{"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":"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":"320465932"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1252.80,"providers":[{"billed_charge":3900.00,"npi":[1609587435]}]}]},{"tin":{"type":"ein","value":"851648079"},"service_code":["56"],"billing_class":"institutional","payments":[{"allowed_amount":23575.00,"providers":[{"billed_charge":131200.00,"npi":[1861089690]}]}]}]},{"name":"MED-SUR-GY/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"111","description":"ROOM AND BOARD - PRIVATE -MEDICAL/SURGICAL/GYN","allowed_amounts":[{"tin":{"type":"ein","value":"350892672"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":29341.03,"providers":[{"billed_charge":7779.48,"npi":[1063457380]}]}]}]},{"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":"350868157"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":125181.60,"providers":[{"billed_charge":62820.00,"npi":[1841245594]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"340714456"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39.13,"providers":[{"billed_charge":130.20,"npi":[1790837235]}]}]},{"tin":{"type":"ein","value":"436003859"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38.37,"providers":[{"billed_charge":127.88,"npi":[1699769901]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18.48,"providers":[{"billed_charge":8264.40,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":354.35,"providers":[{"billed_charge":1904.50,"npi":[1174571129]}]}]}]},{"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":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":605.48,"providers":[{"billed_charge":7833.62,"npi":[1063457380]}]}]}]},{"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":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2.40,"providers":[{"billed_charge":12.00,"npi":[1740686443]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":44716.71,"providers":[{"billed_charge":112901.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9854.07,"providers":[{"billed_charge":22960.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":49279.55,"providers":[{"billed_charge":112140.43,"npi":[1063457380]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"362167869"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1318.35,"providers":[{"billed_charge":3378.00,"npi":[1588771919]}]}]},{"tin":{"type":"ein","value":"364015560"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":74.41,"providers":[{"billed_charge":162.00,"npi":[1376521575]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":908.44,"providers":[{"billed_charge":2227.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1681.85,"providers":[{"billed_charge":7839.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":880.71,"providers":[{"billed_charge":2058.00,"npi":[1174571129]}]},{"allowed_amount":3.00,"providers":[{"billed_charge":8.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"610444707"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":994.43,"providers":[{"billed_charge":8173.68,"npi":[1689282147]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":38.58,"providers":[{"billed_charge":988.39,"npi":[1063457380]}]},{"allowed_amount":12.15,"providers":[{"billed_charge":60824.90,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"351151208"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":14.70,"providers":[{"billed_charge":387.00,"npi":[1699757401]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":46.77,"providers":[{"billed_charge":13685.37,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"922355855"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":19.62,"providers":[{"billed_charge":2012.00,"npi":[1144914532]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":243.07,"providers":[{"billed_charge":716.54,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":5278.97,"providers":[{"billed_charge":53505.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"356001583"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":310.14,"providers":[{"billed_charge":4451.20,"npi":[1356428429]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":91.89,"providers":[{"billed_charge":150322.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":61.26,"providers":[{"billed_charge":32837.00,"npi":[1174571129]}]},{"allowed_amount":9.40,"providers":[{"billed_charge":229.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":14.88,"providers":[{"billed_charge":416.80,"npi":[1063457380]}]},{"allowed_amount":294.82,"providers":[{"billed_charge":51532.36,"npi":[1063457380]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":302.36,"providers":[{"billed_charge":3980.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":55.06,"providers":[{"billed_charge":4062.00,"npi":[1841245594]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.13,"providers":[{"billed_charge":2434.23,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":357.36,"providers":[{"billed_charge":3633.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8.63,"providers":[{"billed_charge":122.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8.63,"providers":[{"billed_charge":351.14,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":354.00,"providers":[{"billed_charge":17777.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":211.22,"providers":[{"billed_charge":1140.00,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":590.94,"providers":[{"billed_charge":1705.00,"npi":[1457366189]}]},{"allowed_amount":192.55,"providers":[{"billed_charge":1005.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11266.19,"providers":[{"billed_charge":57640.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":7.36,"providers":[{"billed_charge":156.00,"npi":[1174571129]}]},{"allowed_amount":3454.20,"providers":[{"billed_charge":8398.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":18.58,"providers":[{"billed_charge":207.95,"npi":[1063457380]}]},{"allowed_amount":363.60,"providers":[{"billed_charge":16691.54,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1847.20,"providers":[{"billed_charge":25757.00,"npi":[1851833230]}]}]}]},{"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":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":549.82,"providers":[{"billed_charge":2178.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":99.70,"providers":[{"billed_charge":1146.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":332.06,"providers":[{"billed_charge":10368.00,"npi":[1851833230]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":513.12,"providers":[{"billed_charge":1386.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":525.96,"providers":[{"billed_charge":1130.76,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":776.46,"providers":[{"billed_charge":1723.83,"npi":[1831116441]}]},{"allowed_amount":96.18,"providers":[{"billed_charge":270.92,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8325.58,"providers":[{"billed_charge":23116.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":169.91,"providers":[{"billed_charge":487.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10417.35,"providers":[{"billed_charge":26727.92,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1826.33,"providers":[{"billed_charge":3209.00,"npi":[1851833230]}]}]}]},{"name":"CT SCAN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"350","description":"CT SCAN - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":10598.22,"providers":[{"billed_charge":16272.00,"npi":[1851833230]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7492.61,"providers":[{"billed_charge":67631.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":16096.82,"providers":[{"billed_charge":43371.33,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2081.19,"providers":[{"billed_charge":21519.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29893.00,"providers":[{"billed_charge":397426.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":361.17,"providers":[{"billed_charge":2376.05,"npi":[1063457380]}]},{"allowed_amount":30744.41,"providers":[{"billed_charge":174821.64,"npi":[1063457380]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3004.28,"providers":[{"billed_charge":8335.52,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":206.72,"providers":[{"billed_charge":2331.04,"npi":[1234567893]}]}]}]},{"name":"ULTRASOUND","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"402","description":"OTHER IMAGING SERVICES - ULTRASOUND","allowed_amounts":[{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2835.62,"providers":[{"billed_charge":24432.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":201.22,"providers":[{"billed_charge":2006.27,"npi":[1063457380]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":58229.96,"providers":[{"billed_charge":228055.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":57845.57,"providers":[{"billed_charge":115218.73,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12249.88,"providers":[{"billed_charge":63260.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":25346.91,"providers":[{"billed_charge":51540.73,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":253811.95,"providers":[{"billed_charge":382164.00,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":57345.88,"providers":[{"billed_charge":93864.00,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":388486.21,"providers":[{"billed_charge":1058305.80,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":233639.74,"providers":[{"billed_charge":945059.00,"npi":[1851833230]}]}]}]},{"name":"PSYCH CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"513","description":"CLINIC - PSYCHIATRIC CLINIC","allowed_amounts":[{"tin":{"type":"ein","value":"350869066"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1979.61,"providers":[{"billed_charge":56001.00,"npi":[1003866740]}]}]}]},{"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":"351461805"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":88.70,"providers":[{"billed_charge":25421.00,"npi":[1073550133]}]}]},{"tin":{"type":"ein","value":"472105584"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27.91,"providers":[{"billed_charge":4374.14,"npi":[1740686443]}]}]},{"tin":{"type":"ein","value":"352087092"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":48368.99,"providers":[{"billed_charge":213413.70,"npi":[1457366189]}]},{"allowed_amount":3.87,"providers":[{"billed_charge":2652.09,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"381359087"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.48,"providers":[{"billed_charge":1072.31,"npi":[1831116441]}]}]},{"tin":{"type":"ein","value":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":7943.62,"providers":[{"billed_charge":18471.72,"npi":[1841245594]}]}]},{"tin":{"type":"ein","value":"351142669"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":44.18,"providers":[{"billed_charge":2005.85,"npi":[1174571129]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":314.60,"providers":[{"billed_charge":100481.18,"npi":[1063457380]}]}]},{"tin":{"type":"ein","value":"350869066"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4987.82,"providers":[{"billed_charge":28175.40,"npi":[1851833230]}]},{"allowed_amount":561.65,"providers":[{"billed_charge":1122.99,"npi":[1851833230]}]}]}]},{"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":"274591786"},"service_code":["23","21"],"billing_class":"professional","payments":[{"allowed_amount":14.87,"providers":[{"billed_charge":176.00,"npi":[1467410068]}]},{"allowed_amount":59.48,"providers":[{"billed_charge":704.00,"npi":[1467410068]}]}]}]},{"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":"352087092"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":84.01,"providers":[{"billed_charge":380.00,"npi":[1457366189]}]}]},{"tin":{"type":"ein","value":"350892672"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":120.14,"providers":[{"billed_charge":657.78,"npi":[1063457380]}]}]}]},{"name":"MRI JNT OF LWR EXTRE W/O DYE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"73721","description":"MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL","allowed_amounts":[{"tin":{"type":"ein","value":"351158723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":47.62,"providers":[{"billed_charge":250.00,"npi":[1285809103]}]}]}]},{"name":"ULTRASOUND BREAST LIMITED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76642","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":920.70,"providers":[{"billed_charge":7990.00,"npi":[1659725323]}]}]}]},{"name":"ECHO EXAM OF ABDOMEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76705","description":"ULTRASOUND, ABDOMINAL, REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":144.30,"providers":[{"billed_charge":1386.00,"npi":[1467410068]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":494.64,"providers":[{"billed_charge":3348.00,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11","22"],"billing_class":"professional","payments":[{"allowed_amount":21.15,"providers":[{"billed_charge":50.00,"npi":[1407902786]}]},{"allowed_amount":344.97,"providers":[{"billed_charge":900.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"351464192"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":39.66,"providers":[{"billed_charge":90.00,"npi":[1467846881]}]},{"allowed_amount":436.26,"providers":[{"billed_charge":990.00,"npi":[1467846881]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1217.25,"providers":[{"billed_charge":4975.00,"npi":[1790049377]}]},{"allowed_amount":292.14,"providers":[{"billed_charge":1194.00,"npi":[1942598073]}]},{"allowed_amount":6829.89,"providers":[{"billed_charge":27860.00,"npi":[1659725323]}]},{"allowed_amount":681.66,"providers":[{"billed_charge":2786.00,"npi":[1366647034]}]}]}]},{"name":"DX MAMMO INCL CAD UNI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77065","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; UNILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":444.57,"providers":[{"billed_charge":2233.00,"npi":[1659725323]}]}]}]},{"name":"DX MAMMO INCL CAD BI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77066","description":"DIAGNOSTIC MAMMOGRAPHY, INCLUDING COMPUTER-AIDED DETECTION (CAD) WHEN PERFORMED; BILATERAL","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1105.30,"providers":[{"billed_charge":5614.00,"npi":[1659725323]}]}]}]},{"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":"356005697"},"service_code":["49"],"billing_class":"professional","payments":[{"allowed_amount":1900.08,"providers":[{"billed_charge":9998.10,"npi":[1396500922]}]}]},{"tin":{"type":"ein","value":"351158723"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":928.20,"providers":[{"billed_charge":2750.00,"npi":[1407902786]}]}]},{"tin":{"type":"ein","value":"351464192"},"service_code":["22","19"],"billing_class":"professional","payments":[{"allowed_amount":201.36,"providers":[{"billed_charge":444.00,"npi":[1467846881]}]},{"allowed_amount":402.72,"providers":[{"billed_charge":888.00,"npi":[1467846881]}]}]},{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1504.50,"providers":[{"billed_charge":7375.00,"npi":[1790049377]}]},{"allowed_amount":842.52,"providers":[{"billed_charge":4130.00,"npi":[1366647034]}]},{"allowed_amount":8452.55,"providers":[{"billed_charge":41300.00,"npi":[1659725323]}]},{"allowed_amount":361.08,"providers":[{"billed_charge":1770.00,"npi":[1942598073]}]}]}]},{"name":"DXA BONE DENSITY, AXIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"77080","description":"DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIP","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":232.40,"providers":[{"billed_charge":2716.00,"npi":[1952558561]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":94.72,"providers":[{"billed_charge":270.72,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4833.06,"providers":[{"billed_charge":13812.48,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":67.07,"providers":[{"billed_charge":802.56,"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4968.75,"providers":[{"billed_charge":14193.40,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":89.40,"providers":[{"billed_charge":1071.20,"npi":[1234567893]}]}]}]},{"name":"DRUG TEST PRSMV DIR OPT OBS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80305","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE","allowed_amounts":[{"tin":{"type":"ein","value":"351302836"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":139.36,"providers":[{"billed_charge":780.00,"npi":[1548945389]}]}]},{"tin":{"type":"ein","value":"464126690"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":163.80,"providers":[{"billed_charge":294.84,"npi":[1841358017]}]}]}]},{"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":"271700231"},"service_code":["22","23","21"],"billing_class":"professional","payments":[{"allowed_amount":96.00,"providers":[{"billed_charge":96.00,"npi":[1821319526]}]},{"allowed_amount":480.00,"providers":[{"billed_charge":480.00,"npi":[1821319526]}]},{"allowed_amount":416.00,"providers":[{"billed_charge":416.00,"npi":[1821319526]}]}]}]},{"name":"URINALYSIS AUTO W/SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81001","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1.06,"providers":[{"billed_charge":12.68,"npi":[1234567893]}]}]}]},{"name":"MICROALBUMIN, QUANTITATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82043","description":"ALBUMIN; URINE (EG, MICROALBUMIN), QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":307.42,"providers":[{"billed_charge":878.56,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3936.80,"providers":[{"billed_charge":11248.00,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.89,"providers":[{"billed_charge":118.40,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF URINE CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82570","description":"CREATININE; OTHER SOURCE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":355.25,"providers":[{"billed_charge":1015.28,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":886.62,"providers":[{"billed_charge":2533.44,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":305.28,"providers":[{"billed_charge":872.32,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF FOLIC ACID SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82746","description":"FOLIC ACID; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":473.34,"providers":[{"billed_charge":1352.40,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2011.32,"providers":[{"billed_charge":5748.32,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.60,"providers":[{"billed_charge":582.60,"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":154.02,"providers":[{"billed_charge":439.96,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":208.08,"providers":[{"billed_charge":594.32,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18.76,"providers":[{"billed_charge":53.60,"npi":[1811154388]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.91,"providers":[{"billed_charge":250.32,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF TOTAL TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84403","description":"TESTOSTERONE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":252.91,"providers":[{"billed_charge":722.68,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":353.64,"providers":[{"billed_charge":1010.24,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.03,"providers":[{"billed_charge":108.24,"npi":[1234567893]}]}]}]},{"name":"ASSAY THYROID STIM HORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84443","description":"THYROID STIMULATING HORMONE (TSH)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3339.84,"providers":[{"billed_charge":9542.40,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":100.98,"providers":[{"billed_charge":1209.60,"npi":[1234567893]}]}]}]},{"name":"FREE ASSAY (FT-3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84481","description":"TRIIODOTHYRONINE T3; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":118.60,"providers":[{"billed_charge":338.80,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2480.64,"providers":[{"billed_charge":7086.24,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":57.20,"providers":[{"billed_charge":683.76,"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":199.32,"providers":[{"billed_charge":569.36,"npi":[1811154388]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":65.25,"providers":[{"billed_charge":186.48,"npi":[1811154388]}]}]}]},{"name":"CULTURE AEROBIC IDENTIFY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87077","description":"CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":147.03,"providers":[{"billed_charge":420.16,"npi":[1811154388]}]}]}]},{"name":"URINE CULTURE/COLONY COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87086","description":"CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":485.90,"providers":[{"billed_charge":1388.04,"npi":[1811154388]}]}]}]},{"name":"MICROBE SUSCEPTIBLE MIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87186","description":"SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONC","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.44,"providers":[{"billed_charge":138.40,"npi":[1811154388]}]}]}]},{"name":"CANDIDA, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87481","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1031.73,"providers":[{"billed_charge":2947.56,"npi":[1811154388]}]}]}]},{"name":"HPV HIGH-RISK TYPES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87624","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":164.08,"providers":[{"billed_charge":1603.24,"npi":[1234567893]}]}]}]},{"name":"TRICHOMONAS VAGINALIS AMPLIF","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87661","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":294.78,"providers":[{"billed_charge":842.16,"npi":[1811154388]}]}]}]},{"name":"DETECT AGENT NOS, DNA, AMP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87798","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.52,"providers":[{"billed_charge":1758.51,"npi":[1234567893]}]}]}]},{"name":"INFLUENZA ASSAY W/OPTIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87804","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; INFLUENZA","allowed_amounts":[{"tin":{"type":"ein","value":"463964102"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":63.27,"providers":[{"billed_charge":513.00,"npi":[1023833696]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":21.09,"providers":[{"billed_charge":123.00,"npi":[1366914426]}]}]}]},{"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":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":74.50,"providers":[{"billed_charge":211.92,"npi":[1811154388]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":231.14,"providers":[{"billed_charge":2704.56,"npi":[1234567893]}]}]}]},{"name":"TISSUE EXAM BY PATHOLOGIST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"88305","description":"LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION ABORTION - SPONTANEOUS/MISSED ARTER","allowed_amounts":[{"tin":{"type":"ein","value":"411656670"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":140.41,"providers":[{"billed_charge":640.00,"npi":[1689899817]}]}]},{"tin":{"type":"ein","value":"351604525"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":960.70,"providers":[{"billed_charge":6490.00,"npi":[1093057911]}]}]},{"tin":{"type":"ein","value":"352037910"},"service_code":["22","24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":322.36,"providers":[{"billed_charge":915.00,"npi":[1164586434]}]},{"allowed_amount":344.52,"providers":[{"billed_charge":1010.00,"npi":[1053930487]}]},{"allowed_amount":236.27,"providers":[{"billed_charge":665.00,"npi":[1801117387]}]},{"allowed_amount":21.57,"providers":[{"billed_charge":275.00,"npi":[1508928672,1598154452,1053930487]}]},{"allowed_amount":43.14,"providers":[{"billed_charge":550.00,"npi":[1366738809]}]},{"allowed_amount":429.41,"providers":[{"billed_charge":1200.00,"npi":[1366738809]}]},{"allowed_amount":1073.53,"providers":[{"billed_charge":3000.00,"npi":[1053930487]}]},{"allowed_amount":128.82,"providers":[{"billed_charge":360.00,"npi":[1720321375]}]},{"allowed_amount":539.25,"providers":[{"billed_charge":6875.00,"npi":[1194767780]}]},{"allowed_amount":214.71,"providers":[{"billed_charge":600.00,"npi":[1164586434]}]},{"allowed_amount":10114.05,"providers":[{"billed_charge":28335.00,"npi":[1841448180]}]},{"allowed_amount":1056.93,"providers":[{"billed_charge":13475.00,"npi":[1053930487]}]},{"allowed_amount":172.56,"providers":[{"billed_charge":2200.00,"npi":[1508928672,1598154452]}]},{"allowed_amount":86.28,"providers":[{"billed_charge":1100.00,"npi":[1194767780]}]},{"allowed_amount":85.88,"providers":[{"billed_charge":240.00,"npi":[1366738809]}]},{"allowed_amount":47.54,"providers":[{"billed_charge":275.00,"npi":[1720321375]}]},{"allowed_amount":1288.24,"providers":[{"billed_charge":3600.00,"npi":[1194767780]}]},{"allowed_amount":601.18,"providers":[{"billed_charge":1680.00,"npi":[1841448180]}]},{"allowed_amount":1654.72,"providers":[{"billed_charge":4695.00,"npi":[1194767780]}]}]},{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":347.74,"providers":[{"billed_charge":6607.08,"npi":[1083903058]}]},{"allowed_amount":38.64,"providers":[{"billed_charge":734.12,"npi":[1073075032]}]}]}]},{"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":"352037910"},"service_code":["22","24","81","21"],"billing_class":"professional","payments":[{"allowed_amount":83.68,"providers":[{"billed_charge":300.00,"npi":[1194767780]}]},{"allowed_amount":141.20,"providers":[{"billed_charge":847.00,"npi":[1194767780]}]},{"allowed_amount":675.44,"providers":[{"billed_charge":1622.00,"npi":[1841448180]}]},{"allowed_amount":60.51,"providers":[{"billed_charge":363.00,"npi":[1194767780]}]}]}]},{"name":"IMMUNIZATION ADMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90471","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"356067049"},"service_code":["11","60"],"billing_class":"professional","payments":[{"allowed_amount":329.74,"providers":[{"billed_charge":869.40,"npi":[1083141287]}]},{"allowed_amount":52.38,"providers":[{"billed_charge":144.90,"npi":[1083141287]}]}]}]},{"name":"IMMUNIZATION ADMIN EACH ADD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90472","description":"IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJE","allowed_amounts":[{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":36.88,"providers":[{"billed_charge":104.10,"npi":[1083141287]}]}]}]},{"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":"833632697"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":849.80,"providers":[{"billed_charge":6000.00,"npi":[1780220251]}]}]}]},{"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":"842463346"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":55.88,"providers":[{"billed_charge":120.00,"npi":[1578551495]}]},{"allowed_amount":788.76,"providers":[{"billed_charge":1680.00,"npi":[1578551495]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["19","10"],"billing_class":"professional","payments":[{"allowed_amount":223.52,"providers":[{"billed_charge":780.00,"npi":[1467279794]},{"billed_charge":340.00,"npi":[1467279794]}]}]},{"tin":{"type":"ein","value":"351328806"},"service_code":["53","10"],"billing_class":"professional","payments":[{"allowed_amount":1024.42,"providers":[{"billed_charge":1700.00,"npi":[1851949200]}]},{"allowed_amount":68.52,"providers":[{"billed_charge":100.00,"npi":[1851949200]}]}]},{"tin":{"type":"ein","value":"351922483"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":274.08,"providers":[{"billed_charge":720.00,"npi":[1477066538]}]}]}]},{"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":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":10595.68,"providers":[{"billed_charge":16450.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"842463346"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1690.80,"providers":[{"billed_charge":3200.00,"npi":[1578551495]}]}]},{"tin":{"type":"ein","value":"263205722"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":187.86,"providers":[{"billed_charge":300.00,"npi":[1942871306]}]},{"allowed_amount":93.93,"providers":[{"billed_charge":150.00,"npi":[1942871306]}]}]},{"tin":{"type":"ein","value":"263021772"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":169.08,"providers":[{"billed_charge":450.00,"npi":[1609473834]}]}]},{"tin":{"type":"ein","value":"351147323"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":168.18,"providers":[{"billed_charge":552.00,"npi":[1851162762]}]},{"allowed_amount":588.63,"providers":[{"billed_charge":1932.00,"npi":[1851162762]}]}]},{"tin":{"type":"ein","value":"823874275"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":449.56,"providers":[{"billed_charge":700.00,"npi":[1568016798]}]}]},{"tin":{"type":"ein","value":"842385515"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":169.08,"providers":[{"billed_charge":260.00,"npi":[1629433370]}]}]},{"tin":{"type":"ein","value":"880660774"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":356.64,"providers":[{"billed_charge":480.00,"npi":[1386305332]}]}]},{"tin":{"type":"ein","value":"813929887"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":252.27,"providers":[{"billed_charge":600.00,"npi":[1629570650]}]},{"allowed_amount":169.08,"providers":[{"billed_charge":400.00,"npi":[1629570650]}]},{"allowed_amount":84.09,"providers":[{"billed_charge":200.00,"npi":[1629570650]}]}]},{"tin":{"type":"ein","value":"820783414"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":112.72,"providers":[{"billed_charge":175.00,"npi":[1861635831]}]},{"allowed_amount":2113.50,"providers":[{"billed_charge":4375.00,"npi":[1023428208]}]}]},{"tin":{"type":"ein","value":"932834934"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":788.97,"providers":[{"billed_charge":1400.00,"npi":[1356934582]}]},{"allowed_amount":5646.99,"providers":[{"billed_charge":11400.00,"npi":[1356934582]}]}]},{"tin":{"type":"ein","value":"814409045"},"service_code":["11","12","02"],"billing_class":"professional","payments":[{"allowed_amount":756.81,"providers":[{"billed_charge":1350.00,"npi":[1821468794]}]},{"allowed_amount":3043.44,"providers":[{"billed_charge":5400.00,"npi":[1821468794]}]},{"allowed_amount":422.70,"providers":[{"billed_charge":750.00,"npi":[1821468794]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1092.00,"providers":[{"billed_charge":1920.00,"npi":[1629085717]}]}]},{"tin":{"type":"ein","value":"351070041"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":572.56,"providers":[{"billed_charge":1054.00,"npi":[1578243028]}]},{"allowed_amount":168.40,"providers":[{"billed_charge":310.00,"npi":[1164925798]}]},{"allowed_amount":84.20,"providers":[{"billed_charge":155.00,"npi":[1518645852]}]}]},{"tin":{"type":"ein","value":"350983617"},"service_code":["19"],"billing_class":"professional","payments":[{"allowed_amount":374.25,"providers":[{"billed_charge":900.00,"npi":[1558621060]}]}]},{"tin":{"type":"ein","value":"351135451"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1042.80,"providers":[{"billed_charge":6875.00,"npi":[1760952535]}]}]}]},{"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":"851648079"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9417.55,"providers":[{"billed_charge":121000.00,"npi":[1861089690]}]}]},{"tin":{"type":"ein","value":"833632697"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":15925.00,"providers":[{"billed_charge":24500.00,"npi":[1154979615]}]}]}]},{"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":"350868157"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":205.21,"providers":[{"billed_charge":485.00,"npi":[1841245594]}]}]}]},{"name":"SPEECH/HEARING THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92507","description":"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL","allowed_amounts":[{"tin":{"type":"ein","value":"463204426"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2363.24,"providers":[{"billed_charge":4715.00,"npi":[1538784236]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":21730.28,"providers":[{"billed_charge":87669.92,"npi":[1912166075]}]}]}]},{"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":"351180407"},"service_code":["22","81"],"billing_class":"professional","payments":[{"allowed_amount":55.36,"providers":[{"billed_charge":136.00,"npi":[1487658761]}]},{"allowed_amount":13.84,"providers":[{"billed_charge":34.00,"npi":[1487658761]}]}]}]},{"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":"611389493"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":20.26,"providers":[{"billed_charge":74.00,"npi":[1497968366]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21.78,"providers":[{"billed_charge":56.00,"npi":[1396889788]}]},{"allowed_amount":108.90,"providers":[{"billed_charge":280.00,"npi":[1801838743]}]}]}]},{"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":"351814334"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.30,"providers":[{"billed_charge":72.00,"npi":[1275530800]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":23.30,"providers":[{"billed_charge":56.00,"npi":[1396889788]}]},{"allowed_amount":69.90,"providers":[{"billed_charge":168.00,"npi":[1801838743]}]},{"allowed_amount":58.25,"providers":[{"billed_charge":140.00,"npi":[1134219652]}]},{"allowed_amount":151.45,"providers":[{"billed_charge":364.00,"npi":[1801887138]}]}]}]},{"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":"871365424"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":44.06,"providers":[{"billed_charge":200.00,"npi":[1588478457]}]}]},{"tin":{"type":"ein","value":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":22.03,"providers":[{"billed_charge":115.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"832951018"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":516.39,"providers":[{"billed_charge":1110.00,"npi":[1457160590]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":793.08,"providers":[{"billed_charge":2520.00,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"351720796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2891.70,"providers":[{"billed_charge":8750.00,"npi":[1760607253]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":330.45,"providers":[{"billed_charge":795.00,"npi":[1245913888]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.27,"providers":[{"billed_charge":513.00,"npi":[1134219652]}]},{"allowed_amount":682.94,"providers":[{"billed_charge":1767.00,"npi":[1801887138]}]},{"allowed_amount":154.21,"providers":[{"billed_charge":399.00,"npi":[1396889788]}]},{"allowed_amount":440.60,"providers":[{"billed_charge":1140.00,"npi":[1801838743]}]}]}]},{"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":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.11,"providers":[{"billed_charge":720.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3849.13,"providers":[{"billed_charge":10990.00,"npi":[1912166075]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":147.12,"providers":[{"billed_charge":318.00,"npi":[1245913888]}]}]}]},{"name":"THER IVNTJ 1ST 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97129","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2616.40,"providers":[{"billed_charge":6627.80,"npi":[1912166075]}]}]}]},{"name":"THER IVNTJ EA ADDL 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97130","description":"THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUT","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":7773.05,"providers":[{"billed_charge":20610.32,"npi":[1912166075]}]}]}]},{"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":"412064132"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":41.60,"providers":[{"billed_charge":210.00,"npi":[1154107761]}]}]},{"tin":{"type":"ein","value":"832951018"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":162.50,"providers":[{"billed_charge":370.00,"npi":[1457160590]}]}]},{"tin":{"type":"ein","value":"352086285"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":478.30,"providers":[{"billed_charge":1150.00,"npi":[1245913888]}]}]}]},{"name":"ADAPTIVE BEHAVIOR TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97153","description":"ADAPTIVE BEHAVIOR TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":21077.24,"providers":[{"billed_charge":37240.00,"npi":[1245019769]}]},{"allowed_amount":15335.72,"providers":[{"billed_charge":27200.00,"npi":[1437662731]}]}]},{"tin":{"type":"ein","value":"350965639"},"service_code":["99","11"],"billing_class":"professional","payments":[{"allowed_amount":536.64,"providers":[{"billed_charge":1040.00,"npi":[1891917449]}]},{"allowed_amount":46855.38,"providers":[{"billed_charge":90805.00,"npi":[1891917449]}]}]},{"tin":{"type":"ein","value":"473746811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":37527.37,"providers":[{"billed_charge":93600.00,"npi":[1801470836]}]}]},{"tin":{"type":"ein","value":"453668959"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":34907.00,"providers":[{"billed_charge":145880.00,"npi":[1336772748]}]},{"allowed_amount":35577.00,"providers":[{"billed_charge":148680.00,"npi":[1982389656]}]}]}]},{"name":"GRP ADAPT BHV TX BY TECH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97154","description":"GROUP ADAPTIVE BHV TX BY PROTOCOL TECH EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.26,"providers":[{"billed_charge":30.00,"npi":[1245019769]}]}]}]},{"name":"ADAPT BEHAVIOR TX PHYS/QHP","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97155","description":"ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"208259455"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":882.96,"providers":[{"billed_charge":1950.00,"npi":[1245019769]}]},{"allowed_amount":451.05,"providers":[{"billed_charge":1000.00,"npi":[1437662731]}]}]},{"tin":{"type":"ein","value":"473746811"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2638.68,"providers":[{"billed_charge":9652.50,"npi":[1801470836]}]}]},{"tin":{"type":"ein","value":"453668959"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":2578.16,"providers":[{"billed_charge":11396.00,"npi":[1336772748]}]},{"allowed_amount":992.94,"providers":[{"billed_charge":4389.00,"npi":[1982389656]}]},{"allowed_amount":1968.46,"providers":[{"billed_charge":8701.00,"npi":[1982389656]}]},{"allowed_amount":801.32,"providers":[{"billed_charge":3542.00,"npi":[1336772748]}]}]}]},{"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":"462011273"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":78.91,"providers":[{"billed_charge":120.00,"npi":[1215216072]}]}]},{"tin":{"type":"ein","value":"873621436"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1052.20,"providers":[{"billed_charge":1600.00,"npi":[1811681638]}]}]},{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":36616.47,"providers":[{"billed_charge":93206.74,"npi":[1912166075]}]}]}]},{"name":"SENSORY INTEGRATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97533","description":"SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIR","allowed_amounts":[{"tin":{"type":"ein","value":"356000158"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":727.56,"providers":[{"billed_charge":1060.16,"npi":[1912166075]}]}]}]},{"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":"462011273"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":34.54,"providers":[{"billed_charge":40.00,"npi":[1215216072]}]}]},{"tin":{"type":"ein","value":"351814334"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":482.82,"providers":[{"billed_charge":1339.00,"npi":[1275530800]}]}]},{"tin":{"type":"ein","value":"204508059"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":62.18,"providers":[{"billed_charge":110.00,"npi":[1659438687]}]}]},{"tin":{"type":"ein","value":"352192086"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":79.72,"providers":[{"billed_charge":100.00,"npi":[1720747900]}]}]},{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":297.12,"providers":[{"billed_charge":616.00,"npi":[1134219652]}]},{"allowed_amount":705.66,"providers":[{"billed_charge":1463.00,"npi":[1801887138]}]},{"allowed_amount":74.28,"providers":[{"billed_charge":154.00,"npi":[1396889788]}]},{"allowed_amount":1002.78,"providers":[{"billed_charge":2079.00,"npi":[1801838743]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"851605392"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":47.40,"providers":[{"billed_charge":110.00,"npi":[1396889788]}]},{"allowed_amount":94.80,"providers":[{"billed_charge":220.00,"npi":[1801887138]}]}]}]},{"name":"REM THER MNTR 1ST SETUP&EDU","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98975","description":"REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP","allowed_amounts":[{"tin":{"type":"ein","value":"270550856"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":157.63,"providers":[{"billed_charge":564.52,"npi":[1942798020]}]},{"allowed_amount":57.32,"providers":[{"billed_charge":205.28,"npi":[1942798020]}]}]}]},{"name":"REM THER MNTR 1ST 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98980","description":"REMOTE THER MNTR TX MGMT PHYS/QHP 1ST 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":601.40,"providers":[{"billed_charge":732.66,"npi":[1245420314]}]}]}]},{"name":"REM THER MNTR EA ADDL 20 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98981","description":"REMOTE THER MNTR TX MGMT PHYS/QHP EA ADDL 20 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":56.14,"providers":[{"billed_charge":111.63,"npi":[1245420314]}]},{"allowed_amount":918.53,"providers":[{"billed_charge":1112.50,"npi":[1245420314]}]}]}]},{"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":"351302836"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":713.00,"providers":[{"billed_charge":1800.00,"npi":[1548945389]}]},{"allowed_amount":309.18,"providers":[{"billed_charge":1080.00,"npi":[1548945389]}]}]},{"tin":{"type":"ein","value":"352108729"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.90,"providers":[{"billed_charge":406.21,"npi":[1689222879]}]}]},{"tin":{"type":"ein","value":"351097350"},"service_code":["50"],"billing_class":"professional","payments":[{"allowed_amount":570.40,"providers":[{"billed_charge":1040.00,"npi":[1548766181]}]},{"allowed_amount":713.00,"providers":[{"billed_charge":1300.00,"npi":[1033539481]}]},{"allowed_amount":213.90,"providers":[{"billed_charge":390.00,"npi":[1659974806]}]}]},{"tin":{"type":"ein","value":"351922483"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.90,"providers":[{"billed_charge":417.00,"npi":[1407617368]}]}]},{"tin":{"type":"ein","value":"351875364"},"service_code":["50","10"],"billing_class":"professional","payments":[{"allowed_amount":926.90,"providers":[{"billed_charge":2041.00,"npi":[1265021406]}]},{"allowed_amount":257.65,"providers":[{"billed_charge":785.00,"npi":[1265021406]}]}]},{"tin":{"type":"ein","value":"821786026"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":438.55,"providers":[{"billed_charge":980.00,"npi":[1235209156]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","17","10"],"billing_class":"professional","payments":[{"allowed_amount":634.34,"providers":[{"billed_charge":759.00,"npi":[1234567893]}]},{"allowed_amount":1690.05,"providers":[{"billed_charge":3458.00,"npi":[1234567893]}]},{"allowed_amount":2058.61,"providers":[{"billed_charge":4242.00,"npi":[1234567893]}]},{"allowed_amount":517.11,"providers":[{"billed_charge":1932.91,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351972384"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":880.74,"providers":[{"billed_charge":945.00,"npi":[1164040135]}]}]},{"tin":{"type":"ein","value":"352020403"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":208.83,"providers":[{"billed_charge":450.00,"npi":[1669034492]}]}]},{"tin":{"type":"ein","value":"352092706"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":587.16,"providers":[{"billed_charge":630.00,"npi":[1750497293]}]}]}]},{"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":"142007519"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":118.14,"providers":[{"billed_charge":262.00,"npi":[1851702229]}]}]},{"tin":{"type":"ein","value":"205497203"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":259.90,"providers":[{"billed_charge":479.00,"npi":[1043883259]}]}]},{"tin":{"type":"ein","value":"351516588"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":4844.30,"providers":[{"billed_charge":5740.00,"npi":[1053394023]}]},{"allowed_amount":178.42,"providers":[{"billed_charge":280.00,"npi":[1053394023]}]}]},{"tin":{"type":"ein","value":"356067049"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1535.82,"providers":[{"billed_charge":3923.40,"npi":[1083141287]}]}]},{"tin":{"type":"ein","value":"351141109"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":100.42,"providers":[{"billed_charge":278.00,"npi":[1841594058]}]}]},{"tin":{"type":"ein","value":"351135451"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":354.42,"providers":[{"billed_charge":735.00,"npi":[1184986259]}]}]},{"tin":{"type":"ein","value":"311003977"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":502.10,"providers":[{"billed_charge":1307.00,"npi":[1952947574]}]}]},{"tin":{"type":"ein","value":"270851352"},"service_code":["20"],"billing_class":"professional","payments":[{"allowed_amount":1205.04,"providers":[{"billed_charge":3672.00,"npi":[1366914426]}]}]},{"tin":{"type":"ein","value":"350211370"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":2051.83,"providers":[{"billed_charge":5571.06,"npi":[1821423393]}]},{"allowed_amount":446.05,"providers":[{"billed_charge":1211.10,"npi":[1821423393]}]}]}]},{"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":"825430908"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":185.01,"providers":[{"billed_charge":432.00,"npi":[1720733447]}]}]},{"tin":{"type":"ein","value":"351972384"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":967.08,"providers":[{"billed_charge":1260.00,"npi":[1346075322]}]}]},{"tin":{"type":"ein","value":"471628951"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":611.58,"providers":[{"billed_charge":1152.00,"npi":[1730426958]}]},{"allowed_amount":1169.46,"providers":[{"billed_charge":2304.00,"npi":[1760834147]}]}]}]},{"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":"943342387"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":505.14,"providers":[{"billed_charge":1941.00,"npi":[1154999035]}]}]}]},{"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":"351183940"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":110.18,"providers":[{"billed_charge":990.00,"npi":[1861785396]}]}]},{"tin":{"type":"ein","value":"200323858"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":415.16,"providers":[{"billed_charge":957.00,"npi":[1295116911]}]}]}]},{"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":"351183940"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":319.38,"providers":[{"billed_charge":2950.00,"npi":[1861785396]}]}]},{"tin":{"type":"ein","value":"351811206"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":159.69,"providers":[{"billed_charge":1525.00,"npi":[1174053862]}]}]},{"tin":{"type":"ein","value":"356061776"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":862.35,"providers":[{"billed_charge":3594.00,"npi":[1467034751]}]}]}]},{"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":"862775542"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":10344.42,"providers":[{"billed_charge":30474.00,"npi":[1689683153]}]}]}]},{"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":"851421369"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":74.92,"providers":[{"billed_charge":237.02,"npi":[1871076471]}]}]},{"tin":{"type":"ein","value":"463948461"},"service_code":["32"],"billing_class":"professional","payments":[{"allowed_amount":85.79,"providers":[{"billed_charge":215.00,"npi":[1710210521]}]}]},{"tin":{"type":"ein","value":"202195652"},"service_code":["31","32"],"billing_class":"professional","payments":[{"allowed_amount":74.92,"providers":[{"billed_charge":139.00,"npi":[1730556267]}]},{"allowed_amount":524.44,"providers":[{"billed_charge":973.00,"npi":[1730556267]}]}]}]},{"name":"HOME VISIT NEW PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99344","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":668.76,"providers":[{"billed_charge":2166.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99348","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":8823.08,"providers":[{"billed_charge":24382.00,"npi":[1770167280]}]}]}]},{"name":"HOME VISIT EST PATIENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99349","description":"HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF","allowed_amounts":[{"tin":{"type":"ein","value":"205351085"},"service_code":["55"],"billing_class":"professional","payments":[{"allowed_amount":397.56,"providers":[{"billed_charge":1016.00,"npi":[1669982070]}]},{"allowed_amount":11131.68,"providers":[{"billed_charge":28448.00,"npi":[1770167280]}]}]}]},{"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":"264214938"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":603.40,"providers":[{"billed_charge":1028.00,"npi":[1619360161]}]}]}]},{"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":"311575051"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":97.32,"providers":[{"billed_charge":420.00,"npi":[1518720432]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1821.80,"providers":[{"billed_charge":1821.80,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001134"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":90.00,"providers":[{"billed_charge":90.00,"npi":[1023127206]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4547.21,"providers":[{"billed_charge":4547.21,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":67636.80,"providers":[{"billed_charge":132908.13,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"271130459"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1945.56,"providers":[{"billed_charge":6942.00,"npi":[1952683229]}]}]},{"tin":{"type":"ein","value":"356000195"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1440.00,"providers":[{"billed_charge":1440.00,"npi":[1457459737]}]}]},{"tin":{"type":"ein","value":"356001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":722.40,"providers":[{"billed_charge":722.40,"npi":[1841418324]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":44754.48,"providers":[{"billed_charge":44772.78,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3178.80,"providers":[{"billed_charge":3750.60,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1880.00,"providers":[{"billed_charge":1880.00,"npi":[1114072964]}]}]},{"tin":{"type":"ein","value":"830966826"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":44.04,"providers":[{"billed_charge":222.00,"npi":[1780338756]}]}]},{"tin":{"type":"ein","value":"356001127"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":420.00,"providers":[{"billed_charge":420.00,"npi":[1871146365]}]}]},{"tin":{"type":"ein","value":"351311688"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1450.00,"providers":[{"billed_charge":1450.00,"npi":[1841246998]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":103980.60,"providers":[{"billed_charge":105117.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"356000939"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":39.46,"providers":[{"billed_charge":39.46,"npi":[1235137829]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":54647.50,"providers":[{"billed_charge":55477.80,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3587.22,"providers":[{"billed_charge":4098.85,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351549572"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":22495.32,"providers":[{"billed_charge":22519.98,"npi":[1215973888]}]}]}]},{"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":"351311688"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4440.00,"providers":[{"billed_charge":4440.00,"npi":[1841246998]}]}]},{"tin":{"type":"ein","value":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9240.00,"providers":[{"billed_charge":9240.00,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":18401.04,"providers":[{"billed_charge":23904.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":11807.33,"providers":[{"billed_charge":11807.33,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":296461.20,"providers":[{"billed_charge":296461.20,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":118584.48,"providers":[{"billed_charge":118900.00,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7700.00,"providers":[{"billed_charge":7700.00,"npi":[1114072964]}]}]}]},{"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":"274099979"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":63488.72,"providers":[{"billed_charge":85078.00,"npi":[1578869665]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":17217.28,"providers":[{"billed_charge":44850.40,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":2152.16,"providers":[{"billed_charge":2200.00,"npi":[1558681700]}]}]}]},{"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":"356001210"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":4113.00,"providers":[{"billed_charge":4113.00,"npi":[1912990268]}]}]},{"tin":{"type":"ein","value":"356001201"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10588.82,"providers":[{"billed_charge":10588.82,"npi":[1629025713]}]}]},{"tin":{"type":"ein","value":"351941122"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":5165.28,"providers":[{"billed_charge":9086.43,"npi":[1174528335]}]}]},{"tin":{"type":"ein","value":"356001174"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":500.00,"providers":[{"billed_charge":500.00,"npi":[1841418324]}]}]},{"tin":{"type":"ein","value":"351511077"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":211713.75,"providers":[{"billed_charge":211713.75,"npi":[1861499139]}]}]},{"tin":{"type":"ein","value":"931689569"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":10330.56,"providers":[{"billed_charge":11736.00,"npi":[1386338382]}]}]},{"tin":{"type":"ein","value":"272430695"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":3443.52,"providers":[{"billed_charge":3500.00,"npi":[1558681700]}]}]},{"tin":{"type":"ein","value":"356001016"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1200.00,"providers":[{"billed_charge":1200.00,"npi":[1114072964]}]}]}]},{"name":"SLINGS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4565","description":"SLINGS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":270.15,"providers":[{"billed_charge":720.00,"npi":[1234567893]}]}]}]},{"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":1762.99,"providers":[{"billed_charge":6757.42,"npi":[1234567893]}]}]}]},{"name":"SPACR BAG/RESRVOR METRD DOSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A4627","description":"SPACER, BAG OR RESERVOIR, WITH OR WITHOUT MASK, FOR USE WITH METERED DOSE INHALER","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":85.11,"providers":[{"billed_charge":180.00,"npi":[1669415394]}]}]}]},{"name":"ADMN SET SM VOL NONFLTR NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7005","description":"ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, NONDISPOSABLE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":504.07,"providers":[{"billed_charge":760.00,"npi":[1669415394]}]}]}]},{"name":"AREO MASK USED W/ DME NEB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A7015","description":"AEROSOL MASK, USED WITH DME NEBULIZER","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":8.95,"providers":[{"billed_charge":25.00,"npi":[1669415394]}]}]}]},{"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":745.75,"providers":[{"billed_charge":4369.32,"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":1050.48,"providers":[{"billed_charge":5242.46,"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":1096.55,"providers":[{"billed_charge":4429.27,"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":2168.36,"providers":[{"billed_charge":8897.98,"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":832.41,"providers":[{"billed_charge":3848.86,"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":327.34,"providers":[{"billed_charge":1125.11,"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":1396.92,"providers":[{"billed_charge":4159.04,"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":250.24,"providers":[{"billed_charge":2025.80,"npi":[1234567893]}]}]}]},{"name":"CRTCHES UNDARM OTH THAN WOOD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0114","description":"CRUTCHES, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS, AND HANDGRIPS","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1988.10,"providers":[{"billed_charge":2390.40,"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":347.48,"providers":[{"billed_charge":689.00,"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":3128.86,"providers":[{"billed_charge":13670.42,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351925619"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":449.02,"providers":[{"billed_charge":695.72,"npi":[1427870310]}]}]}]},{"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":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":773.94,"providers":[{"billed_charge":3600.00,"npi":[1669415394]}]}]}]},{"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":4829.40,"providers":[{"billed_charge":78117.24,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"351925619"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1854.90,"providers":[{"billed_charge":2782.22,"npi":[1427870310]}]}]}]},{"name":"BREAST PUMP ELECTRIC ANY TYP","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E0603","description":"BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"201830598"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":10676.29,"providers":[{"billed_charge":41500.00,"npi":[1669415394]}]}]}]},{"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":3388.00,"providers":[{"billed_charge":25374.38,"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":45.91,"providers":[{"billed_charge":210.00,"npi":[1234567893]}]}]}]},{"name":"PROSTATE CANCER SCREENING","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0103","description":"PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA)","allowed_amounts":[{"tin":{"type":"ein","value":"610445850"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":810.90,"providers":[{"billed_charge":2317.20,"npi":[1811154388]}]}]}]},{"name":"DX DIGTL BRST TOMOSYN UNI/BI","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0279","description":"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 770","allowed_amounts":[{"tin":{"type":"ein","value":"274591786"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":3824.00,"providers":[{"billed_charge":9560.00,"npi":[1659725323]}]},{"allowed_amount":95.60,"providers":[{"billed_charge":239.00,"npi":[1790049377]}]}]}]},{"name":"OFF-BSD TX OUD;AL 60 M SUBSE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2087","description":"OFF-BASED TX OUD; AL 60 MIN SUBSEQ CALENDAR MO","allowed_amounts":[{"tin":{"type":"ein","value":"464126690"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":9359.96,"providers":[{"billed_charge":11071.28,"npi":[1841358017]}]}]}]},{"name":"OFF-B TX OUD;EA ADD 30M BYD","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2088","description":"OFF-BASED TX OUD;EA ADD 30 MIN BYD 1ST 120 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"464126690"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1717.46,"providers":[{"billed_charge":1814.80,"npi":[1841358017]}]}]}]},{"name":"ALC &/OTH RX TST: CLCT&HNDL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0048","description":"ALCOHOL AND/OR OTHER DRUG TESTING: COLLECTION AND HANDLING ONLY, SPECIMENS OTHER THAN BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"460722516"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":75.00,"providers":[{"billed_charge":300.00,"npi":[1629085717]}]}]}]},{"name":"KNEE ORTHOSIS ELASTIC W/JNTS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1812","description":"KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":903.63,"providers":[{"billed_charge":1549.21,"npi":[1234567893]}]}]}]},{"name":"ANK ORTH ANK GAUNTLT/SIM PRE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L1902","description":"ANKLE ORTHOSIS, ANKLE GAUNTLET OR SIMILAR, WITH OR WITHOUT JOINTS, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":1205.00,"providers":[{"billed_charge":1931.80,"npi":[1234567893]}]}]}]},{"name":"ADD LW EXT ORTH KNEE CNTRL F","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L2795","description":"ADDITION TO LOWER EXTREMITY ORTHOTIC, KNEE CONTROL, FULL KNEECAP","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":198.63,"providers":[{"billed_charge":308.46,"npi":[1234567893]}]}]}]},{"name":"SURGICAL BOOT/SHOE EACH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3260","description":"SURGICAL BOOT/SHOE, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":726.00,"providers":[{"billed_charge":1210.00,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOS FIG 8 CANVAS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3660","description":"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, O","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":2429.44,"providers":[{"billed_charge":3894.40,"npi":[1234567893]}]}]}]},{"name":"SHOULDER ORTHOSIS, ACROMIO/C","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3670","description":"SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":584.64,"providers":[{"billed_charge":937.23,"npi":[1234567893]}]}]}]},{"name":"WHF ORTHO NO JOINTS PREFAB","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3809","description":"WRIST HAND FINGER ORTHOSIS, WITHOUT JOINT(S), PREFABRICATED, OFF-THE-SHELF, ANY TYPE","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":3857.91,"providers":[{"billed_charge":4158.00,"npi":[1234567893]}]}]}]},{"name":"WRST HND ORTHOS CNTRL COCK-U","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L3908","description":"WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":3662.48,"providers":[{"billed_charge":4823.92,"npi":[1234567893]}]},{"allowed_amount":47.90,"providers":[{"billed_charge":105.00,"npi":[1234567893]}]}]}]},{"name":"WALKING BOOT, PNEUMATIC AND/","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"L4361","description":"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, P","allowed_amounts":[{"tin":{"type":"ein","value":"999999999"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":16720.00,"providers":[{"billed_charge":26803.20,"npi":[1234567893]}]}]}]}]}