"providers":[{"billed_charge":6040.00,"npi":[1275106429]}]}]},{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1093.18,"providers":[{"billed_charge":2750.00,"npi":[1902551682]}]},{"allowed_amount":1788.84,"providers":[{"billed_charge":4500.00,"npi":[1760111934]}]}]},{"tin":{"type":"ein","value":"843362796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3776.44,"providers":[{"billed_charge":9028.80,"npi":[1477091122]}]}]},{"tin":{"type":"ein","value":"471157530"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":901.32,"providers":[{"billed_charge":1085.28,"npi":[1982229076]}]}]},{"tin":{"type":"ein","value":"820603989"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2186.36,"providers":[{"billed_charge":6688.00,"npi":[1992376115]}]}]},{"tin":{"type":"ein","value":"621484602"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1192.56,"providers":[{"billed_charge":1500.00,"npi":[1053467589]}]}]},{"tin":{"type":"ein","value":"621307839"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":3390.39,"providers":[{"billed_charge":4060.00,"npi":[1326381856]}]}]},{"tin":{"type":"ein","value":"262777772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":116.91,"providers":[{"billed_charge":310.00,"npi":[1740766922]}]}]},{"tin":{"type":"ein","value":"841737116"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":150.96,"providers":[{"billed_charge":408.00,"npi":[1629846720]}]},{"allowed_amount":596.28,"providers":[{"billed_charge":1224.00,"npi":[1629846720]}]}]},{"tin":{"type":"ein","value":"611594871"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":993.80,"providers":[{"billed_charge":3510.00,"npi":[1093414914]}]}]},{"tin":{"type":"ein","value":"626000101"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":290.91,"providers":[{"billed_charge":687.00,"npi":[1780048785]}]},{"allowed_amount":884.94,"providers":[{"billed_charge":1603.00,"npi":[1780048785]}]}]},{"tin":{"type":"ein","value":"871243993"},"service_code":["22","02"],"billing_class":"professional","payments":[{"allowed_amount":656.69,"providers":[{"billed_charge":1880.00,"npi":[1780044792]}]},{"allowed_amount":1381.29,"providers":[{"billed_charge":4230.00,"npi":[1780044792]}]}]},{"tin":{"type":"ein","value":"473734336"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1590.08,"providers":[{"billed_charge":2400.00,"npi":[1881112308]}]},{"allowed_amount":1358.64,"providers":[{"billed_charge":2700.00,"npi":[1881112308]}]},{"allowed_amount":75.48,"providers":[{"billed_charge":150.00,"npi":[1386238129]}]},{"allowed_amount":298.14,"providers":[{"billed_charge":450.00,"npi":[1386238129]}]}]},{"tin":{"type":"ein","value":"320165938"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.76,"providers":[{"billed_charge":350.00,"npi":[1154832459]}]}]},{"tin":{"type":"ein","value":"621841865"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1636.74,"providers":[{"billed_charge":3388.00,"npi":[1659036879]}]}]},{"tin":{"type":"ein","value":"824982979"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":150.96,"providers":[{"billed_charge":450.00,"npi":[1073121182]}]},{"allowed_amount":1391.32,"providers":[{"billed_charge":3150.00,"npi":[1073121182]}]}]},{"tin":{"type":"ein","value":"922040476"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":75.48,"providers":[{"billed_charge":150.00,"npi":[1578074480]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["19","10"],"billing_class":"professional","payments":[{"allowed_amount":141.12,"providers":[{"billed_charge":250.00,"npi":[1558970517]}]},{"allowed_amount":2822.40,"providers":[{"billed_charge":5000.00,"npi":[1558970517]}]},{"allowed_amount":423.36,"providers":[{"billed_charge":750.00,"npi":[1386964641]}]},{"allowed_amount":2540.16,"providers":[{"billed_charge":4500.00,"npi":[1386964641]}]}]},{"tin":{"type":"ein","value":"620913596"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2572.00,"providers":[{"billed_charge":5460.00,"npi":[1942705637]}]}]},{"tin":{"type":"ein","value":"834383631"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":301.92,"providers":[{"billed_charge":1200.00,"npi":[1043870157,1770079675]}]},{"allowed_amount":3396.60,"providers":[{"billed_charge":13500.00,"npi":[1356764088]}]}]},{"tin":{"type":"ein","value":"30417049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1583.01,"providers":[{"billed_charge":2421.00,"npi":[1669134177]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"831989830"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":111.66,"providers":[{"billed_charge":150.51,"npi":[1083130330]}]},{"allowed_amount":1674.90,"providers":[{"billed_charge":2257.65,"npi":[1417516469]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99221","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"621400167"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":139.96,"providers":[{"billed_charge":550.00,"npi":[1861080343]}]}]}]},{"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":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":526.48,"providers":[{"billed_charge":1200.00,"npi":[1982199634]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":443.92,"providers":[{"billed_charge":1500.00,"npi":[1992371330]}]}]}]},{"name":"INITIAL HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99223","description":"INITIAL HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE","allowed_amounts":[{"tin":{"type":"ein","value":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":12480.64,"providers":[{"billed_charge":22400.00,"npi":[1982199634]}]}]},{"tin":{"type":"ein","value":"821101530"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":950.58,"providers":[{"billed_charge":2772.00,"npi":[1316364680]}]},{"allowed_amount":633.72,"providers":[{"billed_charge":1848.00,"npi":[1942887500]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99231","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"621400167"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2344.16,"providers":[{"billed_charge":4200.00,"npi":[1861080343]}]}]},{"tin":{"type":"ein","value":"205566098"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":483.52,"providers":[{"billed_charge":800.00,"npi":[1710542303]}]}]},{"tin":{"type":"ein","value":"471052932"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":418.60,"providers":[{"billed_charge":750.00,"npi":[1679235212]}]},{"allowed_amount":1172.08,"providers":[{"billed_charge":2100.00,"npi":[1164104543]}]},{"allowed_amount":2218.58,"providers":[{"billed_charge":3975.00,"npi":[1992371330]}]}]},{"tin":{"type":"ein","value":"581897274"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":931.94,"providers":[{"billed_charge":1802.00,"npi":[1609694702]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99232","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"934267912"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":289.08,"providers":[{"billed_charge":590.88,"npi":[1235106154]}]}]},{"tin":{"type":"ein","value":"832572761"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2021.59,"providers":[{"billed_charge":3388.36,"npi":[1386609055]}]},{"allowed_amount":278.84,"providers":[{"billed_charge":467.36,"npi":[1083711535]}]},{"allowed_amount":1882.17,"providers":[{"billed_charge":3154.68,"npi":[1336435551]}]}]},{"tin":{"type":"ein","value":"621650705"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":93.95,"providers":[{"billed_charge":100.00,"npi":[1235247958]}]}]},{"tin":{"type":"ein","value":"832356574"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":361.35,"providers":[{"billed_charge":1010.00,"npi":[1558331306]}]},{"allowed_amount":72.27,"providers":[{"billed_charge":202.00,"npi":[1558331306]}]}]},{"tin":{"type":"ein","value":"883208334"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":574.72,"providers":[{"billed_charge":840.00,"npi":[1215233192]}]}]},{"tin":{"type":"ein","value":"271861450"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":307.15,"providers":[{"billed_charge":1108.35,"npi":[1063160489]}]}]},{"tin":{"type":"ein","value":"320530876"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":209.13,"providers":[{"billed_charge":480.00,"npi":[1477904241]}]}]},{"tin":{"type":"ein","value":"205291426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":8444.60,"providers":[{"billed_charge":15600.00,"npi":[1013135623]}]}]},{"tin":{"type":"ein","value":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":1394.20,"providers":[{"billed_charge":3000.00,"npi":[1982199634]}]}]},{"tin":{"type":"ein","value":"202371276"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":81.68,"providers":[{"billed_charge":202.36,"npi":[1871522201]}]}]},{"tin":{"type":"ein","value":"821101530"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":2095.83,"providers":[{"billed_charge":6119.00,"npi":[1528621661]}]},{"allowed_amount":72.27,"providers":[{"billed_charge":211.00,"npi":[1528621661,1760010185]}]},{"allowed_amount":939.51,"providers":[{"billed_charge":2743.00,"npi":[1891997961]}]},{"allowed_amount":1259.90,"providers":[{"billed_charge":3798.00,"npi":[1306209689]}]},{"allowed_amount":1156.32,"providers":[{"billed_charge":3376.00,"npi":[1437737228]}]},{"allowed_amount":144.54,"providers":[{"billed_charge":422.00,"npi":[1841606456,1760010185]}]},{"allowed_amount":578.16,"providers":[{"billed_charge":1688.00,"npi":[1245893544,1538747993]}]}]},{"tin":{"type":"ein","value":"810718016"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":139.42,"providers":[{"billed_charge":556.00,"npi":[1467510693]}]}]},{"tin":{"type":"ein","value":"842814288"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1479.85,"providers":[{"billed_charge":2720.00,"npi":[1194448258]}]}]},{"tin":{"type":"ein","value":"821743859"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":2764.35,"providers":[{"billed_charge":8460.00,"npi":[1710692900]}]}]},{"tin":{"type":"ein","value":"680489162"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":59.25,"providers":[{"billed_charge":219.00,"npi":[1881143360]}]},{"allowed_amount":258.68,"providers":[{"billed_charge":876.00,"npi":[1851815542]}]}]},{"tin":{"type":"ein","value":"922727340"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":2021.59,"providers":[{"billed_charge":4350.00,"npi":[1639631252]}]}]},{"tin":{"type":"ein","value":"203279920"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":331.68,"providers":[{"billed_charge":1488.00,"npi":[1699093286]}]},{"allowed_amount":209.13,"providers":[{"billed_charge":771.00,"npi":[1184644247]}]},{"allowed_amount":780.48,"providers":[{"billed_charge":2976.00,"npi":[1285054239]}]},{"allowed_amount":910.56,"providers":[{"billed_charge":3472.00,"npi":[1144718677]}]},{"allowed_amount":130.08,"providers":[{"billed_charge":496.00,"npi":[1255319067]},{"billed_charge":584.00,"npi":[1568091205]}]},{"allowed_amount":195.12,"providers":[{"billed_charge":744.00,"npi":[1619457868]},{"billed_charge":876.00,"npi":[1679156806]}]},{"allowed_amount":520.32,"providers":[{"billed_charge":1984.00,"npi":[1972164580]}]},{"allowed_amount":455.28,"providers":[{"billed_charge":1736.00,"npi":[1639116999]}]}]},{"tin":{"type":"ein","value":"621825715"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":533.25,"providers":[{"billed_charge":1215.00,"npi":[1720302185]}]}]},{"tin":{"type":"ein","value":"274396698"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":216.82,"providers":[{"billed_charge":388.00,"npi":[1639261001]}]}]},{"tin":{"type":"ein","value":"621650432"},"service_code":["61","21"],"billing_class":"professional","payments":[{"allowed_amount":84.19,"providers":[{"billed_charge":195.00,"npi":[1992202899]}]},{"allowed_amount":71.11,"providers":[{"billed_charge":195.00,"npi":[1992202899]}]}]},{"tin":{"type":"ein","value":"621638512"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":118.17,"providers":[{"billed_charge":152.68,"npi":[1205814605]}]}]},{"tin":{"type":"ein","value":"264290352"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":557.68,"providers":[{"billed_charge":920.00,"npi":[1386609055]}]}]}]},{"name":"SUBSEQUENT HOSPITAL CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99233","description":"SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES AT","allowed_amounts":[{"tin":{"type":"ein","value":"203279920"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":486.70,"providers":[{"billed_charge":1780.00,"npi":[1275765950]}]}]},{"tin":{"type":"ein","value":"450573649"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":200.64,"providers":[{"billed_charge":200.76,"npi":[1235234808]}]}]},{"tin":{"type":"ein","value":"205291426"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":300.96,"providers":[{"billed_charge":462.00,"npi":[1013135623]}]}]},{"tin":{"type":"ein","value":"821101530"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":757.12,"providers":[{"billed_charge":2219.00,"npi":[1740860022]}]},{"allowed_amount":324.48,"providers":[{"billed_charge":951.00,"npi":[1477716793]}]},{"allowed_amount":648.96,"providers":[{"billed_charge":1902.00,"npi":[1760010185]}]}]},{"tin":{"type":"ein","value":"850791745"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":20465.28,"providers":[{"billed_charge":40800.00,"npi":[1982199634]}]}]},{"tin":{"type":"ein","value":"882728544"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":200.64,"providers":[{"billed_charge":438.00,"npi":[1326071804]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"815117929"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1534.59,"providers":[{"billed_charge":15060.00,"npi":[1336802479]}]},{"allowed_amount":1023.06,"providers":[{"billed_charge":9450.00,"npi":[1487198925]}]},{"allowed_amount":1203.60,"providers":[{"billed_charge":8860.00,"npi":[1205465424]}]},{"allowed_amount":3209.60,"providers":[{"billed_charge":22960.00,"npi":[1518594761]}]}]},{"tin":{"type":"ein","value":"731723107"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":452.97,"providers":[{"billed_charge":980.00,"npi":[1619918851]}]},{"allowed_amount":323.55,"providers":[{"billed_charge":600.00,"npi":[1902078041]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1222.05,"providers":[{"billed_charge":3465.00,"npi":[1942625645]}]}]},{"tin":{"type":"ein","value":"824971170"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":464.87,"providers":[{"billed_charge":9385.00,"npi":[1922596410]}]},{"allowed_amount":398.46,"providers":[{"billed_charge":7246.00,"npi":[1861541351]}]}]},{"tin":{"type":"ein","value":"621179254"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8386.97,"providers":[{"billed_charge":51565.00,"npi":[1669052940]}]},{"allowed_amount":1690.21,"providers":[{"billed_charge":10724.00,"npi":[1548903362]}]},{"allowed_amount":474.78,"providers":[{"billed_charge":3328.00,"npi":[1073183703]}]},{"allowed_amount":11040.98,"providers":[{"billed_charge":67041.00,"npi":[1205413051]}]},{"allowed_amount":1452.82,"providers":[{"billed_charge":7859.00,"npi":[1285377267]}]},{"allowed_amount":481.90,"providers":[{"billed_charge":3353.00,"npi":[1285088435]}]},{"allowed_amount":6718.12,"providers":[{"billed_charge":39987.00,"npi":[1528590346]}]},{"allowed_amount":3344.82,"providers":[{"billed_charge":18457.00,"npi":[1942760160]}]},{"allowed_amount":970.92,"providers":[{"billed_charge":6194.00,"npi":[1497498893]}]},{"allowed_amount":2157.87,"providers":[{"billed_charge":12825.00,"npi":[1437646478]}]},{"allowed_amount":1899.12,"providers":[{"billed_charge":11187.00,"npi":[1093396111]}]},{"allowed_amount":2409.50,"providers":[{"billed_charge":15153.00,"npi":[1760126783]}]},{"allowed_amount":956.68,"providers":[{"billed_charge":6681.00,"npi":[1669009353]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99284","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"621795045"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1252.44,"providers":[{"billed_charge":3417.00,"npi":[1700118411]}]},{"allowed_amount":1246.59,"providers":[{"billed_charge":3261.00,"npi":[1740763184,1346813888]}]},{"allowed_amount":3341.79,"providers":[{"billed_charge":9288.00,"npi":[1467195594]}]},{"allowed_amount":836.91,"providers":[{"billed_charge":2322.00,"npi":[1467158105]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":6671.88,"providers":[{"billed_charge":18576.00,"npi":[1649233305]},{"billed_charge":17392.00,"npi":[1972371946]}]},{"allowed_amount":5407.74,"providers":[{"billed_charge":15137.00,"npi":[1548458375]}]},{"allowed_amount":7912.62,"providers":[{"billed_charge":18202.00,"npi":[1003514894]}]},{"allowed_amount":4576.68,"providers":[{"billed_charge":10538.00,"npi":[1639633191]},{"billed_charge":12771.00,"npi":[1578073219]}]},{"allowed_amount":4167.00,"providers":[{"billed_charge":9300.00,"npi":[1720580582]}]},{"allowed_amount":6232.95,"providers":[{"billed_charge":17475.00,"npi":[1225324601]}]},{"allowed_amount":3745.62,"providers":[{"billed_charge":8370.00,"npi":[1528094471]}]},{"allowed_amount":1662.12,"providers":[{"billed_charge":3832.00,"npi":[1497217608,1275989048,1174085443,1124413455]}]},{"allowed_amount":4992.21,"providers":[{"billed_charge":13932.00,"npi":[1588472815]}]},{"allowed_amount":19143.63,"providers":[{"billed_charge":53590.00,"npi":[1790491298]}]},{"allowed_amount":7075.71,"providers":[{"billed_charge":15810.00,"npi":[1346858917]}]},{"allowed_amount":2077.65,"providers":[{"billed_charge":4790.00,"npi":[1891479457]},{"billed_charge":3820.00,"npi":[1457325755]},{"billed_charge":5817.00,"npi":[1508813700]}]},{"allowed_amount":7918.47,"providers":[{"billed_charge":18202.00,"npi":[1003400284]}]},{"allowed_amount":2083.50,"providers":[{"billed_charge":4790.00,"npi":[1053995860]},{"billed_charge":5685.00,"npi":[1043283765]}]},{"allowed_amount":3330.09,"providers":[{"billed_charge":7664.00,"npi":[1235403999]}]},{"allowed_amount":421.38,"providers":[{"billed_charge":1161.00,"npi":[1831650779]}]},{"allowed_amount":2920.41,"providers":[{"billed_charge":8127.00,"npi":[1235446766]}]},{"allowed_amount":1252.44,"providers":[{"billed_charge":2874.00,"npi":[1659876324]}]},{"allowed_amount":6238.80,"providers":[{"billed_charge":14370.00,"npi":[1770196206]}]},{"allowed_amount":4986.36,"providers":[{"billed_charge":11496.00,"npi":[1255959425]}]},{"allowed_amount":2510.73,"providers":[{"billed_charge":5748.00,"npi":[1306134986]}]},{"allowed_amount":5823.27,"providers":[{"billed_charge":15918.00,"npi":[1386949022]},{"billed_charge":13412.00,"npi":[1396298824]}]},{"allowed_amount":4570.83,"providers":[{"billed_charge":12771.00,"npi":[1003904723]}]},{"allowed_amount":2908.71,"providers":[{"billed_charge":8155.00,"npi":[1710173653]}]},{"allowed_amount":9984.42,"providers":[{"billed_charge":27288.00,"npi":[1194030809]}]},{"allowed_amount":4155.30,"providers":[{"billed_charge":7640.00,"npi":[1205375623]}]},{"allowed_amount":25797.96,"providers":[{"billed_charge":72230.00,"npi":[1942625645]}]},{"allowed_amount":3739.77,"providers":[{"billed_charge":8370.00,"npi":[1598488165]}]},{"allowed_amount":831.06,"providers":[{"billed_charge":1528.00,"npi":[1821203357]},{"billed_charge":2274.00,"npi":[1205356441,1588622732]},{"billed_charge":1860.00,"npi":[1922628882]},{"billed_charge":2322.00,"npi":[1982412912,1205026440]}]},{"allowed_amount":4161.15,"providers":[{"billed_charge":11574.00,"npi":[1245272400]},{"billed_charge":11404.00,"npi":[1548204951]}]},{"allowed_amount":5425.29,"providers":[{"billed_charge":12330.00,"npi":[1154673085]}]},{"allowed_amount":9141.66,"providers":[{"billed_charge":25542.00,"npi":[1639416720]}]},{"allowed_amount":1667.97,"providers":[{"billed_charge":3832.00,"npi":[1902420250]}]},{"allowed_amount":9996.12,"providers":[{"billed_charge":27792.00,"npi":[1538789383]}]},{"allowed_amount":5829.12,"providers":[{"billed_charge":16258.00,"npi":[1780004002]}]},{"allowed_amount":24966.90,"providers":[{"billed_charge":69900.00,"npi":[1053762732]}]},{"allowed_amount":415.53,"providers":[{"billed_charge":958.00,"npi":[1174681639,1174588297,1770218877]},{"billed_charge":930.00,"npi":[1730628603]},{"billed_charge":993.00,"npi":[1780612481]},{"billed_charge":1165.00,"npi":[1902212657,1568402857]}]},{"allowed_amount":3324.24,"providers":[{"billed_charge":6112.00,"npi":[1063458479]},{"billed_charge":7664.00,"npi":[1487812160]}]},{"allowed_amount":8322.30,"providers":[{"billed_charge":21129.00,"npi":[1447237110]},{"billed_charge":22740.00,"npi":[1417580754]}]},{"allowed_amount":6654.33,"providers":[{"billed_charge":14880.00,"npi":[1811255607]}]},{"allowed_amount":836.91,"providers":[{"billed_charge":1916.00,"npi":[1447294848]},{"billed_charge":2322.00,"npi":[1083422901]},{"billed_charge":2308.00,"npi":[1447667423]}]},{"allowed_amount":10821.33,"providers":[{"billed_charge":24908.00,"npi":[1801561279]}]},{"allowed_amount":2499.03,"providers":[{"billed_charge":5748.00,"npi":[1780030536]}]},{"allowed_amount":2089.35,"providers":[{"billed_charge":4790.00,"npi":[1508196924]}]}]},{"tin":{"type":"ein","value":"621130266"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3330.09,"providers":[{"billed_charge":9112.00,"npi":[1194259630]}]},{"allowed_amount":2083.50,"providers":[{"billed_charge":5695.00,"npi":[1104355163]},{"billed_charge":4820.00,"npi":[1588333116]}]},{"allowed_amount":3324.24,"providers":[{"billed_charge":9758.00,"npi":[1548622186]},{"billed_charge":7712.00,"npi":[1053038638]}]},{"allowed_amount":1252.44,"providers":[{"billed_charge":3741.00,"npi":[1114298916]}]},{"allowed_amount":4998.06,"providers":[{"billed_charge":13668.00,"npi":[1922628841]}]},{"allowed_amount":2493.18,"providers":[{"billed_charge":6683.00,"npi":[1780682906]}]},{"allowed_amount":4570.83,"providers":[{"billed_charge":12529.00,"npi":[1609189695]}]},{"allowed_amount":2499.03,"providers":[{"billed_charge":7482.00,"npi":[1831400449]}]},{"allowed_amount":1667.97,"providers":[{"billed_charge":3856.00,"npi":[1952863391]}]}]},{"tin":{"type":"ein","value":"922122433"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":330.75,"providers":[{"billed_charge":678.00,"npi":[1063797421]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99285","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"621795045"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":2418.24,"providers":[{"billed_charge":6464.00,"npi":[1912035635]}]},{"allowed_amount":1813.68,"providers":[{"billed_charge":4848.00,"npi":[1346813888]}]},{"allowed_amount":10294.54,"providers":[{"billed_charge":28016.00,"npi":[1700118411]}]}]},{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":11495.15,"providers":[{"billed_charge":26429.00,"npi":[1326676628]},{"billed_charge":32395.00,"npi":[1942625645]}]},{"allowed_amount":23603.37,"providers":[{"billed_charge":54249.00,"npi":[1104867381]}]},{"allowed_amount":8497.88,"providers":[{"billed_charge":23870.00,"npi":[1982858312]}]},{"allowed_amount":32075.72,"providers":[{"billed_charge":90365.00,"npi":[1639433949]}]},{"allowed_amount":4844.99,"providers":[{"billed_charge":11128.00,"npi":[1124413455,1003514894]}]},{"allowed_amount":15182.08,"providers":[{"billed_charge":35089.00,"npi":[1780030536]}]},{"allowed_amount":4853.50,"providers":[{"billed_charge":13496.00,"npi":[1427373760,1013455104]}]},{"allowed_amount":1209.12,"providers":[{"billed_charge":3372.00,"npi":[1649233305,1497011696]},{"billed_charge":3410.00,"npi":[1689223489]}]},{"allowed_amount":15173.57,"providers":[{"billed_charge":42150.00,"npi":[1306378526]}]},{"allowed_amount":21202.15,"providers":[{"billed_charge":52213.00,"npi":[1447237110]}]},{"allowed_amount":5441.04,"providers":[{"billed_charge":15183.00,"npi":[1316502032]}]},{"allowed_amount":11486.64,"providers":[{"billed_charge":32395.00,"npi":[1710173653]}]},{"allowed_amount":4257.45,"providers":[{"billed_charge":11878.00,"npi":[1508813700]},{"billed_charge":11935.00,"npi":[1215318951]},{"billed_charge":9737.00,"npi":[1174588297]}]},{"allowed_amount":20572.06,"providers":[{"billed_charge":57970.00,"npi":[1790491298]}]},{"allowed_amount":5458.06,"providers":[{"billed_charge":12519.00,"npi":[1275989048]}]},{"allowed_amount":15148.04,"providers":[{"billed_charge":42625.00,"npi":[1942647094]}]},{"allowed_amount":9076.91,"providers":[{"billed_charge":20865.00,"npi":[1427678416]}]},{"allowed_amount":9068.40,"providers":[{"billed_charge":19729.00,"npi":[1174681639]}]},{"allowed_amount":3031.31,"providers":[{"billed_charge":8435.00,"npi":[1316500358]},{"billed_charge":8430.00,"npi":[1639416720]}]},{"allowed_amount":3022.80,"providers":[{"billed_charge":6955.00,"npi":[1326546664]},{"billed_charge":8430.00,"npi":[1578903662]}]},{"allowed_amount":6054.11,"providers":[{"billed_charge":16860.00,"npi":[1285212100]},{"billed_charge":13500.00,"npi":[1720580582]}]},{"allowed_amount":1217.63,"providers":[{"billed_charge":2782.00,"npi":[1801561279]}]},{"allowed_amount":1813.68,"providers":[{"billed_charge":4173.00,"npi":[1346866324,1770218877]},{"billed_charge":5061.00,"npi":[1417392812]}]},{"allowed_amount":14534.97,"providers":[{"billed_charge":32400.00,"npi":[1184664872]}]},{"allowed_amount":613.07,"providers":[{"billed_charge":1550.00,"npi":[1184030660]},{"billed_charge":1391.00,"npi":[1346297686]}]},{"allowed_amount":10311.56,"providers":[{"billed_charge":23647.00,"npi":[1497217608]}]},{"allowed_amount":604.56,"providers":[{"billed_charge":1686.00,"npi":[1902485238]},{"billed_charge":1643.00,"npi":[1205356441]},{"billed_charge":1350.00,"npi":[1982874533]}]},{"allowed_amount":9689.98,"providers":[{"billed_charge":26976.00,"npi":[1538366117]}]},{"allowed_amount":1822.19,"providers":[{"billed_charge":4335.00,"npi":[1780612481]}]},{"allowed_amount":5449.55,"providers":[{"billed_charge":15345.00,"npi":[1154663821]}]},{"allowed_amount":31496.69,"providers":[{"billed_charge":88660.00,"npi":[1225324601]}]},{"allowed_amount":6062.62,"providers":[{"billed_charge":17050.00,"npi":[1902212657]}]},{"allowed_amount":28414.32,"providers":[{"billed_charge":80135.00,"npi":[1952613408]}]},{"allowed_amount":16340.14,"providers":[{"billed_charge":37557.00,"npi":[1700981271]}]},{"allowed_amount":20580.57,"providers":[{"billed_charge":57970.00,"npi":[1053762732]}]},{"allowed_amount":7254.72,"providers":[{"billed_charge":16692.00,"npi":[1487812160]}]},{"allowed_amount":6675.69,"providers":[{"billed_charge":15615.00,"npi":[1447294848]}]},{"allowed_amount":1830.70,"providers":[{"billed_charge":4335.00,"npi":[1538160536]}]},{"allowed_amount":2426.75,"providers":[{"billed_charge":5564.00,"npi":[1003400284,1124433107,1659876324]},{"billed_charge":6572.00,"npi":[1548204951]}]},{"allowed_amount":14551.99,"providers":[{"billed_charge":40488.00,"npi":[1003904723]}]},{"allowed_amount":4836.48,"providers":[{"billed_charge":10800.00,"npi":[1346858917]}]},{"allowed_amount":3635.87,"providers":[{"billed_charge":8346.00,"npi":[1770196206]},{"billed_charge":7240.00,"npi":[1154673085]}]},{"allowed_amount":2418.24,"providers":[{"billed_charge":6748.00,"npi":[1548792153]},{"billed_charge":6572.00,"npi":[1942201058,1194030809,1245272400]},{"billed_charge":6744.00,"npi":[1245646850]},{"billed_charge":6701.00,"npi":[1538789383]}]},{"allowed_amount":3644.38,"providers":[{"billed_charge":8100.00,"npi":[1811255607]}]},{"allowed_amount":7910.34,"providers":[{"billed_charge":22165.00,"npi":[1518914951]}]},{"allowed_amount":20606.10,"providers":[{"billed_charge":47294.00,"npi":[1235403999]}]},{"allowed_amount":3627.36,"providers":[{"billed_charge":10230.00,"npi":[1972543536]},{"billed_charge":6642.00,"npi":[1205375623]},{"billed_charge":10116.00,"npi":[1942363379]}]},{"allowed_amount":19431.02,"providers":[{"billed_charge":44512.00,"npi":[1467490805]}]},{"allowed_amount":4240.43,"providers":[{"billed_charge":11501.00,"npi":[1063451672]}]},{"allowed_amount":6667.18,"providers":[{"billed_charge":15301.00,"npi":[1194768085]},{"billed_charge":12177.00,"npi":[1063458479]}]}]},{"tin":{"type":"ein","value":"621130266"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":7901.83,"providers":[{"billed_charge":21424.00,"npi":[1104355163]}]},{"allowed_amount":3022.80,"providers":[{"billed_charge":8240.00,"npi":[1194259630]}]},{"allowed_amount":604.56,"providers":[{"billed_charge":1686.00,"npi":[1770624108]}]},{"allowed_amount":1209.12,"providers":[{"billed_charge":3372.00,"npi":[1841285228]}]},{"allowed_amount":6054.11,"providers":[{"billed_charge":16160.00,"npi":[1184787855]}]},{"allowed_amount":1217.63,"providers":[{"billed_charge":3390.00,"npi":[1700063351]}]},{"allowed_amount":1813.68,"providers":[{"billed_charge":5088.00,"npi":[1205809522]}]},{"allowed_amount":613.07,"providers":[{"billed_charge":1403.00,"npi":[1053038638]}]},{"allowed_amount":3031.31,"providers":[{"billed_charge":8080.00,"npi":[1215275110]}]},{"allowed_amount":10890.59,"providers":[{"billed_charge":29216.00,"npi":[1780682906]}]}]}]},{"name":"CRITICAL CARE, FIRST HOUR","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99291","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; FIRST","allowed_amounts":[{"tin":{"type":"ein","value":"203279920"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1338.84,"providers":[{"billed_charge":6831.00,"npi":[1972965275,1093125197]}]},{"allowed_amount":175.01,"providers":[{"billed_charge":759.00,"npi":[1396188975]}]}]},{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":4424.56,"providers":[{"billed_charge":48400.00,"npi":[1912906660]}]},{"allowed_amount":1014.14,"providers":[{"billed_charge":11000.00,"npi":[1205650124]}]}]}]},{"name":"CRITICAL CARE ADDL 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99292","description":"CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLY ILL OR CRITICALLY INJURED PATIENT; EACH A","allowed_amounts":[{"tin":{"type":"ein","value":"320078468"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":3991.04,"providers":[{"billed_charge":49200.00,"npi":[1205650124]}]},{"allowed_amount":20659.94,"providers":[{"billed_charge":249600.00,"npi":[1912906660]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"270257900"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":197.16,"providers":[{"billed_charge":246.00,"npi":[1407890593]}]}]},{"tin":{"type":"ein","value":"822171018"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":55.86,"providers":[{"billed_charge":138.00,"npi":[1699156323]}]}]},{"tin":{"type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":745.80,"providers":[{"billed_charge":2574.00,"npi":[1518378629]}]}]},{"tin":{"type":"ein","value":"811562199"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":460.04,"providers":[{"billed_charge":966.00,"npi":[1548524861]}]}]},{"tin":{"type":"ein","value":"861285321"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":57.63,"providers":[{"billed_charge":116.00,"npi":[1407631229]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99309","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"822171018"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":261.24,"providers":[{"billed_charge":597.00,"npi":[1962805929]}]},{"allowed_amount":1036.28,"providers":[{"billed_charge":2786.00,"npi":[1699308171]}]},{"allowed_amount":222.06,"providers":[{"billed_charge":597.00,"npi":[1699156323]}]},{"allowed_amount":87.08,"providers":[{"billed_charge":199.00,"npi":[1497498091]}]},{"allowed_amount":74.02,"providers":[{"billed_charge":199.00,"npi":[1699308171,1699156323]}]},{"allowed_amount":1480.36,"providers":[{"billed_charge":3383.00,"npi":[1962805929]}]}]},{"tin":{"type":"ein","value":"811665429"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":501.36,"providers":[{"billed_charge":708.00,"npi":[1932497674]}]},{"allowed_amount":167.12,"providers":[{"billed_charge":244.00,"npi":[1932497674]}]}]},{"tin":{"type":"ein","value":"113490307"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":74.02,"providers":[{"billed_charge":160.00,"npi":[1952771941]}]}]},{"tin":{"type":"ein","value":"921343519"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1480.36,"providers":[{"billed_charge":5746.00,"npi":[1497756258]}]}]},{"tin":{"type":"ein","value":"472590836"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":334.24,"providers":[{"billed_charge":1352.00,"npi":[1811343148]}]}]},{"tin":{"type":"ein","value":"460718058"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":1110.30,"providers":[{"billed_charge":1560.00,"npi":[1467901058]}]},{"allowed_amount":148.04,"providers":[{"billed_charge":208.00,"npi":[1033628284]}]},{"allowed_amount":1332.36,"providers":[{"billed_charge":1872.00,"npi":[1033628284]}]}]},{"tin":{"type":"ein","value":"810712242"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":740.20,"providers":[{"billed_charge":2150.00,"npi":[1447742259]}]},{"allowed_amount":444.12,"providers":[{"billed_charge":1290.00,"npi":[1447742259]}]}]}]},{"name":"BEHAV CHNG SMOKING 3-10 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99406","description":"SMOKING AND TOBACCO USE CESSATION COUNSELING VISIT; INTERMEDIATE, GREATER THAN 3 MINUTES UP TO 10 MI","allowed_amounts":[{"tin":{"type":"ein","value":"621266047"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":294.59,"providers":[{"billed_charge":609.00,"npi":[1942647094]}]}]}]},{"name":"TRANS CARE MGMT 7 DAY DISCH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99496","description":"TRANSITIONAL CARE MANAGEMENT SERVICES W THE FOLLOWING REQUIRED ELEMENTS: COMMUNICATION (DIRECT CONTA","allowed_amounts":[{"tin":{"type":"ein","value":"831989830"},"service_code":["12","10"],"billing_class":"professional","payments":[{"allowed_amount":1032.22,"providers":[{"billed_charge":1596.35,"npi":[1417516469]}]},{"allowed_amount":216.19,"providers":[{"billed_charge":228.05,"npi":[1417516469]}]}]}]},{"name":"GRND MLGE PER STATUTE MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0425","description":"GROUND MILEAGE, PER STATUTE MILE","allowed_amounts":[{"tin":{"type":"ein","value":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":49065.01,"providers":[{"billed_charge":172100.22,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"620946367"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":237.04,"providers":[{"billed_charge":558.00,"npi":[1821071697]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3249.58,"providers":[{"billed_charge":5602.50,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000572"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":236.44,"providers":[{"billed_charge":312.00,"npi":[1801082383]}]}]},{"tin":{"type":"ein","value":"626000890"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2444.68,"providers":[{"billed_charge":3322.00,"npi":[1790760767]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8294.06,"providers":[{"billed_charge":16538.62,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35393.99,"providers":[{"billed_charge":182212.14,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"922991658"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5045.15,"providers":[{"billed_charge":29179.09,"npi":[1770272585]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":25052.41,"providers":[{"billed_charge":39715.00,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"900766703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3328.18,"providers":[{"billed_charge":5553.80,"npi":[1629069430]}]}]},{"tin":{"type":"ein","value":"620879009"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7975.80,"providers":[{"billed_charge":13634.19,"npi":[1871538728]}]}]},{"tin":{"type":"ein","value":"626000806"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4651.68,"providers":[{"billed_charge":13252.70,"npi":[1659348209]}]}]},{"tin":{"type":"ein","value":"823967145"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22816.60,"providers":[{"billed_charge":108167.27,"npi":[1861900961]}]}]},{"tin":{"type":"ein","value":"626000604"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9050.40,"providers":[{"billed_charge":16230.40,"npi":[1083624902]}]}]},{"tin":{"type":"ein","value":"626000723"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2908.22,"providers":[{"billed_charge":5704.00,"npi":[1285745356]}]}]},{"tin":{"type":"ein","value":"626000647"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1679.94,"providers":[{"billed_charge":4525.00,"npi":[1689623050]}]}]},{"tin":{"type":"ein","value":"626000446"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3388.94,"providers":[{"billed_charge":6011.00,"npi":[1447217484]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":255295.88,"providers":[{"billed_charge":766650.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2012.66,"providers":[{"billed_charge":3585.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"621566628"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2168.78,"providers":[{"billed_charge":4044.38,"npi":[1720176761]}]}]},{"tin":{"type":"ein","value":"626000783"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4532.14,"providers":[{"billed_charge":7021.16,"npi":[1326019480]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":96382.93,"providers":[{"billed_charge":515580.54,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5407.08,"providers":[{"billed_charge":18671.12,"npi":[1407274947]}]}]},{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17641.83,"providers":[{"billed_charge":57256.20,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"882026637"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":176.42,"providers":[{"billed_charge":966.00,"npi":[1972248599]}]}]},{"tin":{"type":"ein","value":"850904868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8072.35,"providers":[{"billed_charge":31607.74,"npi":[1467073338]}]}]},{"tin":{"type":"ein","value":"202864837"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1510.68,"providers":[{"billed_charge":3931.40,"npi":[1245381532]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8062.12,"providers":[{"billed_charge":13461.20,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5380.24,"providers":[{"billed_charge":13127.04,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000614"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2217.08,"providers":[{"billed_charge":4100.29,"npi":[1134110042]}]}]},{"tin":{"type":"ein","value":"626000611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2141.76,"providers":[{"billed_charge":4445.00,"npi":[1780675942]}]}]},{"tin":{"type":"ein","value":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21069.20,"providers":[{"billed_charge":63383.00,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9588.04,"providers":[{"billed_charge":33418.44,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"831147798"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8521.20,"providers":[{"billed_charge":27638.80,"npi":[1285113118]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11670.78,"providers":[{"billed_charge":23930.90,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39842.36,"providers":[{"billed_charge":154114.00,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"831033146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12610.81,"providers":[{"billed_charge":66932.22,"npi":[1205318789]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10836.22,"providers":[{"billed_charge":19918.50,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"882472117"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2869.38,"providers":[{"billed_charge":4778.20,"npi":[1487389698]}]}]},{"tin":{"type":"ein","value":"821436121"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1679.78,"providers":[{"billed_charge":2499.50,"npi":[1154849115]}]}]},{"tin":{"type":"ein","value":"626000703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":690.92,"providers":[{"billed_charge":1216.50,"npi":[1730179250]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10672.51,"providers":[{"billed_charge":13305.68,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9131.49,"providers":[{"billed_charge":16430.66,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000866"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4097.73,"providers":[{"billed_charge":8525.90,"npi":[1487654927]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9058.68,"providers":[{"billed_charge":21396.00,"npi":[1841276300]}]}]},{"tin":{"type":"ein","value":"581468813"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1385.17,"providers":[{"billed_charge":2896.20,"npi":[1992799233]}]}]},{"tin":{"type":"ein","value":"854394625"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5501.57,"providers":[{"billed_charge":23065.00,"npi":[1851974208]}]}]},{"tin":{"type":"ein","value":"626000841"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1412.25,"providers":[{"billed_charge":3580.00,"npi":[1083158570]}]}]},{"tin":{"type":"ein","value":"626000764"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8455.56,"providers":[{"billed_charge":10865.51,"npi":[1053316265]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":41533.14,"providers":[{"billed_charge":99400.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"626000483"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3180.60,"providers":[{"billed_charge":5036.71,"npi":[1215901640]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13658.22,"providers":[{"billed_charge":27732.10,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"621325262"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2404.86,"providers":[{"billed_charge":5888.95,"npi":[1659353761]}]}]},{"tin":{"type":"ein","value":"461615070"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3714.48,"providers":[{"billed_charge":9197.70,"npi":[1215368634]}]}]},{"tin":{"type":"ein","value":"721519591"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7153.60,"providers":[{"billed_charge":13398.40,"npi":[1457322612]}]}]},{"tin":{"type":"ein","value":"621141186"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2213.44,"providers":[{"billed_charge":5508.02,"npi":[1184633679]}]}]},{"tin":{"type":"ein","value":"626000759"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18697.68,"providers":[{"billed_charge":45807.30,"npi":[1417061136]}]}]},{"tin":{"type":"ein","value":"991437440"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1021.09,"providers":[{"billed_charge":1100.00,"npi":[1881406908]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14741.59,"providers":[{"billed_charge":41030.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"621146791"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3910.20,"providers":[{"billed_charge":5462.50,"npi":[1033182704]}]}]},{"tin":{"type":"ein","value":"320434218"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3717.70,"providers":[{"billed_charge":6276.00,"npi":[1376954487]}]}]},{"tin":{"type":"ein","value":"621166264"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4586.26,"providers":[{"billed_charge":11554.20,"npi":[1396829081]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4548.16,"providers":[{"billed_charge":15200.00,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9290.42,"providers":[{"billed_charge":112885.76,"npi":[1720300379]}]}]}]},{"name":"AMB SVC ALS ER TRNSPRT LVL1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0427","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT, LEVEL 1 (ALS 1 - EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":36521.80,"providers":[{"billed_charge":108153.52,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16897.95,"providers":[{"billed_charge":58187.12,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":260919.90,"providers":[{"billed_charge":924665.85,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31008.78,"providers":[{"billed_charge":44200.00,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15360.28,"providers":[{"billed_charge":26400.00,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000890"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8295.36,"providers":[{"billed_charge":10200.00,"npi":[1790760767]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12704.55,"providers":[{"billed_charge":20732.32,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32826.15,"providers":[{"billed_charge":192851.26,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":149732.25,"providers":[{"billed_charge":215800.00,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19398.96,"providers":[{"billed_charge":33600.00,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"900766703"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3233.16,"providers":[{"billed_charge":4550.00,"npi":[1629069430]}]}]},{"tin":{"type":"ein","value":"620879009"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5246.96,"providers":[{"billed_charge":8898.24,"npi":[1871538728]}]}]},{"tin":{"type":"ein","value":"626000806"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8779.69,"providers":[{"billed_charge":25151.00,"npi":[1659348209]}]}]},{"tin":{"type":"ein","value":"626000604"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16280.34,"providers":[{"billed_charge":39100.00,"npi":[1083624902]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19698.26,"providers":[{"billed_charge":26445.00,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9206.40,"providers":[{"billed_charge":14731.40,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000866"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9400.35,"providers":[{"billed_charge":22680.00,"npi":[1487654927]}]}]},{"tin":{"type":"ein","value":"626000647"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":506.22,"providers":[{"billed_charge":1075.00,"npi":[1689623050]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35574.30,"providers":[{"billed_charge":96760.00,"npi":[1841276300]}]}]},{"tin":{"type":"ein","value":"626000764"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32514.25,"providers":[{"billed_charge":43764.00,"npi":[1053316265]}]}]},{"tin":{"type":"ein","value":"626000841"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7395.15,"providers":[{"billed_charge":19937.44,"npi":[1083158570]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6362.86,"providers":[{"billed_charge":9590.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"621566628"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7663.52,"providers":[{"billed_charge":15034.50,"npi":[1720176761]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":172806.90,"providers":[{"billed_charge":1532849.22,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":350629.95,"providers":[{"billed_charge":958815.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":900.15,"providers":[{"billed_charge":3929.20,"npi":[1407274947]}]}]},{"tin":{"type":"ein","value":"626000483"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1311.74,"providers":[{"billed_charge":2020.62,"npi":[1215901640]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19986.48,"providers":[{"billed_charge":45000.00,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32427.30,"providers":[{"billed_charge":56450.00,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"721519591"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":402.76,"providers":[{"billed_charge":1200.00,"npi":[1457322612]}]}]},{"tin":{"type":"ein","value":"621141186"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15997.80,"providers":[{"billed_charge":35679.12,"npi":[1184633679]}]}]},{"tin":{"type":"ein","value":"626000759"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15256.82,"providers":[{"billed_charge":25080.00,"npi":[1417061136]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17102.85,"providers":[{"billed_charge":42768.00,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":122954.55,"providers":[{"billed_charge":398790.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"626000614"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2404.05,"providers":[{"billed_charge":3524.85,"npi":[1134110042]}]}]},{"tin":{"type":"ein","value":"621146791"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3635.92,"providers":[{"billed_charge":4800.00,"npi":[1033182704]}]}]},{"tin":{"type":"ein","value":"626000611"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1415.20,"providers":[{"billed_charge":3084.00,"npi":[1780675942]}]}]},{"tin":{"type":"ein","value":"320434218"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2830.40,"providers":[{"billed_charge":5700.00,"npi":[1376954487]}]}]},{"tin":{"type":"ein","value":"621166264"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4142.14,"providers":[{"billed_charge":19800.00,"npi":[1396829081]}]}]}]},{"name":"AMB SERVICE BLS NONEMERG TRA","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0428","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, NONEMERGENCY TRANSPORT, (BLS)","allowed_amounts":[{"tin":{"type":"ein","value":"621642499"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1326.33,"providers":[{"billed_charge":6047.33,"npi":[1750688172]}]}]},{"tin":{"type":"ein","value":"831147798"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11166.08,"providers":[{"billed_charge":69368.00,"npi":[1285113118]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2149.58,"providers":[{"billed_charge":15750.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28119.36,"providers":[{"billed_charge":335118.95,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7222.38,"providers":[{"billed_charge":55912.22,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"581716804"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1421.28,"providers":[{"billed_charge":4650.00,"npi":[1508117722]}]}]},{"tin":{"type":"ein","value":"582605844"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14422.72,"providers":[{"billed_charge":215188.48,"npi":[1720300379]}]}]},{"tin":{"type":"ein","value":"922991658"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6212.80,"providers":[{"billed_charge":40005.08,"npi":[1770272585]}]}]},{"tin":{"type":"ein","value":"831033146"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8985.67,"providers":[{"billed_charge":56398.00,"npi":[1205318789]}]}]},{"tin":{"type":"ein","value":"850904868"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7160.32,"providers":[{"billed_charge":45124.36,"npi":[1467073338]}]}]},{"tin":{"type":"ein","value":"823967145"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12065.44,"providers":[{"billed_charge":96572.42,"npi":[1861900961]}]}]},{"tin":{"type":"ein","value":"821436121"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9161.70,"providers":[{"billed_charge":11900.00,"npi":[1154849115]}]}]},{"tin":{"type":"ein","value":"991437440"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9457.92,"providers":[{"billed_charge":64500.00,"npi":[1881406908]}]}]}]},{"name":"AMB SERVICE BLS EMERGENCY TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0429","description":"AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS, EMERGENCY)","allowed_amounts":[{"tin":{"type":"ein","value":"626000477"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1429.76,"providers":[{"billed_charge":5157.88,"npi":[1518017649]}]}]},{"tin":{"type":"ein","value":"621623714"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":47191.33,"providers":[{"billed_charge":166951.05,"npi":[1366487944]}]}]},{"tin":{"type":"ein","value":"452393528"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":301348.91,"providers":[{"billed_charge":1184625.00,"npi":[1639462476]}]}]},{"tin":{"type":"ein","value":"626000541"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1530.92,"providers":[{"billed_charge":2400.00,"npi":[1750380978]}]}]},{"tin":{"type":"ein","value":"626000795"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4418.52,"providers":[{"billed_charge":6600.00,"npi":[1679576169]}]}]},{"tin":{"type":"ein","value":"626000575"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4340.71,"providers":[{"billed_charge":7425.00,"npi":[1578576740]}]}]},{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":48618.06,"providers":[{"billed_charge":146900.00,"npi":[1942381819]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10516.75,"providers":[{"billed_charge":115216.36,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":28622.95,"providers":[{"billed_charge":109956.00,"npi":[1407274947]}]}]},{"tin":{"type":"ein","value":"990611768"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":41087.30,"providers":[{"billed_charge":490577.50,"npi":[1053172767]}]}]},{"tin":{"type":"ein","value":"621211867"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1180.17,"providers":[{"billed_charge":1865.91,"npi":[1427043702]}]}]},{"tin":{"type":"ein","value":"621533948"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4931.93,"providers":[{"billed_charge":11050.00,"npi":[1457943177]}]}]},{"tin":{"type":"ein","value":"620694743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":98086.48,"providers":[{"billed_charge":169650.00,"npi":[1134131915]}]}]},{"tin":{"type":"ein","value":"300127143"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1104.63,"providers":[{"billed_charge":1800.00,"npi":[1083725592]}]}]},{"tin":{"type":"ein","value":"626000818"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19631.49,"providers":[{"billed_charge":35725.00,"npi":[1205832797]}]}]},{"tin":{"type":"ein","value":"721519591"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":678.34,"providers":[{"billed_charge":2100.00,"npi":[1457322612]}]}]},{"tin":{"type":"ein","value":"626000549"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1618.04,"providers":[{"billed_charge":2000.00,"npi":[1467598896]}]}]},{"tin":{"type":"ein","value":"626000506"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4797.71,"providers":[{"billed_charge":7957.43,"npi":[1699844399]}]}]},{"tin":{"type":"ein","value":"626000858"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8928.34,"providers":[{"billed_charge":22604.46,"npi":[1154320687]}]}]},{"tin":{"type":"ein","value":"626000636"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2868.77,"providers":[{"billed_charge":8316.00,"npi":[1194797761]}]}]},{"tin":{"type":"ein","value":"626000501"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13558.08,"providers":[{"billed_charge":34020.00,"npi":[1841276300]}]}]}]},{"name":"AMB RSPN&TREATMENT NO TRNSPT","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0998","description":"AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT","allowed_amounts":[{"tin":{"type":"ein","value":"626000361"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":21448.00,"providers":[{"billed_charge":53620.00,"npi":[1942381819]}]}]}]},{"name":"INCONTNCE GARMENT ANY TYPE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4520","description":"INCONTINENCE GARMENT, ANY TYPE, (E.G., BRIEF, DIAPER), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"541818883"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":26.75,"providers":[{"billed_charge":89.16,"npi":[1992070593]}]}]}]},{"name":"TUBING W/INTGR HEAT ELEM W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4604","description":"TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":976.93,"providers":[{"billed_charge":980.90,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1325.35,"providers":[{"billed_charge":7439.31,"npi":[1234567893]}]}]}]},{"name":"FULL FCE MASK POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7030","description":"FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1139.95,"providers":[{"billed_charge":1161.28,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3727.25,"providers":[{"billed_charge":25028.91,"npi":[1234567893]}]}]}]},{"name":"FCE MASK INTERFCE REPL FULL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7031","description":"FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1837.43,"providers":[{"billed_charge":1859.52,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5708.08,"providers":[{"billed_charge":24654.03,"npi":[1234567893]}]}]}]},{"name":"CUSHN NASAL MASK INTF REPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7032","description":"CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":480.48,"providers":[{"billed_charge":5305.68,"npi":[1234567893]}]}]}]},{"name":"PILLW NASL CANNULA TYPE INTF","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7033","description":"PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":436.72,"providers":[{"billed_charge":3368.15,"npi":[1234567893]}]}]}]},{"name":"NASL INTERFCE POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7034","description":"NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE DEVICE, WITH OR WITHOUT HE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":337.50,"providers":[{"billed_charge":337.50,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":876.40,"providers":[{"billed_charge":7150.67,"npi":[1234567893]}]}]}]},{"name":"HEADGEAR USED W/POS ARWAY PR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7035","description":"HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":323.17,"providers":[{"billed_charge":323.17,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":743.56,"providers":[{"billed_charge":4117.11,"npi":[1234567893]}]}]}]},{"name":"TUBING USED W/POS ARWAY PRES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7037","description":"TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":706.79,"providers":[{"billed_charge":3407.82,"npi":[1234567893]}]}]}]},{"name":"FLTR DISPBL W/POS ARWAY PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7038","description":"FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":737.36,"providers":[{"billed_charge":1112.10,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":791.70,"providers":[{"billed_charge":5991.36,"npi":[1234567893]}]}]}]},{"name":"WATR CHAMB HUMDIFIR USED W/P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7046","description":"WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, REPLACEMENT, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":148.64,"providers":[{"billed_charge":1395.53,"npi":[1234567893]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":947.85,"providers":[{"billed_charge":1168.64,"npi":[1234567893]}]}]}]},{"name":"PRTBLE GASEOUS O2 SYS RENTAL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0431","description":"PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2257.12,"providers":[{"billed_charge":9730.41,"npi":[1234567893]}]}]}]},{"name":"HUMDIFIR HEAT USED W/POS ARW","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0562","description":"HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1232.46,"providers":[{"billed_charge":1232.46,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4035.68,"providers":[{"billed_charge":15822.00,"npi":[1234567893]}]}]}]},{"name":"NEBULIZER WITH COMPRESSOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0570","description":"NEBULIZER, WITH COMPRESSOR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":433.28,"providers":[{"billed_charge":3246.72,"npi":[1234567893]}]}]}]},{"name":"CONTINUOUS POS AIRWAY PRESSU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0601","description":"CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE","allowed_amounts":[{"tin":{"type":"ein","value":"882022864"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6817.43,"providers":[{"billed_charge":8500.00,"npi":[1811206741]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5349.70,"providers":[{"billed_charge":30178.36,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"621212286"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":135.69,"providers":[{"billed_charge":400.00,"npi":[1962587832]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":12456.00,"providers":[{"billed_charge":68478.22,"npi":[1234567893]}]}]}]},{"name":"PORTABLE OXYGEN CONCENTRATOR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1392","description":"PORTABLE OXYGEN CONCENTRATOR, RENTAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":995.40,"providers":[{"billed_charge":5420.00,"npi":[1234567893]}]}]}]},{"name":"PRVS TST MATL&EQUIP HM INR M","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0249","description":"PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WITH EITHER MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12","49"],"billing_class":"professional","payments":[{"allowed_amount":108.60,"providers":[{"billed_charge":280.00,"npi":[1234567893]}]},{"allowed_amount":1303.20,"providers":[{"billed_charge":3360.00,"npi":[1234567893]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 1-7","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0480","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"832297809"},"service_code":["57"],"billing_class":"professional","payments":[{"allowed_amount":1264.38,"providers":[{"billed_charge":5200.00,"npi":[1760111934]}]},{"allowed_amount":1604.79,"providers":[{"billed_charge":6600.00,"npi":[1902551682]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1183.72,"providers":[{"billed_charge":7700.94,"npi":[1234567893]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"274135289"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":2240.91,"providers":[{"billed_charge":5602.23,"npi":[1497135503]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"463723510"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":12404.35,"providers":[{"billed_charge":14875.00,"npi":[1073569695]}]},{"allowed_amount":132132.03,"providers":[{"billed_charge":144075.00,"npi":[1073569695]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"473488727"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":201.12,"providers":[{"billed_charge":800.00,"npi":[1881142784]}]},{"allowed_amount":477.66,"providers":[{"billed_charge":1900.00,"npi":[1225648009]}]},{"allowed_amount":414.81,"providers":[{"billed_charge":1650.00,"npi":[1881142784]}]},{"allowed_amount":427.38,"providers":[{"billed_charge":1700.00,"npi":[1225648009]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;11","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6013","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"621526296"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2081.07,"providers":[{"billed_charge":6387.93,"npi":[1285869362]}]}]}]},{"name":"INTENS MOD TX DEL 1/MX FLDS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6015","description":"INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM","allowed_amounts":[{"tin":{"type":"ein","value":"621526296"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2163.24,"providers":[{"billed_charge":6565.68,"npi":[1285869362]}]}]}]},{"name":"ALCOHL&/RX SRVC;AC DTOX RES","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0011","description":"ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)","allowed_amounts":[{"tin":{"type":"ein","value":"455381950"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":1170.00,"providers":[{"billed_charge":3900.00,"npi":[1225177710]}]}]}]},{"name":"ALCOHL&/RX SRVC; INTENSV OP;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0015","description":"ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":463800.00,"providers":[{"billed_charge":1159500.00,"npi":[1679985105]}]}]},{"tin":{"type":"ein","value":"472571637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76890.00,"providers":[{"billed_charge":193800.00,"npi":[1982684361]}]}]}]},{"name":"MENTAL HLTH PART HOSP TX <24","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0035","description":"MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS","allowed_amounts":[{"tin":{"type":"ein","value":"472571637"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10800.00,"providers":[{"billed_charge":43200.00,"npi":[1982684361]}]}]}]},{"name":"STANDARD WHEELCHAIR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0001","description":"STANDARD WHEELCHAIR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":574.66,"providers":[{"billed_charge":2952.70,"npi":[1234567893]}]}]}]},{"name":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1821","description":"prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":293.61,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":886.34,"providers":[{"billed_charge":1352.26,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":911.04,"providers":[{"billed_charge":1460.40,"npi":[1234567893]}]}]}]},{"name":"WHF ORTHO NO JOINTS PREFAB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3809","description":"WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, OFF-THE-SHELF, ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1662.39,"providers":[{"billed_charge":1782.00,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1516.39,"providers":[{"billed_charge":2452.02,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":18759.30,"providers":[{"billed_charge":28485.28,"npi":[1234567893]}]}]}]},{"name":"TRAVL 1 WAY NEC LAB SPEC; TR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"P9604","description":"TRAVEL ALLOWANCE, ONE WAY IN CONNECTION W MEDICALLY NECESSARY LABORATORY SPECIMEN COLLECTION DRAWN F","allowed_amounts":[{"tin":{"type":"ein","value":"650214185"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":81.60,"providers":[{"billed_charge":408.00,"npi":[1295823540]}]}]}]},{"name":"LOCM 300-399 MG/ML I CONC PE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"Q9967","description":"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML","allowed_amounts":[{"tin":{"type":"ein","value":"843073102"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":128.00,"providers":[{"billed_charge":400.00,"npi":[1932148244]}]}]}]},{"name":"INTNSVE OP PSYC SVC PER DIEM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9480","description":"INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"874825160"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":93600.00,"providers":[{"billed_charge":234000.00,"npi":[1679985105]}]}]}]}]}