{
    "reporting_entity_name": "Centene Management Company LLC",
    "reporting_entity_type": "Third Party Administrator",
    "version": "2.0.0",
    "last_updated_on": "2026-09-02",
    "out_of_network": [{
            "name": "Physical Therapy",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "0420",
            "description": "Physical Therapy",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "730717979"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 3979.48,
                            "providers": [{
                                    "billed_charge": 7137.86,
                                    "npi": [1659347623]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Emergency Room",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "0450",
            "description": "Emergency Room",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "824121998"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 3615.98,
                            "providers": [{
                                    "billed_charge": 11630.47,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 27206.77,
                            "providers": [{
                                    "billed_charge": 50190.68,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 7666.94,
                            "providers": [{
                                    "billed_charge": 18526.52,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 8933.90,
                            "providers": [{
                                    "billed_charge": 11630.47,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 27394.73,
                            "providers": [{
                                    "billed_charge": 45876.43,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 2843.95,
                            "providers": [{
                                    "billed_charge": 2872.68,
                                    "npi": [1972070993]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "862211233"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 69702.34,
                            "providers": [{
                                    "billed_charge": 120755.40,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 7623.90,
                            "providers": [{
                                    "billed_charge": 9908.94,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 658.00,
                            "providers": [{
                                    "billed_charge": 2872.68,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 19019.89,
                            "providers": [{
                                    "billed_charge": 35612.46,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 7642.90,
                            "providers": [{
                                    "billed_charge": 12136.17,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 13530.23,
                            "providers": [{
                                    "billed_charge": 19097.36,
                                    "npi": [1104551134]
                                }
                            ]
                        }, {
                            "allowed_amount": 1968.00,
                            "providers": [{
                                    "billed_charge": 4594.21,
                                    "npi": [1104551134]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Clinic",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "0510",
            "description": "Clinic",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "730717979"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 957.04,
                            "providers": [{
                                    "billed_charge": 6174.04,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 69.40,
                            "providers": [{
                                    "billed_charge": 483.44,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 208.20,
                            "providers": [{
                                    "billed_charge": 1450.32,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 277.60,
                            "providers": [{
                                    "billed_charge": 1933.76,
                                    "npi": [1659347623]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "746001118"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 540.54,
                            "providers": [{
                                    "billed_charge": 693.00,
                                    "npi": [1174582050]
                                }
                            ]
                        }, {
                            "allowed_amount": 4660.80,
                            "providers": [{
                                    "billed_charge": 6009.00,
                                    "npi": [1174582050]
                                }
                            ]
                        }, {
                            "allowed_amount": 308.88,
                            "providers": [{
                                    "billed_charge": 396.00,
                                    "npi": [1174582050]
                                }
                            ]
                        }, {
                            "allowed_amount": 130.12,
                            "providers": [{
                                    "billed_charge": 396.00,
                                    "npi": [1174582050]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Behavioral Health Treatments/Services - Intensive Outpatient Services,",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "0906",
            "description": "Behavioral Health Treatments/Services - Intensive Outpatient Services,",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "851603446"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 3052.56,
                            "providers": [{
                                    "billed_charge": 64260.00,
                                    "npi": [1033737762]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Psychiatric/Psychological Services - Night Care",
            "billing_code_type": "RC",
            "billing_code_type_version": "2022",
            "billing_code": "0913",
            "description": "Psychiatric/Psychological Services - Night Care",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "990989017"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 6132.03,
                            "providers": [{
                                    "billed_charge": 98726.81,
                                    "npi": [1437912581]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "77063",
            "description": "SCREENING DIGITAL BREAST TOMOSYNTHESIS BI",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710402700"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 149.42,
                            "providers": [{
                                    "billed_charge": 294.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 47.54,
                            "providers": [{
                                    "billed_charge": 98.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 54.34,
                            "providers": [{
                                    "billed_charge": 98.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 101.88,
                            "providers": [{
                                    "billed_charge": 196.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 984.86,
                            "providers": [{
                                    "billed_charge": 1862.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "77067",
            "description": "SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710402700"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1246.24,
                            "providers": [{
                                    "billed_charge": 2318.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 189.42,
                            "providers": [{
                                    "billed_charge": 366.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 68.62,
                            "providers": [{
                                    "billed_charge": 122.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 60.40,
                            "providers": [{
                                    "billed_charge": 122.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 129.02,
                            "providers": [{
                                    "billed_charge": 244.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "GENERAL HEALTH PANEL",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "80050",
            "description": "GENERAL HEALTH PANEL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 12.76,
                            "providers": [{
                                    "billed_charge": 96.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 12.87,
                            "providers": [{
                                    "billed_charge": 96.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 4.29,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1942260443]
                                }, {
                                    "billed_charge": 59.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 4.18,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 29.81,
                            "providers": [{
                                    "billed_charge": 251.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "COMPREHENSIVE METABOLIC PANEL",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "80053",
            "description": "COMPREHENSIVE METABOLIC PANEL",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 34.63,
                            "providers": [{
                                    "billed_charge": 1155.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 18.73,
                            "providers": [{
                                    "billed_charge": 560.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.34,
                            "providers": [{
                                    "billed_charge": 35.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 4.02,
                            "providers": [{
                                    "billed_charge": 105.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.65,
                            "providers": [{
                                    "billed_charge": 70.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 13.37,
                            "providers": [{
                                    "billed_charge": 385.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 14.71,
                            "providers": [{
                                    "billed_charge": 455.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 11.97,
                            "providers": [{
                                    "billed_charge": 385.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 16.02,
                            "providers": [{
                                    "billed_charge": 525.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "80307",
            "description": "DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "843260526"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 186.42,
                            "providers": [{
                                    "billed_charge": 234.00,
                                    "npi": [1659900348]
                                }
                            ]
                        }, {
                            "allowed_amount": 559.26,
                            "providers": [{
                                    "billed_charge": 702.00,
                                    "npi": [1659900348]
                                }
                            ]
                        }, {
                            "allowed_amount": 372.84,
                            "providers": [{
                                    "billed_charge": 468.00,
                                    "npi": [1659900348]
                                }
                            ]
                        }, {
                            "allowed_amount": 124.28,
                            "providers": [{
                                    "billed_charge": 156.00,
                                    "npi": [1659900348]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "822704194"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 434.98,
                            "providers": [{
                                    "billed_charge": 546.00,
                                    "npi": [1841798667]
                                }
                            ]
                        }, {
                            "allowed_amount": 310.70,
                            "providers": [{
                                    "billed_charge": 390.00,
                                    "npi": [1841798667]
                                }
                            ]
                        }, {
                            "allowed_amount": 248.56,
                            "providers": [{
                                    "billed_charge": 312.00,
                                    "npi": [1841798667]
                                }
                            ]
                        }, {
                            "allowed_amount": 62.14,
                            "providers": [{
                                    "billed_charge": 78.00,
                                    "npi": [1841798667]
                                }
                            ]
                        }, {
                            "allowed_amount": 140.40,
                            "providers": [{
                                    "billed_charge": 234.00,
                                    "npi": [1841798667]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "81001",
            "description": "URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2.05,
                            "providers": [{
                                    "billed_charge": 40.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.21,
                            "providers": [{
                                    "billed_charge": 24.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.64,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 6.50,
                            "providers": [{
                                    "billed_charge": 128.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.40,
                            "providers": [{
                                    "billed_charge": 8.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "ASSAY OF MAGNESIUM",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "83735",
            "description": "ASSAY OF MAGNESIUM",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 3.40,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 9.40,
                            "providers": [{
                                    "billed_charge": 88.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.70,
                            "providers": [{
                                    "billed_charge": 16.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 3.44,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.58,
                            "providers": [{
                                    "billed_charge": 24.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.86,
                            "providers": [{
                                    "billed_charge": 8.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 6.02,
                            "providers": [{
                                    "billed_charge": 56.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "85025",
            "description": "BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["22", "23", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 4.00,
                            "providers": [{
                                    "billed_charge": 36.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.00,
                            "providers": [{
                                    "billed_charge": 9.00,
                                    "npi": [1689069478, 1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 22.94,
                            "providers": [{
                                    "billed_charge": 207.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 19.91,
                            "providers": [{
                                    "billed_charge": 180.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 12.88,
                            "providers": [{
                                    "billed_charge": 117.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.00,
                            "providers": [{
                                    "billed_charge": 18.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.97,
                            "providers": [{
                                    "billed_charge": 9.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.97,
                            "providers": [{
                                    "billed_charge": 27.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 13.97,
                            "providers": [{
                                    "billed_charge": 126.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 5.00,
                            "providers": [{
                                    "billed_charge": 45.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.94,
                            "providers": [{
                                    "billed_charge": 18.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 40.49,
                            "providers": [{
                                    "billed_charge": 369.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.97,
                            "providers": [{
                                    "billed_charge": 18.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }, {
                            "allowed_amount": 13.94,
                            "providers": [{
                                    "billed_charge": 126.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 3.00,
                            "providers": [{
                                    "billed_charge": 27.00,
                                    "npi": [1942260443]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "ANTIBODY SCREEN RBC EACH SERUM TECHNIQUE",
            "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": "710294698"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1.01,
                            "providers": [{
                                    "billed_charge": 18.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 4.04,
                            "providers": [{
                                    "billed_charge": 72.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 7.99,
                            "providers": [{
                                    "billed_charge": 144.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 3.03,
                            "providers": [{
                                    "billed_charge": 54.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 3.00,
                            "providers": [{
                                    "billed_charge": 54.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.98,
                            "providers": [{
                                    "billed_charge": 18.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "710294698"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 0.36,
                            "providers": [{
                                    "billed_charge": 15.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.11,
                            "providers": [{
                                    "billed_charge": 60.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.37,
                            "providers": [{
                                    "billed_charge": 15.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.74,
                            "providers": [{
                                    "billed_charge": 45.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.56,
                            "providers": [{
                                    "billed_charge": 120.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.47,
                            "providers": [{
                                    "billed_charge": 60.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.48,
                            "providers": [{
                                    "billed_charge": 60.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "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": "710294698"
                    },
                    "service_code": ["22", "23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 0.36,
                            "providers": [{
                                    "billed_charge": 8.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.11,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.37,
                            "providers": [{
                                    "billed_charge": 8.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 0.74,
                            "providers": [{
                                    "billed_charge": 24.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 2.56,
                            "providers": [{
                                    "billed_charge": 64.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.47,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 1.48,
                            "providers": [{
                                    "billed_charge": 32.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "87481",
            "description": "IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "821936336"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 140.36,
                            "providers": [{
                                    "billed_charge": 212.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 596.53,
                            "providers": [{
                                    "billed_charge": 901.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 666.71,
                            "providers": [{
                                    "billed_charge": 1007.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 105.27,
                            "providers": [{
                                    "billed_charge": 159.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.09,
                            "providers": [{
                                    "billed_charge": 53.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "IADNA S AUREUS AMPLIFIED PROBE TQ",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "87640",
            "description": "IADNA S AUREUS AMPLIFIED PROBE TQ",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "821936336"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 175.45,
                            "providers": [{
                                    "billed_charge": 265.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 385.99,
                            "providers": [{
                                    "billed_charge": 583.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 70.18,
                            "providers": [{
                                    "billed_charge": 106.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.09,
                            "providers": [{
                                    "billed_charge": 53.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "872325001"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 140.36,
                            "providers": [{
                                    "billed_charge": 313.86,
                                    "npi": [1023751633]
                                }, {
                                    "billed_charge": 350.92,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 70.18,
                            "providers": [{
                                    "billed_charge": 175.46,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 456.17,
                            "providers": [{
                                    "billed_charge": 1140.49,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.09,
                            "providers": [{
                                    "billed_charge": 50.67,
                                    "npi": [1023751633]
                                }, {
                                    "billed_charge": 87.73,
                                    "npi": [1023751633]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "87641",
            "description": "IADNA S AUREUS METHICILLIN RESIST AMP PROBE TQ",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "872325001"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 175.45,
                            "providers": [{
                                    "billed_charge": 438.65,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 70.18,
                            "providers": [{
                                    "billed_charge": 175.46,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 456.17,
                            "providers": [{
                                    "billed_charge": 1140.49,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.09,
                            "providers": [{
                                    "billed_charge": 50.67,
                                    "npi": [1023751633]
                                }, {
                                    "billed_charge": 87.73,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 105.27,
                            "providers": [{
                                    "billed_charge": 263.19,
                                    "npi": [1023751633]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "87651",
            "description": "IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "872325001"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 421.08,
                            "providers": [{
                                    "billed_charge": 1052.76,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 140.36,
                            "providers": [{
                                    "billed_charge": 350.92,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 70.18,
                            "providers": [{
                                    "billed_charge": 175.46,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 35.09,
                            "providers": [{
                                    "billed_charge": 87.73,
                                    "npi": [1023751633]
                                }, {
                                    "billed_charge": 50.12,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 105.27,
                            "providers": [{
                                    "billed_charge": 263.19,
                                    "npi": [1023751633]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "87798",
            "description": "IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "821936336"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 456.17,
                            "providers": [{
                                    "billed_charge": 689.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 2280.85,
                            "providers": [{
                                    "billed_charge": 3445.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 912.34,
                            "providers": [{
                                    "billed_charge": 1378.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 526.35,
                            "providers": [{
                                    "billed_charge": 795.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }, {
                            "allowed_amount": 5474.04,
                            "providers": [{
                                    "billed_charge": 8268.00,
                                    "npi": [1619488418]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "872325001"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 561.44,
                            "providers": [{
                                    "billed_charge": 1403.68,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 456.17,
                            "providers": [{
                                    "billed_charge": 651.56,
                                    "npi": [1023751633]
                                }, {
                                    "billed_charge": 1140.49,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 2280.85,
                            "providers": [{
                                    "billed_charge": 5702.45,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 912.34,
                            "providers": [{
                                    "billed_charge": 2280.98,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 1824.68,
                            "providers": [{
                                    "billed_charge": 4073.03,
                                    "npi": [1023751633]
                                }
                            ]
                        }, {
                            "allowed_amount": 5017.87,
                            "providers": [{
                                    "billed_charge": 12545.39,
                                    "npi": [1023751633]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "88305",
            "description": "LEVEL IV SURG PATHOLOGY GROSS&MICROSCOPIC EXAM",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "352037910"
                    },
                    "service_code": ["81"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 373.50,
                            "providers": [{
                                    "billed_charge": 1144.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 118.02,
                            "providers": [{
                                    "billed_charge": 450.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 354.06,
                            "providers": [{
                                    "billed_charge": 1350.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }, {
                            "allowed_amount": 109.80,
                            "providers": [{
                                    "billed_charge": 183.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 395.70,
                            "providers": [{
                                    "billed_charge": 915.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 73.20,
                            "providers": [{
                                    "billed_charge": 122.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 831.90,
                            "providers": [{
                                    "billed_charge": 2850.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }, {
                            "allowed_amount": 363.49,
                            "providers": [{
                                    "billed_charge": 1500.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }, {
                            "allowed_amount": 225.00,
                            "providers": [{
                                    "billed_charge": 750.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }, {
                            "allowed_amount": 51.75,
                            "providers": [{
                                    "billed_charge": 122.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 66.90,
                            "providers": [{
                                    "billed_charge": 122.00,
                                    "npi": [1265433890]
                                }
                            ]
                        }, {
                            "allowed_amount": 90.00,
                            "providers": [{
                                    "billed_charge": 300.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }, {
                            "allowed_amount": 45.00,
                            "providers": [{
                                    "billed_charge": 150.00,
                                    "npi": [1982605820]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "92507",
            "description": "TX SPEECH LANG VOICE COMMJ&/AUD PROC DO INDIV",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "208148759"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1428.40,
                            "providers": [{
                                    "billed_charge": 9000.00,
                                    "npi": [1043669732]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "97110",
            "description": "THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "454311285"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 500.08,
                            "providers": [{
                                    "billed_charge": 1680.00,
                                    "npi": [1245901594]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "97112",
            "description": "THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "454311285"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 510.44,
                            "providers": [{
                                    "billed_charge": 1960.00,
                                    "npi": [1245901594]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "97530",
            "description": "THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "454311285"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 521.92,
                            "providers": [{
                                    "billed_charge": 2100.00,
                                    "npi": [1245901594]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "462302294"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2534.32,
                            "providers": [{
                                    "billed_charge": 3950.00,
                                    "npi": [1184347007]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "99233",
            "description": "SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "760273984"
                    },
                    "service_code": ["21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 7234.50,
                            "providers": [{
                                    "billed_charge": 11130.00,
                                    "npi": [1073574810]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "EMERGENCY DEPARTMENT VISIT MODERATE MDM",
            "billing_code_type": "CPT",
            "billing_code_type_version": "2022",
            "billing_code": "99284",
            "description": "EMERGENCY DEPARTMENT VISIT MODERATE MDM",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "824121998"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 4336.99,
                            "providers": [{
                                    "billed_charge": 14072.52,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 6965.90,
                            "providers": [{
                                    "billed_charge": 7036.26,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 7701.92,
                            "providers": [{
                                    "billed_charge": 17590.65,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 2079.98,
                            "providers": [{
                                    "billed_charge": 7036.26,
                                    "npi": [1972070993]
                                }
                            ]
                        }, {
                            "allowed_amount": 17110.78,
                            "providers": [{
                                    "billed_charge": 24626.91,
                                    "npi": [1972070993]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "GROUND MILEAGE 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": "710827582"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 587.40,
                            "providers": [{
                                    "billed_charge": 587.40,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 2571.67,
                            "providers": [{
                                    "billed_charge": 3432.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 2143.05,
                            "providers": [{
                                    "billed_charge": 2310.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 1431.07,
                            "providers": [{
                                    "billed_charge": 1870.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 2112.45,
                            "providers": [{
                                    "billed_charge": 2717.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 5051.49,
                            "providers": [{
                                    "billed_charge": 6787.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 3030.90,
                            "providers": [{
                                    "billed_charge": 5247.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 887.84,
                            "providers": [{
                                    "billed_charge": 957.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 581.69,
                            "providers": [{
                                    "billed_charge": 1045.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 396.00,
                            "providers": [{
                                    "billed_charge": 396.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 1003.54,
                            "providers": [{
                                    "billed_charge": 1540.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1",
            "billing_code_type": "HCPCS",
            "billing_code_type_version": "2022",
            "billing_code": "A0427",
            "description": "AMB SERVICE ALS EMERGENCY TRANSPORT LEVEL 1",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710827582"
                    },
                    "service_code": ["41"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 8156.20,
                            "providers": [{
                                    "billed_charge": 8950.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 1650.00,
                            "providers": [{
                                    "billed_charge": 1650.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 9787.44,
                            "providers": [{
                                    "billed_charge": 12700.00,
                                    "npi": [1477652501]
                                }, {
                                    "billed_charge": 11300.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 2350.00,
                            "providers": [{
                                    "billed_charge": 2350.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 1631.24,
                            "providers": [{
                                    "billed_charge": 1650.00,
                                    "npi": [1477652501]
                                }, {
                                    "billed_charge": 2350.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 5612.48,
                            "providers": [{
                                    "billed_charge": 7050.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }, {
                            "allowed_amount": 4893.72,
                            "providers": [{
                                    "billed_charge": 5650.00,
                                    "npi": [1477652501]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Acute lymphoblastic leukemia not having achieved remission",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "C9100",
            "description": "Acute lymphoblastic leukemia not having achieved remission",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "760273984"
                    },
                    "service_code": ["22", "21"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 9954.75,
                            "providers": [{
                                    "billed_charge": 15315.00,
                                    "npi": [1073574810]
                                }
                            ]
                        }, {
                            "allowed_amount": 18481.90,
                            "providers": [{
                                    "billed_charge": 23438.00,
                                    "npi": [1073574810]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Anemia, unspecified",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "D649",
            "description": "Anemia, unspecified",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710294698"
                    },
                    "service_code": ["23"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 15.06,
                            "providers": [{
                                    "billed_charge": 166.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 4.16,
                            "providers": [{
                                    "billed_charge": 64.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }, {
                            "allowed_amount": 77.93,
                            "providers": [{
                                    "billed_charge": 1046.00,
                                    "npi": [1689069478]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Alcohol dependence, uncomplicated",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "F1020",
            "description": "Alcohol dependence, uncomplicated",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "990989017"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 6568.11,
                            "providers": [{
                                    "billed_charge": 112558.29,
                                    "npi": [1437912581]
                                }
                            ]
                        }
                    ]
                }, {
                    "tin": {
                        "type": "ein",
                        "value": "851603446"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 3052.56,
                            "providers": [{
                                    "billed_charge": 64260.00,
                                    "npi": [1033737762]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Developmental disorder of speech and language, unspecified",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "F809",
            "description": "Developmental disorder of speech and language, unspecified",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "208148759"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1428.40,
                            "providers": [{
                                    "billed_charge": 9000.00,
                                    "npi": [1043669732]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Autistic disorder",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "F840",
            "description": "Autistic disorder",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "462302294"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 2534.32,
                            "providers": [{
                                    "billed_charge": 3950.00,
                                    "npi": [1184347007]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "HOSPITAL OUTPATIENT CLIN VISIT ASSESS & MGMT PT",
            "billing_code_type": "HCPCS",
            "billing_code_type_version": "2022",
            "billing_code": "G0463",
            "description": "HOSPITAL OUTPATIENT CLIN VISIT ASSESS & MGMT PT",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "730717979"
                    },
                    "service_code": ["13"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 69.40,
                            "providers": [{
                                    "billed_charge": 483.44,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 208.20,
                            "providers": [{
                                    "billed_charge": 1450.32,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 832.80,
                            "providers": [{
                                    "billed_charge": 5801.28,
                                    "npi": [1659347623]
                                }
                            ]
                        }, {
                            "allowed_amount": 277.60,
                            "providers": [{
                                    "billed_charge": 1933.76,
                                    "npi": [1659347623]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "ALCOHL&/RX SRVC;INTENSV OP;CRISIS INTRVN&ACTV TX",
            "billing_code_type": "HCPCS",
            "billing_code_type_version": "2022",
            "billing_code": "H0015",
            "description": "ALCOHL&/RX SRVC;INTENSV OP;CRISIS INTRVN&ACTV TX",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "851603446"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 3052.56,
                            "providers": [{
                                    "billed_charge": 64260.00,
                                    "npi": [1033737762]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Radiculopathy, cervical region",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "M5412",
            "description": "Radiculopathy, cervical region",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "820701328"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 451.38,
                            "providers": [{
                                    "billed_charge": 1350.00,
                                    "npi": [1770940371]
                                }
                            ]
                        }, {
                            "allowed_amount": 21.68,
                            "providers": [{
                                    "billed_charge": 65.00,
                                    "npi": [1770940371]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "PARTIAL HOSITALIZATION SERVICES < 24 HR PER DIEM",
            "billing_code_type": "HCPCS",
            "billing_code_type_version": "2022",
            "billing_code": "S0201",
            "description": "PARTIAL HOSITALIZATION SERVICES < 24 HR PER DIEM",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "990989017"
                    },
                    "service_code": ["89"],
                    "billing_class": "institutional",
                    "payments": [{
                            "allowed_amount": 6132.03,
                            "providers": [{
                                    "billed_charge": 98726.81,
                                    "npi": [1437912581]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Encounter for screening mammogram for malignant neoplasm of breast",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "Z1231",
            "description": "Encounter for screening mammogram for malignant neoplasm of breast",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "710402700"
                    },
                    "service_code": ["22"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 230.90,
                            "providers": [{
                                    "billed_charge": 440.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 107.94,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 338.84,
                            "providers": [{
                                    "billed_charge": 660.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 122.96,
                            "providers": [{
                                    "billed_charge": 220.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }, {
                            "allowed_amount": 2231.10,
                            "providers": [{
                                    "billed_charge": 4180.00,
                                    "npi": [1588003461]
                                }
                            ]
                        }
                    ]
                }
            ]
        }, {
            "name": "Encounter for other orthopedic aftercare",
            "billing_code_type": "ICD",
            "billing_code_type_version": "10",
            "billing_code": "Z4789",
            "description": "Encounter for other orthopedic aftercare",
            "allowed_amounts": [{
                    "tin": {
                        "type": "ein",
                        "value": "454311285"
                    },
                    "service_code": ["11"],
                    "billing_class": "professional",
                    "payments": [{
                            "allowed_amount": 1498.03,
                            "providers": [{
                                    "billed_charge": 5530.00,
                                    "npi": [1245901594]
                                }
                            ]
                        }
                    ]
                }
            ]
        }
    ]
}