{"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":"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":"831898339"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":1200.00,"providers":[{"billed_charge":4500.00,"npi":[1649813858]}]}]}]},{"name":"ROOM-BOARD/SEMI","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"120","description":"ROOM AND BOARD - SEMI PRIVATE TWO BED -GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"911631806"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":246197.19,"providers":[{"billed_charge":136076.41,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["21"],"billing_class":"institutional","payments":[{"allowed_amount":315132.58,"providers":[{"billed_charge":73467.79,"npi":[1326002049]}]}]}]},{"name":"PHARMACY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"250","description":"PHARMACY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":397.26,"providers":[{"billed_charge":567.50,"npi":[1467536276]}]},{"allowed_amount":970.72,"providers":[{"billed_charge":1386.70,"npi":[1467536276]}]},{"allowed_amount":64.09,"providers":[{"billed_charge":91.55,"npi":[1467536276]}]},{"allowed_amount":7340.06,"providers":[{"billed_charge":10485.80,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":311.28,"providers":[{"billed_charge":777.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":485.96,"providers":[{"billed_charge":1154.00,"npi":[1366556227]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3.66,"providers":[{"billed_charge":151.73,"npi":[1073566246]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5.74,"providers":[{"billed_charge":2402.62,"npi":[1700809829]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":711.60,"providers":[{"billed_charge":5786.46,"npi":[1326002049]}]}]}]},{"name":"DRUGS/OTHER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"259","description":"PHARMACY - OTHER PHARMACY","allowed_amounts":[{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":9.80,"providers":[{"billed_charge":14.00,"npi":[1467536276]}]},{"allowed_amount":0.70,"providers":[{"billed_charge":1.00,"npi":[1467536276]}]},{"allowed_amount":6.30,"providers":[{"billed_charge":9.00,"npi":[1467536276]}]},{"allowed_amount":9.10,"providers":[{"billed_charge":13.00,"npi":[1467536276]}]}]}]},{"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":"910564748"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":6077.61,"providers":[{"billed_charge":8682.30,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8953.78,"providers":[{"billed_charge":19898.00,"npi":[1972507580]}]},{"allowed_amount":273.17,"providers":[{"billed_charge":5644.00,"npi":[1972507580]}]}]}]},{"name":"MED-SUR SUPPLIES","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"270","description":"MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"953372911"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":1902.95,"providers":[{"billed_charge":7611.30,"npi":[1225265606]}]}]}]},{"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":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2022.48,"providers":[{"billed_charge":89873.49,"npi":[1972507580]}]}]}]},{"name":"LABORATORY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"300","description":"LABORATORY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"910564748"},"service_code":["22","20"],"billing_class":"institutional","payments":[{"allowed_amount":1969.80,"providers":[{"billed_charge":2814.00,"npi":[1467536276]}]},{"allowed_amount":33.60,"providers":[{"billed_charge":48.00,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":98.56,"providers":[{"billed_charge":1296.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":83.08,"providers":[{"billed_charge":169.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":5657.18,"providers":[{"billed_charge":38269.50,"npi":[1073566246]}]},{"allowed_amount":2333.21,"providers":[{"billed_charge":39344.00,"npi":[1053357244]}]},{"allowed_amount":21.42,"providers":[{"billed_charge":479.00,"npi":[1053357244]}]}]},{"tin":{"type":"ein","value":"364851166"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":15.00,"providers":[{"billed_charge":45.97,"npi":[1225090954]}]},{"allowed_amount":542.54,"providers":[{"billed_charge":2110.10,"npi":[1225090954]}]}]},{"tin":{"type":"ein","value":"910729255"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":821.27,"providers":[{"billed_charge":11075.00,"npi":[1710913140]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":342.10,"providers":[{"billed_charge":514.80,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"866007596"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":572.92,"providers":[{"billed_charge":729.00,"npi":[1194706655]}]}]},{"tin":{"type":"ein","value":"930583856"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1292.84,"providers":[{"billed_charge":2347.00,"npi":[1134146939]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3669.52,"providers":[{"billed_charge":76510.54,"npi":[1649209230]}]}]}]},{"name":"LAB/CHEMISTRY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"301","description":"LABORATORY - CHEMISTRY","allowed_amounts":[{"tin":{"type":"ein","value":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":252.83,"providers":[{"billed_charge":34714.76,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"916018764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":43.06,"providers":[{"billed_charge":10863.00,"npi":[1013074061]}]}]},{"tin":{"type":"ein","value":"911935159"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":4467.21,"providers":[{"billed_charge":6872.50,"npi":[1164493847]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":437.43,"providers":[{"billed_charge":624.90,"npi":[1467536276]}]},{"allowed_amount":18724.65,"providers":[{"billed_charge":26749.50,"npi":[1467536276]}]},{"allowed_amount":18171.86,"providers":[{"billed_charge":25948.60,"npi":[1467536276]}]},{"allowed_amount":7384.86,"providers":[{"billed_charge":10549.80,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":339.53,"providers":[{"billed_charge":6924.00,"npi":[1326564071]}]},{"allowed_amount":173.18,"providers":[{"billed_charge":31749.00,"npi":[1841231461]}]},{"allowed_amount":172.60,"providers":[{"billed_charge":376.00,"npi":[1366556227]}]},{"allowed_amount":608.58,"providers":[{"billed_charge":16680.00,"npi":[1356528269]}]},{"allowed_amount":34.88,"providers":[{"billed_charge":16637.00,"npi":[1841258639]}]},{"allowed_amount":584.07,"providers":[{"billed_charge":8057.00,"npi":[1366556227]}]},{"allowed_amount":420.00,"providers":[{"billed_charge":1578.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":553.60,"providers":[{"billed_charge":29519.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":99.08,"providers":[{"billed_charge":49940.45,"npi":[1972507580]}]},{"allowed_amount":239.66,"providers":[{"billed_charge":5893.95,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911158307"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1594.42,"providers":[{"billed_charge":3009.00,"npi":[1740211028]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29.70,"providers":[{"billed_charge":25621.52,"npi":[1700809829]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":210.01,"providers":[{"billed_charge":58528.34,"npi":[1326002049]}]},{"allowed_amount":216.22,"providers":[{"billed_charge":2680.66,"npi":[1326002049]}]}]}]},{"name":"LAB/IMMUNOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"302","description":"LABORATORY - IMMUNOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":126.68,"providers":[{"billed_charge":2816.65,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":2302.23,"providers":[{"billed_charge":3288.90,"npi":[1467536276]}]},{"allowed_amount":710.99,"providers":[{"billed_charge":1015.70,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2373.48,"providers":[{"billed_charge":7655.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":285.26,"providers":[{"billed_charge":2507.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":29.36,"providers":[{"billed_charge":3324.59,"npi":[1326002049]}]}]}]},{"name":"LAB/HEMATOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"305","description":"LABORATORY - HEMATOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":71.89,"providers":[{"billed_charge":10767.67,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"916018764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.26,"providers":[{"billed_charge":779.00,"npi":[1013074061]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":4068.75,"providers":[{"billed_charge":5812.50,"npi":[1467536276]}]},{"allowed_amount":1341.20,"providers":[{"billed_charge":1916.00,"npi":[1467536276]}]},{"allowed_amount":1514.24,"providers":[{"billed_charge":2163.20,"npi":[1467536276]}]},{"allowed_amount":79.80,"providers":[{"billed_charge":114.00,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":74.99,"providers":[{"billed_charge":7008.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":26.26,"providers":[{"billed_charge":5352.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":12.94,"providers":[{"billed_charge":321.00,"npi":[1841231461]}]},{"allowed_amount":15.54,"providers":[{"billed_charge":36.00,"npi":[1366556227]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":25.58,"providers":[{"billed_charge":11740.90,"npi":[1326002049]}]},{"allowed_amount":31.72,"providers":[{"billed_charge":360.62,"npi":[1326002049]}]}]}]},{"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":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2890.55,"providers":[{"billed_charge":16473.53,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":2410.66,"providers":[{"billed_charge":3443.80,"npi":[1467536276]}]},{"allowed_amount":929.11,"providers":[{"billed_charge":1327.30,"npi":[1467536276]}]},{"allowed_amount":947.17,"providers":[{"billed_charge":1353.10,"npi":[1467536276]}]},{"allowed_amount":2622.76,"providers":[{"billed_charge":3746.80,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":569.34,"providers":[{"billed_charge":1366.00,"npi":[1538345251]},{"billed_charge":3101.00,"npi":[1326564071]}]},{"allowed_amount":7905.49,"providers":[{"billed_charge":19426.00,"npi":[1841231461]}]},{"allowed_amount":13.26,"providers":[{"billed_charge":30.00,"npi":[1366556227]}]},{"allowed_amount":1138.68,"providers":[{"billed_charge":2467.00,"npi":[1366556227]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":284.67,"providers":[{"billed_charge":936.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":102.41,"providers":[{"billed_charge":596.48,"npi":[1700809829]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3919.16,"providers":[{"billed_charge":7850.27,"npi":[1326002049]}]}]}]},{"name":"LAB/UROLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"307","description":"LABORATORY - UROLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"911158307"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":81.29,"providers":[{"billed_charge":108.00,"npi":[1740211028]}]}]}]},{"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":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2648.60,"providers":[{"billed_charge":28205.74,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20","21"],"billing_class":"institutional","payments":[{"allowed_amount":12554.92,"providers":[{"billed_charge":17935.60,"npi":[1467536276]}]},{"allowed_amount":5462.66,"providers":[{"billed_charge":7803.80,"npi":[1467536276]}]},{"allowed_amount":1805.44,"providers":[{"billed_charge":2579.20,"npi":[1467536276]}]},{"allowed_amount":754.60,"providers":[{"billed_charge":1078.00,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":844.20,"providers":[{"billed_charge":4806.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9038.06,"providers":[{"billed_charge":98614.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1703.05,"providers":[{"billed_charge":5464.00,"npi":[1073566246]}]},{"allowed_amount":382.96,"providers":[{"billed_charge":1216.00,"npi":[1053357244]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":157.47,"providers":[{"billed_charge":659.29,"npi":[1326002049]}]},{"allowed_amount":5540.34,"providers":[{"billed_charge":28856.67,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5071.72,"providers":[{"billed_charge":13877.00,"npi":[1649209230]}]}]}]},{"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":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3220.77,"providers":[{"billed_charge":13365.00,"npi":[1972507580]}]},{"allowed_amount":2085.48,"providers":[{"billed_charge":10260.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":4167.28,"providers":[{"billed_charge":12504.00,"npi":[1841231461]}]},{"allowed_amount":192.74,"providers":[{"billed_charge":521.00,"npi":[1326564071]}]},{"allowed_amount":199.60,"providers":[{"billed_charge":417.00,"npi":[1841231461]}]}]}]},{"name":"CHEMOTHER/INJ","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"331","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--INJECTED","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":140.47,"providers":[{"billed_charge":345.00,"npi":[1972507580]}]},{"allowed_amount":2371.22,"providers":[{"billed_charge":4712.00,"npi":[1972507580]}]}]}]},{"name":"RADIATION RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"333","description":"RADIOLOGY--THERAPEUTIC - RADIATION THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"911935159"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":49404.15,"providers":[{"billed_charge":178403.00,"npi":[1164493847]}]}]}]},{"name":"CHEMOTHERP-IV","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"335","description":"RADIOLOGY--THERAPEUTIC - CHEMOTHERAPY--IV","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3170.83,"providers":[{"billed_charge":4736.00,"npi":[1972507580]}]},{"allowed_amount":795.11,"providers":[{"billed_charge":1458.00,"npi":[1972507580]}]}]}]},{"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":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":8530.62,"providers":[{"billed_charge":97043.78,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":8132.84,"providers":[{"billed_charge":60956.00,"npi":[1972507580]}]},{"allowed_amount":14083.02,"providers":[{"billed_charge":114587.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":719.59,"providers":[{"billed_charge":15474.50,"npi":[1053357244]}]},{"allowed_amount":2734.83,"providers":[{"billed_charge":22632.00,"npi":[1073566246]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":22903.40,"providers":[{"billed_charge":109487.14,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21482.13,"providers":[{"billed_charge":167330.64,"npi":[1649209230]}]}]}]},{"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":"911352172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":2727.58,"providers":[{"billed_charge":16964.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3581.56,"providers":[{"billed_charge":16969.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":491.52,"providers":[{"billed_charge":1543.57,"npi":[1326002049]}]}]}]},{"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":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2354.79,"providers":[{"billed_charge":15792.00,"npi":[1366556227]}]},{"allowed_amount":241.06,"providers":[{"billed_charge":6053.00,"npi":[1841231461]}]},{"allowed_amount":29526.45,"providers":[{"billed_charge":234499.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3318.32,"providers":[{"billed_charge":40585.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":351.35,"providers":[{"billed_charge":2673.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":3711.21,"providers":[{"billed_charge":20182.00,"npi":[1700809829]}]}]}]},{"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":"911631806"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":23100.11,"providers":[{"billed_charge":21454.31,"npi":[1053359729]}]},{"allowed_amount":6744.24,"providers":[{"billed_charge":14494.14,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":13225.80,"providers":[{"billed_charge":21563.00,"npi":[1841231461]}]},{"allowed_amount":57126.60,"providers":[{"billed_charge":148751.79,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":11515.01,"providers":[{"billed_charge":16549.00,"npi":[1972507580]}]},{"allowed_amount":97633.27,"providers":[{"billed_charge":173960.00,"npi":[1972507580]}]}]}]},{"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":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":99354.48,"providers":[{"billed_charge":196371.00,"npi":[1972507580]}]}]}]},{"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":"840611484"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":43.24,"providers":[{"billed_charge":566.25,"npi":[1821886615]}]}]},{"tin":{"type":"ein","value":"911491167"},"service_code":["81","10"],"billing_class":"professional","payments":[{"allowed_amount":3227.88,"providers":[{"billed_charge":3774.00,"npi":[1902141500]}]},{"allowed_amount":14.54,"providers":[{"billed_charge":17.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":3109.92,"providers":[{"billed_charge":3534.00,"npi":[1699485821]}]}]},{"tin":{"type":"ein","value":"922547827"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":620.81,"providers":[{"billed_charge":1100.00,"npi":[1508338799]}]}]}]},{"name":"ANESTHESIA","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"370","description":"ANESTHESIA - GENERAL CLASSIFICATIION","allowed_amounts":[{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":2626.40,"providers":[{"billed_charge":3752.00,"npi":[1467536276]}]},{"allowed_amount":8929.76,"providers":[{"billed_charge":12756.80,"npi":[1467536276]}]}]}]},{"name":"MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"401","description":"OTHER IMAGING SERVICES - MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3574.86,"providers":[{"billed_charge":12917.00,"npi":[1972507580]}]}]}]},{"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":"910564748"},"service_code":["22","23","21"],"billing_class":"institutional","payments":[{"allowed_amount":4052.09,"providers":[{"billed_charge":5788.70,"npi":[1467536276]}]},{"allowed_amount":817.95,"providers":[{"billed_charge":1168.50,"npi":[1467536276]}]},{"allowed_amount":803.81,"providers":[{"billed_charge":1148.30,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":3821.24,"providers":[{"billed_charge":21149.00,"npi":[1841231461]}]},{"allowed_amount":964.24,"providers":[{"billed_charge":4607.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":13338.49,"providers":[{"billed_charge":64898.00,"npi":[1972507580]}]},{"allowed_amount":1580.33,"providers":[{"billed_charge":9326.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":581.95,"providers":[{"billed_charge":7430.08,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1051.74,"providers":[{"billed_charge":5234.00,"npi":[1649209230]}]}]}]},{"name":"SCRN MAMMOGRAPHY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"403","description":"OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":16017.63,"providers":[{"billed_charge":35617.00,"npi":[1972507580]}]}]}]},{"name":"HYPERBARIC O2","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"413","description":"RESPIRATORY SERVICES - HYPERBARIC OXYGEN THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"621867232"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":9809.89,"providers":[{"billed_charge":137688.00,"npi":[1093791170]}]}]}]},{"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":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":8302.53,"providers":[{"billed_charge":24493.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2658.96,"providers":[{"billed_charge":7323.00,"npi":[1841231461]}]}]}]},{"name":"PHYS THERP/VISIT","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"421","description":"PHYSICAL THERAPY/VISIT","allowed_amounts":[{"tin":{"type":"ein","value":"352369417"},"service_code":["12"],"billing_class":"institutional","payments":[{"allowed_amount":1201.96,"providers":[{"billed_charge":1884.00,"npi":[1174856892]}]}]}]},{"name":"OCCUPATION THER","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"430","description":"OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":492.62,"providers":[{"billed_charge":1296.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":131.16,"providers":[{"billed_charge":423.00,"npi":[1972507580]}]}]}]},{"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":"916018764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":21043.26,"providers":[{"billed_charge":51476.00,"npi":[1013074061]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["23","21"],"billing_class":"institutional","payments":[{"allowed_amount":21372.68,"providers":[{"billed_charge":30532.40,"npi":[1467536276]}]},{"allowed_amount":9158.31,"providers":[{"billed_charge":13083.30,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":157002.59,"providers":[{"billed_charge":414445.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":20476.91,"providers":[{"billed_charge":68044.00,"npi":[1841258639]}]},{"allowed_amount":59117.37,"providers":[{"billed_charge":192742.00,"npi":[1366556227]}]},{"allowed_amount":59402.78,"providers":[{"billed_charge":195625.00,"npi":[1326564071]}]},{"allowed_amount":317046.22,"providers":[{"billed_charge":949599.00,"npi":[1841231461]}]},{"allowed_amount":71890.48,"providers":[{"billed_charge":158405.00,"npi":[1538345251]}]},{"allowed_amount":16614.06,"providers":[{"billed_charge":56491.00,"npi":[1255327201]}]},{"allowed_amount":79056.77,"providers":[{"billed_charge":176348.00,"npi":[1356528269]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":177083.01,"providers":[{"billed_charge":374977.79,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":178752.67,"providers":[{"billed_charge":621514.00,"npi":[1649209230]}]}]},{"tin":{"type":"ein","value":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":114194.99,"providers":[{"billed_charge":355156.10,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":97800.20,"providers":[{"billed_charge":215430.40,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"911158307"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":31731.75,"providers":[{"billed_charge":72391.00,"npi":[1740211028]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":53719.03,"providers":[{"billed_charge":136103.00,"npi":[1073566246]}]},{"allowed_amount":43245.42,"providers":[{"billed_charge":104288.00,"npi":[1053357244]}]}]},{"tin":{"type":"ein","value":"364851166"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1155.00,"providers":[{"billed_charge":2040.00,"npi":[1225090954]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":98681.08,"providers":[{"billed_charge":222746.00,"npi":[1700809829]}]}]},{"tin":{"type":"ein","value":"910729255"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":5095.87,"providers":[{"billed_charge":9398.00,"npi":[1710913140]}]}]}]},{"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":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":2530.82,"providers":[{"billed_charge":6050.00,"npi":[1972507580]}]}]}]},{"name":"ECHOCARDIOLOGY","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"483","description":"CARDIOLOGY - ECHOCARDIOLOGY","allowed_amounts":[{"tin":{"type":"ein","value":"910564748"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":6291.32,"providers":[{"billed_charge":8987.60,"npi":[1467536276]}]},{"allowed_amount":2908.15,"providers":[{"billed_charge":4154.50,"npi":[1467536276]}]}]}]},{"name":"CLINIC","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"510","description":"CLINIC - GENERAL CLASSIFICATION","allowed_amounts":[{"tin":{"type":"ein","value":"911631806"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":151.80,"providers":[{"billed_charge":189.75,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3307.50,"providers":[{"billed_charge":4725.00,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":1078.14,"providers":[{"billed_charge":927.00,"npi":[1841231461]}]}]}]},{"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":"916018764"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":108.89,"providers":[{"billed_charge":3512.00,"npi":[1013074061]}]}]},{"tin":{"type":"ein","value":"910564748"},"service_code":["22","23","20"],"billing_class":"institutional","payments":[{"allowed_amount":137.20,"providers":[{"billed_charge":196.00,"npi":[1467536276]}]},{"allowed_amount":335912.38,"providers":[{"billed_charge":479874.66,"npi":[1467536276]}]},{"allowed_amount":203.52,"providers":[{"billed_charge":290.73,"npi":[1467536276]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":499.32,"providers":[{"billed_charge":5862.70,"npi":[1366556227]}]},{"allowed_amount":6.00,"providers":[{"billed_charge":1241.00,"npi":[1255327201]}]},{"allowed_amount":26.97,"providers":[{"billed_charge":8545.90,"npi":[1538345251]}]},{"allowed_amount":25.46,"providers":[{"billed_charge":3762.45,"npi":[1326564071]}]},{"allowed_amount":17.64,"providers":[{"billed_charge":9084.55,"npi":[1356528269]}]},{"allowed_amount":90.50,"providers":[{"billed_charge":35338.50,"npi":[1841231461]}]},{"allowed_amount":125.64,"providers":[{"billed_charge":20194.80,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":545264.13,"providers":[{"billed_charge":925634.48,"npi":[1972507580]}]},{"allowed_amount":22454.33,"providers":[{"billed_charge":41630.78,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"916001537"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":1216.17,"providers":[{"billed_charge":30824.63,"npi":[1326002049]}]}]},{"tin":{"type":"ein","value":"916000986"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":79.79,"providers":[{"billed_charge":6306.25,"npi":[1649209230]}]}]},{"tin":{"type":"ein","value":"911631806"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":96.24,"providers":[{"billed_charge":19993.33,"npi":[1053359729]}]}]},{"tin":{"type":"ein","value":"621867232"},"service_code":["22","21"],"billing_class":"institutional","payments":[{"allowed_amount":3001.94,"providers":[{"billed_charge":21912.00,"npi":[1093791170]}]},{"allowed_amount":1506.54,"providers":[{"billed_charge":10111.00,"npi":[1093791170]}]}]},{"tin":{"type":"ein","value":"910541383"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":456.28,"providers":[{"billed_charge":650.28,"npi":[1780778423]}]}]},{"tin":{"type":"ein","value":"910844563"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":679.56,"providers":[{"billed_charge":9310.00,"npi":[1033174933]}]}]},{"tin":{"type":"ein","value":"911158307"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":360.55,"providers":[{"billed_charge":621.24,"npi":[1740211028]}]}]},{"tin":{"type":"ein","value":"562392010"},"service_code":["22","23"],"billing_class":"institutional","payments":[{"allowed_amount":156.39,"providers":[{"billed_charge":7343.67,"npi":[1073566246]}]},{"allowed_amount":25.46,"providers":[{"billed_charge":6530.83,"npi":[1053357244]}]},{"allowed_amount":878.03,"providers":[{"billed_charge":2826.49,"npi":[1053357244]}]}]},{"tin":{"type":"ein","value":"331065485"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":27.02,"providers":[{"billed_charge":5137.01,"npi":[1700809829]}]}]},{"tin":{"type":"ein","value":"910729255"},"service_code":["23"],"billing_class":"institutional","payments":[{"allowed_amount":24.67,"providers":[{"billed_charge":639.75,"npi":[1710913140]}]}]}]},{"name":"HOSPICE/RTN HOME","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"651","description":"HOSPICE SERVICES - ROUTINE HOME CARE","allowed_amounts":[{"tin":{"type":"ein","value":"352369417"},"service_code":["34"],"billing_class":"institutional","payments":[{"allowed_amount":33520.32,"providers":[{"billed_charge":41200.00,"npi":[1083947709]}]}]}]},{"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":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":403.98,"providers":[{"billed_charge":1380.00,"npi":[1841231461]}]}]},{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":234.46,"providers":[{"billed_charge":906.00,"npi":[1972507580]}]}]}]},{"name":"TREATMENT ROOM","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"761","description":"TREATMENT OR OBSERVATION ROOM - TREATMENT ROOM","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3052.08,"providers":[{"billed_charge":6152.00,"npi":[1972507580]}]}]},{"tin":{"type":"ein","value":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":450.42,"providers":[{"billed_charge":1109.00,"npi":[1841231461]}]}]}]},{"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":"911855796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":3112.42,"providers":[{"billed_charge":5600.00,"npi":[1821450537]}]}]}]},{"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":"911855796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":7684.61,"providers":[{"billed_charge":13600.00,"npi":[1821450537]}]}]}]},{"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":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":542.08,"providers":[{"billed_charge":616.00,"npi":[1699485821]}]}]}]},{"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":"911491167"},"service_code":["81","10"],"billing_class":"professional","payments":[{"allowed_amount":929.50,"providers":[{"billed_charge":2475.00,"npi":[1902141500]}]},{"allowed_amount":16.90,"providers":[{"billed_charge":45.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6547.20,"providers":[{"billed_charge":7440.00,"npi":[1699485821]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":385.56,"providers":[{"billed_charge":846.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2918.96,"providers":[{"billed_charge":3317.00,"npi":[1699485821]}]}]}]},{"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":"800270103"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":6804.33,"providers":[{"billed_charge":40764.66,"npi":[1649418351]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":96.33,"providers":[{"billed_charge":228.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":74.80,"providers":[{"billed_charge":85.00,"npi":[1699485821]}]}]}]},{"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":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.92,"providers":[{"billed_charge":9.00,"npi":[1699485821]}]}]}]},{"name":"HEMO/COMPOSITE","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"821","description":"HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE","allowed_amounts":[{"tin":{"type":"ein","value":"953372911"},"service_code":["65"],"billing_class":"institutional","payments":[{"allowed_amount":65512.48,"providers":[{"billed_charge":262680.00,"npi":[1225265606]}]}]}]},{"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":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":7.04,"providers":[{"billed_charge":8.00,"npi":[1699485821]}]}]}]},{"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":"911491167"},"service_code":["81","10"],"billing_class":"professional","payments":[{"allowed_amount":15.54,"providers":[{"billed_charge":34.00,"npi":[1902141500]}]},{"allowed_amount":124.32,"providers":[{"billed_charge":272.00,"npi":[1902141500]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":215.04,"providers":[{"billed_charge":560.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":2779.92,"providers":[{"billed_charge":3159.00,"npi":[1699485821]}]}]}]},{"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":80.85,"providers":[{"billed_charge":598.50,"npi":[1821886615]}]}]},{"tin":{"type":"ein","value":"911491167"},"service_code":["81","10"],"billing_class":"professional","payments":[{"allowed_amount":609.07,"providers":[{"billed_charge":1617.00,"npi":[1902141500]}]},{"allowed_amount":12.43,"providers":[{"billed_charge":33.00,"npi":[1902141500]}]}]},{"tin":{"type":"ein","value":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5749.92,"providers":[{"billed_charge":6534.00,"npi":[1699485821]}]}]}]},{"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":"910171250"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":42.24,"providers":[{"billed_charge":48.00,"npi":[1699485821]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":148.26,"providers":[{"billed_charge":322.00,"npi":[1902141500]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":269.71,"providers":[{"billed_charge":504.00,"npi":[1902141500]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1066.66,"providers":[{"billed_charge":2299.00,"npi":[1902141500]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":1066.66,"providers":[{"billed_charge":2299.00,"npi":[1902141500]}]}]}]},{"name":"STREP A, DNA, AMP PROBE","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"87651","description":"INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); STREPTOCOCCUS, GROUP A, AMPLIFIED PROBE TEC","allowed_amounts":[{"tin":{"type":"ein","value":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":224.56,"providers":[{"billed_charge":484.00,"npi":[1902141500]}]}]}]},{"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":"911491167"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":617.54,"providers":[{"billed_charge":803.00,"npi":[1902141500]}]}]}]},{"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":"910545036"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":227.78,"providers":[{"billed_charge":256.00,"npi":[1710110820]}]},{"allowed_amount":113.89,"providers":[{"billed_charge":128.00,"npi":[1710110820]}]}]},{"tin":{"type":"ein","value":"333018484"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":602.01,"providers":[{"billed_charge":2500.00,"npi":[1699448969]}]}]}]},{"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":1249.92,"providers":[{"billed_charge":3200.00,"npi":[1508510918]}]},{"allowed_amount":78.12,"providers":[{"billed_charge":200.00,"npi":[1669571956,1265762975]}]},{"allowed_amount":156.24,"providers":[{"billed_charge":400.00,"npi":[1508510918]}]}]},{"tin":{"type":"ein","value":"910882971"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":84.34,"providers":[{"billed_charge":145.50,"npi":[1679839575]}]}]}]},{"name":"PSYTX W PT W E/M 45 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90836","description":"PSYCHOTHERAPY, 45 MINUTES WITH PATIENT WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE","allowed_amounts":[{"tin":{"type":"ein","value":"333018484"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":425.02,"providers":[{"billed_charge":1500.00,"npi":[1699448969]},{"billed_charge":1700.00,"npi":[1699448969]}]}]}]},{"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":"823250339"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":701.93,"providers":[{"billed_charge":960.00,"npi":[1811519879]}]},{"allowed_amount":350.96,"providers":[{"billed_charge":480.00,"npi":[1245689918]}]},{"allowed_amount":350.97,"providers":[{"billed_charge":480.00,"npi":[1245689918,1619603875]}]}]},{"tin":{"type":"ein","value":"844541952"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1158.08,"providers":[{"billed_charge":1760.00,"npi":[1750856076]}]}]},{"tin":{"type":"ein","value":"910882971"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":1092.32,"providers":[{"billed_charge":1929.24,"npi":[1679839575]}]},{"allowed_amount":1123.92,"providers":[{"billed_charge":1929.24,"npi":[1679839575]}]},{"allowed_amount":233.98,"providers":[{"billed_charge":428.72,"npi":[1730870791]}]},{"allowed_amount":741.39,"providers":[{"billed_charge":1286.16,"npi":[1679839575]}]},{"allowed_amount":3871.28,"providers":[{"billed_charge":6645.16,"npi":[1730870791]}]},{"allowed_amount":249.76,"providers":[{"billed_charge":428.72,"npi":[1245055987]}]}]},{"tin":{"type":"ein","value":"813124438"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":467.96,"providers":[{"billed_charge":720.00,"npi":[1932701992]}]}]},{"tin":{"type":"ein","value":"299465735"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":315.84,"providers":[{"billed_charge":600.00,"npi":[1952452302]}]}]},{"tin":{"type":"ein","value":"223916626"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":350.94,"providers":[{"billed_charge":450.00,"npi":[1104986488]}]}]},{"tin":{"type":"ein","value":"465670950"},"service_code":["11","02"],"billing_class":"professional","payments":[{"allowed_amount":449.56,"providers":[{"billed_charge":1000.00,"npi":[1578044079]}]},{"allowed_amount":674.34,"providers":[{"billed_charge":1500.00,"npi":[1578044079]}]}]},{"tin":{"type":"ein","value":"815340264"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":350.94,"providers":[{"billed_charge":525.00,"npi":[1124205364]}]},{"allowed_amount":116.98,"providers":[{"billed_charge":175.00,"npi":[1124205364]}]}]},{"tin":{"type":"ein","value":"910849093"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":333.00,"providers":[{"billed_charge":350.00,"npi":[1356496335]}]},{"allowed_amount":832.50,"providers":[{"billed_charge":875.00,"npi":[1356496335]}]},{"allowed_amount":1165.50,"providers":[{"billed_charge":1225.00,"npi":[1356496335]}]}]},{"tin":{"type":"ein","value":"208930064"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":350.94,"providers":[{"billed_charge":525.00,"npi":[1457007494]}]}]},{"tin":{"type":"ein","value":"842103456"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":7135.95,"providers":[{"billed_charge":12200.00,"npi":[1861720195]}]},{"allowed_amount":12294.80,"providers":[{"billed_charge":21000.00,"npi":[1861720195]}]}]},{"tin":{"type":"ein","value":"831117903"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":116.98,"providers":[{"billed_charge":140.00,"npi":[1497194393]}]}]},{"tin":{"type":"ein","value":"821903479"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":594.10,"providers":[{"billed_charge":750.00,"npi":[1942500624]}]},{"allowed_amount":716.46,"providers":[{"billed_charge":780.00,"npi":[1942500624]}]},{"allowed_amount":357.64,"providers":[{"billed_charge":360.00,"npi":[1942500624]}]}]},{"tin":{"type":"ein","value":"814581707"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":116.99,"providers":[{"billed_charge":170.00,"npi":[1740759935]}]},{"allowed_amount":1052.91,"providers":[{"billed_charge":1530.00,"npi":[1740707207]}]},{"allowed_amount":5626.49,"providers":[{"billed_charge":8160.00,"npi":[1396318218]}]}]},{"tin":{"type":"ein","value":"475003891"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":3509.40,"providers":[{"billed_charge":4500.00,"npi":[1619247921]}]}]},{"tin":{"type":"ein","value":"991665149"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":4008.00,"providers":[{"billed_charge":6080.00,"npi":[1760768188]}]},{"allowed_amount":3008.96,"providers":[{"billed_charge":4560.00,"npi":[1760768188]}]},{"allowed_amount":624.40,"providers":[{"billed_charge":950.00,"npi":[1760768188]}]}]},{"tin":{"type":"ein","value":"883162646"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":233.96,"providers":[{"billed_charge":450.00,"npi":[1174197081]}]}]},{"tin":{"type":"ein","value":"910907090"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":116.98,"providers":[{"billed_charge":185.00,"npi":[1245788694]}]}]},{"tin":{"type":"ein","value":"881998725"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1748.32,"providers":[{"billed_charge":2800.00,"npi":[1568838019]}]}]},{"tin":{"type":"ein","value":"881604038"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":265.16,"providers":[{"billed_charge":354.38,"npi":[1104496132]}]}]},{"tin":{"type":"ein","value":"832507546"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":1388.61,"providers":[{"billed_charge":3159.00,"npi":[1952472649]}]},{"allowed_amount":2468.64,"providers":[{"billed_charge":5616.00,"npi":[1043601545]}]}]},{"tin":{"type":"ein","value":"921635939"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":1623.44,"providers":[{"billed_charge":2275.00,"npi":[1932847258]}]},{"allowed_amount":999.04,"providers":[{"billed_charge":1400.00,"npi":[1932847258]}]}]},{"tin":{"type":"ein","value":"871139508"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":4725.96,"providers":[{"billed_charge":10500.00,"npi":[1205498607]}]}]},{"tin":{"type":"ein","value":"851563447"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":350.97,"providers":[{"billed_charge":450.00,"npi":[1841021821]}]}]},{"tin":{"type":"ein","value":"932096659"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":233.98,"providers":[{"billed_charge":360.00,"npi":[1992499065]}]},{"allowed_amount":1871.80,"providers":[{"billed_charge":2880.00,"npi":[1992499065]}]}]},{"tin":{"type":"ein","value":"882713064"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":7130.00,"providers":[{"billed_charge":10260.00,"npi":[1225484306]}]},{"allowed_amount":249.76,"providers":[{"billed_charge":360.00,"npi":[1609345941]}]}]},{"tin":{"type":"ein","value":"934241890"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":584.90,"providers":[{"billed_charge":875.00,"npi":[1700267036]}]}]},{"tin":{"type":"ein","value":"843164214"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":374.64,"providers":[{"billed_charge":525.00,"npi":[1629505847]}]}]}]},{"name":"GROUP PSYCHOTHERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"90853","description":"GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP)","allowed_amounts":[{"tin":{"type":"ein","value":"823250339"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":277.10,"providers":[{"billed_charge":520.00,"npi":[1811519879]}]}]},{"tin":{"type":"ein","value":"911113010"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":1575.00,"providers":[{"billed_charge":8400.00,"npi":[1518186600]}]}]}]},{"name":"PSTAY/GROUP RX","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"915","description":"PSYCHIATRIC/PSYCHOLOGICAL SERVICES - GROUP THERAPY","allowed_amounts":[{"tin":{"type":"ein","value":"272305304"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":11083.47,"providers":[{"billed_charge":38070.00,"npi":[1033107214]}]}]}]},{"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":"911352172"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":354.68,"providers":[{"billed_charge":896.00,"npi":[1841231461]}]}]}]},{"name":"AEP SCR AUDITORY POTENTIAL","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"92650","description":"AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS","allowed_amounts":[{"tin":{"type":"ein","value":"650737187"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1275.30,"providers":[{"billed_charge":4238.00,"npi":[1548556376]}]}]}]},{"name":"CARDIAC REHAB","billing_code_type":"RC","billing_code_type_version":"2022","billing_code":"943","description":"OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION","allowed_amounts":[{"tin":{"type":"ein","value":"910655392"},"service_code":["22"],"billing_class":"institutional","payments":[{"allowed_amount":3230.63,"providers":[{"billed_charge":5603.00,"npi":[1972507580]}]}]}]},{"name":"MECHANICAL TRACTION THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97012","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; TRACTION, MECHANICAL","allowed_amounts":[{"tin":{"type":"ein","value":"465140421"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":19.00,"providers":[{"billed_charge":41.00,"npi":[1043502131]}]}]}]},{"name":"INFRARED THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97026","description":"APPLICATION OF A MODALITY TO 1 OR MORE AREAS; INFRARED","allowed_amounts":[{"tin":{"type":"ein","value":"464567301"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":39.55,"providers":[{"billed_charge":77.00,"npi":[1962824755]}]}]}]},{"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":"911928166"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":390.74,"providers":[{"billed_charge":1004.52,"npi":[1801534409]}]},{"allowed_amount":3606.52,"providers":[{"billed_charge":10045.20,"npi":[1447133475]}]},{"allowed_amount":1269.08,"providers":[{"billed_charge":3515.82,"npi":[1730792052]}]},{"allowed_amount":363.88,"providers":[{"billed_charge":920.81,"npi":[1255213294]}]},{"allowed_amount":89.91,"providers":[{"billed_charge":251.13,"npi":[1902772254]}]},{"allowed_amount":99.24,"providers":[{"billed_charge":251.13,"npi":[1124717681]}]},{"allowed_amount":33.08,"providers":[{"billed_charge":83.71,"npi":[1497428924]}]},{"allowed_amount":529.28,"providers":[{"billed_charge":1339.36,"npi":[1780322024]}]},{"allowed_amount":131.80,"providers":[{"billed_charge":334.84,"npi":[1376206326]}]},{"allowed_amount":297.72,"providers":[{"billed_charge":753.39,"npi":[1508567090]}]},{"allowed_amount":697.72,"providers":[{"billed_charge":1845.80,"npi":[1124990387]}]},{"allowed_amount":280.11,"providers":[{"billed_charge":757.57,"npi":[1598938730]}]},{"allowed_amount":29.97,"providers":[{"billed_charge":83.71,"npi":[1982492039]}]},{"allowed_amount":223.82,"providers":[{"billed_charge":592.24,"npi":[1114791092]}]},{"allowed_amount":690.43,"providers":[{"billed_charge":1841.62,"npi":[1144193269]}]}]}]},{"name":"NEUROMUSCULAR REEDUCATION","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97112","description":"THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; NEUROMUSCULAR REEDUCATION OF MOVEMENT, BALA","allowed_amounts":[{"tin":{"type":"ein","value":"911928166"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":280.60,"providers":[{"billed_charge":655.36,"npi":[1144193269]}]},{"allowed_amount":70.15,"providers":[{"billed_charge":163.84,"npi":[1124717681]}]},{"allowed_amount":106.96,"providers":[{"billed_charge":245.76,"npi":[1801534409]}]},{"allowed_amount":147.24,"providers":[{"billed_charge":327.68,"npi":[1780322024]}]}]}]},{"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":"911928166"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":59.45,"providers":[{"billed_charge":128.26,"npi":[1780322024]}]}]}]},{"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":"911928166"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1641.54,"providers":[{"billed_charge":3542.83,"npi":[1598938730]}]},{"allowed_amount":1259.65,"providers":[{"billed_charge":2870.35,"npi":[1730792052]}]},{"allowed_amount":323.04,"providers":[{"billed_charge":656.08,"npi":[1124717681]}]},{"allowed_amount":723.20,"providers":[{"billed_charge":1640.20,"npi":[1982492039]}]},{"allowed_amount":1482.56,"providers":[{"billed_charge":3362.41,"npi":[1447133475]}]},{"allowed_amount":72.32,"providers":[{"billed_charge":164.02,"npi":[1265029094]}]},{"allowed_amount":299.33,"providers":[{"billed_charge":660.18,"npi":[1114791092]}]},{"allowed_amount":439.12,"providers":[{"billed_charge":902.11,"npi":[1376206326]}]},{"allowed_amount":333.88,"providers":[{"billed_charge":738.09,"npi":[1801534409]}]},{"allowed_amount":1633.67,"providers":[{"billed_charge":3362.41,"npi":[1255213294]}]},{"allowed_amount":3327.32,"providers":[{"billed_charge":7069.26,"npi":[1124990387]}]},{"allowed_amount":403.80,"providers":[{"billed_charge":820.10,"npi":[1508567090]}]},{"allowed_amount":116.92,"providers":[{"billed_charge":246.03,"npi":[1497428924]}]},{"allowed_amount":733.46,"providers":[{"billed_charge":1558.19,"npi":[1144193269]}]},{"allowed_amount":359.20,"providers":[{"billed_charge":738.09,"npi":[1780322024]}]},{"allowed_amount":459.24,"providers":[{"billed_charge":984.12,"npi":[1720749831]}]},{"allowed_amount":306.16,"providers":[{"billed_charge":656.08,"npi":[1902772254]}]}]}]},{"name":"ACUPUNCT W/O STIMUL 15 MIN","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97810","description":"ACUPUNCTURE, 1 OR MORE NEEDLES; WITHOUT ELECTRICAL STIMULATION, INITIAL 15 MINUTES OF PERSONAL ONE-O","allowed_amounts":[{"tin":{"type":"ein","value":"464567301"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":340.00,"providers":[{"billed_charge":600.00,"npi":[1962824755]}]}]}]},{"name":"ACUPUNCT W/O STIMUL ADDL 15M","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"97811","description":"ACUPUNCTURE, 1 OR MORE NEEDLES; WITHOUT ELECTRICAL STIMULATION, EACH ADDITIONAL 15 MINUTES OF PERSON","allowed_amounts":[{"tin":{"type":"ein","value":"464567301"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":297.00,"providers":[{"billed_charge":495.00,"npi":[1962824755]}]}]}]},{"name":"CHIROPRACT MANJ 3-4 REGIONS","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98941","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, 3-4 REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"465140421"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":252.00,"providers":[{"billed_charge":581.00,"npi":[1043502131]}]}]}]},{"name":"CHIROPRACT MANJ XTRSPINL 1/>","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"98943","description":"CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); EXTRASPINAL, 1 OR MORE REGIONS","allowed_amounts":[{"tin":{"type":"ein","value":"465140421"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":175.00,"providers":[{"billed_charge":385.00,"npi":[1043502131]}]}]}]},{"name":"HYPERBARIC OXYGEN THERAPY","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99183","description":"PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGE","allowed_amounts":[{"tin":{"type":"ein","value":"833999154"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":1263.96,"providers":[{"billed_charge":2700.00,"npi":[1023017381]}]}]}]},{"name":"OFFICE/OUTPATIENT VISIT NEW","billing_code_type":"CPT","billing_code_type_version":"2022","billing_code":"99204","description":"OFFICE OR OTH OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES TH","allowed_amounts":[{"tin":{"type":"ein","value":"333018484"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":308.64,"providers":[{"billed_charge":600.00,"npi":[1699448969]}]},{"allowed_amount":154.32,"providers":[{"billed_charge":300.00,"npi":[1699448969]}]}]}]},{"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":"874141751"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":614.40,"providers":[{"billed_charge":2082.00,"npi":[1245662048]}]}]},{"tin":{"type":"ein","value":"911020139"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":198.78,"providers":[{"billed_charge":651.56,"npi":[1326020884]}]}]},{"tin":{"type":"ein","value":"262808517"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":399.56,"providers":[{"billed_charge":500.00,"npi":[1538109525]}]}]},{"tin":{"type":"ein","value":"999999999"},"service_code":["11","02","10"],"billing_class":"professional","payments":[{"allowed_amount":775.65,"providers":[{"billed_charge":1820.00,"npi":[1234567893]}]},{"allowed_amount":444.75,"providers":[{"billed_charge":910.00,"npi":[1234567893]}]},{"allowed_amount":152.00,"providers":[{"billed_charge":164.00,"npi":[1234567893]}]}]},{"tin":{"type":"ein","value":"333018484"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":84.91,"providers":[{"billed_charge":300.00,"npi":[1699448969]}]},{"allowed_amount":764.19,"providers":[{"billed_charge":2400.00,"npi":[1699448969]}]}]}]},{"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":"910545036"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":196.83,"providers":[{"billed_charge":226.00,"npi":[1710110820]}]},{"allowed_amount":590.49,"providers":[{"billed_charge":678.00,"npi":[1710110820]}]}]},{"tin":{"type":"ein","value":"874141751"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":215.88,"providers":[{"billed_charge":705.00,"npi":[1245662048]}]}]},{"tin":{"type":"ein","value":"934461641"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":539.70,"providers":[{"billed_charge":1295.00,"npi":[1760226211]}]}]},{"tin":{"type":"ein","value":"922547827"},"service_code":["11","10"],"billing_class":"professional","payments":[{"allowed_amount":9915.33,"providers":[{"billed_charge":16430.00,"npi":[1508338799]}]},{"allowed_amount":188.93,"providers":[{"billed_charge":310.00,"npi":[1508338799]}]}]},{"tin":{"type":"ein","value":"871139508"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":990.52,"providers":[{"billed_charge":2000.00,"npi":[1043521487]}]}]},{"tin":{"type":"ein","value":"911255170"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":226.68,"providers":[{"billed_charge":560.00,"npi":[1205460656]}]}]},{"tin":{"type":"ein","value":"333018484"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":118.96,"providers":[{"billed_charge":300.00,"npi":[1699448969]}]}]}]},{"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":"912146629"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":584.22,"providers":[{"billed_charge":4308.00,"npi":[1598135782]}]}]},{"tin":{"type":"ein","value":"923837442"},"service_code":["21"],"billing_class":"professional","payments":[{"allowed_amount":1576.32,"providers":[{"billed_charge":2288.00,"npi":[1396442844,1992528343,1881474716]}]},{"allowed_amount":197.04,"providers":[{"billed_charge":286.00,"npi":[1851953855]}]}]}]},{"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":"916001283"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":257.50,"providers":[{"billed_charge":267.50,"npi":[1477645414]}]}]},{"tin":{"type":"ein","value":"822238883"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1453.60,"providers":[{"billed_charge":1453.60,"npi":[1740709393]}]}]},{"tin":{"type":"ein","value":"204384107"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":42198.80,"providers":[{"billed_charge":57134.28,"npi":[1679770549]}]}]},{"tin":{"type":"ein","value":"930567420"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":746.49,"providers":[{"billed_charge":746.75,"npi":[1285685578]}]}]},{"tin":{"type":"ein","value":"911005433"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":40994.88,"providers":[{"billed_charge":43108.98,"npi":[1912083023]}]}]},{"tin":{"type":"ein","value":"911225672"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1727.50,"providers":[{"billed_charge":1727.50,"npi":[1750354528]}]}]},{"tin":{"type":"ein","value":"752474011"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":9159.26,"providers":[{"billed_charge":15246.00,"npi":[1689608820]}]},{"allowed_amount":16274.20,"providers":[{"billed_charge":23784.73,"npi":[1770518490]}]}]},{"tin":{"type":"ein","value":"651193452"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":16765.10,"providers":[{"billed_charge":16765.10,"npi":[1699760892]}]}]}]},{"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":"204384107"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":14450.80,"providers":[{"billed_charge":23152.00,"npi":[1679770549]}]}]},{"tin":{"type":"ein","value":"822238883"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1308.00,"providers":[{"billed_charge":1308.00,"npi":[1740709393]}]}]},{"tin":{"type":"ein","value":"752474011"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":105256.91,"providers":[{"billed_charge":144245.98,"npi":[1770518490]}]}]}]},{"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":"204384107"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":24277.08,"providers":[{"billed_charge":34850.00,"npi":[1679770549]}]}]},{"tin":{"type":"ein","value":"651193452"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":1150.00,"providers":[{"billed_charge":1150.00,"npi":[1699760892]}]}]}]},{"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":"204384107"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":8551.39,"providers":[{"billed_charge":10579.76,"npi":[1679770549]}]}]},{"tin":{"type":"ein","value":"752474011"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":68303.20,"providers":[{"billed_charge":138394.40,"npi":[1689608820]}]}]},{"tin":{"type":"ein","value":"651193452"},"service_code":["41"],"billing_class":"professional","payments":[{"allowed_amount":62750.00,"providers":[{"billed_charge":62750.00,"npi":[1699760892]}]}]}]},{"name":"NEG PRSS WND TX PUMP STATN","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"E2402","description":"NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE","allowed_amounts":[{"tin":{"type":"ein","value":"742152396"},"service_code":["12"],"billing_class":"professional","payments":[{"allowed_amount":4718.82,"providers":[{"billed_charge":12915.10,"npi":[1073500161]}]}]}]},{"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":"910545036"},"service_code":["02","10"],"billing_class":"professional","payments":[{"allowed_amount":24.24,"providers":[{"billed_charge":62.00,"npi":[1710110820]}]}]},{"tin":{"type":"ein","value":"871139508"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":345.68,"providers":[{"billed_charge":1150.00,"npi":[1043521487]}]}]}]},{"name":"ALCOHL&/RX SRVC; GRP CNSL CL","billing_code_type":"HCPCS","billing_code_type_version":"2022","billing_code":"H0005","description":"ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN","allowed_amounts":[{"tin":{"type":"ein","value":"200559564"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":596.13,"providers":[{"billed_charge":3515.00,"npi":[1396328407]}]},{"allowed_amount":1858.53,"providers":[{"billed_charge":7695.00,"npi":[1154075141]}]}]}]},{"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":"910882971"},"service_code":["12","58"],"billing_class":"professional","payments":[{"allowed_amount":278.80,"providers":[{"billed_charge":948.60,"npi":[1881144046]}]},{"allowed_amount":32.80,"providers":[{"billed_charge":111.60,"npi":[1922550862]}]},{"allowed_amount":196.80,"providers":[{"billed_charge":669.60,"npi":[1790435733]}]},{"allowed_amount":213.20,"providers":[{"billed_charge":725.40,"npi":[1972067601]}]},{"allowed_amount":1197.20,"providers":[{"billed_charge":4073.40,"npi":[1144772807]}]},{"allowed_amount":524.80,"providers":[{"billed_charge":1785.60,"npi":[1154873933]}]},{"allowed_amount":2738.80,"providers":[{"billed_charge":9318.60,"npi":[1346095072]}]},{"allowed_amount":3080.40,"providers":[{"billed_charge":10408.80,"npi":[1093313967]}]},{"allowed_amount":3542.40,"providers":[{"billed_charge":12052.80,"npi":[1609698356]}]},{"allowed_amount":295.20,"providers":[{"billed_charge":1004.40,"npi":[1609698356]}]},{"allowed_amount":2376.00,"providers":[{"billed_charge":5356.80,"npi":[1467544171]}]},{"allowed_amount":738.00,"providers":[{"billed_charge":2511.00,"npi":[1992256473]}]},{"allowed_amount":82.00,"providers":[{"billed_charge":279.00,"npi":[1144772807]}]},{"allowed_amount":2082.80,"providers":[{"billed_charge":7086.60,"npi":[1922550862]}]},{"allowed_amount":3165.20,"providers":[{"billed_charge":10769.40,"npi":[1831885722]}]},{"allowed_amount":2804.40,"providers":[{"billed_charge":9541.80,"npi":[1790435733]}]},{"allowed_amount":147.60,"providers":[{"billed_charge":502.20,"npi":[1770055303]}]},{"allowed_amount":180.40,"providers":[{"billed_charge":613.80,"npi":[1194292656]}]},{"allowed_amount":2984.80,"providers":[{"billed_charge":10155.60,"npi":[1790663383]}]},{"allowed_amount":344.40,"providers":[{"billed_charge":1171.80,"npi":[1821623562]}]},{"allowed_amount":16.40,"providers":[{"billed_charge":55.80,"npi":[1386339745,1427683366]}]},{"allowed_amount":2460.00,"providers":[{"billed_charge":8370.00,"npi":[1881144046]}]},{"allowed_amount":3262.20,"providers":[{"billed_charge":11063.40,"npi":[1235971417]}]},{"allowed_amount":1230.00,"providers":[{"billed_charge":4185.00,"npi":[1194292656]}]},{"allowed_amount":1787.60,"providers":[{"billed_charge":6082.20,"npi":[1770055303]}]},{"allowed_amount":4034.40,"providers":[{"billed_charge":13726.80,"npi":[1427683366]}]},{"allowed_amount":131.20,"providers":[{"billed_charge":446.40,"npi":[1386339745]}]},{"allowed_amount":787.20,"providers":[{"billed_charge":2678.40,"npi":[1053861484]}]}]},{"tin":{"type":"ein","value":"910963298"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":1650.00,"providers":[{"billed_charge":1650.00,"npi":[1457672792]}]}]},{"tin":{"type":"ein","value":"464197680"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":5500.65,"providers":[{"billed_charge":10263.00,"npi":[1992798169]}]}]},{"tin":{"type":"ein","value":"862144408"},"service_code":["58"],"billing_class":"professional","payments":[{"allowed_amount":660.00,"providers":[{"billed_charge":660.00,"npi":[1699356683]}]}]}]}]}