{
	"reporting_entity_name": "Hometown Health",
	"reporting_entity_type": "Group Health Plan",
	"issuer_name": "HTH Renown Health",
	"plan_name": "HOMETOWN HEALTH RENOWN HEALTH: TPA RENOWN",
	"plan_id_type": "HIOS",
	"plan_id": "9990115",
	"plan_market_type": "group",
	"last_updated_on": "2026-05-08",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "PHARMACY - GENERAL CLASSIFICATION",
		"billing_code_type": "RC",
		"billing_code_type_version": "2026",
		"billing_code": "0250",
		"description": "Pharmacy",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "352472136"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 2214.23,
				"providers":[{
					"billed_charge": 41.00,
					"npi": [1427493246]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["22", "23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1.78,
				"providers":[{
					"billed_charge": 7.74,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 3.63,
				"providers":[{
					"billed_charge": 16.43,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 4.39,
				"providers":[{
					"billed_charge": 21.03,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 8.38,
				"providers":[{
					"billed_charge": 8.38,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 57.83,
				"providers":[{
					"billed_charge": 264.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 21.03,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814791043"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 4138.56,
				"providers":[{
					"billed_charge": 11.00,
					"npi": [1609858950]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 6.97,
					"npi": [1609858950]
				},{
					"billed_charge": 5.00,
					"npi": [1609858950]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "860181654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1505.00,
				"providers":[{
					"billed_charge": 374.60,
					"npi": [1811951429]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "870692237"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 4.74,
				"providers":[{
					"billed_charge": 12.00,
					"npi": [1104981661]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "870692258"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 3.92,
				"providers":[{
					"billed_charge": 9.00,
					"npi": [1417089350]
				}]
			},{
				"allowed_amount": 38.37,
				"providers":[{
					"billed_charge": 88.00,
					"npi": [1417089350]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["21"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 4537.40,
				"providers":[{
					"billed_charge": 6482.00,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 11.00,
				"providers":[{
					"billed_charge": 11.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 121.00,
				"providers":[{
					"billed_charge": 121.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 13.00,
				"providers":[{
					"billed_charge": 13.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 165.00,
				"providers":[{
					"billed_charge": 165.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 178.00,
				"providers":[{
					"billed_charge": 178.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 3.00,
				"providers":[{
					"billed_charge": 3.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 31.00,
				"providers":[{
					"billed_charge": 31.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 34.00,
				"providers":[{
					"billed_charge": 34.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 4.00,
				"providers":[{
					"billed_charge": 4.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 55.00,
				"providers":[{
					"billed_charge": 55.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 62.00,
				"providers":[{
					"billed_charge": 62.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 85.00,
				"providers":[{
					"billed_charge": 85.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1060.00,
				"providers":[{
					"billed_charge": 1060.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 11.00,
				"providers":[{
					"billed_charge": 11.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 28.00,
				"providers":[{
					"billed_charge": 28.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 43.00,
				"providers":[{
					"billed_charge": 43.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1.71,
				"providers":[{
					"billed_charge": 3.00,
					"npi": [1548250582]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 196.00,
				"providers":[{
					"billed_charge": 196.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 200.00,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1346934569]
				}]
			},{
				"allowed_amount": 3.00,
				"providers":[{
					"billed_charge": 3.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880213754"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 2.17,
				"providers":[{
					"billed_charge": 6.00,
					"npi": [1932517299]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942823538"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 26.15,
					"npi": [1396725677]
				},{
					"billed_charge": 26.96,
					"npi": [1396725677]
				},{
					"billed_charge": 114.62,
					"npi": [1396725677]
				},{
					"billed_charge": 30.90,
					"npi": [1396725677]
				}]
			},{
				"allowed_amount": 9618.00,
				"providers":[{
					"billed_charge": 30.61,
					"npi": [1396725677]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943302014"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 5.92,
					"npi": [1831529049]
				},{
					"billed_charge": 27.49,
					"npi": [1831529049]
				}]
			}]
		}]
	},{
		"name": "MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION",
		"billing_code_type": "RC",
		"billing_code_type_version": "2026",
		"billing_code": "0270",
		"description": "Medical/Surgical Supplies and Devices",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "204993360"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 590.83,
				"providers":[{
					"billed_charge": 1034.00,
					"npi": [1487771812]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["21"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 3.99,
				"providers":[{
					"billed_charge": 5.70,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 553.00,
				"providers":[{
					"billed_charge": 553.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 608.00,
				"providers":[{
					"billed_charge": 608.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 898.00,
				"providers":[{
					"billed_charge": 898.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 553.00,
				"providers":[{
					"billed_charge": 553.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 608.00,
				"providers":[{
					"billed_charge": 608.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 233.13,
				"providers":[{
					"billed_charge": 408.00,
					"npi": [1548250582]
				}]
			},{
				"allowed_amount": 347.41,
				"providers":[{
					"billed_charge": 608.00,
					"npi": [1215983093]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 408.00,
				"providers":[{
					"billed_charge": 408.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 608.00,
				"providers":[{
					"billed_charge": 608.00,
					"npi": [1346934569,1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 51.00,
					"npi": [1982600920]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946004062"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 14.40,
				"providers":[{
					"billed_charge": 16.00,
					"npi": [1538265780]
				}]
			}]
		}]
	},{
		"name": "PR COLLECTION VENOUS BLOOD,VENIPUNCTURE",
		"billing_code_type": "HCPCS",
		"billing_code_type_version": "2026",
		"billing_code": "36415",
		"description": "Collection Venous Blood,Venipuncture",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "133757370"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 1.13,
				"providers":[{
					"billed_charge": 16.80,
					"npi": [1932184322]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "204993360"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 76.00,
				"providers":[{
					"billed_charge": 133.00,
					"npi": [1487771812]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "362193608"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 4.10,
				"providers":[{
					"billed_charge": 22.80,
					"npi": [1962530451]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "364257926"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 9.09,
				"providers":[{
					"billed_charge": 36.40,
					"npi": [1346389764]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "382084239"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 4.17,
				"providers":[{
					"billed_charge": 36.40,
					"npi": [1932166386]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["22", "23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 9.29,
				"providers":[{
					"billed_charge": 45.45,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 9.95,
				"providers":[{
					"billed_charge": 45.45,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 10.04,
				"providers":[{
					"billed_charge": 45.45,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 45.45,
				"providers":[{
					"billed_charge": 45.45,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 45.45,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "770003859"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 24.40,
				"providers":[{
					"billed_charge": 61.00,
					"npi": [1467442749]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "820207699"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 2.75,
				"providers":[{
					"billed_charge": 30.00,
					"npi": [1376069724]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840255530"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 26.60,
				"providers":[{
					"billed_charge": 28.00,
					"npi": [1235181744]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840611484"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 1.13,
				"providers":[{
					"billed_charge": 26.25,
					"npi": [1740262880]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 20.51,
				"providers":[{
					"billed_charge": 29.30,
					"npi": [1588656870]
				}]
			},{
				"allowed_amount": 23.44,
				"providers":[{
					"billed_charge": 29.30,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 142.00,
				"providers":[{
					"billed_charge": 142.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 156.00,
				"providers":[{
					"billed_charge": 156.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 142.00,
				"providers":[{
					"billed_charge": 142.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 156.00,
				"providers":[{
					"billed_charge": 156.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 89.14,
				"providers":[{
					"billed_charge": 156.00,
					"npi": [1073612065,1215983093]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 142.00,
				"providers":[{
					"billed_charge": 142.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 156.00,
				"providers":[{
					"billed_charge": 156.00,
					"npi": [1346934569,1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942854057"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 9.34,
				"providers":[{
					"billed_charge": 22.74,
					"npi": [1235148594]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 22.74,
					"npi": [1235148594]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943302014"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 52.00,
					"npi": [1831529049]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946036494"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 9.09,
				"providers":[{
					"billed_charge": 59.07,
					"npi": [1710918545]
				}]
			},{
				"allowed_amount": 9.34,
				"providers":[{
					"billed_charge": 59.07,
					"npi": [1710918545]
				}]
			},{
				"allowed_amount": 32.22,
				"providers":[{
					"billed_charge": 59.07,
					"npi": [1710918545]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990511786"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 9.09,
				"providers":[{
					"billed_charge": 20.00,
					"npi": [1699701185]
				}]
			}]
		}]
	},{
		"name": "PR METABOLIC PANEL,COMPREHENSIVE",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "80053",
		"description": "Metabolic Panel,Comehensive",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "133971298"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["XS"],
				"providers":[{
					"billed_charge": 325.51,
					"npi": [1801992631]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "330488938"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 10.56,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1346467354]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "334335561"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 100.91,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 644.00,
					"npi": [1619084605]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "362193608"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 19.80,
				"providers":[{
					"billed_charge": 110.00,
					"npi": [1962530451]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "611259833"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 3265.00,
				"providers":[{
					"billed_charge": 3265.00,
					"npi": [1639128820]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "770003859"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 497.20,
				"providers":[{
					"billed_charge": 1243.00,
					"npi": [1467442749]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "820207699"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 7.80,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 30.00,
					"npi": [1376069724]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840611484"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 15.82,
				"providers":[{
					"billed_charge": 51.45,
					"npi": [1740262880]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "860181654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 581.00,
					"npi": [1811951429]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "860323025"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 16.65,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 45.00,
					"npi": [1891763496]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 37.76,
				"providers":[{
					"billed_charge": 47.20,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1386.00,
				"providers":[{
					"billed_charge": 1386.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 1525.00,
				"providers":[{
					"billed_charge": 1525.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1386.00,
				"providers":[{
					"billed_charge": 1386.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 1525.00,
				"providers":[{
					"billed_charge": 1525.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 871.39,
				"providers":[{
					"billed_charge": 1525.00,
					"npi": [1073612065,1215983093]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1386.00,
				"providers":[{
					"billed_charge": 1386.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 1525.00,
				"providers":[{
					"billed_charge": 1525.00,
					"npi": [1346934569,1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "930386868"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 82.99,
				"providers":[{
					"billed_charge": 112.00,
					"npi": [1477590198]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 220.00,
					"npi": [1982600920]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942854057"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 10.56,
				"providers":[{
					"billed_charge": 67.07,
					"npi": [1235148594]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 67.07,
					"npi": [1235148594]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943302014"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 564.00,
					"npi": [1831529049]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946036494"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 10.56,
				"providers":[{
					"billed_charge": 73.01,
					"npi": [1710918545]
				}]
			}]
		}]
	},{
		"name": "PR COMPLETE CBC & AUTO DIFF WBC",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "85025",
		"description": "Complete Cbc & Auto Diff Wbc",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "133757370"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 11.30,
				"providers":[{
					"billed_charge": 27.00,
					"npi": [1932184322]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "133971298"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["XS"],
				"providers":[{
					"billed_charge": 138.61,
					"npi": [1801992631]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "204993360"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 497.12,
				"providers":[{
					"billed_charge": 870.00,
					"npi": [1487771812]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "330488938"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 7.77,
				"providers":[{
					"billed_charge": 55.00,
					"npi": [1346467354]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "334335561"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 18.18,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 116.00,
					"npi": [1619084605]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["22", "23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 25.99,
				"providers":[{
					"billed_charge": 127.11,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 27.84,
				"providers":[{
					"billed_charge": 127.11,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 28.08,
				"providers":[{
					"billed_charge": 127.11,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 127.11,
				"providers":[{
					"billed_charge": 127.11,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 127.11,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "770003859"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 178.00,
				"providers":[{
					"billed_charge": 445.00,
					"npi": [1467442749]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "820207699"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 5.72,
				"providers":[{
					"billed_charge": 25.00,
					"npi": [1376069724]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 45.20,
				"providers":[{
					"billed_charge": 56.50,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 762.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 255.00,
				"providers":[{
					"billed_charge": 693.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 762.00,
				"providers":[{
					"billed_charge": 762.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 693.00,
				"providers":[{
					"billed_charge": 693.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 762.00,
				"providers":[{
					"billed_charge": 762.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 435.41,
				"providers":[{
					"billed_charge": 762.00,
					"npi": [1073612065,1215983093]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 693.00,
				"providers":[{
					"billed_charge": 693.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 762.00,
				"providers":[{
					"billed_charge": 762.00,
					"npi": [1346934569,1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "930386868"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 102.26,
				"providers":[{
					"billed_charge": 138.00,
					"npi": [1477590198]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 147.00,
					"npi": [1982600920]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942854057"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 7.77,
				"providers":[{
					"billed_charge": 64.02,
					"npi": [1235148594]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 64.02,
					"npi": [1235148594]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943302014"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 253.00,
					"npi": [1831529049]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946036494"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 7.77,
				"providers":[{
					"billed_charge": 54.77,
					"npi": [1710918545]
				}]
			}]
		}]
	},{
		"name": "PR SARS-COV-2 COVID-19 IADNA INF A&B&RSV AMP PRB",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "87637",
		"description": "Sars-Cov-2 Covid-19 Iadna Inf a&B&Rsv Amp Prb",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "161387862"
			},
			"service_code": ["81"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 142.63,
				"providers":[{
					"billed_charge": 1058.95,
					"npi": [1932145778]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 149.41,
				"providers":[{
					"billed_charge": 715.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 156.61,
				"providers":[{
					"billed_charge": 715.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 715.00,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475349604"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 189.19,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 325.00,
					"npi": [1891762142]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 325.00,
					"npi": [1891762142]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840255530"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 427.50,
				"providers":[{
					"billed_charge": 450.00,
					"npi": [1235181744]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "876000525"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 169.05,
				"providers":[{
					"billed_charge": 241.50,
					"npi": [1588656870]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 571.00,
				"providers":[{
					"billed_charge": 571.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 628.00,
				"providers":[{
					"billed_charge": 628.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 571.00,
				"providers":[{
					"billed_charge": 571.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 628.00,
				"providers":[{
					"billed_charge": 628.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 358.84,
				"providers":[{
					"billed_charge": 628.00,
					"npi": [1073612065,1215983093,1538689419]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 571.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 571.00,
				"providers":[{
					"billed_charge": 571.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880236758"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["QW"],
				"providers":[{
					"billed_charge": 457.00,
					"npi": [1093551475,1861079709]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 126.00,
					"npi": [1982600920]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942823538"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 620.00,
					"npi": [1396725677]
				}]
			}]
		}]
	},{
		"name": "PR SUBSEQUENT HOSPITAL CARE,LEVL II",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99232",
		"description": "Subsequent Hospital Care,Levl II",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "813574137"
			},
			"service_code": ["21", "51"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.68,
				"providers":[{
					"billed_charge": 395.10,
					"npi": [1700934825]
				}]
			}]
		}]
	},{
		"name": "PB EMERGENCY DEPT VISIT,LEVEL III",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99283",
		"description": "Emergency Dept Visit,Level III",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "330185031"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.57,
				"providers":[{
					"billed_charge": 235.00,
					"npi": [1053374371]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "394560753"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 666.80,
					"npi": [1023638988,1154881829]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 357.35,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 1550.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 1550.00,
				"providers":[{
					"billed_charge": 1550.00,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814791043"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 2936.00,
					"npi": [1609858950]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853780150"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 493.00,
				"providers":[{
					"billed_charge": 853.00,
					"npi": [1265097166]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "870692237"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1971.00,
					"npi": [1104981661]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "870692258"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 1850.00,
					"npi": [1417089350]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 493.00,
				"providers":[{
					"billed_charge": 707.93,
					"npi": [1659337350]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1386.20,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 1774.54,
					"npi": [1639128069]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1654.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 1689.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 1744.00,
				"providers":[{
					"billed_charge": 1858.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 683.00,
				"providers":[{
					"billed_charge": 1858.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1689.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1609451327]
				},{
					"billed_charge": 1858.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 1400.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 1689.00,
				"providers":[{
					"billed_charge": 1689.00,
					"npi": [1346934569]
				}]
			},{
				"allowed_amount": 1858.00,
				"providers":[{
					"billed_charge": 1858.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941450151"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 2210.00,
					"npi": [1972503142]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990107330"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1464.88,
				"providers":[{
					"billed_charge": 1835.00,
					"npi": [1316937691]
				}]
			}]
		}]
	},{
		"name": "PB EMERGENCY DEPT VISIT,LEVEL IV",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99284",
		"description": "Emergency Dept Visit,Level IV",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "000000000"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 750.00,
					"npi": [1109999999]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "271369141"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 195.44,
				"providers":[{
					"billed_charge": 962.00,
					"npi": [1881934503]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "273883025"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1151.76,
					"npi": [1902126402]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "274096788"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 978.98,
					"npi": [1275876856]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "352472136"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2680.00,
					"npi": [1427493246]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "383924217"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 97.74,
				"providers":[{
					"billed_charge": 1266.00,
					"npi": [1043947062]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "394560753"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1129.57,
					"npi": [1023638988,1104566926,1215983093,1336695659,1538689419,1588126684,1811283427, ]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 567.29,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2590.00,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "474944608"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 219.81,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 1534.00,
					"npi": [1275073355]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "611259833"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 7962.30,
					"npi": [1639128820]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "811630866"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 483.09,
				"providers":[{
					"billed_charge": 737.00,
					"npi": [1033570247]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840255530"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 660.25,
				"providers":[{
					"billed_charge": 695.00,
					"npi": [1750739371]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "840255530"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1045.95,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 1101.00,
					"npi": [1235181744]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853780150"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 493.00,
				"providers":[{
					"billed_charge": 1266.00,
					"npi": [1013539931,1073612065,1265097166,1831516392,1831839935,1891138418,1902365992]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "860181654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 3510.00,
					"npi": [1811951429]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "860593131"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 334.88,
				"providers":[{
					"billed_charge": 1223.00,
					"npi": [1174715726]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1689229353]
				},{
					"billed_charge": 2803.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 1976.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1689229353]
				}]
			},{
				"allowed_amount": 2548.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 2153.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 2803.00,
				"billing_code_modifier": ["ER"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1455.93,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1548250582]
				}]
			},{
				"allowed_amount": 1601.63,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1215983093,1538689419]
				}]
			},{
				"allowed_amount": 1601.63,
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1073612065,1538689419]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1609451327]
				},{
					"billed_charge": 2803.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 1348.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1346934569]
				}]
			},{
				"allowed_amount": 2803.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2803.00,
					"npi": [1609451327]
				}]
			},{
				"allowed_amount": 856.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2548.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880176558"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1349.00,
					"npi": [1811283427]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "930386868"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1897.70,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2561.00,
					"npi": [1477590198]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942823538"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5627.00,
					"npi": [1396725677]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990175536"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 944.00,
					"npi": [1104405117]
				}]
			},{
				"allowed_amount": 493.00,
				"providers":[{
					"billed_charge": 944.00,
					"npi": [1104405117]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "992530371"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 962.00,
					"npi": [1497916324]
				}]
			}]
		}]
	},{
		"name": "PB EMERGENCY DEPT VISIT,LEVEL V",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99285",
		"description": "Emergency Dept Visit,Level V",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "133971298"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5904.10,
					"npi": [1801992631]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "204993360"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 3942.09,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 6899.00,
					"npi": [1487771812]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "334335561"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 813.91,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5194.00,
					"npi": [1619084605]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "394560753"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1722.27,
					"npi": [1538801469]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["22", "23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 754.88,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 3691.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 3691.00,
					"npi": [1801152566]
				}]
			},{
				"allowed_amount": 771.30,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 3691.00,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "752807737"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 350.00,
				"providers":[{
					"billed_charge": 1888.00,
					"npi": [1952758328]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "813574137"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 166.68,
				"providers":[{
					"billed_charge": 889.00,
					"npi": [1700934825]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "815436418"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 281.65,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 2125.00,
					"npi": [1619084605]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853780150"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 290.79,
				"providers":[{
					"billed_charge": 1888.00,
					"npi": [1265097166]
				}]
			},{
				"allowed_amount": 182.10,
				"providers":[{
					"billed_charge": 1888.00,
					"npi": [ ]
				}]
			},{
				"allowed_amount": 493.00,
				"providers":[{
					"billed_charge": 1888.00,
					"npi": [1104566926,1265097166,1841797610]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5628.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5116.00,
					"npi": [1952049132]
				}]
			},{
				"allowed_amount": 406.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5116.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 5116.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880176558"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 1880.00,
					"npi": [1043310998,1790302867]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880303529"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 762.30,
				"providers":[{
					"billed_charge": 1089.00,
					"npi": [1336307297]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "922099454"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 984.00,
					"npi": [1336864156]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942494000"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 295.45,
				"providers":[{
					"billed_charge": 1286.00,
					"npi": [1194923417]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943302014"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 6613.43,
					"npi": [1831529049]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946004062"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 3657.60,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 4064.00,
					"npi": [1538265780]
				}]
			}]
		}]
	},{
		"name": "PR DIALYSIS PROCEDURE",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "90999",
		"description": "Dialysis Procedure",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "261948027"
			},
			"service_code": ["65"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 4582.36,
					"npi": [1306014238]
				}]
			}]
		}]
	},{
		"name": "PR THERAPEUTIC EXERCISES",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "97110",
		"description": "Therapeutic Exercises",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "200008539"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GP"],
				"providers":[{
					"billed_charge": 60.00,
					"npi": [1790169225]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "800090989"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 26.83,
				"providers":[{
					"billed_charge": 28.67,
					"npi": [1104860766]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GP", "XU"],
				"providers":[{
					"billed_charge": 66.91,
					"npi": [1639128069]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880103557"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GP"],
				"providers":[{
					"billed_charge": 177.00,
					"npi": [1215771928]
				},{
					"billed_charge": 236.00,
					"npi": [1215771928]
				},{
					"billed_charge": 59.00,
					"npi": [1215771928]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "886000022"
			},
			"service_code": ["11", "12"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 21.78,
				"billing_code_modifier": ["GP"],
				"providers":[{
					"billed_charge": 34.49,
					"npi": [1679089593]
				}]
			},{
				"allowed_amount": 29.02,
				"billing_code_modifier": ["GP"],
				"providers":[{
					"billed_charge": 34.49,
					"npi": [1679089593]
				}]
			}]
		}]
	},{
		"name": "PR MOST RECENT SYSTOLIC BLOOD PRESSURE < 130*",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "3074F",
		"description": "Most Recent Systolic Blood Pressure < 130 Mm Hg",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "203207688"
			},
			"service_code": ["11", "17"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.00,
					"npi": [1922486083]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "756064033"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.01,
					"npi": [1326480732]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880236758"
			},
			"service_code": ["11", "20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.00,
					"npi": [1417361965,1578121042,1629041702,1861969214]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880293149"
			},
			"service_code": ["50"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.00,
					"npi": [1437787785,1477794188,1720487598]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942533006"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.00,
					"npi": [1073599171]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "994217777"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 0.00,
					"npi": [1407054844]
				}]
			}]
		}]
	},{
		"name": "PR CHEST XRAY SINGLE VIEW",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "71045",
		"description": "Chest Xray Single View",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "333984600"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 25.08,
					"npi": [1619266632,1730593021,1881621621]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "364779215"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 37.44,
					"npi": [1053351510]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454989022"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 100.49,
				"providers":[{
					"billed_charge": 458.82,
					"npi": [1801152566]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880119638"
			},
			"service_code": ["21"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 11.73,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 176.00,
					"npi": [1831150200]
				}]
			},{
				"allowed_amount": 11.73,
				"billing_code_modifier": ["26", "77"],
				"providers":[{
					"billed_charge": 176.00,
					"npi": [1457889354,1831150200]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880145500"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 8.30,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 33.00,
					"npi": [1770740854]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1726.00,
				"providers":[{
					"billed_charge": 1726.00,
					"npi": [1689229353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1726.00,
				"providers":[{
					"billed_charge": 1726.00,
					"npi": [1952049132]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1085.09,
				"providers":[{
					"billed_charge": 1899.00,
					"npi": [1215983093,1538689419]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880159958"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 1726.00,
				"providers":[{
					"billed_charge": 1726.00,
					"npi": [1609451327]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 12.01,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 73.00,
					"npi": [1285622175]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["26"],
				"providers":[{
					"billed_charge": 73.00,
					"npi": [1285622175]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941741654"
			},
			"service_code": ["23"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 292.00,
					"npi": [1982600920]
				}]
			}]
		}]
	},{
		"name": "PR PSYCHOTHERAPY PATIENT &/ FAMILY 60 MINUTES",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "90837",
		"description": "Psychotherapy Patient &/ Family 60 Minutes",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "000000000"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 151.85,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1109999999]
				}]
			},{
				"allowed_amount": 164.80,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1109999999]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "264372637"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 68.00,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1467693465]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "364524632"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 153.89,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1306291547]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462879359"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1093686305]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464040274"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 210.00,
					"npi": [1720213374]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 210.00,
					"npi": [1720213374]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "471013467"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 176.97,
				"providers":[{
					"billed_charge": 265.00,
					"npi": [1639962848]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "472963503"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 166.99,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1316371487]
				}]
			},{
				"allowed_amount": 180.98,
				"providers":[{
					"billed_charge": 195.00,
					"npi": [1316371487]
				}]
			},{
				"allowed_amount": 170.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1316371487]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "551025401"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1194960567]
				}]
			},{
				"allowed_amount": 68.00,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1194960567]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "825259010"
			},
			"service_code": ["10", "11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 331.00,
					"npi": [1558119636]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 331.00,
					"npi": [1558119636]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "833557341"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 176.97,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1144534983]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "842617739"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 153.89,
				"providers":[{
					"billed_charge": 210.00,
					"npi": [1376192872]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853799068"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 153.89,
				"providers":[{
					"billed_charge": 215.00,
					"npi": [1134483019]
				}]
			},{
				"allowed_amount": 166.93,
				"providers":[{
					"billed_charge": 215.00,
					"npi": [1134483019]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "854135482"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.16,
				"providers":[{
					"billed_charge": 341.00,
					"npi": [1104330976]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "921559823"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.86,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1841663721]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "934402438"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1477095271]
				}]
			}]
		}]
	},{
		"name": "PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99213",
		"description": "Office/Outpatient Established Low Mdm 20 Min",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "201919447"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.19,
				"providers":[{
					"billed_charge": 158.00,
					"npi": [1568790046]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 158.00,
					"npi": [1568790046]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "202630141"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 114.84,
				"providers":[{
					"billed_charge": 188.00,
					"npi": [1245321942]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "203153475"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 98.19,
				"providers":[{
					"billed_charge": 125.00,
					"npi": [1518458165]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "203207688"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 71.30,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 276.13,
					"npi": [1922486083]
				}]
			},{
				"allowed_amount": 71.30,
				"providers":[{
					"billed_charge": 276.13,
					"npi": [1922486083]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "203395567"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 153.02,
				"providers":[{
					"billed_charge": 276.00,
					"npi": [1659062966]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "208488778"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 85.49,
				"billing_code_modifier": ["GC"],
				"providers":[{
					"billed_charge": 219.00,
					"npi": [1316334089]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "261513495"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["TC", "25"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1801642947]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "362193608"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 88.45,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 305.81,
					"npi": [1497745772]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "430653611"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.55,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 167.00,
					"npi": [1225472178]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "463525328"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.57,
				"providers":[{
					"billed_charge": 212.67,
					"npi": [1679523450]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "470896546"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 78.40,
				"providers":[{
					"billed_charge": 98.00,
					"npi": [1942640172]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475101944"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 72.38,
				"providers":[{
					"billed_charge": 120.00,
					"npi": [1548266018]
				}]
			},{
				"allowed_amount": 98.19,
				"providers":[{
					"billed_charge": 120.00,
					"npi": [1548266018]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "636001138"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 69.58,
				"providers":[{
					"billed_charge": 90.00,
					"npi": [1487995395]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "742161737"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 164.34,
				"providers":[{
					"billed_charge": 361.00,
					"npi": [1760481519]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 361.00,
					"npi": [1760481519]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "756064033"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 86.34,
				"providers":[{
					"billed_charge": 178.00,
					"npi": [1326480732]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "813253496"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 137.35,
				"providers":[{
					"billed_charge": 187.84,
					"npi": [1174620496]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "813574137"
			},
			"service_code": ["11", "22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 63.22,
				"providers":[{
					"billed_charge": 457.30,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 94.74,
				"providers":[{
					"billed_charge": 457.30,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 457.30,
					"npi": [1700934825]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 53.74,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 162.69,
					"npi": [1730795691]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 276.77,
					"npi": [1639128069]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880103557"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 156.00,
					"npi": [1831717925]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880236758"
			},
			"service_code": ["10", "11", "20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 139.75,
				"billing_code_modifier": ["GE"],
				"providers":[{
					"billed_charge": 276.00,
					"npi": [1417361965]
				}]
			},{
				"allowed_amount": 139.75,
				"providers":[{
					"billed_charge": 276.00,
					"npi": [1205618402,1417361965]
				}]
			},{
				"allowed_amount": 149.69,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 290.00,
					"npi": [1194344895]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 290.00,
					"npi": [1093551475]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880459017"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1134253701]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "916001108"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 90.36,
				"providers":[{
					"billed_charge": 203.11,
					"npi": [1891996054]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "934895258"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 330.00,
					"npi": [1109999999]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "942533006"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 99.22,
				"providers":[{
					"billed_charge": 205.00,
					"npi": [1073599171]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946004062"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 252.00,
					"npi": [1386744126]
				}]
			},{
				"allowed_amount": 176.40,
				"providers":[{
					"billed_charge": 252.00,
					"npi": [1386744126]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "994217777"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.58,
				"providers":[{
					"billed_charge": 243.00,
					"npi": [1407054844]
				}]
			}]
		}]
	},{
		"name": "PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99214",
		"description": "Office/Outpatient Established Mod Mdm 30 Min",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "204906817"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 75.00,
					"npi": [1245575315]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "260089066"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 317.25,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 423.00,
					"npi": [1104116292]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "333490961"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.76,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1114201365]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1114201365]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "362193608"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 97.97,
				"providers":[{
					"billed_charge": 409.16,
					"npi": [1629203898]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "430653611"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 209.45,
				"providers":[{
					"billed_charge": 262.00,
					"npi": [1265542146]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "471484556"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 192.57,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 275.10,
					"npi": [1417216516]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "471484631"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 192.57,
				"providers":[{
					"billed_charge": 275.10,
					"npi": [1063256659,1144319997]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "471497384"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 192.57,
				"providers":[{
					"billed_charge": 275.10,
					"npi": [1295232155,1487094066]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "611922162"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 102.36,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "680334324"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 426.45,
				"providers":[{
					"billed_charge": 502.00,
					"npi": [1073544722]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 502.00,
					"npi": [1366429771,1407993264]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "742161737"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 254.19,
				"providers":[{
					"billed_charge": 512.00,
					"npi": [1851998967]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 512.00,
					"npi": [1851998967]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "770465765"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 606.75,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 809.00,
					"npi": [1194952416,1255607214]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "811366784"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 330.34,
				"providers":[{
					"billed_charge": 347.73,
					"npi": [1740504547]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "811878397"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 325.00,
					"npi": [1669525911]
				}]
			},{
				"allowed_amount": 134.19,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 650.00,
					"npi": [1669525911]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "812219401"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.76,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 407.79,
					"npi": [1548997109]
				}]
			},{
				"allowed_amount": 114.66,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 407.79,
					"npi": [1548997109]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "813574137"
			},
			"service_code": ["10", "11", "22", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 83.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 83.03,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 93.05,
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 93.05,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 124.42,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 124.42,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 134.19,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			},{
				"allowed_amount": 134.89,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 645.00,
					"npi": [1700934825]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814113791"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.76,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 407.79,
					"npi": [1215471859]
				}]
			},{
				"allowed_amount": 114.06,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 407.79,
					"npi": [1548997109]
				}]
			},{
				"allowed_amount": 148.38,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 407.79,
					"npi": [1578148680]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "820207699"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 163.42,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 235.00,
					"npi": [1376069724]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "831492203"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 134.89,
				"providers":[{
					"billed_charge": 269.00,
					"npi": [1407067119]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "842142825"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 88.72,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 285.00,
					"npi": [1225482201]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "843237145"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"providers":[{
					"billed_charge": 311.00,
					"npi": [1609968395]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853548549"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 186.63,
				"providers":[{
					"billed_charge": 267.00,
					"npi": [1780207969]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853652211"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 130.64,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1538548516]
				}]
			},{
				"allowed_amount": 141.63,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1538548516]
				}]
			},{
				"allowed_amount": 148.38,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1538548516]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 79.09,
				"providers":[{
					"billed_charge": 240.53,
					"npi": [1447539820,1447879010,1982799466]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880059762"
			},
			"service_code": ["19", "22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 371.56,
					"npi": [1639128069]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25", "PO"],
				"providers":[{
					"billed_charge": 371.56,
					"npi": [1912301102]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880103557"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.76,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 239.00,
					"npi": [1174019764]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880120723"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 114.66,
				"providers":[{
					"billed_charge": 328.90,
					"npi": [1487624474]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880213397"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 101.06,
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1508740630]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880236758"
			},
			"service_code": ["11", "20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 196.58,
				"providers":[{
					"billed_charge": 389.00,
					"npi": [1629041702]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 389.00,
					"npi": [1760837595]
				},{
					"billed_charge": 408.00,
					"npi": [1073547261,1205203585,1861079709]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880293149"
			},
			"service_code": ["50"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 161.87,
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1437787785]
				}]
			},{
				"allowed_amount": 149.30,
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1477794188,1720487598]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880323773"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1336156546]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880459017"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1407599871,1720895246]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1407599871]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880479581"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 105.76,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 450.00,
					"npi": [1770977407]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "883530187"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 134.89,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 161.00,
					"npi": [1700174802]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "932988983"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 102.36,
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1568108025]
				}]
			},{
				"allowed_amount": 136.86,
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1568108025]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "941156581"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 388.00,
					"npi": [1720009160]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943281657"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 152.35,
				"providers":[{
					"billed_charge": 594.00,
					"npi": [1134155898]
				}]
			},{
				"allowed_amount": 594.00,
				"billing_code_modifier": ["GT", "GC"],
				"providers":[{
					"billed_charge": 594.00,
					"npi": [1366784274]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "943281660"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 124.42,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 594.00,
					"npi": [1295822393]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "946036494"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 309.88,
					"npi": [1710918545]
				}]
			}]
		}]
	},{
		"name": "PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2026",
		"billing_code": "99204",
		"description": "Office/Outpatient New Moderate Mdm 45 Minutes",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "208488778"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 158.11,
				"billing_code_modifier": ["GC"],
				"providers":[{
					"billed_charge": 493.00,
					"npi": [1730405176]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "362193608"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 115.29,
				"providers":[{
					"billed_charge": 640.48,
					"npi": [1497745772]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "453984319"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 121.80,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 350.00,
					"npi": [1992720916]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454298417"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 575.00,
					"npi": [1114796992]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "460224743"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 308.97,
				"providers":[{
					"billed_charge": 401.00,
					"npi": [1972131712]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "463370553"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 162.00,
				"providers":[{
					"billed_charge": 246.09,
					"npi": [ ]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "471497384"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 292.39,
				"providers":[{
					"billed_charge": 417.70,
					"npi": [1467807750]
				}]
			},{
				"allowed_amount": 405.67,
				"providers":[{
					"billed_charge": 507.09,
					"npi": [1326450123,1912401845]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475349604"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 325.16,
				"providers":[{
					"billed_charge": 434.00,
					"npi": [1891762142]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 434.00,
					"npi": [1891762142]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "630825248"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 128.08,
				"providers":[{
					"billed_charge": 262.00,
					"npi": [1891102703]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "680273974"
			},
			"service_code": ["20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 574.00,
				"providers":[{
					"billed_charge": 574.00,
					"npi": [1316902000]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "811366784"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 534.08,
				"providers":[{
					"billed_charge": 562.19,
					"npi": [1558781674]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "813574137"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 845.00,
					"npi": [1700934825]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880103557"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 137.82,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 317.00,
					"npi": [1174019764]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880236758"
			},
			"service_code": ["11", "20"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 256.18,
				"providers":[{
					"billed_charge": 506.00,
					"npi": [1578121042,1861969214]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "880459017"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 230.00,
					"npi": [1407599871]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "932988983"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 178.35,
				"providers":[{
					"billed_charge": 220.00,
					"npi": [1568108025]
				}]
			}]
		}]
	}]
}
