{"reporting_entity_name":"Centene Management Company LLC","reporting_entity_type":"Third Party Administrator","version":"2.0.0","last_updated_on":"2026-01-28","out_of_network":[{"name":"Under Proprietary Laboratory Analyses","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"0340U","description":"Under Proprietary Laboratory Analyses","allowed_amounts":[{"tin":{"type":"ein","value":"10894487"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23520.00,"providers":[{"billed_charge":39200.00,"npi":[1558672279]}]}]}]},{"name":"RESIDENTIAL TREATMENT-PSYCHI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"1001","description":"BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL TREATMENT - PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"993480958"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":23191.00,"providers":[{"billed_charge":242340.00,"npi":[1629895370]}]}]}]},{"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":"873572700"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":9800.00,"providers":[{"billed_charge":114000.00,"npi":[1245981760]}]}]}]},{"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":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":133472.12,"providers":[{"billed_charge":52309.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1878278.69,"providers":[{"billed_charge":393516.00,"npi":[1982733655]}]}]}]},{"name":"PEDS/PVT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"113","description":"ROOM AND BOARD - PRIVATE -PEDIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":361974.60,"providers":[{"billed_charge":549140.00,"npi":[1760480503]}]}]}]},{"name":"PSTAY/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"124","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -PSYCHIATRIC","allowed_amounts":[{"tin":{"type":"ein","value":"364795061"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":77300.24,"providers":[{"billed_charge":78863.76,"npi":[1336504380]}]},{"allowed_amount":183178.08,"providers":[{"billed_charge":207382.48,"npi":[1407480254]}]}]},{"tin":{"type":"ein","value":"331313844"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":111003.13,"providers":[{"billed_charge":259900.00,"npi":[1841012424]}]}]},{"tin":{"type":"ein","value":"134310760"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":120806.22,"providers":[{"billed_charge":123000.00,"npi":[1770506024]}]}]},{"tin":{"type":"ein","value":"834598911"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":41931.46,"providers":[{"billed_charge":46200.00,"npi":[1295494292]}]}]},{"tin":{"type":"ein","value":"464207180"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":184180.70,"providers":[{"billed_charge":187000.00,"npi":[1740604636]}]}]},{"tin":{"type":"ein","value":"270355566"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":870121.49,"providers":[{"billed_charge":859420.00,"npi":[1083942098]}]}]},{"tin":{"type":"ein","value":"844337864"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":37977.84,"providers":[{"billed_charge":57000.00,"npi":[1760017099]}]}]}]},{"name":"DETOX/2 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"126","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"270355566"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":430769.30,"providers":[{"billed_charge":505020.00,"npi":[1083942098]}]}]},{"tin":{"type":"ein","value":"472097678"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":53638.10,"providers":[{"billed_charge":201244.64,"npi":[1972132231]}]}]}]},{"name":"DETOX/3&4 BED","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"136","description":"SEMI-PRIVATE - THREE AND FOUR BEDS -DETOXIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"870833629"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1923.00,"providers":[{"billed_charge":2250.00,"npi":[1245908763]}]}]}]},{"name":"INTENSIVE CARE OR ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"200","description":"INTENSIVE CARE - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":589246.25,"providers":[{"billed_charge":117054.00,"npi":[1982733655]}]}]}]},{"name":"POST ICU","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"206","description":"INTENSIVE CARE - POST ICU","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":26408.57,"providers":[{"billed_charge":15255.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":300520.79,"providers":[{"billed_charge":401715.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1047522.07,"providers":[{"billed_charge":752142.00,"npi":[1982733655]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2285.28,"providers":[{"billed_charge":70143.00,"npi":[1992735088]}]},{"allowed_amount":1351.89,"providers":[{"billed_charge":3052.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":20143.90,"providers":[{"billed_charge":33364.00,"npi":[1760480503]}]},{"allowed_amount":9803.40,"providers":[{"billed_charge":16339.00,"npi":[1760480503]}]},{"allowed_amount":502148.14,"providers":[{"billed_charge":953309.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29.70,"providers":[{"billed_charge":108.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":641.86,"providers":[{"billed_charge":2139.54,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":729.42,"providers":[{"billed_charge":2966.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":143.67,"providers":[{"billed_charge":3553.28,"npi":[1700910189]}]},{"allowed_amount":7510.40,"providers":[{"billed_charge":209437.53,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":192.78,"providers":[{"billed_charge":880.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":559.34,"providers":[{"billed_charge":152.00,"npi":[1609408665]}]},{"allowed_amount":1179.26,"providers":[{"billed_charge":10232.00,"npi":[1982733655]}]},{"allowed_amount":4960.20,"providers":[{"billed_charge":156419.00,"npi":[1982733655]}]},{"allowed_amount":1.62,"providers":[{"billed_charge":59.00,"npi":[1265065445]}]}]},{"tin":{"type":"ein","value":"270355566"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":364.83,"providers":[{"billed_charge":112472.94,"npi":[1083942098]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":0.76,"providers":[{"billed_charge":2451.83,"npi":[]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22.74,"providers":[{"billed_charge":6131.50,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":779.12,"providers":[{"billed_charge":3139.00,"npi":[1992131734]}]}]}]},{"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":"860422559"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8058.20,"providers":[{"billed_charge":10066.00,"npi":[1760480503]}]},{"allowed_amount":3568.60,"providers":[{"billed_charge":5886.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21099.44,"providers":[{"billed_charge":100199.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2803.25,"providers":[{"billed_charge":8830.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22671.51,"providers":[{"billed_charge":69951.60,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8140.64,"providers":[{"billed_charge":33249.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":494.64,"providers":[{"billed_charge":916.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":73632.16,"providers":[{"billed_charge":184759.00,"npi":[1982733655]}]},{"allowed_amount":5832.00,"providers":[{"billed_charge":170174.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":272.92,"providers":[{"billed_charge":272.92,"npi":[1083643738]}]},{"allowed_amount":2607.14,"providers":[{"billed_charge":2695.58,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":107.61,"providers":[{"billed_charge":15645.61,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":33.48,"providers":[{"billed_charge":7442.00,"npi":[1992131734]}]},{"allowed_amount":27282.23,"providers":[{"billed_charge":61624.00,"npi":[1992131734]}]}]}]},{"name":"IV THERAPY/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"269","description":"IV THERAPY - OTHER IV THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1276.88,"providers":[{"billed_charge":3521.62,"npi":[1881352037]}]}]}]},{"name":"STERILE SUPPLY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"272","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY","allowed_amounts":[{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1958.16,"providers":[{"billed_charge":6527.22,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1615.68,"providers":[{"billed_charge":108130.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1186.92,"providers":[{"billed_charge":216014.00,"npi":[1982733655]}]},{"allowed_amount":633.42,"providers":[{"billed_charge":7121.00,"npi":[1982733655]}]},{"allowed_amount":7416.00,"providers":[{"billed_charge":9888.00,"npi":[1982733655]}]}]}]},{"name":"SUPPLY/IMPLANTS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"278","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANTS","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1051.38,"providers":[{"billed_charge":58745.00,"npi":[1700910189]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":388.80,"providers":[{"billed_charge":3904.00,"npi":[1992735088]}]},{"allowed_amount":97.20,"providers":[{"billed_charge":10616.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19146.40,"providers":[{"billed_charge":32273.66,"npi":[1760480503]}]},{"allowed_amount":4577.40,"providers":[{"billed_charge":7629.00,"npi":[1760480503]}]},{"allowed_amount":625.20,"providers":[{"billed_charge":1042.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"741536936"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6.45,"providers":[{"billed_charge":1303.00,"npi":[1205900370]}]}]},{"tin":{"type":"ein","value":"900214335"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":143.22,"providers":[{"billed_charge":717.60,"npi":[1194705202]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":558.00,"providers":[{"billed_charge":5192.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3204.01,"providers":[{"billed_charge":3204.01,"npi":[1083643738]}]},{"allowed_amount":11058.09,"providers":[{"billed_charge":13411.58,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":234.21,"providers":[{"billed_charge":3618.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"821703810"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2939.79,"providers":[{"billed_charge":15415.87,"npi":[1356818496]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":373.45,"providers":[{"billed_charge":488.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2575.04,"providers":[{"billed_charge":12719.10,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":507.28,"providers":[{"billed_charge":9145.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":641.52,"providers":[{"billed_charge":18816.00,"npi":[1700910189]}]},{"allowed_amount":158.02,"providers":[{"billed_charge":3164.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1456.80,"providers":[{"billed_charge":21648.92,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2171.30,"providers":[{"billed_charge":20904.00,"npi":[1982733655]}]},{"allowed_amount":3469.98,"providers":[{"billed_charge":53408.00,"npi":[1982733655]}]},{"allowed_amount":36.18,"providers":[{"billed_charge":335.00,"npi":[1609408665]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":77.04,"providers":[{"billed_charge":806.14,"npi":[]}]},{"allowed_amount":2125.70,"providers":[{"billed_charge":76452.63,"npi":[]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":828.90,"providers":[{"billed_charge":216943.48,"npi":[1992735088]}]},{"allowed_amount":4298.94,"providers":[{"billed_charge":58262.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":38447.20,"providers":[{"billed_charge":63896.00,"npi":[1760480503]}]},{"allowed_amount":65580.10,"providers":[{"billed_charge":106388.00,"npi":[1760480503]}]},{"allowed_amount":178339.20,"providers":[{"billed_charge":361496.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8488.99,"providers":[{"billed_charge":107757.00,"npi":[1689121188]}]},{"allowed_amount":3787.02,"providers":[{"billed_charge":65183.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":658.92,"providers":[{"billed_charge":32484.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5464.65,"providers":[{"billed_charge":102291.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"370635502"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2293.24,"providers":[{"billed_charge":8049.00,"npi":[1982796181]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15.00,"providers":[{"billed_charge":2977.00,"npi":[1114744752]}]},{"allowed_amount":36.79,"providers":[{"billed_charge":96370.17,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5684.83,"providers":[{"billed_charge":12985.00,"npi":[1902897820]}]},{"allowed_amount":1221.04,"providers":[{"billed_charge":4536.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":943.20,"providers":[{"billed_charge":7045.92,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":13224.12,"providers":[{"billed_charge":249471.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":24.30,"providers":[{"billed_charge":45.00,"npi":[1700910189]}]},{"allowed_amount":8040.60,"providers":[{"billed_charge":459671.56,"npi":[1700910189]}]},{"allowed_amount":3751.38,"providers":[{"billed_charge":124603.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37960.08,"providers":[{"billed_charge":394468.69,"npi":[1982733655]}]},{"allowed_amount":337.50,"providers":[{"billed_charge":450.00,"npi":[1982733655]}]},{"allowed_amount":1874.34,"providers":[{"billed_charge":21811.00,"npi":[1609408665]}]},{"allowed_amount":43712.64,"providers":[{"billed_charge":765169.00,"npi":[1982733655]}]},{"allowed_amount":2486.53,"providers":[{"billed_charge":21983.00,"npi":[1265065445]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":606.64,"providers":[{"billed_charge":4629.41,"npi":[]}]},{"allowed_amount":3325.96,"providers":[{"billed_charge":66162.30,"npi":[]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4472.40,"providers":[{"billed_charge":7454.00,"npi":[1760480503]}]},{"allowed_amount":1785.00,"providers":[{"billed_charge":2975.00,"npi":[1760480503]}]},{"allowed_amount":4104.70,"providers":[{"billed_charge":6738.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12.13,"providers":[{"billed_charge":570.00,"npi":[1700910189]}]},{"allowed_amount":73.03,"providers":[{"billed_charge":2405.72,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1998.96,"providers":[{"billed_charge":20578.00,"npi":[1982733655]}]},{"allowed_amount":1109.42,"providers":[{"billed_charge":6533.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":76.38,"providers":[{"billed_charge":581.00,"npi":[]}]},{"allowed_amount":13.91,"providers":[{"billed_charge":42.00,"npi":[]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":25866.60,"providers":[{"billed_charge":44391.00,"npi":[1760480503]}]},{"allowed_amount":16360.80,"providers":[{"billed_charge":26894.00,"npi":[1760480503]}]},{"allowed_amount":7394.60,"providers":[{"billed_charge":12299.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":133.92,"providers":[{"billed_charge":37127.00,"npi":[1992735088]}]},{"allowed_amount":336.96,"providers":[{"billed_charge":9596.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":672.30,"providers":[{"billed_charge":13100.00,"npi":[1689121188]}]},{"allowed_amount":2354.50,"providers":[{"billed_charge":36826.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":86.72,"providers":[{"billed_charge":86.72,"npi":[1083643738]}]},{"allowed_amount":706.77,"providers":[{"billed_charge":737.12,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":90.42,"providers":[{"billed_charge":4399.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":407.16,"providers":[{"billed_charge":3942.00,"npi":[1992131734]}]},{"allowed_amount":943.27,"providers":[{"billed_charge":17714.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9.19,"providers":[{"billed_charge":1089.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":567.71,"providers":[{"billed_charge":4591.34,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":376.58,"providers":[{"billed_charge":558.00,"npi":[1902897820]}]},{"allowed_amount":453.16,"providers":[{"billed_charge":1820.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4070.58,"providers":[{"billed_charge":79749.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":558.12,"providers":[{"billed_charge":17673.00,"npi":[1700910189]}]},{"allowed_amount":891.54,"providers":[{"billed_charge":72027.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9720.04,"providers":[{"billed_charge":103924.60,"npi":[1982733655]}]},{"allowed_amount":272.16,"providers":[{"billed_charge":2016.00,"npi":[1609408665]}]},{"allowed_amount":179.75,"providers":[{"billed_charge":1512.00,"npi":[1265065445]}]},{"allowed_amount":11094.78,"providers":[{"billed_charge":222535.00,"npi":[1982733655]}]},{"allowed_amount":425.25,"providers":[{"billed_charge":567.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":465.11,"providers":[{"billed_charge":11042.04,"npi":[]}]},{"allowed_amount":28.82,"providers":[{"billed_charge":253.36,"npi":[]}]}]}]},{"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":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":56.63,"providers":[{"billed_charge":4760.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36439.20,"providers":[{"billed_charge":60732.00,"npi":[1760480503]}]},{"allowed_amount":19441.60,"providers":[{"billed_charge":30982.00,"npi":[1760480503]}]},{"allowed_amount":30621.00,"providers":[{"billed_charge":66738.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1012.65,"providers":[{"billed_charge":8747.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":170.83,"providers":[{"billed_charge":5545.54,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1274.16,"providers":[{"billed_charge":3328.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11634.39,"providers":[{"billed_charge":64741.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":2492.82,"providers":[{"billed_charge":3812.08,"npi":[1700910189]}]},{"allowed_amount":167.94,"providers":[{"billed_charge":35379.00,"npi":[1700910189]}]},{"allowed_amount":1997.39,"providers":[{"billed_charge":5535.72,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4375.17,"providers":[{"billed_charge":23454.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":17227.20,"providers":[{"billed_charge":200518.00,"npi":[1982733655]}]},{"allowed_amount":9213.59,"providers":[{"billed_charge":88871.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":285.93,"providers":[{"billed_charge":2192.35,"npi":[]}]},{"allowed_amount":91.76,"providers":[{"billed_charge":1201.81,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1968.83,"providers":[{"billed_charge":19135.00,"npi":[1992131734]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2329.20,"providers":[{"billed_charge":3882.00,"npi":[1760480503]}]},{"allowed_amount":832.20,"providers":[{"billed_charge":1387.00,"npi":[1760480503]}]},{"allowed_amount":2713.20,"providers":[{"billed_charge":6040.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":11.88,"providers":[{"billed_charge":337.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1238.30,"providers":[{"billed_charge":54180.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":18.90,"providers":[{"billed_charge":4083.00,"npi":[1700910189]}]},{"allowed_amount":56.16,"providers":[{"billed_charge":3710.00,"npi":[1700910189]}]},{"allowed_amount":125.13,"providers":[{"billed_charge":291.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1279.26,"providers":[{"billed_charge":27020.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3140.04,"providers":[{"billed_charge":33672.00,"npi":[1982733655]}]},{"allowed_amount":762.90,"providers":[{"billed_charge":11299.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":30.12,"providers":[{"billed_charge":30.12,"npi":[1083643738]}]},{"allowed_amount":371.63,"providers":[{"billed_charge":392.55,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":57.37,"providers":[{"billed_charge":1286.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":9.90,"providers":[{"billed_charge":213.00,"npi":[]}]},{"allowed_amount":22.89,"providers":[{"billed_charge":883.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":349.05,"providers":[{"billed_charge":5432.00,"npi":[1992131734]}]}]}]},{"name":"LAB/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"309","description":"LABORATORY - OTHER LABORATORY","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":127.86,"providers":[{"billed_charge":23109.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":691.50,"providers":[{"billed_charge":922.00,"npi":[1982733655]}]},{"allowed_amount":2154.60,"providers":[{"billed_charge":18720.00,"npi":[1982733655]}]},{"allowed_amount":6349.26,"providers":[{"billed_charge":89942.00,"npi":[1982733655]}]}]}]},{"name":"PATHOL/HYSTOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"312","description":"LABORATORY PATHOLOGICAL - HISTOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4285.80,"providers":[{"billed_charge":7143.00,"npi":[1760480503]}]},{"allowed_amount":511.20,"providers":[{"billed_charge":852.00,"npi":[1760480503]}]},{"allowed_amount":3273.00,"providers":[{"billed_charge":5455.00,"npi":[1760480503]}]}]}]},{"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":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":682.02,"providers":[{"billed_charge":2586.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":19514.40,"providers":[{"billed_charge":32047.00,"npi":[1760480503]}]},{"allowed_amount":4366.80,"providers":[{"billed_charge":7739.00,"npi":[1760480503]}]},{"allowed_amount":24295.20,"providers":[{"billed_charge":40492.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4499.00,"providers":[{"billed_charge":78180.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":1819.80,"providers":[{"billed_charge":44415.00,"npi":[1700910189]}]},{"allowed_amount":751.50,"providers":[{"billed_charge":1002.00,"npi":[1700910189]}]},{"allowed_amount":3883.68,"providers":[{"billed_charge":24017.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1983.33,"providers":[{"billed_charge":32762.00,"npi":[1689121188]}]},{"allowed_amount":438.48,"providers":[{"billed_charge":3509.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":8292.31,"providers":[{"billed_charge":92373.55,"npi":[1982733655]}]},{"allowed_amount":1725.84,"providers":[{"billed_charge":194290.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":232.83,"providers":[{"billed_charge":232.83,"npi":[1083643738]}]},{"allowed_amount":637.50,"providers":[{"billed_charge":637.50,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":1038.74,"providers":[{"billed_charge":20356.80,"npi":[]}]},{"allowed_amount":402.49,"providers":[{"billed_charge":2644.38,"npi":[]}]}]}]},{"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":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5665.14,"providers":[{"billed_charge":13795.00,"npi":[1992735088]}]},{"allowed_amount":293.22,"providers":[{"billed_charge":9774.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":12964.80,"providers":[{"billed_charge":22302.00,"npi":[1760480503]}]},{"allowed_amount":5162.40,"providers":[{"billed_charge":8604.00,"npi":[1760480503]}]},{"allowed_amount":5750.30,"providers":[{"billed_charge":9509.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1199.43,"providers":[{"billed_charge":5715.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21109.78,"providers":[{"billed_charge":59587.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1759.32,"providers":[{"billed_charge":52282.00,"npi":[1700910189]}]},{"allowed_amount":11068.60,"providers":[{"billed_charge":26438.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9044.28,"providers":[{"billed_charge":25502.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2854.41,"providers":[{"billed_charge":72317.00,"npi":[1982733655]}]},{"allowed_amount":20792.19,"providers":[{"billed_charge":54297.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1538.07,"providers":[{"billed_charge":1668.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":511.43,"providers":[{"billed_charge":2884.79,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1982.82,"providers":[{"billed_charge":4708.00,"npi":[1992131734]}]}]}]},{"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":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1291.64,"providers":[{"billed_charge":20198.60,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":245.39,"providers":[{"billed_charge":19117.00,"npi":[]}]}]}]},{"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":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8296.20,"providers":[{"billed_charge":33410.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":38068.16,"providers":[{"billed_charge":171651.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":12107.34,"providers":[{"billed_charge":79175.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1964.52,"providers":[{"billed_charge":7276.00,"npi":[1689121188]}]},{"allowed_amount":5657.70,"providers":[{"billed_charge":50322.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10672.56,"providers":[{"billed_charge":176797.00,"npi":[1982733655]}]},{"allowed_amount":54882.19,"providers":[{"billed_charge":308766.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":110.39,"providers":[{"billed_charge":2413.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1146.24,"providers":[{"billed_charge":10079.00,"npi":[1992131734]}]}]}]},{"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":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5729.56,"providers":[{"billed_charge":80640.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27521.85,"providers":[{"billed_charge":152685.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96458.03,"providers":[{"billed_charge":733899.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":41586.57,"providers":[{"billed_charge":320326.00,"npi":[1700910189]}]},{"allowed_amount":4983.66,"providers":[{"billed_charge":384391.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":59856.06,"providers":[{"billed_charge":381173.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":18703.44,"providers":[{"billed_charge":468326.00,"npi":[1982733655]}]},{"allowed_amount":98712.04,"providers":[{"billed_charge":779142.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8623.83,"providers":[{"billed_charge":28209.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":18698.56,"providers":[{"billed_charge":144882.00,"npi":[1992131734]}]}]}]},{"name":"OR SERVICES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"360","description":"OPERATING ROOM SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36651.00,"providers":[{"billed_charge":61085.00,"npi":[1760480503]}]},{"allowed_amount":209700.00,"providers":[{"billed_charge":349500.00,"npi":[1760480503]}]},{"allowed_amount":140946.00,"providers":[{"billed_charge":232875.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":9553.68,"providers":[{"billed_charge":185705.00,"npi":[1700910189]}]},{"allowed_amount":15369.71,"providers":[{"billed_charge":45415.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":24192.54,"providers":[{"billed_charge":467812.00,"npi":[1982733655]}]},{"allowed_amount":17344.02,"providers":[{"billed_charge":38213.00,"npi":[1982733655]}]}]}]},{"name":"OR/MINOR","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"361","description":"OPERATING ROOM SERVICES - MINOR SURGERY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":6553.20,"providers":[{"billed_charge":10922.00,"npi":[1760480503]}]},{"allowed_amount":24200.40,"providers":[{"billed_charge":40334.00,"npi":[1760480503]}]}]}]},{"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":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.50,"providers":[{"billed_charge":192.40,"npi":[1033166012]}]},{"allowed_amount":13.50,"providers":[{"billed_charge":133.20,"npi":[1073578159]}]}]},{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5968.27,"providers":[{"billed_charge":85267.20,"npi":[1740262880]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":43818.00,"providers":[{"billed_charge":73030.00,"npi":[1760480503]}]},{"allowed_amount":73451.00,"providers":[{"billed_charge":121540.00,"npi":[1760480503]}]},{"allowed_amount":3744.00,"providers":[{"billed_charge":6240.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":3195.72,"providers":[{"billed_charge":60500.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":7147.44,"providers":[{"billed_charge":235115.00,"npi":[1982733655]}]},{"allowed_amount":5280.75,"providers":[{"billed_charge":7041.00,"npi":[1982733655]}]}]}]},{"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":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1736.07,"providers":[{"billed_charge":7681.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":14879.40,"providers":[{"billed_charge":24799.00,"npi":[1760480503]}]},{"allowed_amount":7407.60,"providers":[{"billed_charge":14869.00,"npi":[1760480503]}]},{"allowed_amount":19868.80,"providers":[{"billed_charge":32826.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6180.00,"providers":[{"billed_charge":42898.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1260.63,"providers":[{"billed_charge":10757.00,"npi":[1700910189]}]},{"allowed_amount":493.56,"providers":[{"billed_charge":7990.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3853.14,"providers":[{"billed_charge":16232.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":10976.95,"providers":[{"billed_charge":54837.00,"npi":[1982733655]}]},{"allowed_amount":3113.64,"providers":[{"billed_charge":56645.00,"npi":[1982733655]}]}]}]},{"name":"RESPIRATORY SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"410","description":"RESPIRATORY SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":315.00,"providers":[{"billed_charge":525.00,"npi":[1760480503]}]}]}]},{"name":"INHALATION SVC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"412","description":"RESPIRATORY SERVICES - INHALATION SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":511.92,"providers":[{"billed_charge":948.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":39.79,"providers":[{"billed_charge":3456.00,"npi":[1982733655]}]}]}]},{"name":"PHYSICAL THERP","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"420","description":"PHYSICAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":9873.24,"providers":[{"billed_charge":16538.00,"npi":[1760480503]}]},{"allowed_amount":1299.00,"providers":[{"billed_charge":2165.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":198.72,"providers":[{"billed_charge":1618.00,"npi":[1700910189]}]}]}]},{"name":"PHYS THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"424","description":"PHYSICAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":1420.20,"providers":[{"billed_charge":2367.00,"npi":[1760480503]}]},{"allowed_amount":568.20,"providers":[{"billed_charge":947.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":214.38,"providers":[{"billed_charge":397.00,"npi":[1700910189]}]},{"allowed_amount":312.66,"providers":[{"billed_charge":7087.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1386.45,"providers":[{"billed_charge":14355.00,"npi":[1982733655]}]}]}]},{"name":"OCCUP THERP/EVAL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"434","description":"OCCUPATIONAL THERAPY - EVALUATION OR RE-EVALUATION","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":2028.60,"providers":[{"billed_charge":13735.00,"npi":[1982733655]}]}]}]},{"name":"SPEECH PATHOL","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"440","description":"SPEECH-LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6388.80,"providers":[{"billed_charge":10648.00,"npi":[1760480503]}]}]}]},{"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":"860422559"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":531042.70,"providers":[{"billed_charge":883422.00,"npi":[1760480503]}]},{"allowed_amount":77493.00,"providers":[{"billed_charge":129155.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":172049.00,"providers":[{"billed_charge":471268.00,"npi":[1992735088]}]},{"allowed_amount":2852.28,"providers":[{"billed_charge":228138.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":419411.00,"providers":[{"billed_charge":1097899.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":27246.75,"providers":[{"billed_charge":27715.75,"npi":[1083643738]}]},{"allowed_amount":1912.00,"providers":[{"billed_charge":1912.00,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":135890.07,"providers":[{"billed_charge":288853.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":123384.10,"providers":[{"billed_charge":343126.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":78143.69,"providers":[{"billed_charge":389119.00,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":80306.20,"providers":[{"billed_charge":281619.83,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":36879.05,"providers":[{"billed_charge":54790.00,"npi":[1902897820]}]},{"allowed_amount":1656.56,"providers":[{"billed_charge":9668.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":725074.14,"providers":[{"billed_charge":1982051.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":109800.84,"providers":[{"billed_charge":231002.90,"npi":[1518539048]}]},{"allowed_amount":6442.00,"providers":[{"billed_charge":6000.00,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21382.45,"providers":[{"billed_charge":73968.11,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":15540.12,"providers":[{"billed_charge":473546.00,"npi":[1700910189]}]},{"allowed_amount":258824.78,"providers":[{"billed_charge":705180.54,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":23961.96,"providers":[{"billed_charge":587950.00,"npi":[1982733655]}]},{"allowed_amount":86115.07,"providers":[{"billed_charge":129706.00,"npi":[1609408665]}]},{"allowed_amount":69075.00,"providers":[{"billed_charge":100497.00,"npi":[1265065445]}]},{"allowed_amount":531881.72,"providers":[{"billed_charge":1293677.67,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43627.50,"providers":[{"billed_charge":406634.73,"npi":[]}]}]}]},{"name":"URGENT CARE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"456","description":"EMERGENCY ROOM - URGENT CARE","allowed_amounts":[{"tin":{"type":"ein","value":"721561132"},"service_code":["20"],"billing_class":"institutional","payments":[{"allowed_amount":1235.97,"providers":[{"billed_charge":2164.00,"npi":[1700910189]}]}]}]},{"name":"PULMONARY FUNC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"460","description":"PULMONARY FUNCTION - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2661.60,"providers":[{"billed_charge":4436.00,"npi":[1760480503]}]}]}]},{"name":"AUDIOLOGY/DX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"471","description":"AUDIOLOGY - DIAGNOSTIC","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9036.00,"providers":[{"billed_charge":15060.00,"npi":[1760480503]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":42199.20,"providers":[{"billed_charge":70332.00,"npi":[1760480503]}]},{"allowed_amount":44998.80,"providers":[{"billed_charge":123842.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":8048.70,"providers":[{"billed_charge":78459.00,"npi":[1982733655]}]}]}]},{"name":"MRI-BRAIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"611","description":"MRI - BRAIN (INCLUDING BRAINSTEM)","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1786.32,"providers":[{"billed_charge":3308.00,"npi":[1982733655]}]},{"allowed_amount":9945.51,"providers":[{"billed_charge":23628.00,"npi":[1982733655]}]}]}]},{"name":"MRA - Head and Neck","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"615","description":"MRA - Head and Neck","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2124.36,"providers":[{"billed_charge":38564.00,"npi":[1982733655]}]}]}]},{"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":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":37364.20,"providers":[{"billed_charge":61071.00,"npi":[1760480503]}]},{"allowed_amount":645184.20,"providers":[{"billed_charge":1184953.00,"npi":[1760480503]}]},{"allowed_amount":9807.60,"providers":[{"billed_charge":16338.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"352263845"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3139.21,"providers":[{"billed_charge":52837.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6958.48,"providers":[{"billed_charge":117830.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"860212139"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1625.50,"providers":[{"billed_charge":2904.18,"npi":[1083643738]}]},{"allowed_amount":3017.86,"providers":[{"billed_charge":3017.86,"npi":[1083643738]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":237.38,"providers":[{"billed_charge":9081.60,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22422.14,"providers":[{"billed_charge":46499.00,"npi":[1992131734]}]}]},{"tin":{"type":"ein","value":"821703810"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":638.77,"providers":[{"billed_charge":2129.18,"npi":[1356818496]}]}]},{"tin":{"type":"ein","value":"860181654"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":21.31,"providers":[{"billed_charge":37614.50,"npi":[1114744752]}]},{"allowed_amount":2.43,"providers":[{"billed_charge":17275.50,"npi":[1114744752]}]}]},{"tin":{"type":"ein","value":"860098923"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":750.54,"providers":[{"billed_charge":1531.00,"npi":[1902897820]}]}]},{"tin":{"type":"ein","value":"833547294"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":6807.69,"providers":[{"billed_charge":22691.15,"npi":[1609496397]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":9997.20,"providers":[{"billed_charge":212497.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"851516898"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":68.00,"providers":[{"billed_charge":21294.70,"npi":[1518539048]}]}]},{"tin":{"type":"ein","value":"862195601"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21.08,"providers":[{"billed_charge":9224.58,"npi":[1881352037]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":23772.03,"providers":[{"billed_charge":878502.00,"npi":[1700910189]}]},{"allowed_amount":232.74,"providers":[{"billed_charge":431.00,"npi":[1700910189]}]},{"allowed_amount":150933.96,"providers":[{"billed_charge":372004.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":16840.54,"providers":[{"billed_charge":66769.50,"npi":[1982733655]}]},{"allowed_amount":19438.17,"providers":[{"billed_charge":415157.00,"npi":[1982733655]}]},{"allowed_amount":136.95,"providers":[{"billed_charge":4165.00,"npi":[1609408665]}]},{"allowed_amount":8141.25,"providers":[{"billed_charge":10855.00,"npi":[1982733655]}]},{"allowed_amount":386.16,"providers":[{"billed_charge":3697.00,"npi":[1265065445]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":345.32,"providers":[{"billed_charge":5916.33,"npi":[]}]}]}]},{"name":"RECOVERY ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"710","description":"RECOVERY ROOM - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":84969.50,"providers":[{"billed_charge":141050.00,"npi":[1760480503]}]},{"allowed_amount":43347.00,"providers":[{"billed_charge":72245.00,"npi":[1760480503]}]},{"allowed_amount":8862.00,"providers":[{"billed_charge":14770.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":8022.75,"providers":[{"billed_charge":10697.00,"npi":[1982733655]}]},{"allowed_amount":3158.46,"providers":[{"billed_charge":68540.00,"npi":[1982733655]}]}]}]},{"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":"201291415"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":194.40,"providers":[{"billed_charge":324.00,"npi":[1336128461]}]}]}]},{"name":"X-RAY EXAM CHEST 2 VIEWS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"71046","description":"RADIOLOGIC EXAMINATION, CHEST; 2 VIEWS","allowed_amounts":[{"tin":{"type":"ein","value":"264000683"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":29.39,"providers":[{"billed_charge":159.00,"npi":[1790887222]}]}]}]},{"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":"352263845"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1933.20,"providers":[{"billed_charge":28640.00,"npi":[1992735088]}]},{"allowed_amount":386.64,"providers":[{"billed_charge":25060.00,"npi":[1992735088]}]}]},{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":7831.20,"providers":[{"billed_charge":13052.00,"npi":[1760480503]}]},{"allowed_amount":2364.00,"providers":[{"billed_charge":10466.00,"npi":[1760480503]}]},{"allowed_amount":5614.80,"providers":[{"billed_charge":9358.00,"npi":[1760480503]}]}]},{"tin":{"type":"ein","value":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":4538.38,"providers":[{"billed_charge":78565.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":57.78,"providers":[{"billed_charge":107.00,"npi":[1700910189]}]},{"allowed_amount":2621.44,"providers":[{"billed_charge":48688.00,"npi":[1700910189]}]},{"allowed_amount":4253.04,"providers":[{"billed_charge":50836.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"383990879"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2305.48,"providers":[{"billed_charge":23156.00,"npi":[1689121188]}]},{"allowed_amount":446.58,"providers":[{"billed_charge":827.00,"npi":[1689121188]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":3881.52,"providers":[{"billed_charge":71880.00,"npi":[1982733655]}]},{"allowed_amount":449.25,"providers":[{"billed_charge":599.00,"npi":[1982733655]}]},{"allowed_amount":7826.92,"providers":[{"billed_charge":73078.00,"npi":[1982733655]}]}]},{"tin":{"type":"ein","value":"860800150"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":145.16,"providers":[{"billed_charge":5628.00,"npi":[1154392231]}]}]},{"tin":{"type":"ein","value":"571165217"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":737.65,"providers":[{"billed_charge":10810.22,"npi":[]}]},{"allowed_amount":173.54,"providers":[{"billed_charge":1777.00,"npi":[]}]}]},{"tin":{"type":"ein","value":"463533638"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":396.04,"providers":[{"billed_charge":8985.00,"npi":[1992131734]}]}]}]},{"name":"OBSERVATION ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"762","description":"TREATMENT OR OBSERVATION ROOM - OBSERVATION ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":5461.20,"providers":[{"billed_charge":9102.00,"npi":[1760480503]}]},{"allowed_amount":1771.20,"providers":[{"billed_charge":2952.00,"npi":[1760480503]}]},{"allowed_amount":1918.80,"providers":[{"billed_charge":3198.00,"npi":[1760480503]}]}]}]},{"name":"ULTRASOUND BREAST COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"76641","description":"ULTRASOUND, BREAST, UNILATERAL, REAL TIME WITH IMAGE DOCUMENTATION, INCLUDING AXILLA WHEN PERFORMED;","allowed_amounts":[{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":581.40,"providers":[{"billed_charge":2862.00,"npi":[1154558039]}]}]}]},{"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":"264000683"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":688.35,"providers":[{"billed_charge":4065.00,"npi":[1811156367]}]}]},{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1845.56,"providers":[{"billed_charge":9028.00,"npi":[1154558039]}]}]}]},{"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":"264000683"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1681.35,"providers":[{"billed_charge":10500.00,"npi":[1811156367]}]}]},{"tin":{"type":"ein","value":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":4508.08,"providers":[{"billed_charge":21830.00,"npi":[1154558039]}]}]}]},{"name":"VACCINE ADMIN","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"771","description":"PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION","allowed_amounts":[{"tin":{"type":"ein","value":"721561134"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71.42,"providers":[{"billed_charge":714.00,"npi":[1982733655]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":686.88,"providers":[{"billed_charge":4811.60,"npi":[1740262880]}]}]}]},{"name":"GENERAL HEALTH PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80050","description":"GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1435.20,"providers":[{"billed_charge":8543.50,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":36645.98,"providers":[{"billed_charge":230862.71,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.60,"providers":[{"billed_charge":264.50,"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":34548.28,"providers":[{"billed_charge":342712.53,"npi":[1740262880]}]}]}]},{"name":"RENAL FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80069","description":"RENAL FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) CALCIUM, TOTAL (82310) C","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":166.25,"providers":[{"billed_charge":1310.60,"npi":[1740262880]}]}]}]},{"name":"ACUTE HEPATITIS PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80074","description":"ACUTE HEPATITIS PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: HEPATITIS A ANTIBODY (HAAB), IGM ANTIBO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9174.48,"providers":[{"billed_charge":121260.64,"npi":[1740262880]}]}]}]},{"name":"HEPATIC FUNCTION PANEL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80076","description":"HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":181.54,"providers":[{"billed_charge":1396.99,"npi":[1740262880]}]}]}]},{"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":"870847992"},"service_code":["11","99"],"billing_class":"professional","payments":[{"allowed_amount":6.30,"providers":[{"billed_charge":31.50,"npi":[1871547380]}]},{"allowed_amount":88.20,"providers":[{"billed_charge":441.00,"npi":[1871547380]}]}]}]},{"name":"DRUG TEST PRSMV INSTRMNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"80306","description":"DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; READ BY ","allowed_amounts":[{"tin":{"type":"ein","value":"454995568"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":356.48,"providers":[{"billed_charge":650.00,"npi":[1891971628]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1043.52,"providers":[{"billed_charge":1961.15,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1292.76,"providers":[{"billed_charge":19949.46,"npi":[1740262880]}]}]}]},{"name":"URINALYSIS NONAUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81002","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":6.96,"providers":[{"billed_charge":34.80,"npi":[1073578159,1033166012]}]}]}]},{"name":"URINALYSIS AUTO W/O SCOPE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81003","description":"URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":218.44,"providers":[{"billed_charge":4170.71,"npi":[1740262880]}]}]}]},{"name":"URINE PREGNANCY TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81025","description":"URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS","allowed_amounts":[{"tin":{"type":"ein","value":"870847992"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.24,"providers":[{"billed_charge":138.00,"npi":[1871547380]}]}]}]},{"name":"CFTR GENE COM VARIANTS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81220","description":"CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMM","allowed_amounts":[{"tin":{"type":"ein","value":"10894487"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12525.25,"providers":[{"billed_charge":87500.00,"npi":[1558672279]}]}]}]},{"name":"SMN1 GENE DOS/DELETION ALYS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81329","description":"SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS","allowed_amounts":[{"tin":{"type":"ein","value":"10894487"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3206.00,"providers":[{"billed_charge":5200.00,"npi":[1558672279]}]}]}]},{"name":"MOPATH PROCEDURE LEVEL 9","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81408","description":"MOLECULAR PATHOLOGY PROCEDURE LEVEL 9","allowed_amounts":[{"tin":{"type":"ein","value":"10894487"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25199.72,"providers":[{"billed_charge":32200.00,"npi":[1558672279]}]}]}]},{"name":"FETAL CHRMOML ANEUPLOIDY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"81420","description":"FETAL CHROMOSOMAL ANEUPLOIDY (EG, TRISOMY 21, MONOSOMY X) GENOMIC SEQUENCE ANALYSIS PANEL, CIRCULATI","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14984.56,"providers":[{"billed_charge":26149.41,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ACTH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82024","description":"ADRENOCORTICOTROPIC HORMONE (ACTH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":59.20,"providers":[{"billed_charge":558.60,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM ALBUMIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82040","description":"ALBUMIN; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":640.73,"providers":[{"billed_charge":1151.19,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3196.80,"providers":[{"billed_charge":53316.99,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BREATH ETHANOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82075","description":"ALCOHOL (ETHANOL), BREATH","allowed_amounts":[{"tin":{"type":"ein","value":"870847992"},"service_code":["11","99"],"billing_class":"professional","payments":[{"allowed_amount":210.00,"providers":[{"billed_charge":630.00,"npi":[1871547380]}]},{"allowed_amount":15.00,"providers":[{"billed_charge":45.00,"npi":[1871547380]}]}]},{"tin":{"type":"ein","value":"237086112"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":621.00,"providers":[{"billed_charge":1378.62,"npi":[1477016921]}]}]}]},{"name":"ALPHA-FETOPROTEIN, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82105","description":"ALPHA-FETOPROTEIN (AFP); SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":182.16,"providers":[{"billed_charge":1984.40,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF AMYLASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82150","description":"AMYLASE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":168.98,"providers":[{"billed_charge":1924.86,"npi":[1740262880]}]}]}]},{"name":"chemistry test for anti-mullerian hormone (AMH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82166","description":"chemistry test for anti-mullerian hormone (AMH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":206.60,"providers":[{"billed_charge":1155.05,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF APOLIPOPROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82172","description":"APOLIPOPROTEIN, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":854.64,"providers":[{"billed_charge":2642.22,"npi":[1740262880]}]}]}]},{"name":"BILIRUBIN, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82247","description":"BILIRUBIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":622.87,"providers":[{"billed_charge":777.04,"npi":[1740262880]}]}]}]},{"name":"BILIRUBIN, DIRECT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82248","description":"BILIRUBIN; DIRECT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":153.65,"providers":[{"billed_charge":315.63,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":35994.04,"providers":[{"billed_charge":593917.40,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CALCIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82310","description":"CALCIUM; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":612.01,"providers":[{"billed_charge":867.13,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CALCIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82330","description":"CALCIUM; IONIZED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.62,"providers":[{"billed_charge":693.00,"npi":[1740262880]}]}]}]},{"name":"ASSAY, BLOOD CARBON DIOXIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82374","description":"CARBON DIOXIDE (BICARBONATE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":203.94,"providers":[{"billed_charge":211.09,"npi":[1740262880]}]}]}]},{"name":"CARCINOEMBRYONIC ANTIGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82378","description":"CARCINOEMBRYONIC ANTIGEN (CEA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":392.58,"providers":[{"billed_charge":3721.17,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BLOOD CHLORIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82435","description":"CHLORIDE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":532.55,"providers":[{"billed_charge":637.28,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF COPPER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82525","description":"COPPER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":142.63,"providers":[{"billed_charge":1326.25,"npi":[1740262880]}]}]}]},{"name":"TOTAL CORTISOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82533","description":"CORTISOL; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2597.92,"providers":[{"billed_charge":24088.81,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82550","description":"CREATINE KINASE (CK), (CPK); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":164.67,"providers":[{"billed_charge":1490.09,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF CREATININE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82565","description":"CREATININE; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":690.11,"providers":[{"billed_charge":1454.90,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2795.78,"providers":[{"billed_charge":45294.92,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9725.10,"providers":[{"billed_charge":89846.94,"npi":[1740262880]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82626","description":"DEHYDROEPIANDROSTERONE (DHEA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":116.22,"providers":[{"billed_charge":1449.00,"npi":[1740262880]}]}]}]},{"name":"DEHYDROEPIANDROSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82627","description":"DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4583.76,"providers":[{"billed_charge":47487.13,"npi":[1740262880]}]}]}]},{"name":"DIHYDROTESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82642","description":"DIHYDROTESTOSTERONE (DHT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":381.31,"providers":[{"billed_charge":3217.18,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTRADIOL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82670","description":"ESTRADIOL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":15136.87,"providers":[{"billed_charge":125944.76,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTROGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82672","description":"ESTROGENS; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1445.94,"providers":[{"billed_charge":14915.68,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ESTRONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82679","description":"ESTRONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1205.19,"providers":[{"billed_charge":12830.97,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FERRITIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82728","description":"FERRITIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5898.60,"providers":[{"billed_charge":49416.90,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6604.22,"providers":[{"billed_charge":61589.46,"npi":[1740262880]}]}]}]},{"name":"ASSAY IGA/IGD/IGG/IGM EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82784","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":600.47,"providers":[{"billed_charge":11578.56,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF IGE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82785","description":"GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":302.88,"providers":[{"billed_charge":2727.94,"npi":[1740262880]}]}]}]},{"name":"ASSAY, GLUCOSE, BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82947","description":"GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":303.20,"providers":[{"billed_charge":787.23,"npi":[1740262880]}]}]}]},{"name":"GLUCOSE TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82950","description":"GLUCOSE; POST GLUCOSE DOSE (INCLUDES GLUCOSE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":611.52,"providers":[{"billed_charge":5221.69,"npi":[1740262880]}]}]}]},{"name":"GLUCOSE TOLERANCE TEST (GTT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82951","description":"GLUCOSE; TOLERANCE TEST (GTT), 3 SPECIMENS (INCLUDES GLUCOSE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":180.90,"providers":[{"billed_charge":1775.76,"npi":[1740262880]}]}]}]},{"name":"GTT-ADDED SAMPLES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82952","description":"GLUCOSE; TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS (LIST SEPARATELY IN ADDITION TO CODE FOR","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":78.00,"providers":[{"billed_charge":500.66,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GGT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"82977","description":"GLUTAMYLTRANSFERASE, GAMMA (GGT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":469.20,"providers":[{"billed_charge":3304.48,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (FSH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83001","description":"GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7276.64,"providers":[{"billed_charge":61157.67,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF GONADOTROPIN (LH)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83002","description":"GONADOTROPIN; LUTEINIZING HORMONE (LH)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5661.81,"providers":[{"billed_charge":46984.13,"npi":[1740262880]}]}]}]},{"name":"H PYLORI (C-13), BREATH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83013","description":"HELICOBACTER PYLORI; BREATH TEST ANALYSIS FOR UREASE ACTIVITY, NON-RADIOACTIVE ISOTOPE (EG, C-13)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5212.61,"providers":[{"billed_charge":34360.20,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23510.40,"providers":[{"billed_charge":245751.79,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF HOMOCYSTINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83090","description":"HOMOCYSTEINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":995.61,"providers":[{"billed_charge":14728.31,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY NONANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83516","description":"IMMUNOASSAY FOR ANALYTE OTH THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":282.84,"providers":[{"billed_charge":3722.09,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY QUANT NOS NONAB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83520","description":"IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATI","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":595.18,"providers":[{"billed_charge":11453.87,"npi":[1740262880]}]}]}]},{"name":"IG LIGHT CHAINS FREE EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83521","description":"IMMUNOGLOBULIN LIGHT CHAINS FREE EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":55.44,"providers":[{"billed_charge":934.11,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF INSULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83525","description":"INSULIN; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1277.34,"providers":[{"billed_charge":17284.31,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF IRON","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83540","description":"IRON","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3017.13,"providers":[{"billed_charge":22546.59,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3417.00,"providers":[{"billed_charge":25340.98,"npi":[1740262880]}]}]}]},{"name":"LACTATE (LD) (LDH) ENZYME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83615","description":"LACTATE DEHYDROGENASE (LD), (LDH);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":383.43,"providers":[{"billed_charge":2431.41,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF LIPASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83690","description":"LIPASE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":237.60,"providers":[{"billed_charge":2685.55,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF LIPOPROTEIN(A)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83695","description":"LIPOPROTEIN (A)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":198.40,"providers":[{"billed_charge":3141.14,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF LIPOPROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83718","description":"LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.56,"providers":[{"billed_charge":126.00,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BLOOD LIPOPROTEIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83721","description":"LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":51.17,"providers":[{"billed_charge":683.55,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF MAGNESIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83735","description":"MAGNESIUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1063.98,"providers":[{"billed_charge":10339.59,"npi":[1740262880]}]}]}]},{"name":"MASS SPECTROMETRY QUAL/QUAN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83789","description":"MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (EG, MS, MS/MS, MALDI, MS-TOF, QTOF), NON-DRUG ANALYT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13.84,"providers":[{"billed_charge":165.33,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF NATRIURETIC PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83880","description":"NATRIURETIC PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":78.03,"providers":[{"billed_charge":664.12,"npi":[1740262880]}]}]}]},{"name":"ORGANIC ACID SINGLE QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83921","description":"ORGANIC ACID, SINGLE, QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":50.48,"providers":[{"billed_charge":1108.80,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PARATHORMONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83970","description":"PARATHORMONE (PARATHYROID HORMONE)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2055.95,"providers":[{"billed_charge":13167.58,"npi":[1740262880]}]}]}]},{"name":"ASSAY FOR CALPROTECTIN FECAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"83993","description":"CALPROTECTIN, FECAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":30.08,"providers":[{"billed_charge":504.00,"npi":[1740262880]}]}]}]},{"name":"ASSAY ALKALINE PHOSPHATASE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84075","description":"PHOSPHATASE, ALKALINE;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":616.59,"providers":[{"billed_charge":709.98,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PHOSPHORUS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84100","description":"PHOSPHORUS INORGANIC (PHOSPHATE);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":366.09,"providers":[{"billed_charge":2861.25,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM POTASSIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84132","description":"POTASSIUM; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":270.38,"providers":[{"billed_charge":334.31,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PREGNENOLONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84140","description":"PREGNENOLONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.02,"providers":[{"billed_charge":417.34,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROGESTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84144","description":"PROGESTERONE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7371.39,"providers":[{"billed_charge":66391.99,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROLACTIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84146","description":"PROLACTIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2866.05,"providers":[{"billed_charge":25812.71,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PSA, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84153","description":"PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5030.13,"providers":[{"billed_charge":41827.38,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PSA, FREE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84154","description":"PROSTATE SPECIFIC ANTIGEN (PSA); FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":929.94,"providers":[{"billed_charge":6436.68,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROTEIN SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84155","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":496.83,"providers":[{"billed_charge":992.24,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF PROTEIN, URINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84156","description":"PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":196.70,"providers":[{"billed_charge":2820.68,"npi":[1740262880]}]}]}]},{"name":"PROTEIN E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84165","description":"PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":189.29,"providers":[{"billed_charge":1558.25,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF VITAMIN B-6","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84207","description":"PYRIDOXAL PHOSPHATE (VITAMIN B-6)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":86.12,"providers":[{"billed_charge":802.20,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SEX HORMONE GLOBUL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84270","description":"SEX HORMONE BINDING GLOBULIN (SHBG)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2013.00,"providers":[{"billed_charge":18821.82,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SERUM SODIUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84295","description":"SODIUM; SERUM, PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":556.71,"providers":[{"billed_charge":630.77,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF SOMATOMEDIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84305","description":"SOMATOMEDIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":521.28,"providers":[{"billed_charge":9646.89,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF FREE TESTOSTERONE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84402","description":"TESTOSTERONE; FREE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":13539.94,"providers":[{"billed_charge":127280.47,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":18276.77,"providers":[{"billed_charge":168963.76,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF VITAMIN B-1","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84425","description":"THIAMINE (VITAMIN B-1)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":195.24,"providers":[{"billed_charge":1680.03,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF TOTAL THYROXINE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84436","description":"THYROXINE; TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":982.78,"providers":[{"billed_charge":9016.89,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9687.82,"providers":[{"billed_charge":145970.10,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38686.08,"providers":[{"billed_charge":367408.95,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":12.87,"providers":[{"billed_charge":109.20,"npi":[1234567893]}]}]}]},{"name":"ASSAY OF TSI GLOBULIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84445","description":"THYROID STIMULATING IMMUNE GLOBULINS (TSI)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":38.96,"providers":[{"billed_charge":340.20,"npi":[1740262880]}]}]}]},{"name":"TRANSFERASE (AST) (SGOT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84450","description":"TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":682.19,"providers":[{"billed_charge":1177.71,"npi":[1740262880]}]}]}]},{"name":"ALANINE AMINO (ALT) (SGPT)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84460","description":"TRANSFERASE; ALANINE AMINO (ALT) (SGPT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":369.20,"providers":[{"billed_charge":1264.56,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF TRANSFERRIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84466","description":"TRANSFERRIN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":450.34,"providers":[{"billed_charge":4241.44,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF THYROID (T3 OR T4)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84479","description":"THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":381.52,"providers":[{"billed_charge":3448.21,"npi":[1740262880]}]}]}]},{"name":"ASSAY, TRIIODOTHYRONINE (T3)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84480","description":"TRIIODOTHYRONINE T3; TOTAL (TT-3)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":456.54,"providers":[{"billed_charge":4878.66,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9271.28,"providers":[{"billed_charge":154705.28,"npi":[1740262880]}]}]}]},{"name":"T3 REVERSE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84482","description":"TRIIODOTHYRONINE T3; REVERSE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":857.68,"providers":[{"billed_charge":16179.38,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF UREA NITROGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84520","description":"UREA NITROGEN; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":504.48,"providers":[{"billed_charge":854.79,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF BLOOD/URIC ACID","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84550","description":"URIC ACID; BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":626.27,"providers":[{"billed_charge":6070.73,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF VITAMIN A","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84590","description":"VITAMIN A","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.45,"providers":[{"billed_charge":671.50,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF ZINC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84630","description":"ZINC","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":192.06,"providers":[{"billed_charge":2151.16,"npi":[1740262880]}]}]}]},{"name":"ASSAY OF C-PEPTIDE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84681","description":"C-PEPTIDE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":339.02,"providers":[{"billed_charge":2825.09,"npi":[1740262880]}]}]}]},{"name":"CHORIONIC GONADOTROPIN TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"84702","description":"GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1581.72,"providers":[{"billed_charge":10951.06,"npi":[1740262880]}]}]}]},{"name":"HEMATOCRIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85014","description":"BLOOD COUNT; HEMATOCRIT (HCT)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":61.54,"providers":[{"billed_charge":784.91,"npi":[1740262880]}]}]}]},{"name":"HEMOGLOBIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85018","description":"BLOOD COUNT; HEMOGLOBIN (HGB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":48.87,"providers":[{"billed_charge":508.76,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19999.32,"providers":[{"billed_charge":157236.10,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":29.52,"providers":[{"billed_charge":185.20,"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1023.35,"providers":[{"billed_charge":7989.81,"npi":[1740262880]}]}]}]},{"name":"AUTOMATED RETICULOCYTE COUNT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85045","description":"BLOOD COUNT; RETICULOCYTE, AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":27.63,"providers":[{"billed_charge":340.01,"npi":[1740262880]}]}]}]},{"name":"FIBRIN DEGRADATION, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85379","description":"FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":31.16,"providers":[{"billed_charge":979.95,"npi":[1740262880]}]}]}]},{"name":"PROTHROMBIN TIME","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85610","description":"PROTHROMBIN TIME;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":481.58,"providers":[{"billed_charge":6467.87,"npi":[1740262880]}]}]}]},{"name":"RBC SED RATE, AUTOMATED","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85652","description":"SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":573.39,"providers":[{"billed_charge":10176.02,"npi":[1740262880]}]}]}]},{"name":"THROMBOPLASTIN TIME, PARTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"85730","description":"THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":492.20,"providers":[{"billed_charge":6876.34,"npi":[1740262880]}]}]}]},{"name":"ANTINUCLEAR ANTIBODIES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86038","description":"ANTINUCLEAR ANTIBODIES (ANA);","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1789.11,"providers":[{"billed_charge":19395.74,"npi":[1740262880]}]}]}]},{"name":"ANTISTREPTOLYSIN O, TITER","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86060","description":"ANTISTREPTOLYSIN 0; TITER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":44.80,"providers":[{"billed_charge":531.05,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1057.32,"providers":[{"billed_charge":18210.20,"npi":[1740262880]}]}]}]},{"name":"C-REACTIVE PROTEIN, HS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86141","description":"C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1636.80,"providers":[{"billed_charge":13535.14,"npi":[1740262880]}]}]}]},{"name":"CARDIOLIPIN ANTIBODY EA IG","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86147","description":"CARDIOLIPIN (PHOSPHOLIPID) ANTIBODY, EACH IG CLASS","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":311.94,"providers":[{"billed_charge":2643.07,"npi":[1740262880]}]}]}]},{"name":"CCP ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86200","description":"CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":664.64,"providers":[{"billed_charge":7338.73,"npi":[1740262880]}]}]}]},{"name":"DNA ANTIBODY NATIVE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86225","description":"DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":452.79,"providers":[{"billed_charge":4534.63,"npi":[1740262880]}]}]}]},{"name":"NUCLEAR ANTIGEN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86235","description":"EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG, NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3085.89,"providers":[{"billed_charge":40118.06,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY, TUMOR, CA 15-3","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86300","description":"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 15-3 (27.29)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":941.05,"providers":[{"billed_charge":9761.56,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY, TUMOR, CA 125","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86304","description":"IMMUNOASSAY FOR TUMOR ANTIGEN, QUANTITATIVE; CA 125","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":239.25,"providers":[{"billed_charge":2726.06,"npi":[1740262880]}]}]}]},{"name":"IMMUNOASSAY INFECTIOUS AGENT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86317","description":"IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOT OTHERWISE SPECIFIED","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":229.79,"providers":[{"billed_charge":1981.35,"npi":[1740262880]}]}]}]},{"name":"IMMUNOFIX E-PHORESIS, SERUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86334","description":"IMMUNOFIXATION ELECTROPHORESIS; SERUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":119.84,"providers":[{"billed_charge":1027.54,"npi":[1740262880]}]}]}]},{"name":"TISS TRNSGLTMNASE EA IG CLAS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86364","description":"TISSUE TRANSGLUTAMINASE EA IMMUNOGLOBULIN CLASS","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":80.21,"providers":[{"billed_charge":1568.77,"npi":[1740262880]}]}]}]},{"name":"MICROSOMAL ANTIBODY EACH","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86376","description":"MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2762.76,"providers":[{"billed_charge":31803.76,"npi":[1740262880]}]}]}]},{"name":"RHEUMATOID FACTOR, QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86431","description":"RHEUMATOID FACTOR; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":543.75,"providers":[{"billed_charge":5956.08,"npi":[1740262880]}]}]}]},{"name":"TB TEST CELL IMMUN MEASURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86480","description":"TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3609.24,"providers":[{"billed_charge":17887.09,"npi":[1740262880]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86592","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2750.07,"providers":[{"billed_charge":29337.45,"npi":[1740262880]}]}]}]},{"name":"SYPHILIS TEST NON-TREP QUANT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86593","description":"SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUANTITATIVE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":20.22,"providers":[{"billed_charge":207.70,"npi":[1740262880]}]}]}]},{"name":"COCCIDIOIDES ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86635","description":"ANTIBODY; COCCIDIOIDES","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1362.45,"providers":[{"billed_charge":17282.29,"npi":[1740262880]}]}]}]},{"name":"EPSTEIN-BARR NUCLEAR ANTIGEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86664","description":"ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":46.88,"providers":[{"billed_charge":469.35,"npi":[1740262880]}]}]}]},{"name":"EPSTEIN-BARR CAPSID VCA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86665","description":"ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":166.80,"providers":[{"billed_charge":1633.94,"npi":[1740262880]}]}]}]},{"name":"HERPES SIMPLEX TYPE 1 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86695","description":"ANTIBODY; HERPES SIMPLEX, TYPE 1","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2254.53,"providers":[{"billed_charge":20456.42,"npi":[1740262880]}]}]}]},{"name":"HERPES SIMPLEX TYPE 2 TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86696","description":"ANTIBODY; HERPES SIMPLEX, TYPE 2","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3692.67,"providers":[{"billed_charge":33278.69,"npi":[1740262880]}]}]}]},{"name":"HEP B CORE ANTIBODY, TOTAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86704","description":"HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":729.17,"providers":[{"billed_charge":7938.38,"npi":[1740262880]}]}]}]},{"name":"HEP B CORE ANTIBODY, IGM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86705","description":"HEPATITIS B CORE ANTIBODY (HBCAB); IGM ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":90.20,"providers":[{"billed_charge":1292.55,"npi":[1740262880]}]}]}]},{"name":"HEP B SURFACE ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86706","description":"HEPATITIS B SURFACE ANTIBODY (HBSAB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1053.44,"providers":[{"billed_charge":11661.55,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS A ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86708","description":"HEPATITIS A ANTIBODY (HAAB)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":494.00,"providers":[{"billed_charge":5002.34,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS A IGM ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86709","description":"HEPATITIS A ANTIBODY (HAAB), IGM ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":25.86,"providers":[{"billed_charge":343.35,"npi":[1740262880]}]}]}]},{"name":"RUBELLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86762","description":"ANTIBODY; RUBELLA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1819.93,"providers":[{"billed_charge":11166.19,"npi":[1740262880]}]}]}]},{"name":"RUBEOLA ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86765","description":"ANTIBODY; RUBEOLA","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.88,"providers":[{"billed_charge":103.63,"npi":[1740262880]}]}]}]},{"name":"TREPONEMA PALLIDUM","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86780","description":"ANTIBODY; TREPONEMA PALLIDUM","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":416.15,"providers":[{"billed_charge":3933.22,"npi":[1740262880]}]}]}]},{"name":"VARICELLA-ZOSTER ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86787","description":"ANTIBODY; VARICELLA-ZOSTER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":187.69,"providers":[{"billed_charge":2266.65,"npi":[1740262880]}]}]}]},{"name":"THYROGLOBULIN ANTIBODY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86800","description":"THYROGLOBULIN ANTIBODY","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1489.71,"providers":[{"billed_charge":17291.30,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS C AB TEST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86803","description":"HEPATITIS C ANTIBODY;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4354.12,"providers":[{"billed_charge":38653.66,"npi":[1740262880]}]}]}]},{"name":"RBC ANTIBODY SCREEN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86850","description":"ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1333.65,"providers":[{"billed_charge":11876.48,"npi":[1740262880]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC ABO","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86900","description":"BLOOD TYPING, SEROLOGIC; ABO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":563.16,"providers":[{"billed_charge":5444.41,"npi":[1740262880]}]}]}]},{"name":"BLOOD TYPING SEROLOGIC RH(D)","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"86901","description":"BLOOD TYPING, SEROLOGIC; RH (D)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":560.88,"providers":[{"billed_charge":5171.20,"npi":[1740262880]}]}]}]},{"name":"FECES CULTURE AEROBIC BACT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87045","description":"CULTURE, BACTERIAL; STOOL, AEROBIC, WITH ISOLATION AND PRELIMINARY EXAMINATION (EG, KIA, LIA), SALMO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.23,"providers":[{"billed_charge":73.86,"npi":[1740262880]}]}]}]},{"name":"STOOL CULTR AEROBIC BACT EA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87046","description":"CULTURE, BACTERIAL; STOOL, AEROBIC, ADDITIONAL PATHOGENS, ISOLATION AND PRESUMPTIVE IDENTIFICATION O","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":21.69,"providers":[{"billed_charge":221.58,"npi":[1740262880]}]}]}]},{"name":"CULTURE OTHR SPECIMN AEROBIC","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87070","description":"CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITH ISOLATION AND PRESU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":257.40,"providers":[{"billed_charge":3378.95,"npi":[1740262880]}]}]}]},{"name":"CULTR BACTERIA, EXCEPT BLOOD","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87075","description":"CULTURE, BACTERIAL; ANY SOURCE, EXCEPT BLOOD, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATIO","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":58.00,"providers":[{"billed_charge":1046.19,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":755.18,"providers":[{"billed_charge":2950.57,"npi":[1740262880]}]}]}]},{"name":"CULTURE SCREEN ONLY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87081","description":"CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY;","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":894.09,"providers":[{"billed_charge":7577.81,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5886.69,"providers":[{"billed_charge":49758.81,"npi":[1740262880]}]}]}]},{"name":"URINE BACTERIA CULTURE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87088","description":"CULTURE, BACTERIAL; WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF EACH ISOLATE, URINE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1763.64,"providers":[{"billed_charge":8198.95,"npi":[1740262880]}]}]}]},{"name":"DNA/RNA AMPLIFIED PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87150","description":"CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER C","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2581.44,"providers":[{"billed_charge":10587.34,"npi":[1740262880]}]}]}]},{"name":"OVA AND PARASITES SMEARS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87177","description":"OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION AND IDENTIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":47.74,"providers":[{"billed_charge":287.31,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1661.72,"providers":[{"billed_charge":20256.85,"npi":[1740262880]}]}]}]},{"name":"SMEAR, COMPLEX STAIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87209","description":"SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEX SPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) F","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.39,"providers":[{"billed_charge":580.22,"npi":[1740262880]}]}]}]},{"name":"HPYLORI STOOL IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87338","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HELICOBACTER PYLORI, STOOL; (EG, ENZYME","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":45.95,"providers":[{"billed_charge":1207.50,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS B SURFACE AG IA","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87340","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2680.62,"providers":[{"billed_charge":25836.26,"npi":[1740262880]}]}]}]},{"name":"HIV-1 AG W/HIV-1 & HIV-2 AB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87389","description":"INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":11056.50,"providers":[{"billed_charge":96338.26,"npi":[1740262880]}]}]}]},{"name":"CANDIDA, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87480","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CANDIDA SPECIES, DIRECT PROBE TECHNIQUE","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":491.84,"providers":[{"billed_charge":3041.65,"npi":[1740262880]}]}]}]},{"name":"CHYLMD TRACH, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87491","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33561.62,"providers":[{"billed_charge":133935.41,"npi":[1740262880]}]}]}]},{"name":"GARDNER VAG, DNA, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87510","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); GARDNERELLA VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":491.84,"providers":[{"billed_charge":3247.60,"npi":[1740262880]}]}]}]},{"name":"HEPATITIS C REVRS TRNSCRPJ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87522","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HEPATITIS C, QUANTIFICATION, INCLUDES REVER","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":820.50,"providers":[{"billed_charge":13307.17,"npi":[1740262880]}]}]}]},{"name":"HSV, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87529","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHN","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":134.45,"providers":[{"billed_charge":1568.25,"npi":[1740262880]}]}]}]},{"name":"M. GENITALIUM AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87563","description":"IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2258.76,"providers":[{"billed_charge":7424.78,"npi":[1740262880]}]}]}]},{"name":"N.GONORRHOEAE, DNA, AMP PROB","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87591","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":33561.62,"providers":[{"billed_charge":134055.35,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":23826.00,"providers":[{"billed_charge":108426.67,"npi":[1740262880]}]}]}]},{"name":"Infectious Agent Antigen Detection","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87626","description":"the detection of human papillomavirus (HPV) by nucleic acid (DNA or RNA) tests, specifically reporting separately the high-risk types (16, 18, 31, 45, 51, and 52) and any high-risk pooled results.","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":826.32,"providers":[{"billed_charge":5087.70,"npi":[1740262880]}]}]}]},{"name":"TRICHOMONAS VAGIN, DIR PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87660","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); TRICHOMONAS VAGINALIS, DIRECT PROBE TECHNIQ","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":891.46,"providers":[{"billed_charge":5851.95,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":8146.18,"providers":[{"billed_charge":46022.99,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1156.37,"providers":[{"billed_charge":4541.42,"npi":[1740262880]}]}]}]},{"name":"DETECT AGNT MULT, DNA, AMPLI","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87801","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECH","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":14254.35,"providers":[{"billed_charge":49064.44,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2030.00,"providers":[{"billed_charge":8539.52,"npi":[1740262880]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4524.26,"providers":[{"billed_charge":15073.60,"npi":[1740262880]}]}]},{"tin":{"type":"ein","value":"860564320"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":139.86,"providers":[{"billed_charge":375.00,"npi":[1205290996]}]}]},{"tin":{"type":"ein","value":"208893571"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2131.77,"providers":[{"billed_charge":7200.00,"npi":[1497956569]}]}]}]},{"name":"PSYCH DIAG EVAL W/MED SRVCS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90792","description":"PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES","allowed_amounts":[{"tin":{"type":"ein","value":"822076807"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5188.47,"providers":[{"billed_charge":31000.00,"npi":[1922112572]}]}]}]},{"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":"822076807"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9020.16,"providers":[{"billed_charge":115200.00,"npi":[1922112572]}]}]}]},{"name":"PSYTX W PT W E/M 30 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90833","description":"PSYCHOTHERAPY, 30 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"462629779"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":55.12,"providers":[{"billed_charge":125.00,"npi":[1669884847]}]}]}]},{"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":"201020949"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":1093.68,"providers":[{"billed_charge":2800.00,"npi":[1265841027]}]},{"allowed_amount":156.24,"providers":[{"billed_charge":400.00,"npi":[1265841027]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":703.08,"providers":[{"billed_charge":1800.00,"npi":[1234567893]}]},{"allowed_amount":156.24,"providers":[{"billed_charge":400.00,"npi":[1234567893]}]}]}]},{"name":"PSYTX W PT 60 MINUTES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90837","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT","allowed_amounts":[{"tin":{"type":"ein","value":"824104161"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":628.43,"providers":[{"billed_charge":1050.00,"npi":[1033618103]}]},{"allowed_amount":516.60,"providers":[{"billed_charge":875.00,"npi":[1033618103]}]}]},{"tin":{"type":"ein","value":"833023625"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1697.19,"providers":[{"billed_charge":3861.00,"npi":[1073028635]}]},{"allowed_amount":3085.80,"providers":[{"billed_charge":7020.00,"npi":[1376852327]}]},{"allowed_amount":154.29,"providers":[{"billed_charge":351.00,"npi":[1881466175]}]}]},{"tin":{"type":"ein","value":"990632329"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":800.52,"providers":[{"billed_charge":840.00,"npi":[1174221741]}]}]},{"tin":{"type":"ein","value":"830540117"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":516.60,"providers":[{"billed_charge":1325.00,"npi":[1720856859]}]},{"allowed_amount":826.56,"providers":[{"billed_charge":2120.00,"npi":[1720856859]}]}]},{"tin":{"type":"ein","value":"571203051"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":1239.75,"providers":[{"billed_charge":1980.00,"npi":[1023726866]}]},{"allowed_amount":3581.50,"providers":[{"billed_charge":5720.00,"npi":[1023726866]}]}]}]},{"name":"PSYTX W PT W E/M 60 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90838","description":"PSYCHOTHERAPY, 60 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"61040288"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":3450.00,"providers":[{"billed_charge":3450.00,"npi":[1952430647]}]}]}]},{"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":"271239632"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2108.80,"providers":[{"billed_charge":4000.00,"npi":[1164744736]}]}]}]},{"name":"OTHER DX SVS","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"920","description":"OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"860422559"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":466.20,"providers":[{"billed_charge":777.00,"npi":[1760480503]}]}]}]},{"name":"SPECIAL EYE EVALUATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92060","description":"SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR PARETIC ","allowed_amounts":[{"tin":{"type":"ein","value":"753032761"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":120.22,"providers":[{"billed_charge":140.00,"npi":[1275912347]}]}]}]},{"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":"471587223"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3744.18,"providers":[{"billed_charge":13340.00,"npi":[1154748416]}]}]},{"tin":{"type":"ein","value":"721561132"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":2976.48,"providers":[{"billed_charge":13807.00,"npi":[1700910189]}]},{"allowed_amount":1273.56,"providers":[{"billed_charge":5290.00,"npi":[1700910189]}]}]},{"tin":{"type":"ein","value":"721561134"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":1526.58,"providers":[{"billed_charge":30441.00,"npi":[1982733655]}]},{"allowed_amount":11247.40,"providers":[{"billed_charge":39474.00,"npi":[1982733655]}]}]}]},{"name":"EYE PHOTOGRAPHY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92285","description":"EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG","allowed_amounts":[{"tin":{"type":"ein","value":"753032761"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":45.00,"providers":[{"billed_charge":45.00,"npi":[1275912347]}]}]}]},{"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":"201015104"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":177.84,"providers":[{"billed_charge":672.00,"npi":[1780163055]}]}]}]},{"name":"ELECTROCARDIOGRAM, COMPLETE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"93000","description":"ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.58,"providers":[{"billed_charge":35.13,"npi":[1033166012]}]}]}]},{"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":"201291415"},"service_code":["11","22","19","21"],"billing_class":"professional","payments":[{"allowed_amount":495.00,"providers":[{"billed_charge":825.00,"npi":[1568480093]}]},{"allowed_amount":19.80,"providers":[{"billed_charge":33.00,"npi":[1568480093]}]},{"allowed_amount":39.60,"providers":[{"billed_charge":66.00,"npi":[1568480093]}]},{"allowed_amount":295.20,"providers":[{"billed_charge":492.00,"npi":[1568480093]}]}]},{"tin":{"type":"ein","value":"860137567"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":6.52,"providers":[{"billed_charge":50.00,"npi":[1851622112]}]}]}]},{"name":"IMMUNOTHERAPY, ONE INJECTION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95115","description":"PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SIN","allowed_amounts":[{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":11.06,"providers":[{"billed_charge":32.84,"npi":[1407016348]}]}]}]},{"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":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1842.78,"providers":[{"billed_charge":5251.68,"npi":[1407016348]}]},{"allowed_amount":767.74,"providers":[{"billed_charge":2188.20,"npi":[1851382550]}]}]}]},{"name":"ANTIGEN THERAPY SERVICES","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"95165","description":"PROF SERVICES FOR THE SPRVSN OF PREPARATION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHAPY; SING","allowed_amounts":[{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3283.94,"providers":[{"billed_charge":7247.60,"npi":[1851382550]}]},{"allowed_amount":1791.24,"providers":[{"billed_charge":3936.10,"npi":[1407016348]}]}]}]},{"name":"PT-FOCUSED HLTH RISK ASSMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"96160","description":"ADMINISTRATION OF PATIENT-FOCUSED HEALTH RISK ASSESSMENT INSTRUMENT (EG, HEALTH HAZARD APPRAISAL) WI","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":31.38,"providers":[{"billed_charge":85.54,"npi":[1033166012]}]},{"allowed_amount":12.07,"providers":[{"billed_charge":32.90,"npi":[1073578159]}]},{"allowed_amount":4.83,"providers":[{"billed_charge":13.16,"npi":[1073578159]}]},{"allowed_amount":9.66,"providers":[{"billed_charge":26.32,"npi":[1033166012]}]}]}]},{"name":"ULTRASOUND THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97035","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ULTRASOUND, EACH 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"204761143"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":48.60,"providers":[{"billed_charge":100.00,"npi":[1972556421]}]}]},{"tin":{"type":"ein","value":"822296616"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":213.84,"providers":[{"billed_charge":330.00,"npi":[1710234224]}]}]}]},{"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":"204761143"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":262.03,"providers":[{"billed_charge":455.00,"npi":[1972556421]}]}]},{"tin":{"type":"ein","value":"205881475"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":204.39,"providers":[{"billed_charge":711.00,"npi":[1225714702]}]},{"allowed_amount":454.21,"providers":[{"billed_charge":1580.00,"npi":[1831931583]}]}]},{"tin":{"type":"ein","value":"201291415"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":840.00,"providers":[{"billed_charge":1400.00,"npi":[1184176109]}]}]},{"tin":{"type":"ein","value":"843032154"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":201.58,"providers":[{"billed_charge":607.20,"npi":[1871979195]}]}]},{"tin":{"type":"ein","value":"822296616"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1330.34,"providers":[{"billed_charge":2640.00,"npi":[1710234224]}]}]}]},{"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":"204761143"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":247.36,"providers":[{"billed_charge":520.00,"npi":[1972556421]}]}]},{"tin":{"type":"ein","value":"843032154"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":152.24,"providers":[{"billed_charge":446.56,"npi":[1871979195]}]}]},{"tin":{"type":"ein","value":"822296616"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1255.76,"providers":[{"billed_charge":2310.00,"npi":[1710234224]}]}]}]},{"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":"271402749"},"service_code":["11","12"],"billing_class":"professional","payments":[{"allowed_amount":4388.40,"providers":[{"billed_charge":9200.00,"npi":[1346827805]}]},{"allowed_amount":27260.55,"providers":[{"billed_charge":57150.00,"npi":[1477446680]}]},{"allowed_amount":31601.25,"providers":[{"billed_charge":66250.00,"npi":[1427845569]}]},{"allowed_amount":20391.75,"providers":[{"billed_charge":43400.00,"npi":[1497554901]}]},{"allowed_amount":333.90,"providers":[{"billed_charge":700.00,"npi":[1477446680]}]}]}]},{"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":"205881475"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":217.99,"providers":[{"billed_charge":800.00,"npi":[1831931583]}]},{"allowed_amount":245.25,"providers":[{"billed_charge":900.00,"npi":[1225714702]}]}]},{"tin":{"type":"ein","value":"843032154"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":120.92,"providers":[{"billed_charge":394.30,"npi":[1871979195]}]}]}]},{"name":"Under Established Patient","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98006","description":"Under Established Patient","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1330.88,"providers":[{"billed_charge":5293.28,"npi":[1033166012]}]},{"allowed_amount":1918.20,"providers":[{"billed_charge":7609.09,"npi":[1073578159]}]}]}]},{"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":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":76.10,"providers":[{"billed_charge":80.99,"npi":[1124405915]}]}]}]},{"name":"Under Remote Therapeutic Monitoring Services","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98978","description":"Under Remote Therapeutic Monitoring Services","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":711.30,"providers":[{"billed_charge":2371.03,"npi":[1124405915]}]}]}]},{"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","22"],"billing_class":"professional","payments":[{"allowed_amount":1766.60,"providers":[{"billed_charge":1959.40,"npi":[1124405915]}]},{"allowed_amount":23.92,"providers":[{"billed_charge":40.15,"npi":[1124405915]}]}]}]},{"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"],"billing_class":"professional","payments":[{"allowed_amount":1827.00,"providers":[{"billed_charge":2009.27,"npi":[1124405915]}]}]}]},{"name":"MED SERV EVE/WKEND/HOLIDAY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99051","description":"SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOU","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":17.00,"providers":[{"billed_charge":120.00,"npi":[1073578159]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99211","description":"OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT M","allowed_amounts":[{"tin":{"type":"ein","value":"237086112"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8250.96,"providers":[{"billed_charge":12582.90,"npi":[1477016921]}]}]}]},{"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":"812124295"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":69.91,"providers":[{"billed_charge":200.00,"npi":[1932557675]}]},{"allowed_amount":1048.65,"providers":[{"billed_charge":3000.00,"npi":[1932557675]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":875.65,"providers":[{"billed_charge":2184.00,"npi":[1234567893]}]},{"allowed_amount":51.29,"providers":[{"billed_charge":135.00,"npi":[1234567893]}]},{"allowed_amount":533.70,"providers":[{"billed_charge":1092.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"61040288"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":4800.00,"providers":[{"billed_charge":4800.00,"npi":[1952430647]}]}]}]},{"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":"203134104"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":2823.39,"providers":[{"billed_charge":8523.90,"npi":[1073578159]}]},{"allowed_amount":209.14,"providers":[{"billed_charge":631.40,"npi":[1033166012]}]},{"allowed_amount":731.99,"providers":[{"billed_charge":2209.90,"npi":[1073578159]}]}]},{"tin":{"type":"ein","value":"462629779"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":188.22,"providers":[{"billed_charge":400.00,"npi":[1669884847]}]},{"allowed_amount":94.11,"providers":[{"billed_charge":200.00,"npi":[1669884847]}]}]},{"tin":{"type":"ein","value":"262566417"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":516.66,"providers":[{"billed_charge":900.00,"npi":[1609638311]}]},{"allowed_amount":86.11,"providers":[{"billed_charge":150.00,"npi":[1609638311]}]}]},{"tin":{"type":"ein","value":"473723202"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":172.22,"providers":[{"billed_charge":370.00,"npi":[1407548845]}]}]},{"tin":{"type":"ein","value":"873164803"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":405.96,"providers":[{"billed_charge":766.58,"npi":[1407016348]}]}]},{"tin":{"type":"ein","value":"753032761"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":123.02,"providers":[{"billed_charge":145.00,"npi":[1275912347]}]}]},{"tin":{"type":"ein","value":"200589060"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":350.61,"providers":[{"billed_charge":600.00,"npi":[1659379378]}]}]},{"tin":{"type":"ein","value":"823913679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":313.71,"providers":[{"billed_charge":973.44,"npi":[1932467727]}]}]},{"tin":{"type":"ein","value":"812124295"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2362.08,"providers":[{"billed_charge":6000.00,"npi":[1932557675]}]}]},{"tin":{"type":"ein","value":"454995568"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":8888.45,"providers":[{"billed_charge":14875.00,"npi":[1891971628]}]},{"allowed_amount":4705.65,"providers":[{"billed_charge":7875.00,"npi":[1891971628]}]}]},{"tin":{"type":"ein","value":"270630232"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1660.86,"providers":[{"billed_charge":2916.00,"npi":[1003395484]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT EST","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99215","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH RE","allowed_amounts":[{"tin":{"type":"ein","value":"203134104"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":733.95,"providers":[{"billed_charge":2227.00,"npi":[1033166012]}]}]},{"tin":{"type":"ein","value":"823913679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":440.37,"providers":[{"billed_charge":1304.46,"npi":[1932467727]}]}]}]},{"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":"471036151"},"service_code":["61"],"billing_class":"professional","payments":[{"allowed_amount":579.23,"providers":[{"billed_charge":760.00,"npi":[1487632659]}]}]},{"tin":{"type":"ein","value":"208106540"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":225.63,"providers":[{"billed_charge":621.00,"npi":[1013538636]}]}]}]},{"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":"920800921"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":85.90,"providers":[{"billed_charge":340.00,"npi":[1245053008]}]}]},{"tin":{"type":"ein","value":"363966745"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":110.95,"providers":[{"billed_charge":200.00,"npi":[1700141637]}]}]},{"tin":{"type":"ein","value":"824555574"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":852.00,"providers":[{"billed_charge":1420.00,"npi":[1760456032]}]}]}]},{"name":"EMERGENCY DEPT VISIT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99283","description":"EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KE","allowed_amounts":[{"tin":{"type":"ein","value":"352574944"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1310.66,"providers":[{"billed_charge":32224.00,"npi":[1366563249]}]}]}]},{"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":"461813341"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":869.44,"providers":[{"billed_charge":2546.00,"npi":[1144547738]}]},{"allowed_amount":2176.64,"providers":[{"billed_charge":6365.00,"npi":[1275761900]}]}]}]},{"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":"461813341"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":1267.83,"providers":[{"billed_charge":3798.00,"npi":[1336728575,1356091904]}]},{"allowed_amount":7633.59,"providers":[{"billed_charge":22788.00,"npi":[1275761900]}]},{"allowed_amount":638.35,"providers":[{"billed_charge":1213.00,"npi":[1982360921]}]}]},{"tin":{"type":"ein","value":"352574944"},"service_code":["23"],"billing_class":"professional","payments":[{"allowed_amount":747.81,"providers":[{"billed_charge":10566.00,"npi":[1366563249]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99308","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"473099351"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":781.82,"providers":[{"billed_charge":1786.98,"npi":[1689301293]}]}]},{"tin":{"type":"ein","value":"471098491"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":3639.17,"providers":[{"billed_charge":6065.40,"npi":[1467560565]}]}]},{"tin":{"type":"ein","value":"860831961"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1563.66,"providers":[{"billed_charge":2405.50,"npi":[1982637849]}]}]}]},{"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":"472188010"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":21084.30,"providers":[{"billed_charge":35140.50,"npi":[1740420041]}]}]},{"tin":{"type":"ein","value":"860975566"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":2830.50,"providers":[{"billed_charge":3774.00,"npi":[1992866651]}]}]},{"tin":{"type":"ein","value":"473350388"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":3972.09,"providers":[{"billed_charge":7030.00,"npi":[1659771186]}]}]},{"tin":{"type":"ein","value":"471554329"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":359.10,"providers":[{"billed_charge":890.00,"npi":[1720688443]}]}]},{"tin":{"type":"ein","value":"810764980"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":148.79,"providers":[{"billed_charge":248.00,"npi":[1235433426]}]}]},{"tin":{"type":"ein","value":"843902969"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":1622.72,"providers":[{"billed_charge":3245.28,"npi":[1679235808]}]}]},{"tin":{"type":"ein","value":"842787515"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":104.50,"providers":[{"billed_charge":209.00,"npi":[1083458756]}]}]}]},{"name":"NURSING FAC CARE SUBSEQ","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99310","description":"SUBSEQUENT NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQ","allowed_amounts":[{"tin":{"type":"ein","value":"843902969"},"service_code":["31"],"billing_class":"professional","payments":[{"allowed_amount":722.60,"providers":[{"billed_charge":1445.20,"npi":[1679235808]}]}]}]},{"name":"PROLNG OFF/OP E/M EA 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99417","description":"PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN","allowed_amounts":[{"tin":{"type":"ein","value":"823913679"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":374.22,"providers":[{"billed_charge":1448.10,"npi":[1932467727]}]}]}]},{"name":"1ST PSYC COLLAB CARE MGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99492","description":"INITIAL PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 70 MINUTES IN THE FIRST CALENDAR MONTH OF B","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3139.83,"providers":[{"billed_charge":3428.73,"npi":[1124405915]}]}]}]},{"name":"SBSQ PSYC COLLAB CARE MGMT","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99493","description":"SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, FIRST 60 MINUTES IN A SUBSEQUENT MONTH OF BEHA","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5793.66,"providers":[{"billed_charge":6243.21,"npi":[1124405915]}]}]}]},{"name":"1ST/SBSQ PSYC COLLAB CARE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99494","description":"INITIAL OR SUBSEQUENT PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT, EACH ADDITIONAL 30 MINUTES IN A CAL","allowed_amounts":[{"tin":{"type":"ein","value":"923862746"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":14442.39,"providers":[{"billed_charge":15644.24,"npi":[1124405915]}]}]}]},{"name":"BLS ROUTINE DISPOSABLE SUPPL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0382","description":"BLS ROUTINE DISPOSABLE SUPPLIES","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":835.99,"providers":[{"billed_charge":835.99,"npi":[1851781314]}]}]}]},{"name":"ALS ROUTNE DISPSABLE SUPPLS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0398","description":"ALS ROUTINE DISPOSABLE SUPPLIES","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1762.33,"providers":[{"billed_charge":1762.33,"npi":[1851781314]}]}]}]},{"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":"860110232"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":79.91,"providers":[{"billed_charge":84.12,"npi":[1518143205]}]}]},{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":32800.85,"providers":[{"billed_charge":33741.69,"npi":[1851781314]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":194.04,"providers":[{"billed_charge":588.84,"npi":[1234567893]}]}]}]},{"name":"AMB SVC ALS NON ER TRSPRT L1","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"A0426","description":"AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)","allowed_amounts":[{"tin":{"type":"ein","value":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":7096.18,"providers":[{"billed_charge":9621.92,"npi":[1851781314]}]}]}]},{"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":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":31271.24,"providers":[{"billed_charge":31271.24,"npi":[1851781314]}]}]}]},{"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":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":86780.97,"providers":[{"billed_charge":86780.97,"npi":[1851781314]}]}]}]},{"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":"300824958"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":12856.44,"providers":[{"billed_charge":12856.44,"npi":[1851781314]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3677.49,"providers":[{"billed_charge":30647.36,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG THIN LAY W/PHYS","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0123","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":574.61,"providers":[{"billed_charge":2464.50,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG THIN LAY PHYS I","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0124","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":872.61,"providers":[{"billed_charge":4572.35,"npi":[1740262880]}]}]}]},{"name":"SCR CERV/VAG AUTO&MNL RSCR P","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0145","description":"SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY RPTNG SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AU","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":19609.41,"providers":[{"billed_charge":90707.97,"npi":[1740262880]}]}]}]},{"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":"200382536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":375.66,"providers":[{"billed_charge":2196.00,"npi":[1154558039]}]}]}]},{"name":"E-STIM 1/>NOT WND CARE PART","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0283","description":"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, A","allowed_amounts":[{"tin":{"type":"ein","value":"204761143"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":42.90,"providers":[{"billed_charge":100.00,"npi":[1972556421]}]}]},{"tin":{"type":"ein","value":"822296616"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":145.86,"providers":[{"billed_charge":340.00,"npi":[1710234224]}]}]}]},{"name":"COLOREC CA SCR; FOB TST IMMU","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0328","description":"COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS DETERMINATIONS","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":354.20,"providers":[{"billed_charge":3476.50,"npi":[1740262880]}]}]}]},{"name":"HEP C ABO SC IND HI RSK&OTH","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0472","description":"HEPATITIS C ANTIBODY SCREENING FOR INDIVIDUAL AT HIGH RISK AND OTHER COVERED INDICATION(S)","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":942.40,"providers":[{"billed_charge":5014.45,"npi":[1740262880]}]}]}]},{"name":"HIV ANTIGEN/ANTIBODY, COMBIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0475","description":"HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING","allowed_amounts":[{"tin":{"type":"ein","value":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":895.05,"providers":[{"billed_charge":8700.10,"npi":[1740262880]}]}]}]},{"name":"DR TST DEFIN DR ID M P D 1-7","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G0480","description":"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG","allowed_amounts":[{"tin":{"type":"ein","value":"201236503"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":4787.16,"providers":[{"billed_charge":14418.18,"npi":[1225110497]}]}]}]},{"name":"MED ASST TX METHADONE;WEEKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2067","description":"MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"201264723"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":768.70,"providers":[{"billed_charge":3074.90,"npi":[1942704671]}]}]}]},{"name":"MAT BUPRENORPHINE ORAL; WKLY","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2068","description":"MED ASST TX BUPRENORPHINE ORAL; WEEKLY BUNDLE","allowed_amounts":[{"tin":{"type":"ein","value":"201264723"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":627.34,"providers":[{"billed_charge":2509.29,"npi":[1942704671]}]}]}]},{"name":"VISIT CPLX INHERENT E&M ASSO","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"G2211","description":"VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC","allowed_amounts":[{"tin":{"type":"ein","value":"900730397"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":85.84,"providers":[{"billed_charge":188.00,"npi":[1003098070]}]}]}]},{"name":"BEHAVIORAL HEALTH CNSL&TX-15","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0004","description":"BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"460624198"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1598.76,"providers":[{"billed_charge":2400.00,"npi":[1205638368]}]},{"allowed_amount":1199.07,"providers":[{"billed_charge":1800.00,"npi":[1780497677]}]},{"allowed_amount":399.69,"providers":[{"billed_charge":600.00,"npi":[1245110683]}]},{"allowed_amount":266.46,"providers":[{"billed_charge":400.00,"npi":[1780497677]}]},{"allowed_amount":932.61,"providers":[{"billed_charge":1400.00,"npi":[1205638368]}]}]}]},{"name":"ALCOHL&/RX SRVC;METHDONE ADM","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0020","description":"ALCOHOL AND/OR DRUG SERVICES; METHADONE ADMINISTRATION AND/OR SERVICE (PROVISION OF THE DRUG BY A LI","allowed_amounts":[{"tin":{"type":"ein","value":"860606635"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":20.28,"providers":[{"billed_charge":40.80,"npi":[1821431560]}]}]}]},{"name":"ORAL MEDADMIN DIR OBSERV","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0033","description":"ORAL MEDICATION ADMINISTRATION, DIRECT OBSERVATION","allowed_amounts":[{"tin":{"type":"ein","value":"237086112"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2713.52,"providers":[{"billed_charge":10854.18,"npi":[1477016921]}]}]}]},{"name":"COMP MDICTION SVC PER 15 MIN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H2010","description":"COMPREHENSIVE MEDICATION SERVICES, PER 15 MINUTES","allowed_amounts":[{"tin":{"type":"ein","value":"860606635"},"service_code":["53"],"billing_class":"professional","payments":[{"allowed_amount":257.25,"providers":[{"billed_charge":328.44,"npi":[1821431560]}]}]}]},{"name":"NONEMERG TRANSP MLG PER MILE","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S0215","description":"NONEMERGENCY TRANSPORTATION; MILEAGE, PER MILE","allowed_amounts":[{"tin":{"type":"ein","value":"942880847"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":550.62,"providers":[{"billed_charge":2202.48,"npi":[1891288049]}]}]}]},{"name":"CRISIS INTERVEN MENTL HLTH S","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9484","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER HOUR","allowed_amounts":[{"tin":{"type":"ein","value":"942880847"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":2061.82,"providers":[{"billed_charge":8247.21,"npi":[1891288049]}]}]}]},{"name":"CRISIS INTRVNT MNTL HLTH SVC","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"S9485","description":"CRISIS INTERVENTION MENTAL HEALTH SERVICES, PER DIEM","allowed_amounts":[{"tin":{"type":"ein","value":"364872543"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":7008.43,"providers":[{"billed_charge":28033.46,"npi":[1982362943]}]}]},{"tin":{"type":"ein","value":"942880847"},"service_code":["99"],"billing_class":"professional","payments":[{"allowed_amount":3000.00,"providers":[{"billed_charge":12000.00,"npi":[1285127043]}]},{"allowed_amount":52500.00,"providers":[{"billed_charge":210000.00,"npi":[1891288049]}]}]}]}]}