{"reporting_entity_name":"Community Health Choice, Inc","reporting_entity_type":"Group Health Plan","plan_name":"Community Premier Silver Marketplace","plan_id_type":"HIOS","plan_id":"PEPGM0000000041","plan_market_type":"Individual","last_updated_on":"2026-07-14","out_of_network":[{"name":"THER/PROPH/DIAG INJ SC/IM","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96372","description":"THER/PROPH/DIAG INJ SC/IM","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":18.62,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":140.63,"providers":[{"billed_charge":126.57,"npi":[1679976120]},{"billed_charge":70.32,"npi":[1679976120]},{"billed_charge":105.47,"npi":[1679976120]}]},{"allowed_amount":421.88,"providers":[{"billed_charge":421.88,"npi":[1679976120]}]}]}]},{"name":"EMERGENCY DEPT VISIT MOD MDM","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99284","description":"EMERGENCY DEPT VISIT MOD MDM","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":1567.01,"providers":[{"billed_charge":1567.01,"npi":[1679976120]}]},{"allowed_amount":395.01,"providers":[{"billed_charge":395.01,"npi":[1679976120]}]},{"allowed_amount":896.2,"providers":[{"billed_charge":896.2,"npi":[1679976120]}]},{"allowed_amount":273.09,"providers":[{"billed_charge":273.09,"npi":[1679976120]}]},{"allowed_amount":609.74,"providers":[{"billed_charge":609.74,"npi":[1679976120]}]},{"allowed_amount":159.58,"providers":[{"billed_charge":143.62,"npi":[1679976120]}]},{"allowed_amount":750.71,"providers":[{"billed_charge":750.71,"npi":[1679976120]}]},{"allowed_amount":708.82,"providers":[{"billed_charge":708.82,"npi":[1679976120]}]},{"allowed_amount":1827.67,"providers":[{"billed_charge":1827.67,"npi":[1679976120]}]},{"allowed_amount":703.8,"providers":[{"billed_charge":703.8,"npi":[1679976120]}]},{"allowed_amount":1102.75,"providers":[{"billed_charge":1102.75,"npi":[1679976120]}]},{"allowed_amount":1875.67,"providers":[{"billed_charge":1875.67,"npi":[1679976120]}]},{"allowed_amount":1441.65,"providers":[{"billed_charge":1441.65,"npi":[1679976120]}]},{"allowed_amount":2195.13,"providers":[{"billed_charge":2195.13,"npi":[1679976120]}]},{"allowed_amount":1889.46,"providers":[{"billed_charge":1889.46,"npi":[1679976120]}]},{"allowed_amount":1723.84,"providers":[{"billed_charge":1723.84,"npi":[1679976120]}]},{"allowed_amount":1960.41,"providers":[{"billed_charge":1960.41,"npi":[1679976120]}]},{"allowed_amount":1285.88,"providers":[{"billed_charge":1157.29,"npi":[1679976120]},{"billed_charge":964.41,"npi":[1679976120]},{"billed_charge":642.94,"npi":[1679976120]},{"billed_charge":603.22,"npi":[1679976120]}]},{"allowed_amount":1569.82,"providers":[{"billed_charge":1569.82,"npi":[1679976120]}]},{"allowed_amount":3737.48,"providers":[{"billed_charge":3737.48,"npi":[1679976120]}]},{"allowed_amount":1569.16,"providers":[{"billed_charge":1569.16,"npi":[1679976120]}]},{"allowed_amount":1952.85,"providers":[{"billed_charge":1952.85,"npi":[1679976120]}]}]},{"tin":{"type":"ein","value":"383813467"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":835.73,"providers":[{"billed_charge":835.73,"npi":[1497053912]}]},{"allowed_amount":1195.46,"providers":[{"billed_charge":1195.46,"npi":[1497053912]}]},{"allowed_amount":840,"providers":[{"billed_charge":286.26,"npi":[1497053912]},{"billed_charge":433.69,"npi":[1497053912]},{"billed_charge":204,"npi":[1497053912]},{"billed_charge":504,"npi":[1497053912]},{"billed_charge":409.72,"npi":[1497053912]},{"billed_charge":756,"npi":[1497053912]},{"billed_charge":98,"npi":[1497053912]},{"billed_charge":840,"npi":[1497053912]},{"billed_charge":630,"npi":[1497053912]}]},{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1497053912]}]},{"allowed_amount":1196.25,"providers":[{"billed_charge":1196.25,"npi":[1497053912]}]},{"allowed_amount":1345.08,"providers":[{"billed_charge":1345.08,"npi":[1497053912]}]},{"allowed_amount":1025.97,"providers":[{"billed_charge":1025.97,"npi":[1497053912]}]},{"allowed_amount":1426.59,"providers":[{"billed_charge":1426.59,"npi":[1497053912]}]},{"allowed_amount":1137.18,"providers":[{"billed_charge":1137.18,"npi":[1497053912]}]},{"allowed_amount":1355.97,"providers":[{"billed_charge":1355.97,"npi":[1497053912]}]},{"allowed_amount":924,"providers":[{"billed_charge":924,"npi":[1497053912]}]},{"allowed_amount":1337.16,"providers":[{"billed_charge":1337.16,"npi":[1497053912]}]},{"allowed_amount":5063.19,"providers":[{"billed_charge":5063.19,"npi":[1497053912]}]},{"allowed_amount":1172.49,"providers":[{"billed_charge":1172.49,"npi":[1497053912]}]}]},{"tin":{"type":"ein","value":"742501542"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":111.36,"providers":[{"billed_charge":14.63,"npi":[1760409353]}]},{"allowed_amount":127.66,"providers":[{"billed_charge":127.66,"npi":[1952551145,1114415619,1366683393,1720020373,1548480858,1124448097,1730506007,1255317525,1730324054,1346620598,1164665287,1730321860,1639630031,1245971928,1679841720]}]},{"allowed_amount":108.51,"providers":[{"billed_charge":108.51,"npi":[1881070563,1558873349,1588236475]}]},{"allowed_amount":102.47,"providers":[{"billed_charge":102.47,"npi":[1508331422,1780179606]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1255317525,1952551145,1548609365,1336768589,1871579276,1144640418,1366962193,1760019186,1821060369,1720020373,1134700578,1952697658,1710950696,1164536884,1801390679,1952977753,1275513426,1689839136,1881083798,1356453641,1457571804,1215676267,1235690496,1124448097,1114415619,1043274756,1578761243,1194286401,1780211565,1366007916,1245255694,1861607962,1629719281,1730321860,1306061262,1952807729,1033162672,1477086676,1437596723,1316248594,1053990481,1528695384,1154402188,1952982142,1801424353,1164046744,1225693963,1710090329]},{"billed_charge":0,"npi":[1801424353,1336713932]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":120.55,"npi":[1801871538,1124523121,1306157334,1780181511]},{"billed_charge":0,"npi":[1124523121,1326360223]}]},{"allowed_amount":132.02,"providers":[{"billed_charge":132.02,"npi":[1215676267]}]},{"allowed_amount":103.97,"providers":[{"billed_charge":103.97,"npi":[1013334119]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1225118623,1245596337,1619504909,1154902757,1124412267,1124477948,1275569469,1801871538,1124373790,1285376814,1780181511,1609980317,1790899953,1467895086]},{"billed_charge":0,"npi":[1073755773,1326360223]}]},{"allowed_amount":110.01,"providers":[{"billed_charge":110.01,"npi":[1235694597,1770897191,1437768520,1336884014,1952878811,1477502417,1649886995,1366961724,1760199467,1013406503,1518499672,1255673307,1053818831]}]},{"allowed_amount":103.83,"providers":[{"billed_charge":103.83,"npi":[1548798556,1063922813,1508331422,1447748504,1316330400,1760736664,1750825741]}]},{"allowed_amount":123.86,"providers":[{"billed_charge":123.86,"npi":[1154902757]}]},{"allowed_amount":122.77,"providers":[{"billed_charge":122.77,"npi":[1669630067]}]},{"allowed_amount":103.86,"providers":[{"billed_charge":103.86,"npi":[1134638943]}]}]},{"tin":{"type":"ein","value":"474649080"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":551.97,"providers":[{"billed_charge":551.97,"npi":[1902064702]}]},{"allowed_amount":561.39,"providers":[{"billed_charge":561.39,"npi":[1659475796,1629274386]}]},{"allowed_amount":115.69,"providers":[{"billed_charge":115.69,"npi":[1659528594,1114903390]}]},{"allowed_amount":116.69,"providers":[{"billed_charge":116.69,"npi":[1679746473,1114903390,1629274386,1659475796,1356549992,1659528594,1043296692,1902064702,1255311569]}]}]},{"tin":{"type":"ein","value":"270316031"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":122.15,"providers":[{"billed_charge":122.15,"npi":[1679077267,1669437141,1801185210,1497764609]},{"billed_charge":0,"npi":[1659582161,1568756765]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1457324972,1316056542,1861472029,1114205705,1891964318,1689171811,1245216878,1225376072,1740579721,1942565825]},{"billed_charge":0,"npi":[1942565825]}]},{"allowed_amount":122.7,"providers":[{"billed_charge":122.7,"npi":[1346400538,1497764609,1447447875,1073953337,1801185210,1407857725,1568756765]}]},{"allowed_amount":122.07,"providers":[{"billed_charge":0,"npi":[1831393271]},{"billed_charge":122.07,"npi":[1831393271]}]},{"allowed_amount":123.21,"providers":[{"billed_charge":123.21,"npi":[1306258728]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1245310655]}]}]},{"tin":{"type":"ein","value":"472003367"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":302.92,"providers":[{"billed_charge":302.92,"npi":[1922275627]}]},{"allowed_amount":302.48,"providers":[{"billed_charge":302.48,"npi":[1194765263,1033444245,1801910658]}]},{"allowed_amount":349.43,"providers":[{"billed_charge":349.43,"npi":[1922275627,1245508415,1144296237,1902249576,1801910658,1265579882]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":0,"npi":[1265579882]},{"billed_charge":129.42,"npi":[1144296237,1902249576,1801910658,1265579882,1194765263,1982698395,1245508415,1578636270,1629274386,1033444245,1942270772,1922275627]}]}]},{"tin":{"type":"ein","value":"814584169"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":1748.65,"providers":[{"billed_charge":1748.65,"npi":[1376064295]}]},{"allowed_amount":1386,"providers":[{"billed_charge":1386,"npi":[1376064295]}]},{"allowed_amount":3556.14,"providers":[{"billed_charge":3556.14,"npi":[1376064295]}]},{"allowed_amount":5255.91,"providers":[{"billed_charge":5255.91,"npi":[1376064295]}]},{"allowed_amount":1140,"providers":[{"billed_charge":1026,"npi":[1376064295]}]},{"allowed_amount":1665.88,"providers":[{"billed_charge":1665.88,"npi":[1376064295]}]},{"allowed_amount":5633.06,"providers":[{"billed_charge":5633.06,"npi":[1376064295]}]},{"allowed_amount":1829.51,"providers":[{"billed_charge":1829.51,"npi":[1376064295]},{"billed_charge":1646.56,"npi":[1376064295]},{"billed_charge":1372.13,"npi":[1376064295]}]},{"allowed_amount":8606.02,"providers":[{"billed_charge":8606.02,"npi":[1376064295]}]},{"allowed_amount":3316.25,"providers":[{"billed_charge":3316.25,"npi":[1376064295]}]},{"allowed_amount":4965.87,"providers":[{"billed_charge":4965.87,"npi":[1376064295]}]},{"allowed_amount":2012.46,"providers":[{"billed_charge":2012.46,"npi":[1376064295]}]},{"allowed_amount":2144.46,"providers":[{"billed_charge":2144.46,"npi":[1376064295]}]}]},{"tin":{"type":"ein","value":"852464463"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":1931.39,"providers":[{"billed_charge":1931.39,"npi":[1851321582]}]},{"allowed_amount":607.49,"providers":[{"billed_charge":607.49,"npi":[1144473570]}]},{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1144473570,1124068416]}]},{"allowed_amount":1168.06,"providers":[{"billed_charge":1168.06,"npi":[1144473570]}]},{"allowed_amount":1844.77,"providers":[{"billed_charge":1844.77,"npi":[1669727053]}]},{"allowed_amount":548.44,"providers":[{"billed_charge":548.44,"npi":[1700171014,1699102848,1235459769,1821343963]}]},{"allowed_amount":1931.4,"providers":[{"billed_charge":1931.4,"npi":[1730453739,1700171014,1144473570]}]},{"allowed_amount":2232.98,"providers":[{"billed_charge":2232.98,"npi":[1619122017]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":120.55,"npi":[1619122017,1982877387,1396840740,1073545588,1538421557]}]},{"allowed_amount":1672.25,"providers":[{"billed_charge":1672.25,"npi":[1124068416]}]},{"allowed_amount":547.66,"providers":[{"billed_charge":547.66,"npi":[1932395514,1235459769,1659755122,1700171014,1982877387,1851321582,1144473570,1396840740,1073545588,1538421557,1992764419,1710919618]}]},{"allowed_amount":3381.77,"providers":[{"billed_charge":3381.77,"npi":[1629418025]}]},{"allowed_amount":1745.15,"providers":[{"billed_charge":1745.15,"npi":[1932395514]}]},{"allowed_amount":582.22,"providers":[{"billed_charge":582.22,"npi":[1922208776]}]},{"allowed_amount":127.66,"providers":[{"billed_charge":127.66,"npi":[1700171014,1144473570,1992764419]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1144473570,1922595727,1992764419]}]},{"allowed_amount":786.47,"providers":[{"billed_charge":786.47,"npi":[1144473570]}]},{"allowed_amount":122.77,"providers":[{"billed_charge":122.77,"npi":[1710919618]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1619122017,1972751360,1396840740,1982877387,1093837445]}]}]},{"tin":{"type":"ein","value":"470988714"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":548.44,"providers":[{"billed_charge":548.44,"npi":[1437387263]}]},{"allowed_amount":547.66,"providers":[{"billed_charge":547.66,"npi":[1669412243,1952750127]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":120.55,"npi":[1669412243,1952750127]}]},{"allowed_amount":132.6,"providers":[{"billed_charge":132.6,"npi":[1952750127]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1982683108,1669412243]}]},{"allowed_amount":134.38,"providers":[{"billed_charge":134.38,"npi":[1982683108,1669412243]}]}]},{"tin":{"type":"ein","value":"882501936"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":1755.4,"providers":[{"billed_charge":1755.4,"npi":[1750013769]}]},{"allowed_amount":3431.55,"providers":[{"billed_charge":3431.55,"npi":[1750013769]}]},{"allowed_amount":3536.16,"providers":[{"billed_charge":3536.16,"npi":[1750013769]}]},{"allowed_amount":1734.47,"providers":[{"billed_charge":1734.47,"npi":[1750013769]}]},{"allowed_amount":1746.2,"providers":[{"billed_charge":1746.2,"npi":[1750013769]}]},{"allowed_amount":2453.87,"providers":[{"billed_charge":2453.87,"npi":[1750013769]}]},{"allowed_amount":4692.81,"providers":[{"billed_charge":4692.81,"npi":[1750013769]}]},{"allowed_amount":1300.32,"providers":[{"billed_charge":1170.29,"npi":[1750013769]},{"billed_charge":1300.32,"npi":[1750013769]}]},{"allowed_amount":2099.86,"providers":[{"billed_charge":2099.86,"npi":[1750013769]}]},{"allowed_amount":2658.13,"providers":[{"billed_charge":2658.13,"npi":[1750013769]}]},{"allowed_amount":1573.48,"providers":[{"billed_charge":1573.48,"npi":[1750013769]}]},{"allowed_amount":4496.34,"providers":[{"billed_charge":4496.34,"npi":[1750013769]}]},{"allowed_amount":2748.36,"providers":[{"billed_charge":2748.36,"npi":[1750013769]}]},{"allowed_amount":1783.52,"providers":[{"billed_charge":1783.52,"npi":[1750013769]}]},{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1750013769]}]},{"allowed_amount":2306.06,"providers":[{"billed_charge":2306.06,"npi":[1750013769]}]}]},{"tin":{"type":"ein","value":"852713042"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":1657.48,"providers":[{"billed_charge":1657.48,"npi":[1376141556]}]},{"allowed_amount":1573.48,"providers":[{"billed_charge":1573.48,"npi":[1376141556]}]},{"allowed_amount":5275.6,"providers":[{"billed_charge":5275.6,"npi":[1376141556]}]},{"allowed_amount":1300.32,"providers":[{"billed_charge":1170.29,"npi":[1376141556]},{"billed_charge":975.24,"npi":[1376141556]},{"billed_charge":494.8,"npi":[1376141556]}]},{"allowed_amount":2332.96,"providers":[{"billed_charge":2332.96,"npi":[1376141556]}]},{"allowed_amount":2075.92,"providers":[{"billed_charge":2075.92,"npi":[1376141556]}]},{"allowed_amount":6227.76,"providers":[{"billed_charge":6227.76,"npi":[1376141556]}]},{"allowed_amount":1608.66,"providers":[{"billed_charge":1608.66,"npi":[1376141556]}]},{"allowed_amount":2561.94,"providers":[{"billed_charge":2561.94,"npi":[1376141556]}]},{"allowed_amount":4681.08,"providers":[{"billed_charge":4681.08,"npi":[1376141556]}]},{"allowed_amount":1732.63,"providers":[{"billed_charge":1732.63,"npi":[1376141556]}]},{"allowed_amount":3331.15,"providers":[{"billed_charge":3331.15,"npi":[1376141556]}]},{"allowed_amount":6263.36,"providers":[{"billed_charge":6263.36,"npi":[1376141556]}]},{"allowed_amount":1577.77,"providers":[{"billed_charge":1577.77,"npi":[1376141556]}]},{"allowed_amount":4801.7,"providers":[{"billed_charge":4801.7,"npi":[1376141556]}]},{"allowed_amount":6207.09,"providers":[{"billed_charge":6207.09,"npi":[1376141556]}]},{"allowed_amount":1824.35,"providers":[{"billed_charge":1824.35,"npi":[1376141556]}]}]},{"tin":{"type":"ein","value":"883048479"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":134.37,"providers":[{"billed_charge":134.37,"npi":[1740474337]}]},{"allowed_amount":152.46,"providers":[{"billed_charge":152.46,"npi":[1346487915]}]},{"allowed_amount":607.03,"providers":[{"billed_charge":607.03,"npi":[1740474337]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":120.55,"npi":[1710090329]}]},{"allowed_amount":132.6,"providers":[{"billed_charge":132.6,"npi":[1710090329]}]},{"allowed_amount":127.66,"providers":[{"billed_charge":127.66,"npi":[1265627186,1063767382,1265579882]}]},{"allowed_amount":140.43,"providers":[{"billed_charge":140.43,"npi":[1265627186,1063767382,1265579882]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1467895656,1538102660,1902089709,1265627186]}]},{"allowed_amount":142.36,"providers":[{"billed_charge":142.36,"npi":[1467895656,1538102660]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1972583110]}]},{"allowed_amount":122.7,"providers":[{"billed_charge":122.7,"npi":[1740474337]}]}]},{"tin":{"type":"ein","value":"760631448"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":547.66,"providers":[{"billed_charge":547.66,"npi":[1932238821,1770719049,1689777286,1780789131]}]},{"allowed_amount":120.55,"providers":[{"billed_charge":120.55,"npi":[1770719049,1689777286,1780789131]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1770719049,1780789131,1124281456,1871583500,1619148715]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1649382979]}]},{"allowed_amount":569.1,"providers":[{"billed_charge":569.1,"npi":[1124281456]}]}]},{"tin":{"type":"ein","value":"463902289"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":127.66,"providers":[{"billed_charge":127.66,"npi":[1285924142,1083907166,1982862496,1619989415,1255386256,1841441334,1518100064]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1558393520,1255386256,1962723288,1518988393,1083850176,1689608432,1023405677,1326465246,1952721250,1790075943,1144588724,1275997298,1205152220,1215137559,1487888939,1144488685,1952798126,1831517424]}]}]},{"tin":{"type":"ein","value":"841832545"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":103.43,"providers":[{"billed_charge":103.43,"npi":[1215308143]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1346684057,1336721885,1851034292,1467023515,1982838587,1326667205,1003486390,1205871803,1780823682,1184252942]},{"billed_charge":0,"npi":[1851746630]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1386828655,1669902888,1255561437,1780944272]}]},{"allowed_amount":103.83,"providers":[{"billed_charge":103.83,"npi":[1417550773,1528563848,1548138977,1164771002,1164996492]}]},{"allowed_amount":122.07,"providers":[{"billed_charge":122.07,"npi":[1851032205,1043296692]}]}]},{"tin":{"type":"ein","value":"922417967"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":127.66,"providers":[{"billed_charge":127.66,"npi":[1346225018,1245382209,1366857278,1952728156,1619555323,1063691574,1467914796,1619110988]}]},{"allowed_amount":108.51,"providers":[{"billed_charge":108.51,"npi":[1295361624]}]},{"allowed_amount":102.47,"providers":[{"billed_charge":102.47,"npi":[1134146699,1568997666]}]},{"allowed_amount":129.42,"providers":[{"billed_charge":129.42,"npi":[1790963585,1245382209,1881826311,1821451568,1851913669,1578022778,1508094988,1730676586,1821415910,1205199379,1316923808,1518607548,1801097241,1952861759,1295705093,1912951435,1194812669,1982090890,1609372762,1386087815,1003219155,1588674097,1609262542,1942836077,1366857278,1619236445,1548521891,1003886243,1164657821]}]},{"allowed_amount":110.01,"providers":[{"billed_charge":110.01,"npi":[1578221917,1992557177,1518402056,1619772605,1538521133,1780346320,1477319192,1205535960,1033959861,1225618457]},{"billed_charge":0,"npi":[1740800788,1821535261]}]},{"allowed_amount":103.83,"providers":[{"billed_charge":103.83,"npi":[1407574080,1093472524,1013526904,1386251478,1568997666]}]},{"allowed_amount":130.07,"providers":[{"billed_charge":130.07,"npi":[1174812978]}]},{"allowed_amount":122.16,"providers":[{"billed_charge":122.16,"npi":[1316948003]}]}]}]},{"name":"ELECTROLYTE PANEL","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80051","description":"ELECTROLYTE PANEL","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":9.11,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":9.11,"npi":[1679976120]}]}]}]},{"name":"ASSAY OF CK (CPK)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82550","description":"ASSAY OF CK (CPK)","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":8.46,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":8.46,"npi":[1679976120]}]}]},{"tin":{"type":"ein","value":"371520288"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":6.84,"providers":[{"billed_charge":6.84,"npi":[1356501290,1033376181,1043268576,1730398652,1306827381]},{"billed_charge":0,"npi":[1033376181]}]},{"allowed_amount":13.67,"providers":[{"billed_charge":13.67,"npi":[1033376181]}]}]}]},{"name":"ASSAY OF CREATININE","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82565","description":"ASSAY OF CREATININE","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":6.66,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":6.66,"npi":[1679976120]}]}]},{"tin":{"type":"ein","value":"371520288"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":5.38,"providers":[{"billed_charge":5.38,"npi":[1184876518,1770804627]}]}]}]},{"name":"ASSAY GLUCOSE BLOOD QUANT","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82947","description":"ASSAY GLUCOSE BLOOD QUANT","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":5.11,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":3.83,"npi":[1679976120]},{"billed_charge":5.11,"npi":[1679976120]},{"billed_charge":4.6,"npi":[1679976120]},{"billed_charge":3.58,"npi":[1679976120]}]},{"allowed_amount":10.22,"providers":[{"billed_charge":10.22,"npi":[1679976120]}]}]}]},{"name":"ASSAY OF UREA NITROGEN","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84520","description":"ASSAY OF UREA NITROGEN","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":5.14,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":5.14,"npi":[1679976120]}]}]}]},{"name":"COMPLETE CBC W/AUTO DIFF WBC","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"COMPLETE CBC W/AUTO DIFF WBC","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":10.1,"providers":[{"billed_charge":0,"npi":[1679976120]},{"billed_charge":10.1,"npi":[1679976120]}]}]},{"tin":{"type":"ein","value":"371520288"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":8.16,"providers":[{"billed_charge":8.16,"npi":[1538117007,1730398652,1033376181,1306827381,1356501290,1770804627,1184876518,1043268576,1548656101]},{"billed_charge":0,"npi":[1033376181,1538117007,1184876518,1356501290,1730398652,1043268576]}]},{"allowed_amount":16.32,"providers":[{"billed_charge":16.32,"npi":[1033376181,1730398652,1043268576,1184876518,1306827381,1356501290,1770804627]},{"billed_charge":0,"npi":[1033376181]}]},{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1033376181]}]}]},{"tin":{"type":"ein","value":"760545192"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":0,"providers":[{"billed_charge":0,"npi":[1629828405]}]},{"allowed_amount":10.1,"providers":[{"billed_charge":7.58,"npi":[1629828405]}]}]},{"tin":{"type":"ein","value":"760421006"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":8.16,"providers":[{"billed_charge":8.16,"npi":[1346207214,1649358789,1760648349]}]}]}]},{"name":"EMERGENCY DEPT VISIT HI MDM","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99285","description":"EMERGENCY DEPT VISIT HI MDM","allowed_amounts":[{"tin":{"type":"ein","value":"464901030"},"billing_class":"INSTITUTIONAL","payments":[{"allowed_amount":4200.87,"providers":[{"billed_charge":4200.87,"npi":[1679976120]}]},{"allowed_amount":2429.94,"providers":[{"billed_charge":2429.94,"npi":[1679976120]}]},{"allowed_amount":231.19,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":1827.67,"providers":[{"billed_charge":1827.67,"npi":[1679976120]}]},{"allowed_amount":231.14,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":1953.63,"providers":[{"billed_charge":1953.63,"npi":[1679976120]}]},{"allowed_amount":1740.4,"providers":[{"billed_charge":1740.4,"npi":[1679976120]}]},{"allowed_amount":2084.51,"providers":[{"billed_charge":2084.51,"npi":[1679976120]}]},{"allowed_amount":3575.22,"providers":[{"billed_charge":3575.22,"npi":[1679976120]}]},{"allowed_amount":1178.55,"providers":[{"billed_charge":0,"npi":[1679976120]}]},{"allowed_amount":3055.1,"providers":[{"billed_charge":3055.1,"npi":[1679976120]}]},{"allowed_amount":1601.63,"providers":[{"billed_charge":1201.22,"npi":[1679976120]},{"billed_charge":1215.46,"npi":[1679976120]},{"billed_charge":1441.47,"npi":[1679976120]},{"billed_charge":1121.14,"npi":[1679976120]},{"billed_charge":861.74,"npi":[1679976120]},{"billed_charge":1601.63,"npi":[1679976120]},{"billed_charge":960.98,"npi":[1679976120]}]},{"allowed_amount":6234.18,"providers":[{"billed_charge":6234.18,"npi":[1679976120]}]},{"allowed_amount":4018.63,"providers":[{"billed_charge":4018.63,"npi":[1679976120]}]},{"allowed_amount":4037.21,"providers":[{"billed_charge":4037.21,"npi":[1679976120]}]},{"allowed_amount":3954.08,"providers":[{"billed_charge":3954.08,"npi":[1679976120]}]},{"allowed_amount":2700.57,"providers":[{"billed_charge":2700.57,"npi":[1679976120]}]},{"allowed_amount":5106.04,"providers":[{"billed_charge":5106.04,"npi":[1679976120]}]},{"allowed_amount":2763.19,"providers":[{"billed_charge":2763.19,"npi":[1679976120]}]},{"allowed_amount":3431.59,"providers":[{"billed_charge":3431.59,"npi":[1679976120]}]},{"allowed_amount":4248.76,"providers":[{"billed_charge":4248.76,"npi":[1679976120]}]},{"allowed_amount":7967.45,"providers":[{"billed_charge":7967.45,"npi":[1679976120]}]}]},{"tin":{"type":"ein","value":"742501542"},"billing_class":"PROFESSIONAL","payments":[{"allowed_amount":185.25,"providers":[{"billed_charge":185.25,"npi":[1548480858,1134485808,1952807729,1629719281,1245971928,1730324054,1306061262,1174268205,1164046744,1518166404,1679149066,1255907598,1952977753,1245255694,1952551145,1396080305,1669904389,1346620598,1861070583,1801424353,1992369763,1619397742,1770160798,1346821741,1114415619,1134700578,1952697658,1154402188,1528695384,1316680333,1043274756,1871579276,1760019186,1164536884,1295091072,1417537176,1659469708,1619387396,1023351756,1356453641,1114956463,1336768589,1225693963,1992016885,1528599578,1295399533,1538722913,1245499235,1366007916]},{"billed_charge":0,"npi":[1548609365,1205812955,1952982142,1467983890,1720020373,1164046744,1952977753,1376701904,1306061262]}]},{"allowed_amount":174.86,"providers":[{"billed_charge":174.86,"npi":[1942627575,1093212896,1306157334,1669630067,1053368878,1376837021,1275726077,1124477948,1619504909,1952839086,1124523121,1801871538,1639811847,1225118623,1326360223,1043354269,1124412267,1780181511,1851318471]}]},{"allowed_amount":148.63,"providers":[{"billed_charge":148.63,"npi":[1245654821,1497331516,1558526350,1316330400,1508331422]}]},{"allowed_amount":157.47,"providers":[{"billed_charge":157.47,"npi":[1720591159,1982093183,1043605017,1740678036,1013406503,1598825424,1518499672,1437637386]}]},{"allowed_amount":177.27,"providers":[{"billed_charge":177.27,"npi":[1154902757,1639811847]}]},{"allowed_amount":178.01,"providers":[{"billed_charge":178.01,"npi":[1124523121]}]},{"allowed_amount":187.2,"providers":[{"billed_charge":187.2,"npi":[1154402188,1952807729,1255907598,1659469708,1619387396,1356453641,1134700578,1336768589,1760019186,1215676267,1124448097,1871579276,1144617960,1295399533,1538722913,1730324054,1184202376,1821363136,1457571804,1114956463,1295091072,1518166404,1174268205,1144640418,1275513426,1902225956,1033162672,1770772832,1538485784,1316680333,1659875938,1245255694,1114415619,1023377165,1285212373,1306061262,1154694529,1376701904,1902164163,1013477553,1518319318,1134485808,1699065300,1952982142,1437596723,1548609365,1396080305,1689839136,1528599578,1649756800,1124373519,1164046744,1366007916,1871947143,1770163628,1679841720,1508002312,1558387407,1063593002,1396109609,1720020373,1366962193,1548656481,1730321860,1427685726,1629719281,1225693963,1285139055,1467983890,1821060369,1639630031,1669904389,1336713932,1992016885,1528695384,1861607962,1558658195,1811526270,1063091700,1619397742,1245971928,1114423225,1518349133,1851582464,1477086676,1164536884,1831503168,1174152433,1881083798,1336433440,1992369763,1952977753,1861070583,1164927422]},{"billed_charge":0,"npi":[1952982142,1144640418,1114423225,1952862740,1174152433,1659875938]}]},{"allowed_amount":177.11,"providers":[{"billed_charge":177.11,"npi":[1801871538,1225118623,1326360223,1093976342,1124412267,1306157334,1275726077,1780181511,1073755773,1790899953,1093212896,1871869537,1942627575,1063677490,1952839086,1619504909,1376837021,1245596337,1053368878,1376660118,1851318471,1124373790,1811921000,1417452897,1043354269,1215296017,1790149649,1124523121,1669630067,1154902757,1316575285,1275569469,1922008101]}]},{"allowed_amount":159.13,"providers":[{"billed_charge":159.13,"npi":[1437637386,1043605017,1336884014,1518499672,1952878811,1760199467,1922886654,1013406503,1205067048,1427685932,1376004317,1073967253,1053818831,1740678036,1588236475,1083349724,1316594815,1922551753,1891156550,1760409353,1174215552,1235694597,1649677212,1871898320,1720591159]},{"billed_charge":0,"npi":[1992254809,1598303554,1487288767]}]},{"allowed_amount":150.55,"providers":[{"billed_charge":150.55,"npi":[1508331422,1558526350,1760736664,1194003145,1629307806,1245654821,1063922813,1043237506,1912558917,1548798556,1053540187,1750825741,1174550370,1780179606]},{"billed_charge":0,"npi":[1750825741]}]},{"allowed_amount":179.6,"providers":[{"billed_charge":179.6,"npi":[1154902757,1639811847]},{"billed_charge":162.53,"npi":[1154902757]}]},{"allowed_amount":188.14,"providers":[{"billed_charge":188.14,"npi":[1225693963,1811526270,1346534534,1669904389,1831503168]}]},{"allowed_amount":159.92,"providers":[{"billed_charge":159.92,"npi":[1770966384,1982093183,1174215552]}]}]},{"tin":{"type":"ein","value":"463902289"},"billing_class":"PRO