{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"1.0.0","last_updated_on":"2025-12-30","out_of_network":[{"name":"NCNTC R-T FLUOR WND IMG 1ST","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"0598T","description":"NONCONTACT R-T FLUOR WND IMG 1ST ANATOMIC SITE","allowed_amounts":[{"tin":{"type":"ein","value":"841803866"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1184.04,"providers":[{"billed_charge":4979.88,"npi":[1205395282]}]},{"allowed_amount":27.18,"providers":[{"billed_charge":350.00,"npi":[1477093029]}]},{"allowed_amount":182.48,"providers":[{"billed_charge":700.00,"npi":[1841076700]}]}]}]},{"name":"RESIDENTIAL TREATMENT-PSYCHI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1001","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"872960023"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":4167.00,"providers":[{"billed_charge":16200.00,"npi":[1952047391]}]}]}]},{"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":"872960023"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":463.00,"providers":[{"billed_charge":1800.00,"npi":[1952047391]}]}]},{"tin":{"type":"ein","value":"994859635"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":586.00,"providers":[{"billed_charge":4000.00,"npi":[1891584645]}]}]}]},{"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":"636001820"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1600.46,"providers":[{"billed_charge":9305.00,"npi":[1043262488]}]}]}]},{"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":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":1641.90,"providers":[{"billed_charge":9776.45,"npi":[1234567893]}]},{"allowed_amount":54.20,"providers":[{"billed_charge":175.00,"npi":[1234567893]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":871101.01,"providers":[{"billed_charge":479451.00,"npi":[1154386431]}]}]}]},{"name":"ICU/SURGICAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"201","description":"INTENSIVE CARE - SURGICAL","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":20779.12,"providers":[{"billed_charge":23414.00,"npi":[1154386431]}]}]}]},{"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":"472228529"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":60790.28,"providers":[{"billed_charge":20295.04,"npi":[1992103857]}]}]}]},{"name":"POST CCU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"214","description":"CORONARY CARE - POST-CCU","allowed_amounts":[{"tin":{"type":"ein","value":"472228529"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":64168.72,"providers":[{"billed_charge":25030.50,"npi":[1992103857]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636005283"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.95,"providers":[{"billed_charge":76.50,"npi":[1255376828]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":35285.98,"providers":[{"billed_charge":65754.93,"npi":[1043262488]}]},{"allowed_amount":3808.60,"providers":[{"billed_charge":12695.29,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":365.13,"providers":[{"billed_charge":1216.90,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4015.02,"providers":[{"billed_charge":13382.28,"npi":[1972527265]}]},{"allowed_amount":3016.43,"providers":[{"billed_charge":9212.43,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.62,"providers":[{"billed_charge":485.40,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":677.59,"providers":[{"billed_charge":2258.79,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1146.39,"providers":[{"billed_charge":3821.30,"npi":[1992103857]}]},{"allowed_amount":18135.25,"providers":[{"billed_charge":191729.80,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12203.36,"providers":[{"billed_charge":14256.20,"npi":[1841388519]}]},{"allowed_amount":193.23,"providers":[{"billed_charge":731.10,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":574.73,"providers":[{"billed_charge":1959.70,"npi":[1154386431]}]},{"allowed_amount":10051.21,"providers":[{"billed_charge":52229.52,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11.16,"providers":[{"billed_charge":37.20,"npi":[1487699203]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":179.25,"providers":[{"billed_charge":597.50,"npi":[1780655332]}]},{"allowed_amount":82.10,"providers":[{"billed_charge":7403.55,"npi":[1780655332]}]}]}]},{"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":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1365.00,"providers":[{"billed_charge":4550.00,"npi":[1154386431]}]},{"allowed_amount":1807.45,"providers":[{"billed_charge":8315.00,"npi":[1154386431]}]}]}]},{"name":"DRUGS/NONPRSCPT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"257","description":"PHARMACY - NON-PRESCRIPTION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":433.11,"providers":[{"billed_charge":1443.76,"npi":[1154386431]}]},{"allowed_amount":0.34,"providers":[{"billed_charge":1.14,"npi":[1780235002]}]},{"allowed_amount":2379.89,"providers":[{"billed_charge":9992.59,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":135.00,"providers":[{"billed_charge":225.00,"npi":[1912428301]}]},{"allowed_amount":1276.84,"providers":[{"billed_charge":4256.13,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2514.94,"providers":[{"billed_charge":8382.50,"npi":[1972527265]}]},{"allowed_amount":1637.46,"providers":[{"billed_charge":5748.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":157.50,"providers":[{"billed_charge":525.00,"npi":[1801883780]}]},{"allowed_amount":171.16,"providers":[{"billed_charge":4393.08,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":516.68,"providers":[{"billed_charge":3645.30,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":177.30,"providers":[{"billed_charge":591.00,"npi":[1154386431]}]},{"allowed_amount":2464.56,"providers":[{"billed_charge":16895.44,"npi":[1154386431]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20060.61,"providers":[{"billed_charge":86158.82,"npi":[1972527265]}]},{"allowed_amount":1632.74,"providers":[{"billed_charge":5442.19,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":22006.45,"providers":[{"billed_charge":90785.12,"npi":[1154386431]}]},{"allowed_amount":4774.01,"providers":[{"billed_charge":15913.02,"npi":[1154386431]}]},{"allowed_amount":643.63,"providers":[{"billed_charge":2145.30,"npi":[1780235002]}]}]}]},{"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":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7905.09,"providers":[{"billed_charge":39349.00,"npi":[1043262488]}]},{"allowed_amount":32625.00,"providers":[{"billed_charge":42078.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24226.29,"providers":[{"billed_charge":41392.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":27248.60,"providers":[{"billed_charge":57575.50,"npi":[1972527265]}]},{"allowed_amount":4262.17,"providers":[{"billed_charge":10167.75,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":111.98,"providers":[{"billed_charge":10071.00,"npi":[1801883780]}]},{"allowed_amount":24491.94,"providers":[{"billed_charge":36367.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2347.16,"providers":[{"billed_charge":9040.75,"npi":[1841394418]}]},{"allowed_amount":2460.60,"providers":[{"billed_charge":6338.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5035.36,"providers":[{"billed_charge":7666.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"920735990"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":905.30,"providers":[{"billed_charge":2121.17,"npi":[1952427874]}]}]}]},{"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":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":505.06,"providers":[{"billed_charge":1936.80,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15301.02,"providers":[{"billed_charge":49135.93,"npi":[1972527265]}]},{"allowed_amount":9428.01,"providers":[{"billed_charge":31425.95,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":804.30,"providers":[{"billed_charge":2681.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":237.97,"providers":[{"billed_charge":793.10,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43.57,"providers":[{"billed_charge":145.20,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"592851389"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":543.00,"providers":[{"billed_charge":2874.58,"npi":[1003928847]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":48.60,"providers":[{"billed_charge":171.00,"npi":[1780235002]}]},{"allowed_amount":1653.45,"providers":[{"billed_charge":6300.10,"npi":[1154386431]}]},{"allowed_amount":206.70,"providers":[{"billed_charge":689.00,"npi":[1154386431]}]}]}]},{"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":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":360.00,"providers":[{"billed_charge":1200.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":216.30,"providers":[{"billed_charge":1773.99,"npi":[1992103857]}]},{"allowed_amount":73.43,"providers":[{"billed_charge":244.70,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3850.01,"providers":[{"billed_charge":18011.00,"npi":[1154386431]}]},{"allowed_amount":1054.20,"providers":[{"billed_charge":3514.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17.24,"providers":[{"billed_charge":57.47,"npi":[1487699203]}]}]}]},{"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":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4572.74,"providers":[{"billed_charge":7311.25,"npi":[1972527265]}]},{"allowed_amount":1234.72,"providers":[{"billed_charge":4115.70,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":160.20,"providers":[{"billed_charge":534.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":131.95,"providers":[{"billed_charge":439.67,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2156.37,"providers":[{"billed_charge":37687.02,"npi":[1992103857]}]},{"allowed_amount":1159.38,"providers":[{"billed_charge":3864.63,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13322.57,"providers":[{"billed_charge":110238.10,"npi":[1154386431]}]},{"allowed_amount":281.40,"providers":[{"billed_charge":950.00,"npi":[1780235002]}]},{"allowed_amount":3340.68,"providers":[{"billed_charge":11135.60,"npi":[1154386431]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20.70,"providers":[{"billed_charge":69.00,"npi":[1154386431]}]},{"allowed_amount":8.51,"providers":[{"billed_charge":5382.00,"npi":[1154386431]}]}]}]},{"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":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4728.78,"providers":[{"billed_charge":8277.00,"npi":[1538164090]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3339.33,"providers":[{"billed_charge":8969.00,"npi":[1912428301]}]},{"allowed_amount":94.80,"providers":[{"billed_charge":316.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10077.40,"providers":[{"billed_charge":33667.71,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4284.26,"providers":[{"billed_charge":11908.00,"npi":[1043262488]}]},{"allowed_amount":9778.36,"providers":[{"billed_charge":19463.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2144.78,"providers":[{"billed_charge":10760.00,"npi":[1801883780]}]},{"allowed_amount":1532.72,"providers":[{"billed_charge":5670.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"721179027"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":163.22,"providers":[{"billed_charge":308.00,"npi":[1336109768]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":462.05,"providers":[{"billed_charge":10419.50,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"920735990"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4310.63,"providers":[{"billed_charge":8679.56,"npi":[1952427874]}]},{"allowed_amount":1014.52,"providers":[{"billed_charge":1574.62,"npi":[1952427874]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":332.28,"providers":[{"billed_charge":1077.00,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16235.15,"providers":[{"billed_charge":52257.78,"npi":[1972527265]}]},{"allowed_amount":39613.24,"providers":[{"billed_charge":104858.68,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":988.63,"providers":[{"billed_charge":11051.70,"npi":[1992103857]}]},{"allowed_amount":3483.50,"providers":[{"billed_charge":17682.72,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"810977948"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":385.50,"providers":[{"billed_charge":402.00,"npi":[1376197665]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":509.22,"providers":[{"billed_charge":1856.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"630385130"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1826.99,"providers":[{"billed_charge":3859.25,"npi":[1811913460]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":183.78,"providers":[{"billed_charge":976.00,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11351.36,"providers":[{"billed_charge":30565.00,"npi":[1154386431]}]},{"allowed_amount":14254.12,"providers":[{"billed_charge":53735.00,"npi":[1154386431]}]},{"allowed_amount":1958.26,"providers":[{"billed_charge":4990.00,"npi":[1780235002]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2524.33,"providers":[{"billed_charge":4164.07,"npi":[1487699203]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"620479367"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":66.75,"providers":[{"billed_charge":95.00,"npi":[1558365890]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":13817.79,"providers":[{"billed_charge":24512.00,"npi":[1912428301]}]},{"allowed_amount":313.20,"providers":[{"billed_charge":998.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16151.92,"providers":[{"billed_charge":23490.00,"npi":[1043262488]}]},{"allowed_amount":7747.12,"providers":[{"billed_charge":28594.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"630475297"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":368.33,"providers":[{"billed_charge":704.00,"npi":[1225068935]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4332.34,"providers":[{"billed_charge":50132.00,"npi":[1801883780]}]},{"allowed_amount":6915.60,"providers":[{"billed_charge":18838.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1083.45,"providers":[{"billed_charge":4042.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2452.06,"providers":[{"billed_charge":21127.62,"npi":[1841388519]}]},{"allowed_amount":50289.49,"providers":[{"billed_charge":56732.79,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"630307306"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":257.04,"providers":[{"billed_charge":646.33,"npi":[1205935012]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":594.48,"providers":[{"billed_charge":7813.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"550525724"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":934.61,"providers":[{"billed_charge":1178.00,"npi":[1184606600]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1199.88,"providers":[{"billed_charge":24167.25,"npi":[1780655332]}]},{"allowed_amount":403.76,"providers":[{"billed_charge":48227.50,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"636005283"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":542.45,"providers":[{"billed_charge":973.59,"npi":[1255376828]}]}]},{"tin":{"type":"ein","value":"582453303"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":291.03,"providers":[{"billed_charge":896.00,"npi":[1851388748]}]}]},{"tin":{"type":"ein","value":"581694098"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":112.48,"providers":[{"billed_charge":343.00,"npi":[1427055821]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8002.00,"providers":[{"billed_charge":8002.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":144.70,"providers":[{"billed_charge":13706.67,"npi":[1992103857]}]},{"allowed_amount":43062.48,"providers":[{"billed_charge":240641.15,"npi":[1992103857]}]},{"allowed_amount":95892.26,"providers":[{"billed_charge":480913.35,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3726.87,"providers":[{"billed_charge":8109.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"756004221"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":251.62,"providers":[{"billed_charge":5455.00,"npi":[1932123247]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":737.58,"providers":[{"billed_charge":1181.00,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":43551.73,"providers":[{"billed_charge":124083.00,"npi":[1154386431]}]},{"allowed_amount":7380.20,"providers":[{"billed_charge":16896.00,"npi":[1780235002]}]},{"allowed_amount":62200.35,"providers":[{"billed_charge":222428.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":615.55,"providers":[{"billed_charge":828.75,"npi":[1487699203]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.89,"providers":[{"billed_charge":490.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8676.06,"providers":[{"billed_charge":48333.00,"npi":[1154386431]}]},{"allowed_amount":1074.86,"providers":[{"billed_charge":6925.00,"npi":[1154386431]}]}]}]},{"name":"LAB/NR DIALYSIS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"304","description":"LABORATORY - NON-ROUTINE DIALYSIS","allowed_amounts":[{"tin":{"type":"ein","value":"850918397"},"service_code":["12","65"],"billing_class":"institutional","payments":[{"allowed_amount":862.32,"providers":[{"billed_charge":2874.38,"npi":[1588315808]}]},{"allowed_amount":1051.68,"providers":[{"billed_charge":3505.58,"npi":[1588315808]}]}]},{"tin":{"type":"ein","value":"592851389"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":945.49,"providers":[{"billed_charge":5536.34,"npi":[1003928847]}]}]},{"tin":{"type":"ein","value":"42625090"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":2179.12,"providers":[{"billed_charge":7928.85,"npi":[1477665222]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":988.51,"providers":[{"billed_charge":7140.00,"npi":[1043262488]}]},{"allowed_amount":1275.82,"providers":[{"billed_charge":4043.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":263.69,"providers":[{"billed_charge":649.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":242.00,"providers":[{"billed_charge":2547.00,"npi":[1801883780]}]},{"allowed_amount":220.47,"providers":[{"billed_charge":589.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":886.21,"providers":[{"billed_charge":891.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4568.84,"providers":[{"billed_charge":35378.02,"npi":[1992103857]}]},{"allowed_amount":14800.84,"providers":[{"billed_charge":64506.66,"npi":[1992103857]}]},{"allowed_amount":7.77,"providers":[{"billed_charge":1201.29,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7135.09,"providers":[{"billed_charge":8181.26,"npi":[1841388519]}]},{"allowed_amount":354.45,"providers":[{"billed_charge":4253.27,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":47.57,"providers":[{"billed_charge":1360.75,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7123.41,"providers":[{"billed_charge":28613.00,"npi":[1154386431]}]},{"allowed_amount":1110.62,"providers":[{"billed_charge":3393.00,"npi":[1780235002]}]},{"allowed_amount":13224.12,"providers":[{"billed_charge":41722.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":183.28,"providers":[{"billed_charge":2164.75,"npi":[1780655332]}]},{"allowed_amount":89.11,"providers":[{"billed_charge":3928.50,"npi":[1780655332]}]}]}]},{"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":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2159.85,"providers":[{"billed_charge":3238.00,"npi":[1043262488]}]},{"allowed_amount":1374.87,"providers":[{"billed_charge":3138.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5490.74,"providers":[{"billed_charge":7533.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":196.49,"providers":[{"billed_charge":559.01,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"650460321"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":191.89,"providers":[{"billed_charge":220.47,"npi":[1104897859]}]},{"allowed_amount":80.77,"providers":[{"billed_charge":1009.67,"npi":[1104897859]}]}]},{"tin":{"type":"ein","value":"630475297"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":47.42,"providers":[{"billed_charge":88.00,"npi":[1225068935]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":75.00,"providers":[{"billed_charge":75.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2715.96,"providers":[{"billed_charge":4735.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":6169.24,"providers":[{"billed_charge":57899.10,"npi":[1992103857]}]},{"allowed_amount":14843.73,"providers":[{"billed_charge":59035.29,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1283.67,"providers":[{"billed_charge":5663.25,"npi":[1841394418]}]},{"allowed_amount":897.73,"providers":[{"billed_charge":2137.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":218.30,"providers":[{"billed_charge":416.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1583.60,"providers":[{"billed_charge":3848.00,"npi":[1780235002]}]},{"allowed_amount":6558.04,"providers":[{"billed_charge":18852.00,"npi":[1154386431]}]},{"allowed_amount":7527.33,"providers":[{"billed_charge":25308.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":108.23,"providers":[{"billed_charge":1108.25,"npi":[1780655332]}]},{"allowed_amount":142.95,"providers":[{"billed_charge":2906.37,"npi":[1780655332]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":622.48,"providers":[{"billed_charge":952.00,"npi":[1043262488]}]},{"allowed_amount":1356.94,"providers":[{"billed_charge":5470.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2150.67,"providers":[{"billed_charge":4063.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":180.53,"providers":[{"billed_charge":1050.00,"npi":[1801883780]}]},{"allowed_amount":11.06,"providers":[{"billed_charge":799.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":300.00,"providers":[{"billed_charge":300.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3088.76,"providers":[{"billed_charge":9850.24,"npi":[1992103857]}]},{"allowed_amount":2825.36,"providers":[{"billed_charge":21453.16,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":430.36,"providers":[{"billed_charge":1172.00,"npi":[1780235002]}]},{"allowed_amount":3555.52,"providers":[{"billed_charge":7466.00,"npi":[1154386431]}]},{"allowed_amount":1369.42,"providers":[{"billed_charge":3220.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38.71,"providers":[{"billed_charge":412.75,"npi":[1780655332]}]}]}]},{"name":"PATHOLOGY LAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"310","description":"LABORATORY PATHOLOGICAL - GENERAL CLASSIFIATION","allowed_amounts":[{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":919.70,"providers":[{"billed_charge":3556.00,"npi":[1043262488]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2841.88,"providers":[{"billed_charge":5143.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4281.66,"providers":[{"billed_charge":8946.00,"npi":[1043262488]}]},{"allowed_amount":525.75,"providers":[{"billed_charge":8065.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8183.17,"providers":[{"billed_charge":21335.75,"npi":[1972527265]}]},{"allowed_amount":811.72,"providers":[{"billed_charge":3424.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5106.73,"providers":[{"billed_charge":5370.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5999.37,"providers":[{"billed_charge":110983.94,"npi":[1992103857]}]},{"allowed_amount":3097.69,"providers":[{"billed_charge":8817.39,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":64.30,"providers":[{"billed_charge":875.50,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":11848.22,"providers":[{"billed_charge":20652.00,"npi":[1154386431]}]},{"allowed_amount":2021.90,"providers":[{"billed_charge":6798.00,"npi":[1154386431]}]},{"allowed_amount":1264.71,"providers":[{"billed_charge":1954.00,"npi":[1780235002]}]}]}]},{"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":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3328.13,"providers":[{"billed_charge":8608.00,"npi":[1043262488]}]},{"allowed_amount":330.48,"providers":[{"billed_charge":2017.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":132.00,"providers":[{"billed_charge":440.00,"npi":[1912428301]}]},{"allowed_amount":2750.68,"providers":[{"billed_charge":6012.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":342.13,"providers":[{"billed_charge":3297.25,"npi":[1972527265]}]},{"allowed_amount":5145.16,"providers":[{"billed_charge":11608.25,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":761.60,"providers":[{"billed_charge":32192.34,"npi":[1992103857]}]},{"allowed_amount":11257.16,"providers":[{"billed_charge":45344.28,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":257.20,"providers":[{"billed_charge":1068.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2675.52,"providers":[{"billed_charge":14427.00,"npi":[1154386431]}]},{"allowed_amount":10450.39,"providers":[{"billed_charge":19242.00,"npi":[1154386431]}]},{"allowed_amount":455.97,"providers":[{"billed_charge":638.00,"npi":[1780235002]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":99.77,"providers":[{"billed_charge":942.50,"npi":[1780655332]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5724.58,"providers":[{"billed_charge":28091.25,"npi":[1841394418]}]}]}]},{"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":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6856.96,"providers":[{"billed_charge":14215.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1617.00,"providers":[{"billed_charge":4260.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7321.48,"providers":[{"billed_charge":21428.25,"npi":[1972527265]}]},{"allowed_amount":1527.00,"providers":[{"billed_charge":2995.25,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3974.95,"providers":[{"billed_charge":3974.95,"npi":[1992103857]}]},{"allowed_amount":6306.55,"providers":[{"billed_charge":53916.78,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21282.84,"providers":[{"billed_charge":31174.00,"npi":[1154386431]}]},{"allowed_amount":5598.90,"providers":[{"billed_charge":16962.00,"npi":[1154386431]}]},{"allowed_amount":525.56,"providers":[{"billed_charge":2776.00,"npi":[1154386431]}]}]}]},{"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":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9928.65,"providers":[{"billed_charge":16189.00,"npi":[1043262488]}]},{"allowed_amount":9630.01,"providers":[{"billed_charge":45168.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1288.80,"providers":[{"billed_charge":3711.00,"npi":[1912428301]}]},{"allowed_amount":19358.85,"providers":[{"billed_charge":93828.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":31845.67,"providers":[{"billed_charge":262053.00,"npi":[1972527265]}]},{"allowed_amount":11810.00,"providers":[{"billed_charge":45021.25,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2497.36,"providers":[{"billed_charge":13217.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15714.99,"providers":[{"billed_charge":303213.13,"npi":[1992103857]}]},{"allowed_amount":28179.78,"providers":[{"billed_charge":266009.00,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":958.12,"providers":[{"billed_charge":25168.00,"npi":[1841394418]}]},{"allowed_amount":635.52,"providers":[{"billed_charge":4904.00,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14076.05,"providers":[{"billed_charge":45048.00,"npi":[1154386431]}]},{"allowed_amount":62381.14,"providers":[{"billed_charge":64838.00,"npi":[1154386431]}]}]}]},{"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":"636000271"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":54009.63,"providers":[{"billed_charge":194574.68,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9228.79,"providers":[{"billed_charge":53050.00,"npi":[1154386431]}]},{"allowed_amount":10252.43,"providers":[{"billed_charge":11730.00,"npi":[1154386431]}]},{"allowed_amount":10718.45,"providers":[{"billed_charge":14531.00,"npi":[1154386431]}]}]}]},{"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":"721382190"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":3.86,"providers":[{"billed_charge":8.83,"npi":[1023876653]}]}]},{"tin":{"type":"ein","value":"630897317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.35,"providers":[{"billed_charge":425.00,"npi":[1487186094]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":7.73,"providers":[{"billed_charge":10.00,"npi":[1902549991]}]},{"allowed_amount":46.32,"providers":[{"billed_charge":120.00,"npi":[1285250670]}]}]},{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3971.24,"providers":[{"billed_charge":8372.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.28,"providers":[{"billed_charge":813.75,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81","72"],"billing_class":"professional","payments":[{"allowed_amount":359.16,"providers":[{"billed_charge":1082.00,"npi":[1234567893]}]},{"allowed_amount":4.55,"providers":[{"billed_charge":26.00,"npi":[1234567893]}]},{"allowed_amount":12.16,"providers":[{"billed_charge":137.12,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.75,"providers":[{"billed_charge":70.00,"npi":[1790734788]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":3.86,"providers":[{"billed_charge":8.00,"npi":[1700956265]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":983.62,"providers":[{"billed_charge":8593.00,"npi":[1154386431]}]},{"allowed_amount":709.50,"providers":[{"billed_charge":2365.00,"npi":[1154386431]}]}]}]},{"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":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":103.22,"providers":[{"billed_charge":446.00,"npi":[1154386431]}]},{"allowed_amount":5386.76,"providers":[{"billed_charge":8578.00,"npi":[1154386431]}]},{"allowed_amount":901.41,"providers":[{"billed_charge":5298.00,"npi":[1154386431]}]}]}]},{"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":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":841.60,"providers":[{"billed_charge":1906.00,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1360.94,"providers":[{"billed_charge":5068.00,"npi":[1154386431]}]},{"allowed_amount":5794.61,"providers":[{"billed_charge":46318.00,"npi":[1154386431]}]}]}]},{"name":"INHALATION SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"412","description":"RESPIRATORY SERVICES - INHALATION SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":252.76,"providers":[{"billed_charge":1797.10,"npi":[1992103857]}]},{"allowed_amount":3594.20,"providers":[{"billed_charge":36840.55,"npi":[1992103857]}]}]}]},{"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":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":344.75,"providers":[{"billed_charge":512.00,"npi":[1154386431]}]},{"allowed_amount":1192.10,"providers":[{"billed_charge":8177.00,"npi":[1154386431]}]}]}]},{"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":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":934.48,"providers":[{"billed_charge":16488.00,"npi":[1154386431]}]},{"allowed_amount":99.16,"providers":[{"billed_charge":267.00,"npi":[1154386431]}]}]}]},{"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":"475348597"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":83227.37,"providers":[{"billed_charge":125123.00,"npi":[1912428301]}]},{"allowed_amount":411.60,"providers":[{"billed_charge":2058.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27696.28,"providers":[{"billed_charge":55507.24,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":59946.25,"providers":[{"billed_charge":214041.00,"npi":[1043262488]}]},{"allowed_amount":4598.39,"providers":[{"billed_charge":35778.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"854153331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":613.04,"providers":[{"billed_charge":613.04,"npi":[1013386143]}]}]},{"tin":{"type":"ein","value":"630475297"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":346.01,"providers":[{"billed_charge":367.00,"npi":[1225068935]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":54701.53,"providers":[{"billed_charge":66964.00,"npi":[1801883780]}]},{"allowed_amount":3318.06,"providers":[{"billed_charge":19944.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9623.82,"providers":[{"billed_charge":27921.00,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17157.76,"providers":[{"billed_charge":49968.17,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"920735990"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3177.80,"providers":[{"billed_charge":7998.38,"npi":[1952427874]}]},{"allowed_amount":1134.85,"providers":[{"billed_charge":1839.30,"npi":[1952427874]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29766.23,"providers":[{"billed_charge":58596.25,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21627.49,"providers":[{"billed_charge":67520.00,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"636005283"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1246.21,"providers":[{"billed_charge":1246.21,"npi":[1255376828]}]}]},{"tin":{"type":"ein","value":"650460321"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":392.01,"providers":[{"billed_charge":10300.24,"npi":[1104897859]}]},{"allowed_amount":6888.88,"providers":[{"billed_charge":19391.95,"npi":[1104897859]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1842.83,"providers":[{"billed_charge":23489.25,"npi":[1972527265]}]},{"allowed_amount":119389.91,"providers":[{"billed_charge":212032.85,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":87402.35,"providers":[{"billed_charge":90371.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7863.25,"providers":[{"billed_charge":241113.48,"npi":[1992103857]}]},{"allowed_amount":203795.67,"providers":[{"billed_charge":802103.71,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24947.78,"providers":[{"billed_charge":29615.00,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":27563.67,"providers":[{"billed_charge":133947.00,"npi":[1154386431]}]},{"allowed_amount":295652.94,"providers":[{"billed_charge":580652.00,"npi":[1154386431]}]},{"allowed_amount":68056.08,"providers":[{"billed_charge":125787.00,"npi":[1780235002]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3668.83,"providers":[{"billed_charge":6908.00,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":17047.35,"providers":[{"billed_charge":37736.26,"npi":[1487699203]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"472228529"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3112.32,"providers":[{"billed_charge":12449.28,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8689.25,"providers":[{"billed_charge":26437.00,"npi":[1154386431]}]},{"allowed_amount":2965.92,"providers":[{"billed_charge":4042.00,"npi":[1154386431]}]}]}]},{"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":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":870.60,"providers":[{"billed_charge":2945.96,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7777.73,"providers":[{"billed_charge":25821.47,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6340.78,"providers":[{"billed_charge":25045.98,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"854153331"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7.94,"providers":[{"billed_charge":26.46,"npi":[1013386143]}]}]},{"tin":{"type":"ein","value":"630475297"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":340.50,"providers":[{"billed_charge":1135.00,"npi":[1225068935]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4575.21,"providers":[{"billed_charge":14922.42,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"631070858"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":414.45,"providers":[{"billed_charge":1403.04,"npi":[1992812382]}]}]},{"tin":{"type":"ein","value":"621762382"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2258.35,"providers":[{"billed_charge":12477.06,"npi":[1841388519]}]},{"allowed_amount":889.62,"providers":[{"billed_charge":6089.99,"npi":[1841388519]}]}]},{"tin":{"type":"ein","value":"636000271"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":67124.35,"providers":[{"billed_charge":253530.66,"npi":[1841394418]}]},{"allowed_amount":22.01,"providers":[{"billed_charge":11297.88,"npi":[1841394418]}]}]},{"tin":{"type":"ein","value":"920735990"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":234.09,"providers":[{"billed_charge":689.00,"npi":[1952427874]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":250.85,"providers":[{"billed_charge":836.15,"npi":[1780655332]}]}]},{"tin":{"type":"ein","value":"582453303"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":195.49,"providers":[{"billed_charge":651.60,"npi":[1851388748]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11858.13,"providers":[{"billed_charge":38874.66,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"636002184"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":142.80,"providers":[{"billed_charge":476.00,"npi":[1477551554]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":430.73,"providers":[{"billed_charge":1436.13,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24666.15,"providers":[{"billed_charge":106166.80,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"582414416"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":741.34,"providers":[{"billed_charge":2471.13,"npi":[1194712083]}]}]},{"tin":{"type":"ein","value":"630385130"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":143.18,"providers":[{"billed_charge":477.25,"npi":[1811913460]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":67749.05,"providers":[{"billed_charge":576766.21,"npi":[1154386431]}]},{"allowed_amount":28210.21,"providers":[{"billed_charge":93001.14,"npi":[1154386431]}]},{"allowed_amount":1.50,"providers":[{"billed_charge":4840.93,"npi":[1154386431]}]},{"allowed_amount":3706.04,"providers":[{"billed_charge":12964.89,"npi":[1780235002]}]},{"allowed_amount":391.83,"providers":[{"billed_charge":1306.09,"npi":[1073685483]}]}]},{"tin":{"type":"ein","value":"636004942"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":143.82,"providers":[{"billed_charge":479.40,"npi":[1851323836]}]}]},{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":429.76,"providers":[{"billed_charge":1253.10,"npi":[1487699203]}]}]}]},{"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":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13.07,"providers":[{"billed_charge":43.55,"npi":[1134955370]}]}]}]},{"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":"640899562"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":4836.00,"providers":[{"billed_charge":6200.00,"npi":[1104860428]}]}]}]},{"name":"CATARACT SURG W/IOL 1 STAGE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"66984","description":"EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","24"],"billing_class":"professional","payments":[{"allowed_amount":9326.47,"providers":[{"billed_charge":26220.84,"npi":[1234567893]}]},{"allowed_amount":958.62,"providers":[{"billed_charge":2646.76,"npi":[1234567893]}]}]}]},{"name":"INJECTION EYE DRUG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"67028","description":"INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":697.82,"providers":[{"billed_charge":4000.00,"npi":[1234567893]}]}]}]},{"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":"630572355"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":650.32,"providers":[{"billed_charge":3080.00,"npi":[1124559505]}]},{"allowed_amount":177.36,"providers":[{"billed_charge":840.00,"npi":[1124559505]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":445.50,"providers":[{"billed_charge":1485.00,"npi":[1154386431]}]},{"allowed_amount":184.30,"providers":[{"billed_charge":3342.00,"npi":[1154386431]}]}]}]},{"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":"630572355"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":127.60,"providers":[{"billed_charge":440.00,"npi":[1124559505]}]},{"allowed_amount":216.92,"providers":[{"billed_charge":748.00,"npi":[1124559505]}]}]},{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":34.30,"providers":[{"billed_charge":160.00,"npi":[1790305282]}]},{"allowed_amount":137.20,"providers":[{"billed_charge":640.00,"npi":[1275582041]}]},{"allowed_amount":212.66,"providers":[{"billed_charge":972.00,"npi":[1275582041]}]},{"allowed_amount":6.86,"providers":[{"billed_charge":32.00,"npi":[1790305282]}]}]},{"tin":{"type":"ein","value":"820549580"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":6.38,"providers":[{"billed_charge":24.00,"npi":[1831393164]}]},{"allowed_amount":57.42,"providers":[{"billed_charge":216.00,"npi":[1831393164]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"824944510"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":65.68,"providers":[{"billed_charge":312.00,"npi":[1790305282]}]},{"allowed_amount":41.05,"providers":[{"billed_charge":195.00,"npi":[1275582041]}]},{"allowed_amount":16.42,"providers":[{"billed_charge":78.00,"npi":[1275582041]}]},{"allowed_amount":73.89,"providers":[{"billed_charge":351.00,"npi":[1275582041]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.06,"providers":[{"billed_charge":100.00,"npi":[1234567893]}]}]}]},{"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":"636001875"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":445.10,"providers":[{"billed_charge":514.85,"npi":[1942380357]}]}]},{"tin":{"type":"ein","value":"475348597"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2381.28,"providers":[{"billed_charge":5373.00,"npi":[1912428301]}]}]},{"tin":{"type":"ein","value":"636001820"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1723.00,"providers":[{"billed_charge":1970.00,"npi":[1043262488]}]},{"allowed_amount":878.50,"providers":[{"billed_charge":4196.00,"npi":[1043262488]}]}]},{"tin":{"type":"ein","value":"201282261"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4962.86,"providers":[{"billed_charge":12999.25,"npi":[1972527265]}]},{"allowed_amount":1496.34,"providers":[{"billed_charge":2689.50,"npi":[1972527265]}]}]},{"tin":{"type":"ein","value":"581790149"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":231.80,"providers":[{"billed_charge":324.00,"npi":[1801883780]}]}]},{"tin":{"type":"ein","value":"636004474"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":560.00,"providers":[{"billed_charge":560.00,"npi":[1134955370]}]}]},{"tin":{"type":"ein","value":"472228529"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10754.40,"providers":[{"billed_charge":47820.96,"npi":[1992103857]}]},{"allowed_amount":10026.39,"providers":[{"billed_charge":45828.42,"npi":[1992103857]}]}]},{"tin":{"type":"ein","value":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":267.06,"providers":[{"billed_charge":324.00,"npi":[1780235002]}]},{"allowed_amount":10939.62,"providers":[{"billed_charge":13192.00,"npi":[1154386431]}]},{"allowed_amount":3323.93,"providers":[{"billed_charge":9503.00,"npi":[1154386431]}]}]},{"tin":{"type":"ein","value":"822445000"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":89.02,"providers":[{"billed_charge":743.50,"npi":[1780655332]}]}]}]},{"name":"ANES UPR GI NDSC PX NOS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"731","description":"ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED PROXIMAL TO DUODEN","allowed_amounts":[{"tin":{"type":"ein","value":"202904686"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":675.87,"providers":[{"billed_charge":3900.00,"npi":[1801871637]}]}]}]},{"name":"X-RAY EXAM OF HAND","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73120","description":"RADIOLOGIC EXAMINATION, HAND; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":274.46,"providers":[{"billed_charge":1003.00,"npi":[1234567893]}]}]}]},{"name":"X-RAY EXAM OF KNEE 1 OR 2","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73560","description":"RADIOLOGIC EXAMINATION, KNEE; 1 OR 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":235.50,"providers":[{"billed_charge":1121.00,"npi":[1234567893]}]}]}]},{"name":"X-RAY EXAM OF FOOT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73620","description":"RADIOLOGIC EXAMINATION, FOOT; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.77,"providers":[{"billed_charge":243.95,"npi":[1234567893]}]}]}]},{"name":"X-RAY EXAM OF FOOT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73630","description":"RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF 3 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":148.92,"providers":[{"billed_charge":556.50,"npi":[1234567893]}]}]}]},{"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":"630572355"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":120.76,"providers":[{"billed_charge":404.00,"npi":[1124559505]}]}]}]},{"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":"630572355"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":190.29,"providers":[{"billed_charge":696.00,"npi":[1124559505]}]},{"allowed_amount":761.16,"providers":[{"billed_charge":2784.00,"npi":[1124559505]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"636003514"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":137.92,"providers":[{"billed_charge":254.00,"npi":[1487699203]}]}]}]},{"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":"636000526"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":194.00,"providers":[{"billed_charge":958.00,"npi":[1154386431]}]},{"allowed_amount":5703.00,"providers":[{"billed_charge":19010.00,"npi":[1154386431]}]}]}]},{"name":"FETAL BIOPHYS PROFIL W/O NST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76819","description":"FETAL BIOPHYSICAL PROFILE; WITHOUT NON-STRESS TESTING","allowed_amounts":[{"tin":{"type":"ein","value":"834257679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":714.24,"providers":[{"billed_charge":1992.00,"npi":[1831622208]}]}]}]},{"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":"631185834"},"service_code":["11","21"],"billing_class":"professional","payments":[{"allowed_amount":10088.89,"providers":[{"billed_charge":47150.00,"npi":[1225591878]}]},{"allowed_amount":70.46,"providers":[{"billed_charge":820.00,"npi":[1225591878]}]}]},{"tin":{"type":"ein","value":"921551901"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":35.23,"providers":[{"billed_charge":120.00,"npi":[1538666847]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":140.92,"providers":[{"billed_charge":1640.00,"npi":[1234567893]}]},{"allowed_amount":8466.24,"providers":[{"billed_charge":39360.00,"npi":[1234567893]}]}]}]},{"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":"630572355"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":125.52,"providers":[{"billed_charge":252.00,"npi":[1124559505]}]}]},{"tin":{"type":"ein","value":"824600508"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":482.04,"providers":[{"billed_charge":1080.00,"npi":[1306860127]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":394.30,"providers":[{"billed_charge":950.00,"npi":[1234567893]}]}]}]},{"name":"SCR MAMMO BI INCL CAD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77067","description":"SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW STUDY OF EACH BREAST), INCLUDING COMPUTER-AIDED DETECTION (","allowed_amounts":[{"tin":{"type":"ein","value":"630572355"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":159.36,"providers":[{"billed_charge":324.00,"npi":[1124559505]}]}]},{"tin":{"type":"ein","value":"824600508"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":612.72,"providers":[{"billed_charge":1350.00,"npi":[1306860127]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":943.20,"providers":[{"billed_charge":2500.00,"npi":[1234567893]}]}]}]},{"name":"SET RADIATION THERAPY FIELD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77280","description":"THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3495.78,"providers":[{"billed_charge":11559.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TREATMENT AID(S)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77334","description":"TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL SHIELDS, COMPENSATORS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":756.24,"providers":[{"billed_charge":5440.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION PHYSICS CONSULT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77336","description":"CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDING ASSESSMENT OF TREATMENT PARAMETERS, QUALITY ASSUR","allowed_amounts":[{"tin":{"type":"ein","value":"631185834"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":389.40,"providers":[{"billed_charge":2700.00,"npi":[1225591878]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2141.70,"providers":[{"billed_charge":14515.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TREATMENT DELIVERY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77401","description":"RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE, PER DAY","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.31,"providers":[{"billed_charge":52.00,"npi":[1234567893]}]}]}]},{"name":"RADIATION TX MANAGEMENT X5","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77427","description":"RADIATION TREATMENT MANAGEMENT, 5 TREATMENTS","allowed_amounts":[{"tin":{"type":"ein","value":"631185834"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":892.62,"providers":[{"billed_charge":6420.00,"npi":[1225591878]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4611.87,"providers":[{"billed_charge":33170.00,"npi":[1234567893]}]}]}]},{"name":"METABOLIC PANEL TOTAL CA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80048","description":"BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":487.20,"providers":[{"billed_charge":8928.00,"npi":[1497859052]}]}]}]},{"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":"630897317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":132.00,"providers":[{"billed_charge":1075.00,"npi":[1487186094]}]}]},{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1761.13,"providers":[{"billed_charge":37530.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":327.36,"providers":[{"billed_charge":2260.00,"npi":[1234567893]}]},{"allowed_amount":17.65,"providers":[{"billed_charge":211.20,"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":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1237.39,"providers":[{"billed_charge":12936.00,"npi":[1497859052]}]}]}]},{"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":"830392317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":113.96,"providers":[{"billed_charge":210.00,"npi":[1811983596]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.30,"providers":[{"billed_charge":243.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.10,"providers":[{"billed_charge":126.00,"npi":[1457341307]}]},{"allowed_amount":12.60,"providers":[{"billed_charge":36.00,"npi":[1225484561]}]}]},{"tin":{"type":"ein","value":"471991590"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.30,"providers":[{"billed_charge":275.00,"npi":[1306983143]}]}]},{"tin":{"type":"ein","value":"874444819"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.80,"providers":[{"billed_charge":180.00,"npi":[1831210566]}]}]}]},{"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":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":1968.29,"providers":[{"billed_charge":8522.00,"npi":[1234567893]}]},{"allowed_amount":62.25,"providers":[{"billed_charge":559.26,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":57.00,"providers":[{"billed_charge":795.00,"npi":[1497859052]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":95.92,"providers":[{"billed_charge":1432.20,"npi":[1992939417]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":342.44,"providers":[{"billed_charge":1379.00,"npi":[1234567893]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":33.66,"providers":[{"billed_charge":185.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":6.72,"providers":[{"billed_charge":70.00,"npi":[1073247565,1710603659]}]}]},{"tin":{"type":"ein","value":"631176388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.26,"providers":[{"billed_charge":16.00,"npi":[1376681676]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":5.76,"providers":[{"billed_charge":132.00,"npi":[1063215945]}]},{"allowed_amount":2.88,"providers":[{"billed_charge":66.00,"npi":[1447097167]}]}]}]},{"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":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":796.24,"providers":[{"billed_charge":9945.60,"npi":[1992939417]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":110.76,"providers":[{"billed_charge":333.00,"npi":[1234567893]}]}]}]},{"name":"ANES LWR INTST NDSC NOS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"811","description":"ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; NOT","allowed_amounts":[{"tin":{"type":"ein","value":"202904686"},"service_code":["24"],"billing_class":"professional","payments":[{"allowed_amount":67.59,"providers":[{"billed_charge":300.00,"npi":[1801871637]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":152.68,"providers":[{"billed_charge":4444.00,"npi":[1497859052]}]}]}]},{"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":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":284.16,"providers":[{"billed_charge":1672.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":211.40,"providers":[{"billed_charge":2924.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.31,"providers":[{"billed_charge":90.00,"npi":[1234567893]}]}]}]},{"name":"VITAMIN B-12","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82607","description":"CYANOCOBALAMIN (VITAMIN B-12);","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":362.00,"providers":[{"billed_charge":1960.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":278.12,"providers":[{"billed_charge":2839.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.87,"providers":[{"billed_charge":917.70,"npi":[1255566899]}]},{"allowed_amount":73.71,"providers":[{"billed_charge":1304.10,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.82,"providers":[{"billed_charge":90.00,"npi":[1023112307]}]}]}]},{"name":"GLUCOSE BLOOD TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82962","description":"GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE","allowed_amounts":[{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.56,"providers":[{"billed_charge":78.00,"npi":[1275361230]}]},{"allowed_amount":16.40,"providers":[{"billed_charge":195.00,"npi":[1629759501]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.85,"providers":[{"billed_charge":202.00,"npi":[1234567893]}]}]}]},{"name":"GLYCOSYLATED HEMOGLOBIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83036","description":"HEMOGLOBIN; GLYCOSYLATED (A1C)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":966.95,"providers":[{"billed_charge":9960.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"133757370"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":128.06,"providers":[{"billed_charge":1316.70,"npi":[1255566899]}]},{"allowed_amount":161.76,"providers":[{"billed_charge":1663.20,"npi":[1750516381]}]}]},{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":38.88,"providers":[{"billed_charge":208.00,"npi":[1629759501]}]},{"allowed_amount":29.16,"providers":[{"billed_charge":156.00,"npi":[1275361230]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":276.25,"providers":[{"billed_charge":1588.00,"npi":[1234567893]}]},{"allowed_amount":6.48,"providers":[{"billed_charge":77.68,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":116.40,"providers":[{"billed_charge":2100.00,"npi":[1497859052]}]}]}]},{"name":"IRON BINDING TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83550","description":"IRON BINDING CAPACITY","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":83.92,"providers":[{"billed_charge":1088.00,"npi":[1497859052]}]}]}]},{"name":"ASSAY OF FREE THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84439","description":"THYROXINE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":346.24,"providers":[{"billed_charge":4832.00,"npi":[1497859052]}]}]}]},{"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":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1209.60,"providers":[{"billed_charge":12540.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.40,"providers":[{"billed_charge":30.00,"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":"721382190"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":59.40,"providers":[{"billed_charge":142.92,"npi":[1023876653]}]},{"allowed_amount":9.90,"providers":[{"billed_charge":23.82,"npi":[1558124768]}]},{"allowed_amount":19.80,"providers":[{"billed_charge":47.64,"npi":[1023876653]}]},{"allowed_amount":36.30,"providers":[{"billed_charge":87.34,"npi":[1558124768]}]}]},{"tin":{"type":"ein","value":"630897317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97.25,"providers":[{"billed_charge":875.00,"npi":[1487186094]}]}]},{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1137.04,"providers":[{"billed_charge":11956.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"631137578"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.16,"providers":[{"billed_charge":40.00,"npi":[1609890474]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","81"],"billing_class":"professional","payments":[{"allowed_amount":7.80,"providers":[{"billed_charge":93.24,"npi":[1234567893]}]},{"allowed_amount":268.41,"providers":[{"billed_charge":1630.00,"npi":[1234567893]}]}]}]},{"name":"COMPLETE CBC, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85027","description":"BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.80,"providers":[{"billed_charge":290.00,"npi":[1497859052]}]}]}]},{"name":"RBC SED RATE, NONAUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85651","description":"SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":76.80,"providers":[{"billed_charge":1155.00,"npi":[1497859052]}]}]}]},{"name":"C-REACTIVE PROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86140","description":"C-REACTIVE PROTEIN;","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":80.86,"providers":[{"billed_charge":871.00,"npi":[1497859052]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":51.80,"providers":[{"billed_charge":380.00,"npi":[1234567893]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":530.72,"providers":[{"billed_charge":4588.00,"npi":[1497859052]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1300.50,"providers":[{"billed_charge":6570.00,"npi":[1497859052]}]}]}]},{"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":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.11,"providers":[{"billed_charge":144.00,"npi":[1497859052]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"630477348"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2147.61,"providers":[{"billed_charge":7344.00,"npi":[1497859052]}]}]}]},{"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":"721382190"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":28.12,"providers":[{"billed_charge":44.48,"npi":[1023876653,1558124768]}]},{"allowed_amount":7.03,"providers":[{"billed_charge":11.12,"npi":[1558124768]}]},{"allowed_amount":21.09,"providers":[{"billed_charge":33.36,"npi":[1023876653]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":175.75,"providers":[{"billed_charge":1025.00,"npi":[1679109755]}]},{"allowed_amount":7.03,"providers":[{"billed_charge":41.00,"npi":[1598151235]}]},{"allowed_amount":456.95,"providers":[{"billed_charge":2665.00,"npi":[1073247565]}]},{"allowed_amount":91.39,"providers":[{"billed_charge":533.00,"npi":[1659981959,1003546698]}]},{"allowed_amount":189.81,"providers":[{"billed_charge":1107.00,"npi":[1457014375]}]},{"allowed_amount":133.57,"providers":[{"billed_charge":779.00,"npi":[1336793314]}]},{"allowed_amount":520.23,"providers":[{"billed_charge":3034.00,"npi":[1710603659]}]},{"allowed_amount":288.23,"providers":[{"billed_charge":1681.00,"npi":[1326287665]}]},{"allowed_amount":21.09,"providers":[{"billed_charge":123.00,"npi":[1417340936]}]}]}]},{"name":"SARS-COV-2 COVID19 W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87811","description":"IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS","allowed_amounts":[{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":510.11,"providers":[{"billed_charge":2987.00,"npi":[1710603659]}]},{"allowed_amount":52.77,"providers":[{"billed_charge":309.00,"npi":[1679109755]}]},{"allowed_amount":87.95,"providers":[{"billed_charge":515.00,"npi":[1457014375]}]},{"allowed_amount":439.75,"providers":[{"billed_charge":2575.00,"npi":[1073247565]}]},{"allowed_amount":228.67,"providers":[{"billed_charge":1339.00,"npi":[1326287665]}]}]}]},{"name":"STREP A ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87880","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; STREPTOCOCCUS, GR","allowed_amounts":[{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":63.27,"providers":[{"billed_charge":369.00,"npi":[1073247565]}]},{"allowed_amount":56.24,"providers":[{"billed_charge":328.00,"npi":[1710603659]}]}]}]},{"name":"CYTOPATH C/V AUTO FLUID REDO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88175","description":"CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED TH","allowed_amounts":[{"tin":{"type":"ein","value":"382084239"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":63.88,"providers":[{"billed_charge":501.84,"npi":[1891731626]}]}]}]},{"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":"630758227"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1268.41,"providers":[{"billed_charge":4800.00,"npi":[1386699387]}]}]},{"tin":{"type":"ein","value":"630580312"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":785.84,"providers":[{"billed_charge":6453.20,"npi":[1821095167]}]}]}]},{"name":"IMMUNOHISTO ANTB 1ST STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88342","description":"IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE","allowed_amounts":[{"tin":{"type":"ein","value":"630580312"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":78.15,"providers":[{"billed_charge":358.10,"npi":[1821095167]}]}]}]},{"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":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":151800.00,"providers":[{"billed_charge":204600.00,"npi":[1336297605]}]}]},{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8250.00,"providers":[{"billed_charge":152460.00,"npi":[1912670068]}]}]},{"tin":{"type":"ein","value":"861851206"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2940.00,"providers":[{"billed_charge":20250.00,"npi":[1407612633]}]}]}]},{"name":"PSYCH DIAGNOSTIC EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90791","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"631198286"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":261.58,"providers":[{"billed_charge":550.00,"npi":[1528376373]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":834.55,"providers":[{"billed_charge":2080.00,"npi":[1871060756]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":4172.75,"providers":[{"billed_charge":10400.00,"npi":[1234567893]}]}]}]},{"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":"823567923"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":6013.76,"providers":[{"billed_charge":12806.00,"npi":[1437278371]}]},{"allowed_amount":375.86,"providers":[{"billed_charge":776.00,"npi":[1437278371]}]},{"allowed_amount":563.79,"providers":[{"billed_charge":1164.00,"npi":[1316542665]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10","21"],"billing_class":"professional","payments":[{"allowed_amount":538.26,"providers":[{"billed_charge":750.00,"npi":[1234567893]}]},{"allowed_amount":6013.76,"providers":[{"billed_charge":12608.00,"npi":[1234567893]}]},{"allowed_amount":475.02,"providers":[{"billed_charge":900.00,"npi":[1234567893]}]},{"allowed_amount":15410.26,"providers":[{"billed_charge":32758.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":403.77,"providers":[{"billed_charge":900.00,"npi":[1902677511]}]}]}]},{"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":"999999999"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1105.02,"providers":[{"billed_charge":2534.00,"npi":[1234567893]}]},{"allowed_amount":76.09,"providers":[{"billed_charge":92.00,"npi":[1234567893]}]}]}]},{"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":"922872876"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":53.26,"providers":[{"billed_charge":78.36,"npi":[1871968206]}]},{"allowed_amount":143.01,"providers":[{"billed_charge":235.08,"npi":[1871968206]}]}]},{"tin":{"type":"ein","value":"270205345"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":266.30,"providers":[{"billed_charge":350.00,"npi":[1770981458,1861965493]}]}]},{"tin":{"type":"ein","value":"462336113"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1006.06,"providers":[{"billed_charge":1460.00,"npi":[1588350573]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":69.62,"providers":[{"billed_charge":75.00,"npi":[1649890286]}]},{"allowed_amount":186.96,"providers":[{"billed_charge":225.00,"npi":[1649890286]}]}]},{"tin":{"type":"ein","value":"201935552"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":887.70,"providers":[{"billed_charge":1533.00,"npi":[1528744273]}]}]}]},{"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":"850770765"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":170.70,"providers":[{"billed_charge":400.00,"npi":[1184626905]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":208.32,"providers":[{"billed_charge":520.00,"npi":[1154551091]}]},{"allowed_amount":104.16,"providers":[{"billed_charge":260.00,"npi":[1861983785]}]},{"allowed_amount":1562.40,"providers":[{"billed_charge":3900.00,"npi":[1528310455]}]},{"allowed_amount":7499.52,"providers":[{"billed_charge":18720.00,"npi":[1083775464]}]},{"allowed_amount":520.80,"providers":[{"billed_charge":1300.00,"npi":[1063809390]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":937.44,"providers":[{"billed_charge":2040.00,"npi":[1234567893]}]},{"allowed_amount":4869.48,"providers":[{"billed_charge":11860.00,"npi":[1234567893]}]}]}]},{"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":"630695975"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1189.60,"providers":[{"billed_charge":1799.44,"npi":[1568019297]}]},{"allowed_amount":789.30,"providers":[{"billed_charge":1349.58,"npi":[1568019297]}]}]},{"tin":{"type":"ein","value":"204820146"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":148.70,"providers":[{"billed_charge":160.00,"npi":[1134402795]}]},{"allowed_amount":1841.70,"providers":[{"billed_charge":2240.00,"npi":[1497874580]}]},{"allowed_amount":3814.95,"providers":[{"billed_charge":4640.00,"npi":[1306167747]}]},{"allowed_amount":297.40,"providers":[{"billed_charge":320.00,"npi":[1497874580,1306167747]}]},{"allowed_amount":526.20,"providers":[{"billed_charge":640.00,"npi":[1134402795]}]}]},{"tin":{"type":"ein","value":"422153822"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":446.12,"providers":[{"billed_charge":580.00,"npi":[1235747270]}]},{"allowed_amount":296.01,"providers":[{"billed_charge":435.00,"npi":[1235747270]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1388.61,"providers":[{"billed_charge":3159.00,"npi":[1063651651]}]},{"allowed_amount":1697.19,"providers":[{"billed_charge":3861.00,"npi":[1205200169]}]},{"allowed_amount":1234.32,"providers":[{"billed_charge":2808.00,"npi":[1528310455]}]},{"allowed_amount":771.45,"providers":[{"billed_charge":1755.00,"npi":[1548801293]}]},{"allowed_amount":8485.95,"providers":[{"billed_charge":19305.00,"npi":[1861983785]}]},{"allowed_amount":1851.48,"providers":[{"billed_charge":4212.00,"npi":[1083775464]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":7560.21,"providers":[{"billed_charge":17199.00,"npi":[1234567893]}]},{"allowed_amount":308.58,"providers":[{"billed_charge":702.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["11","53"],"billing_class":"professional","payments":[{"allowed_amount":4126.61,"providers":[{"billed_charge":8720.90,"npi":[1497847222]}]},{"allowed_amount":296.01,"providers":[{"billed_charge":420.00,"npi":[1255137568]}]}]},{"tin":{"type":"ein","value":"471991590"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":197.34,"providers":[{"billed_charge":600.00,"npi":[1528219748]}]},{"allowed_amount":111.53,"providers":[{"billed_charge":300.00,"npi":[1528219748]}]}]}]},{"name":"HEMODIALYSIS ONE EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90935","description":"HEMODIALYSIS PROCEDURE WITH SINGLE EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":129.08,"providers":[{"billed_charge":347.00,"npi":[1234567893]}]}]}]},{"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":"650101421"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":25150.91,"providers":[{"billed_charge":216349.20,"npi":[1801227046]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":508125.00,"providers":[{"billed_charge":1113200.00,"npi":[1336297605]}]},{"allowed_amount":166800.00,"providers":[{"billed_charge":343200.00,"npi":[1134277577]}]},{"allowed_amount":55800.00,"providers":[{"billed_charge":260400.00,"npi":[1265580534]}]}]},{"tin":{"type":"ein","value":"465287425"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":19840.00,"providers":[{"billed_charge":197770.24,"npi":[1952719189]}]}]}]},{"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":"631198286"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4950.00,"providers":[{"billed_charge":19800.00,"npi":[1265580534]}]}]},{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3300.00,"providers":[{"billed_charge":44220.00,"npi":[1912670068]}]}]},{"tin":{"type":"ein","value":"461281853"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1890.00,"providers":[{"billed_charge":23970.00,"npi":[1457232589]}]}]}]},{"name":"PSTAY/INDIV RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"914","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - INDIVIDUAL THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"861790384"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":437.64,"providers":[{"billed_charge":5460.00,"npi":[1912670068]}]}]}]},{"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":"636000526"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4991.46,"providers":[{"billed_charge":5531.00,"npi":[1154386431]}]},{"allowed_amount":2020.55,"providers":[{"billed_charge":5702.00,"npi":[1154386431]}]},{"allowed_amount":206.44,"providers":[{"billed_charge":633.00,"npi":[1154386431]}]}]}]},{"name":"CPTR OPHTH DX IMG POST SEGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92134","description":"SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, W INTERPRETATION AND RPT, UN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1111.82,"providers":[{"billed_charge":2879.56,"npi":[1234567893]}]}]}]},{"name":"OPHTHALMIC BIOMETRY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92136","description":"OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH INTRAOCULAR LENS POWER CALCULATION","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.65,"providers":[{"billed_charge":569.40,"npi":[1234567893]}]}]}]},{"name":"ELECTROCARDIOGRAM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93000","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"631205990"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37.86,"providers":[{"billed_charge":180.00,"npi":[1649651217]}]},{"allowed_amount":113.58,"providers":[{"billed_charge":540.00,"npi":[1548298045]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1267.02,"providers":[{"billed_charge":5158.00,"npi":[1234567893]}]}]}]},{"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":"831651180"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":14.74,"providers":[{"billed_charge":86.00,"npi":[1699731935,1821048794]}]},{"allowed_amount":509.50,"providers":[{"billed_charge":2924.00,"npi":[1497740492]}]},{"allowed_amount":339.02,"providers":[{"billed_charge":1978.00,"npi":[1821048794]}]},{"allowed_amount":31.42,"providers":[{"billed_charge":86.00,"npi":[1497740492]}]},{"allowed_amount":58.96,"providers":[{"billed_charge":344.00,"npi":[1699731935]}]},{"allowed_amount":36.85,"providers":[{"billed_charge":215.00,"npi":[1982101846]}]}]},{"tin":{"type":"ein","value":"611956307"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":15.48,"providers":[{"billed_charge":66.00,"npi":[1922493998]}]}]},{"tin":{"type":"ein","value":"460902156"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":331.65,"providers":[{"billed_charge":990.00,"npi":[1386623775]}]},{"allowed_amount":7.37,"providers":[{"billed_charge":22.00,"npi":[1386623775]}]}]}]},{"name":"CARDIOVASCULAR STRESS TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93015","description":"CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":643.60,"providers":[{"billed_charge":2037.00,"npi":[1234567893]}]}]}]},{"name":"TTE W/DOPPLER COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93306","description":"ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME W IMG DOCUMENTATION (2D), INCLUDES M-MODE RECORDING, WHEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","21"],"billing_class":"professional","payments":[{"allowed_amount":1649.20,"providers":[{"billed_charge":6348.11,"npi":[1234567893]}]},{"allowed_amount":53.20,"providers":[{"billed_charge":143.01,"npi":[1234567893]}]},{"allowed_amount":6744.97,"providers":[{"billed_charge":33177.00,"npi":[1234567893]}]}]}]},{"name":"EXTREMITY STUDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93970","description":"DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","21"],"billing_class":"professional","payments":[{"allowed_amount":25.05,"providers":[{"billed_charge":287.00,"npi":[1234567893]}]},{"allowed_amount":2680.00,"providers":[{"billed_charge":10261.00,"npi":[1234567893]}]},{"allowed_amount":100.20,"providers":[{"billed_charge":210.63,"npi":[1234567893]}]}]}]},{"name":"EXTREMITY STUDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93971","description":"DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","21"],"billing_class":"professional","payments":[{"allowed_amount":1973.40,"providers":[{"billed_charge":8280.00,"npi":[1234567893]}]},{"allowed_amount":24.77,"providers":[{"billed_charge":77.00,"npi":[1234567893]}]},{"allowed_amount":16.19,"providers":[{"billed_charge":36.29,"npi":[1234567893]}]}]}]},{"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":"636000526"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":365.68,"providers":[{"billed_charge":917.00,"npi":[1154386431]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":185.58,"providers":[{"billed_charge":354.30,"npi":[1234567893]}]}]}]},{"name":"BRIEF EMOTIONAL/BEHAV ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96127","description":"BRIEF EMOTIONAL/BEHAVIORAL ASSESSMENT (EG, DEPRESSION INVENTORY, ATTENTION-DEFICIT/HYPERACTIVITY DIS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.52,"providers":[{"billed_charge":14.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":78.36,"providers":[{"billed_charge":264.00,"npi":[1710603659]}]}]}]},{"name":"HLTH BHV ASSMT/REASSESSMENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96156","description":"HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT","allowed_amounts":[{"tin":{"type":"ein","value":"630695975"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1047.09,"providers":[{"billed_charge":2706.00,"npi":[1568019297]}]},{"allowed_amount":507.06,"providers":[{"billed_charge":1476.00,"npi":[1568019297]}]}]}]},{"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":"721382190"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":30.15,"providers":[{"billed_charge":57.33,"npi":[1023876653]}]},{"allowed_amount":60.30,"providers":[{"billed_charge":114.66,"npi":[1558124768]}]},{"allowed_amount":50.25,"providers":[{"billed_charge":95.55,"npi":[1023876653,1558124768]}]}]},{"tin":{"type":"ein","value":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":63.55,"providers":[{"billed_charge":100.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":10.81,"providers":[{"billed_charge":20.50,"npi":[1285250670]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":172.96,"providers":[{"billed_charge":416.00,"npi":[1700615846]}]},{"allowed_amount":162.15,"providers":[{"billed_charge":390.00,"npi":[1316271430]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":137.91,"providers":[{"billed_charge":462.00,"npi":[1234567893]}]},{"allowed_amount":1362.84,"providers":[{"billed_charge":3333.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":35.46,"providers":[{"billed_charge":105.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":10.81,"providers":[{"billed_charge":33.00,"npi":[1700869609]}]},{"allowed_amount":183.77,"providers":[{"billed_charge":561.00,"npi":[1073247565]}]},{"allowed_amount":216.20,"providers":[{"billed_charge":660.00,"npi":[1003546698]}]},{"allowed_amount":291.87,"providers":[{"billed_charge":891.00,"npi":[1710603659]}]}]},{"tin":{"type":"ein","value":"931418808"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":321.60,"providers":[{"billed_charge":768.00,"npi":[1710576905]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":978.68,"providers":[{"billed_charge":2310.00,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":158.95,"providers":[{"billed_charge":650.00,"npi":[1295579266]}]},{"allowed_amount":227.01,"providers":[{"billed_charge":1050.00,"npi":[1063215945]}]},{"allowed_amount":108.10,"providers":[{"billed_charge":500.00,"npi":[1689429177]}]},{"allowed_amount":32.43,"providers":[{"billed_charge":150.00,"npi":[1699574368]}]},{"allowed_amount":97.29,"providers":[{"billed_charge":450.00,"npi":[1447097167]}]},{"allowed_amount":21.62,"providers":[{"billed_charge":100.00,"npi":[1023804010]}]}]}]},{"name":"ELECTRIC STIMULATION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97014","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION (UNATTENDED)","allowed_amounts":[{"tin":{"type":"ein","value":"631225408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":215.65,"providers":[{"billed_charge":760.00,"npi":[1538723564]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":363.20,"providers":[{"billed_charge":1023.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":317.80,"providers":[{"billed_charge":1540.00,"npi":[1144569955]}]},{"allowed_amount":11.35,"providers":[{"billed_charge":55.00,"npi":[1629247721]}]},{"allowed_amount":79.45,"providers":[{"billed_charge":385.00,"npi":[1932609492]}]},{"allowed_amount":170.25,"providers":[{"billed_charge":825.00,"npi":[1073924965]}]}]}]},{"name":"VASOPNEUMATIC DEVICE THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97016","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; VASOPNEUMATIC DEVICES","allowed_amounts":[{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":77.70,"providers":[{"billed_charge":590.00,"npi":[1144569955]}]}]}]},{"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":"631225408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3502.82,"providers":[{"billed_charge":10740.00,"npi":[1538723564]}]}]},{"tin":{"type":"ein","value":"300714977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":733.84,"providers":[{"billed_charge":3382.00,"npi":[1518918929]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10550.95,"providers":[{"billed_charge":44326.92,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":347.66,"providers":[{"billed_charge":1404.00,"npi":[1508230178]}]},{"allowed_amount":19.31,"providers":[{"billed_charge":78.00,"npi":[1629247721]}]},{"allowed_amount":270.34,"providers":[{"billed_charge":1092.00,"npi":[1073924965]}]},{"allowed_amount":598.61,"providers":[{"billed_charge":2418.00,"npi":[1144569955]}]},{"allowed_amount":328.27,"providers":[{"billed_charge":1326.00,"npi":[1932609492]}]},{"allowed_amount":58.75,"providers":[{"billed_charge":234.00,"npi":[1851029268]}]}]},{"tin":{"type":"ein","value":"862438010"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":330.48,"providers":[{"billed_charge":748.00,"npi":[1811701980]}]}]}]},{"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":"631225408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":819.05,"providers":[{"billed_charge":2196.00,"npi":[1538723564]}]}]},{"tin":{"type":"ein","value":"300714977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":558.74,"providers":[{"billed_charge":2574.00,"npi":[1518918929]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8273.83,"providers":[{"billed_charge":36080.12,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":544.42,"providers":[{"billed_charge":2150.00,"npi":[1073924965]}]},{"allowed_amount":1002.88,"providers":[{"billed_charge":3956.00,"npi":[1144569955]}]},{"allowed_amount":303.25,"providers":[{"billed_charge":1204.00,"npi":[1932609492]}]},{"allowed_amount":112.23,"providers":[{"billed_charge":430.00,"npi":[1508230178]}]}]},{"tin":{"type":"ein","value":"862438010"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":453.69,"providers":[{"billed_charge":924.00,"npi":[1811701980]}]}]}]},{"name":"GAIT TRAINING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97116","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":212.45,"providers":[{"billed_charge":979.00,"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":"300714977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":346.56,"providers":[{"billed_charge":1596.00,"npi":[1518918929]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4843.92,"providers":[{"billed_charge":19738.70,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":200.64,"providers":[{"billed_charge":803.00,"npi":[1508230178]}]},{"allowed_amount":624.22,"providers":[{"billed_charge":2482.00,"npi":[1144569955]}]},{"allowed_amount":54.72,"providers":[{"billed_charge":219.00,"npi":[1073924965]}]},{"allowed_amount":127.69,"providers":[{"billed_charge":511.00,"npi":[1629247721]}]},{"allowed_amount":456.04,"providers":[{"billed_charge":1825.00,"npi":[1932609492]}]}]},{"tin":{"type":"ein","value":"862438010"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":164.16,"providers":[{"billed_charge":342.00,"npi":[1811701980]}]}]}]},{"name":"PT EVAL LOW COMPLEX 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97161","description":"PHYSICAL THERAPY EVALUATION: LOW COMPLEXITY, REQUIRING THESE COMPONENTS: A HISTORY WITH NO PERSONAL","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":876.60,"providers":[{"billed_charge":2792.50,"npi":[1234567893]}]}]}]},{"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":"631225408"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1138.93,"providers":[{"billed_charge":2898.00,"npi":[1538723564]}]}]},{"tin":{"type":"ein","value":"300714977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1401.34,"providers":[{"billed_charge":6206.00,"npi":[1518918929]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7348.28,"providers":[{"billed_charge":31341.68,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"862438010"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":323.59,"providers":[{"billed_charge":624.00,"npi":[1811701980]}]}]},{"tin":{"type":"ein","value":"883148972"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1054.85,"providers":[{"billed_charge":3906.00,"npi":[1144569955]}]},{"allowed_amount":25.48,"providers":[{"billed_charge":93.00,"npi":[1508230178]}]},{"allowed_amount":394.93,"providers":[{"billed_charge":1488.00,"npi":[1073924965]}]},{"allowed_amount":405.13,"providers":[{"billed_charge":1488.00,"npi":[1932609492]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":399.96,"providers":[{"billed_charge":555.00,"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":"999999999"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":9850.98,"providers":[{"billed_charge":16113.23,"npi":[1234567893]}]},{"allowed_amount":222.39,"providers":[{"billed_charge":480.00,"npi":[1234567893]}]}]}]},{"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":"631205990"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":150.69,"providers":[{"billed_charge":182.00,"npi":[1649651217]}]}]},{"tin":{"type":"ein","value":"631012832"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":203.43,"providers":[{"billed_charge":230.00,"npi":[1417242702]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":35262.22,"providers":[{"billed_charge":59827.46,"npi":[1234567893]}]},{"allowed_amount":954.60,"providers":[{"billed_charge":2516.29,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":896.56,"providers":[{"billed_charge":2765.00,"npi":[1336793314]}]},{"allowed_amount":768.48,"providers":[{"billed_charge":2370.00,"npi":[1457014375]}]},{"allowed_amount":1665.04,"providers":[{"billed_charge":5135.00,"npi":[1326287665]}]},{"allowed_amount":128.08,"providers":[{"billed_charge":395.00,"npi":[1417340936]}]},{"allowed_amount":6404.00,"providers":[{"billed_charge":19750.00,"npi":[1710603659]}]},{"allowed_amount":512.32,"providers":[{"billed_charge":1580.00,"npi":[1659981959]}]},{"allowed_amount":3842.40,"providers":[{"billed_charge":11850.00,"npi":[1073247565]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":640.40,"providers":[{"billed_charge":1660.00,"npi":[1447097167]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99205","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11"],"billing_class":"professional","payments":[{"allowed_amount":164.23,"providers":[{"billed_charge":590.00,"npi":[1234567893]}]},{"allowed_amount":10630.29,"providers":[{"billed_charge":17450.10,"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":"999999999"},"service_code":["11","22","02","10"],"billing_class":"professional","payments":[{"allowed_amount":128.04,"providers":[{"billed_charge":321.00,"npi":[1234567893]}]},{"allowed_amount":457.00,"providers":[{"billed_charge":1026.00,"npi":[1234567893]}]},{"allowed_amount":146.03,"providers":[{"billed_charge":444.00,"npi":[1234567893]}]},{"allowed_amount":1558.68,"providers":[{"billed_charge":4020.80,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630727781"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":940.06,"providers":[{"billed_charge":1452.00,"npi":[1134765886]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":170.38,"providers":[{"billed_charge":490.00,"npi":[1962085233]}]},{"allowed_amount":435.20,"providers":[{"billed_charge":1120.00,"npi":[1568283083]}]}]}]},{"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":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":163.72,"providers":[{"billed_charge":180.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"201165892"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.58,"providers":[{"billed_charge":160.00,"npi":[1114412525]}]}]},{"tin":{"type":"ein","value":"631198286"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":676.92,"providers":[{"billed_charge":1800.00,"npi":[1376237503]}]},{"allowed_amount":3271.78,"providers":[{"billed_charge":8700.00,"npi":[1245513183]}]}]},{"tin":{"type":"ein","value":"830392317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1312.29,"providers":[{"billed_charge":2625.00,"npi":[1811983596]}]}]},{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4256.72,"providers":[{"billed_charge":9161.88,"npi":[1275361230]}]},{"allowed_amount":2373.94,"providers":[{"billed_charge":5109.51,"npi":[1629759501]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2128.36,"providers":[{"billed_charge":4064.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"631176388"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7694.84,"providers":[{"billed_charge":9400.00,"npi":[1376681676]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":491.16,"providers":[{"billed_charge":690.00,"npi":[1457341307]}]},{"allowed_amount":599.30,"providers":[{"billed_charge":1150.00,"npi":[1457341307]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11542.26,"providers":[{"billed_charge":14100.00,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"900874767"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1378.39,"providers":[{"billed_charge":2998.05,"npi":[1760471817]}]},{"allowed_amount":245.58,"providers":[{"billed_charge":391.05,"npi":[1760471817]}]}]},{"tin":{"type":"ein","value":"630819576"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":487.05,"providers":[{"billed_charge":555.00,"npi":[1548673403]}]}]},{"tin":{"type":"ein","value":"270952681"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":257.85,"providers":[{"billed_charge":450.00,"npi":[1174185060]}]}]},{"tin":{"type":"ein","value":"208104245"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1637.20,"providers":[{"billed_charge":4920.00,"npi":[1639152556]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["11","72","20"],"billing_class":"professional","payments":[{"allowed_amount":3479.00,"providers":[{"billed_charge":4750.00,"npi":[1902549991]}]},{"allowed_amount":834.96,"providers":[{"billed_charge":1140.00,"npi":[1881007086]}]},{"allowed_amount":1461.18,"providers":[{"billed_charge":1995.00,"npi":[1285250670]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":834.96,"providers":[{"billed_charge":1320.00,"npi":[1700615846]}]},{"allowed_amount":487.06,"providers":[{"billed_charge":770.00,"npi":[1689374563]}]}]},{"tin":{"type":"ein","value":"630727804"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":208.74,"providers":[{"billed_charge":538.02,"npi":[1558066407]}]},{"allowed_amount":50.94,"providers":[{"billed_charge":179.34,"npi":[1558066407]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","02","72","10"],"billing_class":"professional","payments":[{"allowed_amount":28893.22,"providers":[{"billed_charge":48059.72,"npi":[1234567893]}]},{"allowed_amount":3230.25,"providers":[{"billed_charge":7096.72,"npi":[1234567893]}]},{"allowed_amount":208.74,"providers":[{"billed_charge":801.00,"npi":[1234567893]}]},{"allowed_amount":779.09,"providers":[{"billed_charge":2075.96,"npi":[1234567893]}]},{"allowed_amount":3491.03,"providers":[{"billed_charge":7288.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":305.64,"providers":[{"billed_charge":880.00,"npi":[1720754096]},{"billed_charge":900.00,"npi":[1053117366]}]}]}]},{"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":"630695975"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":883.53,"providers":[{"billed_charge":2385.00,"npi":[1508351297]}]},{"allowed_amount":230.98,"providers":[{"billed_charge":530.00,"npi":[1871080986]}]}]},{"tin":{"type":"ein","value":"850770765"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8540.79,"providers":[{"billed_charge":15300.00,"npi":[1134512072]}]},{"allowed_amount":908.43,"providers":[{"billed_charge":1325.00,"npi":[1023085669]}]}]},{"tin":{"type":"ein","value":"922872876"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":269.96,"providers":[{"billed_charge":562.40,"npi":[1871968206]}]},{"allowed_amount":88.35,"providers":[{"billed_charge":140.60,"npi":[1871968206]}]}]},{"tin":{"type":"ein","value":"721382190"},"service_code":["11","20"],"billing_class":"professional","payments":[{"allowed_amount":954.85,"providers":[{"billed_charge":954.85,"npi":[1023876653]}]},{"allowed_amount":1469.30,"providers":[{"billed_charge":1469.30,"npi":[1558124768]}]},{"allowed_amount":1689.35,"providers":[{"billed_charge":1689.35,"npi":[1023876653]}]},{"allowed_amount":293.80,"providers":[{"billed_charge":293.80,"npi":[1558124768]}]}]},{"tin":{"type":"ein","value":"646001528"},"service_code":["72"],"billing_class":"professional","payments":[{"allowed_amount":1731.60,"providers":[{"billed_charge":2536.00,"npi":[1538553607]}]}]},{"tin":{"type":"ein","value":"851124757"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":224.97,"providers":[{"billed_charge":264.69,"npi":[1548636392]}]}]},{"tin":{"type":"ein","value":"272446754"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1349.75,"providers":[{"billed_charge":2842.40,"npi":[1922696541]}]}]},{"tin":{"type":"ein","value":"630829524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1963.40,"providers":[{"billed_charge":4020.00,"npi":[1184677536]}]}]},{"tin":{"type":"ein","value":"874444819"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2309.80,"providers":[{"billed_charge":3600.00,"npi":[1831210566]}]}]},{"tin":{"type":"ein","value":"270205345"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":441.75,"providers":[{"billed_charge":625.00,"npi":[1770981458,1861965493]}]}]},{"tin":{"type":"ein","value":"630307951"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":1178.04,"providers":[{"billed_charge":1620.00,"npi":[1285250670]}]},{"allowed_amount":981.70,"providers":[{"billed_charge":1350.00,"npi":[1356343271]}]},{"allowed_amount":1472.55,"providers":[{"billed_charge":2025.00,"npi":[1902549991]}]}]},{"tin":{"type":"ein","value":"208104245"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":785.36,"providers":[{"billed_charge":2776.00,"npi":[1366134884]}]}]},{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":923.92,"providers":[{"billed_charge":1200.00,"npi":[1619618733]}]},{"allowed_amount":3002.74,"providers":[{"billed_charge":3900.00,"npi":[1376121392]}]}]},{"tin":{"type":"ein","value":"263065690"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1079.87,"providers":[{"billed_charge":1760.00,"npi":[1821827114]}]}]},{"tin":{"type":"ein","value":"201935552"},"service_code":["11","02","50"],"billing_class":"professional","payments":[{"allowed_amount":230.98,"providers":[{"billed_charge":301.84,"npi":[1548821689]}]},{"allowed_amount":2257.91,"providers":[{"billed_charge":3471.16,"npi":[1528744273]}]},{"allowed_amount":74.99,"providers":[{"billed_charge":150.92,"npi":[1528744273]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","11","02","72"],"billing_class":"professional","payments":[{"allowed_amount":4255.81,"providers":[{"billed_charge":13912.00,"npi":[1234567893]}]},{"allowed_amount":444.93,"providers":[{"billed_charge":1458.72,"npi":[1234567893]}]},{"allowed_amount":105649.39,"providers":[{"billed_charge":174396.99,"npi":[1234567893]}]},{"allowed_amount":8350.11,"providers":[{"billed_charge":20097.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1178.04,"providers":[{"billed_charge":2592.00,"npi":[1689429177]}]},{"allowed_amount":981.70,"providers":[{"billed_charge":2160.00,"npi":[1447097167]}]},{"allowed_amount":1865.23,"providers":[{"billed_charge":4104.00,"npi":[1063215945]}]}]},{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":577.45,"providers":[{"billed_charge":700.00,"npi":[1114487337]}]}]},{"tin":{"type":"ein","value":"462336113"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2257.91,"providers":[{"billed_charge":3450.00,"npi":[1588350573]}]}]},{"tin":{"type":"ein","value":"631205990"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2771.76,"providers":[{"billed_charge":3360.00,"npi":[1548298045]}]}]},{"tin":{"type":"ein","value":"830392317"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":558.06,"providers":[{"billed_charge":900.00,"npi":[1811983596]}]}]},{"tin":{"type":"ein","value":"630477348"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":125.63,"providers":[{"billed_charge":244.00,"npi":[1508811969]}]}]},{"tin":{"type":"ein","value":"870970152"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":808.43,"providers":[{"billed_charge":945.00,"npi":[1073350955]}]}]},{"tin":{"type":"ein","value":"823567923"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":3505.04,"providers":[{"billed_charge":8456.00,"npi":[1831816032]}]},{"allowed_amount":250.36,"providers":[{"billed_charge":604.00,"npi":[1437278371,1831816032]}]},{"allowed_amount":4130.94,"providers":[{"billed_charge":9966.00,"npi":[1437278371]}]},{"allowed_amount":1001.44,"providers":[{"billed_charge":2416.00,"npi":[1154628576]}]}]},{"tin":{"type":"ein","value":"630737968"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3002.74,"providers":[{"billed_charge":4968.60,"npi":[1629759501]}]}]},{"tin":{"type":"ein","value":"272596795"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":149.98,"providers":[{"billed_charge":398.00,"npi":[1184165748]}]},{"allowed_amount":2748.76,"providers":[{"billed_charge":5472.00,"npi":[1184165748]}]},{"allowed_amount":7968.81,"providers":[{"billed_charge":13731.00,"npi":[1023112307]}]}]},{"tin":{"type":"ein","value":"814624215"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":264.69,"providers":[{"billed_charge":495.00,"npi":[1457341307]}]},{"allowed_amount":665.68,"providers":[{"billed_charge":990.00,"npi":[1457341307,1225484561]}]},{"allowed_amount":352.92,"providers":[{"billed_charge":660.00,"npi":[1225484561]}]}]},{"tin":{"type":"ein","value":"931418808"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":4515.82,"providers":[{"billed_charge":8273.24,"npi":[1710576905]}]},{"allowed_amount":74.99,"providers":[{"billed_charge":180.00,"npi":[1710576905]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1847.84,"providers":[{"billed_charge":2400.00,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"900874767"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1616.86,"providers":[{"billed_charge":2579.22,"npi":[1760471817]}]},{"allowed_amount":2911.59,"providers":[{"billed_charge":6079.59,"npi":[1760471817]}]}]},{"tin":{"type":"ein","value":"474123699"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7622.34,"providers":[{"billed_charge":11925.00,"npi":[1427798016]}]}]},{"tin":{"type":"ein","value":"821803192"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":115.49,"providers":[{"billed_charge":140.00,"npi":[1811650609]}]}]},{"tin":{"type":"ein","value":"630727804"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":224.97,"providers":[{"billed_charge":806.31,"npi":[1558066407]}]},{"allowed_amount":3043.27,"providers":[{"billed_charge":8331.87,"npi":[1558066407]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1501.37,"providers":[{"billed_charge":2327.00,"npi":[1578978052]}]},{"allowed_amount":115.49,"providers":[{"billed_charge":179.00,"npi":[1447993522]}]},{"allowed_amount":196.34,"providers":[{"billed_charge":358.00,"npi":[1558042432]}]},{"allowed_amount":3040.83,"providers":[{"billed_charge":4654.00,"npi":[1891435988]}]},{"allowed_amount":2887.25,"providers":[{"billed_charge":4475.00,"npi":[1417417734]}]},{"allowed_amount":3118.23,"providers":[{"billed_charge":4833.00,"npi":[1609397686]}]},{"allowed_amount":176.46,"providers":[{"billed_charge":358.00,"npi":[1609397686]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":2159.74,"providers":[{"billed_charge":6732.00,"npi":[1700956265]}]},{"allowed_amount":392.68,"providers":[{"billed_charge":1224.00,"npi":[1326287665]}]},{"allowed_amount":785.36,"providers":[{"billed_charge":2448.00,"npi":[1003546698]}]},{"allowed_amount":589.02,"providers":[{"billed_charge":1836.00,"npi":[1679109755]}]},{"allowed_amount":5399.35,"providers":[{"billed_charge":16830.00,"npi":[1710603659]}]},{"allowed_amount":4613.99,"providers":[{"billed_charge":14382.00,"npi":[1073247565]}]}]}]},{"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":"999999999"},"service_code":["22","11","02"],"billing_class":"professional","payments":[{"allowed_amount":5682.28,"providers":[{"billed_charge":8999.64,"npi":[1234567893]}]},{"allowed_amount":260.92,"providers":[{"billed_charge":1280.00,"npi":[1234567893]}]},{"allowed_amount":1008.66,"providers":[{"billed_charge":2305.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":235.98,"providers":[{"billed_charge":355.00,"npi":[1234567893]}]},{"allowed_amount":9191.43,"providers":[{"billed_charge":15268.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":12599.20,"providers":[{"billed_charge":22588.73,"npi":[1234567893]}]},{"allowed_amount":370.10,"providers":[{"billed_charge":704.00,"npi":[1234567893]}]}]}]},{"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":"883517085"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":788.05,"providers":[{"billed_charge":1575.00,"npi":[1356821284]}]}]},{"tin":{"type":"ein","value":"834257679"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":268.85,"providers":[{"billed_charge":570.00,"npi":[1801537816]}]}]},{"tin":{"type":"ein","value":"97526954"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":934.92,"providers":[{"billed_charge":1428.00,"npi":[1497852453]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1150.84,"providers":[{"billed_charge":1715.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"630700401"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":2671.20,"providers":[{"billed_charge":5400.00,"npi":[1083146922]}]},{"allowed_amount":2493.12,"providers":[{"billed_charge":5040.00,"npi":[1649899006]}]},{"allowed_amount":44.52,"providers":[{"billed_charge":90.00,"npi":[1871298448]}]}]}]},{"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":"630649108"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":95.19,"providers":[{"billed_charge":210.00,"npi":[1386272136]}]}]},{"tin":{"type":"ein","value":"883208334"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2155.20,"providers":[{"billed_charge":3150.00,"npi":[1215233192]}]}]},{"tin":{"type":"ein","value":"821388539"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":68.72,"providers":[{"billed_charge":210.00,"npi":[1851824429]}]}]},{"tin":{"type":"ein","value":"208785589"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":71.84,"providers":[{"billed_charge":120.00,"npi":[1790779577]}]}]},{"tin":{"type":"ein","value":"822306092"},"service_code":["51"],"billing_class":"professional","payments":[{"allowed_amount":176.76,"providers":[{"billed_charge":450.00,"npi":[1760674949]}]}]},{"tin":{"type":"ein","value":"364902972"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":675.95,"providers":[{"billed_charge":1826.00,"npi":[1346994183]}]}]},{"tin":{"type":"ein","value":"834257679"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1127.88,"providers":[{"billed_charge":2730.00,"npi":[1801537816]}]}]},{"tin":{"type":"ein","value":"262976526"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":174.40,"providers":[{"billed_charge":288.00,"npi":[1588028237]}]}]},{"tin":{"type":"ein","value":"452551611"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":71.84,"providers":[{"billed_charge":120.00,"npi":[1215130307]}]}]},{"tin":{"type":"ein","value":"97526954"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":862.08,"providers":[{"billed_charge":1320.00,"npi":[1497852453]}]}]},{"tin":{"type":"ein","value":"853865175"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":1005.76,"providers":[{"billed_charge":2100.00,"npi":[1093118796]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":45392.04,"providers":[{"billed_charge":58514.11,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"834163880"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":71.84,"providers":[{"billed_charge":700.00,"npi":[1275882656]}]}]},{"tin":{"type":"ein","value":"821528255"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":933.92,"providers":[{"billed_charge":1274.00,"npi":[1639512635]}]}]}]},{"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":"931371454"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":777.90,"providers":[{"billed_charge":2185.00,"npi":[1992026751]}]}]},{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":665.70,"providers":[{"billed_charge":1200.00,"npi":[1053974402]}]}]},{"tin":{"type":"ein","value":"630854645"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":967.50,"providers":[{"billed_charge":1305.00,"npi":[1538188586]}]}]},{"tin":{"type":"ein","value":"812854031"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":274.11,"providers":[{"billed_charge":435.51,"npi":[1922720705]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","21"],"billing_class":"professional","payments":[{"allowed_amount":364.08,"providers":[{"billed_charge":661.00,"npi":[1234567893]}]},{"allowed_amount":15765.24,"providers":[{"billed_charge":19968.24,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"202208207"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1397.50,"providers":[{"billed_charge":2392.00,"npi":[1821002205]}]}]},{"tin":{"type":"ein","value":"464167313"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":860.00,"providers":[{"billed_charge":1024.00,"npi":[1083893309]}]},{"allowed_amount":2795.00,"providers":[{"billed_charge":3328.00,"npi":[1013178375]}]}]}]},{"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":"650622859"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":509.06,"providers":[{"billed_charge":1746.00,"npi":[1417615246]}]}]},{"tin":{"type":"ein","value":"731723107"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":713.47,"providers":[{"billed_charge":1320.00,"npi":[1235571001]}]}]},{"tin":{"type":"ein","value":"636004476"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1046.04,"providers":[{"billed_charge":2160.00,"npi":[1407749526]}]}]}]},{"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":"650622859"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":8198.89,"providers":[{"billed_charge":24757.00,"npi":[1861022030]}]},{"allowed_amount":6516.75,"providers":[{"billed_charge":19545.00,"npi":[1447271481]}]},{"allowed_amount":15968.17,"providers":[{"billed_charge":48211.00,"npi":[1417615246]}]},{"allowed_amount":19096.44,"providers":[{"billed_charge":57332.00,"npi":[1326553264]}]},{"allowed_amount":2595.81,"providers":[{"billed_charge":7818.00,"npi":[1790203461]}]},{"allowed_amount":4768.06,"providers":[{"billed_charge":14333.00,"npi":[1881851491]}]}]},{"tin":{"type":"ein","value":"611956307"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":462.20,"providers":[{"billed_charge":1656.00,"npi":[1922495878]}]},{"allowed_amount":1502.15,"providers":[{"billed_charge":5382.00,"npi":[1306406087]}]},{"allowed_amount":231.10,"providers":[{"billed_charge":828.00,"npi":[1437787140,1447877394]}]},{"allowed_amount":3119.85,"providers":[{"billed_charge":11178.00,"npi":[1760986848]}]},{"allowed_amount":1386.60,"providers":[{"billed_charge":4968.00,"npi":[1629607205]}]}]},{"tin":{"type":"ein","value":"721425772"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1100.50,"providers":[{"billed_charge":7080.00,"npi":[1740366400]}]},{"allowed_amount":1980.90,"providers":[{"billed_charge":12744.00,"npi":[1942663695]}]},{"allowed_amount":2421.10,"providers":[{"billed_charge":15576.00,"npi":[1952322687]}]},{"allowed_amount":2201.00,"providers":[{"billed_charge":14160.00,"npi":[1639790983]}]}]},{"tin":{"type":"ein","value":"800443600"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1115.32,"providers":[{"billed_charge":4004.00,"npi":[1265662183]}]},{"allowed_amount":231.10,"providers":[{"billed_charge":1144.00,"npi":[1215598537]}]},{"allowed_amount":687.54,"providers":[{"billed_charge":4004.00,"npi":[1598334963]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["22","23"],"billing_class":"professional","payments":[{"allowed_amount":1262.52,"providers":[{"billed_charge":4983.00,"npi":[1234567893]}]},{"allowed_amount":330.15,"providers":[{"billed_charge":516.00,"npi":[1234567893]}]}]}]},{"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":"650622859"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":6959.25,"providers":[{"billed_charge":21384.00,"npi":[1881851491]}]},{"allowed_amount":4415.77,"providers":[{"billed_charge":13608.00,"npi":[1447271481]}]},{"allowed_amount":2525.82,"providers":[{"billed_charge":7776.00,"npi":[1265507818]}]},{"allowed_amount":6323.38,"providers":[{"billed_charge":19440.00,"npi":[1417615246]}]},{"allowed_amount":10739.15,"providers":[{"billed_charge":33048.00,"npi":[1790203461]}]},{"allowed_amount":5069.30,"providers":[{"billed_charge":15552.00,"npi":[1861022030]}]}]},{"tin":{"type":"ein","value":"460671713"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":3183.83,"providers":[{"billed_charge":11742.00,"npi":[1396206371]}]}]},{"tin":{"type":"ein","value":"611956307"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":4189.25,"providers":[{"billed_charge":15450.00,"npi":[1306406087]}]},{"allowed_amount":2010.84,"providers":[{"billed_charge":7416.00,"npi":[1437787140]}]},{"allowed_amount":3183.83,"providers":[{"billed_charge":11742.00,"npi":[1760986848]}]},{"allowed_amount":837.85,"providers":[{"billed_charge":3090.00,"npi":[1710566179]}]},{"allowed_amount":1843.27,"providers":[{"billed_charge":6798.00,"npi":[1922495878,1265057178]}]},{"allowed_amount":2513.55,"providers":[{"billed_charge":9270.00,"npi":[1922493998]}]},{"allowed_amount":1675.70,"providers":[{"billed_charge":6180.00,"npi":[1447877394]}]},{"allowed_amount":4524.39,"providers":[{"billed_charge":16686.00,"npi":[1629607205]}]},{"allowed_amount":2345.98,"providers":[{"billed_charge":8652.00,"npi":[1720531023]}]}]}]},{"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":"631012832"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":2883.04,"providers":[{"billed_charge":3850.00,"npi":[1093790032]}]}]}]},{"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":"999999999"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":940.10,"providers":[{"billed_charge":1218.00,"npi":[1234567893]}]}]}]},{"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":"923731464"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":264.81,"providers":[{"billed_charge":624.00,"npi":[1528733284]}]}]},{"tin":{"type":"ein","value":"844972784"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":706.16,"providers":[{"billed_charge":2704.00,"npi":[1437412004]}]}]}]},{"name":"PREV VISIT EST AGE 18-39","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99395","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1052.20,"providers":[{"billed_charge":1600.00,"npi":[1234567893]}]}]}]},{"name":"PREV VISIT EST AGE 40-64","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99396","description":"PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF AN INDIVIDUAL INCL AN AGE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1519.70,"providers":[{"billed_charge":2092.00,"npi":[1234567893]}]}]}]},{"name":"Under Other Evaluation and Management Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99459","description":"Under Other Evaluation and Management Services","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1061.41,"providers":[{"billed_charge":4425.00,"npi":[1234567893]}]}]}]},{"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":"636001249"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14.68,"providers":[{"billed_charge":23.80,"npi":[1689780397]}]}]},{"tin":{"type":"ein","value":"933130363"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2449.99,"providers":[{"billed_charge":6730.00,"npi":[1265211312]}]}]},{"tin":{"type":"ein","value":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5942.47,"providers":[{"billed_charge":10216.11,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"850580697"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12734.05,"providers":[{"billed_charge":38471.80,"npi":[1851917504]}]}]},{"tin":{"type":"ein","value":"630574273"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":210.83,"providers":[{"billed_charge":290.00,"npi":[1760432884]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12970.27,"providers":[{"billed_charge":24890.60,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"201145982"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7340.00,"providers":[{"billed_charge":15343.80,"npi":[1275591794]}]}]},{"tin":{"type":"ein","value":"275404756"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2295.46,"providers":[{"billed_charge":4446.00,"npi":[1447530787]}]}]},{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":68948.68,"providers":[{"billed_charge":138276.72,"npi":[1538236211]}]}]},{"tin":{"type":"ein","value":"631225058"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":210.83,"providers":[{"billed_charge":725.00,"npi":[1821037755]}]}]},{"tin":{"type":"ein","value":"630625224"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":697.30,"providers":[{"billed_charge":2850.00,"npi":[1619455516]}]}]},{"tin":{"type":"ein","value":"636001318"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13087.45,"providers":[{"billed_charge":24910.20,"npi":[1407816713]}]}]},{"tin":{"type":"ein","value":"453639743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2163.01,"providers":[{"billed_charge":6380.00,"npi":[1477830164]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7011.82,"providers":[{"billed_charge":14791.72,"npi":[1194737460]}]}]},{"tin":{"type":"ein","value":"463413109"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3147.91,"providers":[{"billed_charge":10825.00,"npi":[1063847085]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15899.49,"providers":[{"billed_charge":32805.00,"npi":[1215160916]}]}]},{"tin":{"type":"ein","value":"831651180"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14606.60,"providers":[{"billed_charge":35048.64,"npi":[1659071108]}]}]},{"tin":{"type":"ein","value":"872027148"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9424.56,"providers":[{"billed_charge":20507.20,"npi":[1982300422]}]}]},{"tin":{"type":"ein","value":"630866817"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13828.56,"providers":[{"billed_charge":28224.00,"npi":[1013098300]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3664.08,"providers":[{"billed_charge":40846.31,"npi":[1073871836]}]},{"allowed_amount":292.30,"providers":[{"billed_charge":1925.42,"npi":[1356761589]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1308.60,"providers":[{"billed_charge":2436.70,"npi":[1073931515]}]},{"allowed_amount":17931.62,"providers":[{"billed_charge":61148.29,"npi":[1891240859]}]},{"allowed_amount":305.34,"providers":[{"billed_charge":1010.10,"npi":[1659753846]}]}]},{"tin":{"type":"ein","value":"631219758"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2847.92,"providers":[{"billed_charge":6882.50,"npi":[1407186232]}]}]},{"tin":{"type":"ein","value":"636001175"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2701.12,"providers":[{"billed_charge":6029.48,"npi":[1174500078]}]}]},{"tin":{"type":"ein","value":"630737822"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6943.64,"providers":[{"billed_charge":17501.00,"npi":[1851471932]}]}]},{"tin":{"type":"ein","value":"631130184"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":6543.00,"providers":[{"billed_charge":13774.01,"npi":[1558457176]}]}]},{"tin":{"type":"ein","value":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9976.50,"providers":[{"billed_charge":34043.87,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"596000598"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":393.45,"providers":[{"billed_charge":645.00,"npi":[1518960426]}]}]},{"tin":{"type":"ein","value":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":15148.72,"providers":[{"billed_charge":43113.00,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"630621090"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8443.84,"providers":[{"billed_charge":25730.17,"npi":[1508876467]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14281.70,"providers":[{"billed_charge":29957.43,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"631150208"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3075.46,"providers":[{"billed_charge":10422.50,"npi":[1831206713]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18629.27,"providers":[{"billed_charge":38972.01,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"721397961"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":576.40,"providers":[{"billed_charge":998.20,"npi":[1548246010]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18225.22,"providers":[{"billed_charge":49660.00,"npi":[1942277124]}]}]}]},{"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":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":249.63,"providers":[{"billed_charge":650.00,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":756.21,"providers":[{"billed_charge":1425.00,"npi":[1942277124]}]}]}]},{"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":"831651180"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20355.12,"providers":[{"billed_charge":44221.59,"npi":[1659071108]}]}]},{"tin":{"type":"ein","value":"872027148"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9179.76,"providers":[{"billed_charge":18934.98,"npi":[1982300422]}]}]},{"tin":{"type":"ein","value":"630866817"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":19157.76,"providers":[{"billed_charge":34800.00,"npi":[1013098300]}]}]},{"tin":{"type":"ein","value":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":20552.48,"providers":[{"billed_charge":36712.52,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"454506713"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10276.24,"providers":[{"billed_charge":116751.18,"npi":[1073871836]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":395.24,"providers":[{"billed_charge":1337.50,"npi":[1659753846]}]},{"allowed_amount":53881.20,"providers":[{"billed_charge":189493.22,"npi":[1891240859]}]}]},{"tin":{"type":"ein","value":"636001175"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2793.84,"providers":[{"billed_charge":4623.85,"npi":[1174500078]}]}]},{"tin":{"type":"ein","value":"630737822"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5587.68,"providers":[{"billed_charge":9450.00,"npi":[1851471932]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12647.68,"providers":[{"billed_charge":32000.00,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"631130184"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":790.48,"providers":[{"billed_charge":1646.52,"npi":[1558457176]}]}]},{"tin":{"type":"ein","value":"201145982"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3592.08,"providers":[{"billed_charge":7409.34,"npi":[1275591794]}]}]},{"tin":{"type":"ein","value":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33961.20,"providers":[{"billed_charge":144200.00,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"630957564"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":33925.20,"providers":[{"billed_charge":94860.00,"npi":[1467546242]}]}]},{"tin":{"type":"ein","value":"630621090"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13574.48,"providers":[{"billed_charge":54919.74,"npi":[1508876467]}]}]},{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":243072.60,"providers":[{"billed_charge":488334.60,"npi":[1538236211]}]}]},{"tin":{"type":"ein","value":"263403024"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14368.32,"providers":[{"billed_charge":37080.00,"npi":[1225288681]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":35966.84,"providers":[{"billed_charge":74916.66,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"453639743"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":496.38,"providers":[{"billed_charge":900.00,"npi":[1477830164]}]}]},{"tin":{"type":"ein","value":"636001318"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":146634.04,"providers":[{"billed_charge":267120.00,"npi":[1407816713]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":13438.16,"providers":[{"billed_charge":27268.00,"npi":[1215160916]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16763.04,"providers":[{"billed_charge":30450.00,"npi":[1942277124]}]}]},{"tin":{"type":"ein","value":"463413109"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1580.96,"providers":[{"billed_charge":4000.00,"npi":[1063847085]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8695.28,"providers":[{"billed_charge":22660.00,"npi":[1194737460]}]}]}]},{"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":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4368.42,"providers":[{"billed_charge":9450.00,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1248.12,"providers":[{"billed_charge":4200.00,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":416.04,"providers":[{"billed_charge":1442.00,"npi":[1194737460]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":416.04,"providers":[{"billed_charge":844.00,"npi":[1215160916]}]}]}]},{"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":"636001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39607.96,"providers":[{"billed_charge":70749.07,"npi":[1962487355]}]}]},{"tin":{"type":"ein","value":"850580697"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":64799.51,"providers":[{"billed_charge":189381.00,"npi":[1851917504]}]}]},{"tin":{"type":"ein","value":"465007345"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1680.50,"providers":[{"billed_charge":5620.08,"npi":[1891240859]}]}]},{"tin":{"type":"ein","value":"630737822"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5377.60,"providers":[{"billed_charge":9200.00,"npi":[1851471932]}]}]},{"tin":{"type":"ein","value":"631130184"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3328.40,"providers":[{"billed_charge":6878.80,"npi":[1558457176]}]}]},{"tin":{"type":"ein","value":"630725492"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10318.04,"providers":[{"billed_charge":26350.00,"npi":[1386710515]}]}]},{"tin":{"type":"ein","value":"201145982"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":336.10,"providers":[{"billed_charge":693.28,"npi":[1275591794]}]}]},{"tin":{"type":"ein","value":"832156832"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4842.42,"providers":[{"billed_charge":20136.50,"npi":[1770059800]}]}]},{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2329.88,"providers":[{"billed_charge":4680.76,"npi":[1538236211]}]}]},{"tin":{"type":"ein","value":"631150208"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4488.80,"providers":[{"billed_charge":16200.00,"npi":[1831206713]}]}]},{"tin":{"type":"ein","value":"861281752"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2329.88,"providers":[{"billed_charge":4852.96,"npi":[1033782560]}]}]},{"tin":{"type":"ein","value":"263644474"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8986.68,"providers":[{"billed_charge":18225.00,"npi":[1215160916]}]}]},{"tin":{"type":"ein","value":"631149220"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":336.10,"providers":[{"billed_charge":625.00,"npi":[1942277124]}]}]},{"tin":{"type":"ein","value":"630779256"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1331.36,"providers":[{"billed_charge":3502.00,"npi":[1194737460]}]}]}]},{"name":"ADVNCED LIFE SUPPORT LEVEL 2","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0433","description":"ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)","allowed_amounts":[{"tin":{"type":"ein","value":"631058881"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5720.60,"providers":[{"billed_charge":11492.80,"npi":[1538236211]}]}]}]},{"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1162.30,"providers":[{"billed_charge":5548.47,"npi":[1234567893]}]}]}]},{"name":"WND CARE SET NEG PRSS WND TX","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A6550","description":"WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND ACCES","allowed_amounts":[{"tin":{"type":"ein","value":"742152396"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3469.20,"providers":[{"billed_charge":8431.50,"npi":[1538156864]}]}]}]},{"name":"CANSTR DISPBL USD W/SUCTPUMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7000","description":"CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"742152396"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":622.60,"providers":[{"billed_charge":2964.50,"npi":[1538156864]}]}]}]},{"name":"ADMN SET SM VOL NONFILTR NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7003","description":"ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5.94,"providers":[{"billed_charge":90.09,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6226.80,"providers":[{"billed_charge":35158.72,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5690.44,"providers":[{"billed_charge":22616.99,"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":1564.91,"providers":[{"billed_charge":11168.16,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2436.87,"providers":[{"billed_charge":13760.70,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1818.36,"providers":[{"billed_charge":8252.59,"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":1953.51,"providers":[{"billed_charge":7951.69,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1106.96,"providers":[{"billed_charge":6124.11,"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":160.00,"providers":[{"billed_charge":1267.07,"npi":[1234567893]}]}]}]},{"name":"WALKER FOLD WHEELED ADJUSTBL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0143","description":"WALKER, FOLDING, WHEELED, ADJUSTABLE OR FIXED HEIGHT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3541.00,"providers":[{"billed_charge":16466.85,"npi":[1234567893]}]}]}]},{"name":"SEAT ATTACHMENT WALKER","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0156","description":"SEAT ATTACHMENT, WALKER","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":62.21,"providers":[{"billed_charge":170.13,"npi":[1234567893]}]}]}]},{"name":"COMMODE CHAIR W/FIXED ARMS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0163","description":"COMMODE CHAIR, MOBILE OR STATIONARY, WITH FIXED ARMS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":467.29,"providers":[{"billed_charge":1571.62,"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":3528.90,"providers":[{"billed_charge":14527.35,"npi":[1234567893]}]}]}]},{"name":"HOME VENT TYPE USD NON-INVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0466","description":"HOME VENTILATOR, ANY TYPE, USED WITH NONINVASIVE INTERFACE, (E.G., MASK, CHEST SHELL)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":20027.49,"providers":[{"billed_charge":69541.60,"npi":[1234567893]}]}]}]},{"name":"RESP ASST DEVC BI-LEVL PRSS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0470","description":"RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONI","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1104.66,"providers":[{"billed_charge":5691.87,"npi":[1234567893]}]}]}]},{"name":"HI FREQ CHST WALL AIR-PULSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0483","description":"HIGH FREQUENCY CHEST WALL OSCILLATION AIR-PULSE GENERATOR SYSTEM, (INCLUDES HOSES AND VEST), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":5941.65,"providers":[{"billed_charge":11791.02,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":9439.41,"providers":[{"billed_charge":37273.35,"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":1498.90,"providers":[{"billed_charge":9274.40,"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":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":10668.73,"providers":[{"billed_charge":68058.54,"npi":[1234567893]}]}]}]},{"name":"O2 CONC 85%/>02 CONC PRSC FL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E1390","description":"OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":31345.60,"providers":[{"billed_charge":159041.73,"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":6628.62,"providers":[{"billed_charge":36810.00,"npi":[1234567893]}]}]}]},{"name":"NEG PRSS WND TX PUMP STATN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E2402","description":"NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE","allowed_amounts":[{"tin":{"type":"ein","value":"742152396"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":25374.80,"providers":[{"billed_charge":25374.80,"npi":[1538156864]}]}]}]},{"name":"E-STIM 1/>NOT WND CARE PART","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0283","description":"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":294.12,"providers":[{"billed_charge":1416.30,"npi":[1234567893]}]}]}]},{"name":"ANL WELLNES VST PERSNL PPS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0438","description":"ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT","allowed_amounts":[{"tin":{"type":"ein","value":"850770765"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3566.58,"providers":[{"billed_charge":5600.00,"npi":[1134512072]}]}]}]},{"name":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0545","description":"Code for Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation, analysis, and testing, and complex antimicrobial therapy counseling and treatment (add-on code, list separately in addition to hospital inpatient or observation evaluation and management visit, initial, same day discharge, subsequent or discharge)","allowed_amounts":[{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":41.83,"providers":[{"billed_charge":45.00,"npi":[1053974402]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":608.85,"providers":[{"billed_charge":750.00,"npi":[1234567893]}]}]}]},{"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":"850770765"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":162.50,"providers":[{"billed_charge":1300.00,"npi":[1134512072]}]}]},{"tin":{"type":"ein","value":"631205990"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":294.00,"providers":[{"billed_charge":700.00,"npi":[1548298045]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1523.08,"providers":[{"billed_charge":3163.80,"npi":[1234567893]}]}]}]},{"name":"RT D 3/> S TX AR CSTM BLK;6-","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6012","description":"RADIATION TRTMNT DELIVERY, 3 OR MORE SEPARATE TRTMNT AREAS, CUST BLOCKING, TANGENTIAL PORTS, WEDGES,","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":15592.38,"providers":[{"billed_charge":101260.00,"npi":[1234567893]}]}]}]},{"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":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4528.80,"providers":[{"billed_charge":29520.00,"npi":[1234567893]}]}]}]},{"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":"631185834"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":31904.30,"providers":[{"billed_charge":203830.00,"npi":[1225591878]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":24294.10,"providers":[{"billed_charge":155210.00,"npi":[1234567893]}]}]}]},{"name":"INTRA-F LOC&TRCK TRGT/PT M E","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G6017","description":"INTRA-FRACTION LOCALIZATION AND TRACKING OF TARGET OR PATIENT MOTION DURING DELIVERY OF RADIATION TH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4445.73,"providers":[{"billed_charge":18095.00,"npi":[1234567893]}]}]}]},{"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":"923029503"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9562.50,"providers":[{"billed_charge":42500.00,"npi":[1174137673]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"474426818"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1855.38,"providers":[{"billed_charge":1855.38,"npi":[1114398799]}]}]}]},{"name":"INJ CEFTRIAXONE SODM PER 250","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J0696","description":"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":17.26,"providers":[{"billed_charge":247.60,"npi":[1234567893]}]},{"allowed_amount":1.39,"providers":[{"billed_charge":12.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.74,"providers":[{"billed_charge":225.75,"npi":[1124591177]}]}]}]},{"name":"Injection, methylprednisolone acetate, 1 mg","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1010","description":"Injection, methylprednisolone acetate, 1 mg ","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":105.60,"providers":[{"billed_charge":815.60,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":67.20,"providers":[{"billed_charge":281.00,"npi":[1124591177]}]}]}]},{"name":"INJ DEXMETH SODM PHOSHA 1MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1100","description":"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"465658180"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3.69,"providers":[{"billed_charge":8.00,"npi":[1700615846]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","72"],"billing_class":"professional","payments":[{"allowed_amount":21.06,"providers":[{"billed_charge":1322.00,"npi":[1234567893]}]},{"allowed_amount":0.33,"providers":[{"billed_charge":6.00,"npi":[1234567893]}]}]}]},{"name":"INJ KETOROLAC TROMETHAMINE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J1885","description":"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.19,"providers":[{"billed_charge":467.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":5.54,"providers":[{"billed_charge":180.00,"npi":[1710603659]}]}]},{"tin":{"type":"ein","value":"823581568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.70,"providers":[{"billed_charge":10.50,"npi":[1124591177]}]}]},{"tin":{"type":"ein","value":"473524701"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1.11,"providers":[{"billed_charge":103.76,"npi":[1063215945]}]}]}]},{"name":"INJ MICAFUNGIN SODIUM 1 MG","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J2248","description":"INJECTION, MICAFUNGIN SODIUM, 1 MG","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":93.00,"providers":[{"billed_charge":2010.00,"npi":[1234567893]}]}]}]},{"name":"INJ TRIAMCINOLON ACETONID NO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J3301","description":"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG","allowed_amounts":[{"tin":{"type":"ein","value":"461644524"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4.20,"providers":[{"billed_charge":25.00,"npi":[1083604961]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.57,"providers":[{"billed_charge":173.64,"npi":[1234567893]}]}]}]},{"name":"INJ VIT B-12 CYNOCOBLMN TO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"J3420","description":"INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1,000 MCG","allowed_amounts":[{"tin":{"type":"ein","value":"931418808"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.86,"providers":[{"billed_charge":6.00,"npi":[1710576905]}]}]}]},{"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":4395.46,"providers":[{"billed_charge":22157.88,"npi":[1234567893]}]}]}]},{"name":"ELEVATING LEGREST PAIR","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"K0195","description":"ELEVATING LEGRESTS, PAIR (FOR USE WITH CAPPED RENTAL WHEELCHAIR BASE)","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":70.90,"providers":[{"billed_charge":318.64,"npi":[1234567893]}]}]}]},{"name":"HOME INFUS TX CATH CARE COMP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S5501","description":"HOME INFUSION THERAPY, CATHETER CARE/MAINTENANCE, COMPLEX (MORE THAN ONE LUMEN), INCLUDES ADMINISTRA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":48.00,"providers":[{"billed_charge":160.00,"npi":[1234567893]}]}]}]},{"name":"HIT ANTIBIOTIC/ANTIFUNGAL; Q","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9500","description":"HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 24 HOURS; ADMINISTRA","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6356.28,"providers":[{"billed_charge":21187.50,"npi":[1234567893]}]}]}]},{"name":"HIT ABX ANTIVIRL/ANTIFUNGAL;","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9502","description":"HOME INFUSION THERAPY, ANTIBIOTIC, ANTIVIRAL, OR ANTIFUNGAL THERAPY; ONCE EVERY 8 HOURS, ADMINISTRAT","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":6887.70,"providers":[{"billed_charge":22959.00,"npi":[1234567893]}]}]}]}]}