{"reporting_entity_name": "Samaritan Health Plans","reporting_entity_type": "Samaritan Health Plans","last_updated_on": "2026-04-16","version": "1.0.0","out_of_network":[{"name":"Albumin; Urine, Microalbumin, Quantitative","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82043","description":"Albumin; Urine, Microalbumin, Quantitative","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":9.00,"providers":[{"billed_charge":15.00,"npi":[1770582371]}]}]}]},{"name":"Anesthesia","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0370","description":"Anesthesia","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":1904.00,"providers":[{"billed_charge":2240.00,"npi":[1477874337]}]}]}]},{"name":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85027","description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)","allowed_amounts":[{"tin":{"type":"ein","value":"621802294"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":5.82,"providers":[{"billed_charge":36.00,"npi":[1548370745]}]}]}]},{"name":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":8.94,"providers":[{"billed_charge":22.00,"npi":[1659769222]}]},{"allowed_amount":9.00,"providers":[{"billed_charge":22.00,"npi":[1770582371]}]}]}]},{"name":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"85025","description":"Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":55.12,"providers":[{"billed_charge":448.00,"npi":[1538163886]}]}]}]},{"name":"Blood test, lipids (cholesterol and triglycerides)","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80061","description":"Blood test, lipids (cholesterol and triglycerides)","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12.00,"providers":[{"billed_charge":30.00,"npi":[1770582371]}]}]}]},{"name":"Body Mass Index (BMI), documented (PV)1","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3008F","description":"Body Mass Index (BMI), documented (PV)1","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1023251386]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":35.22,"providers":[{"billed_charge":41.44,"npi":[1477874337]}]}]}]},{"name":"Collection, Venous Blood, Venipuncture","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"36415","description":"Collection, Venous Blood, Venipuncture","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":14.39,"providers":[{"billed_charge":117.00,"npi":[1538163886]}]}]}]},{"name":"Comprehensive Metabolic Panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"Comprehensive Metabolic Panel","allowed_amounts":[{"tin":{"type":"ein","value":"621802294"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":9.50,"providers":[{"billed_charge":48.00,"npi":[1548370745]}]}]}]},{"name":"Comprehensive Metabolic Panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"Comprehensive Metabolic Panel","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":12.14,"providers":[{"billed_charge":25.00,"npi":[1659769222]}]},{"allowed_amount":20.00,"providers":[{"billed_charge":25.00,"npi":[1770582371]}]}]}]},{"name":"Comprehensive Metabolic Panel","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"80053","description":"Comprehensive Metabolic Panel","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":131.15,"providers":[{"billed_charge":1066.00,"npi":[1538163886]}]}]}]},{"name":"Creatinine; Other Source","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"82570","description":"Creatinine; Other Source","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":5.05,"providers":[{"billed_charge":25.00,"npi":[1770582371]}]}]}]},{"name":"Diast BP 80-89 MM HG","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3079F","description":"Diast BP 80-89 MM HG","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1023251386]}]}]}]},{"name":"Diast BP 80-89 MM HG","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3079F","description":"Diast BP 80-89 MM HG","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1659769222]}]}]}]},{"name":"Diast BP < 80 MM HG","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3078F","description":"Diast BP < 80 MM HG","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1023251386]}]}]}]},{"name":"Diast BP < 80 MM HG","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3078F","description":"Diast BP < 80 MM HG","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1659769222,1770582371]}]}]}]},{"name":"Emergency Dept Visit, 3 Key Components: Detailed Hx; Detailed Exam; Med Decision Mod Complexity","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9928425","description":"Emergency Dept Visit, 3 Key Components: Detailed Hx; Detailed Exam; Med Decision Mod Complexity","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":512.93,"providers":[{"billed_charge":4169.00,"npi":[1538163886]}]}]}]},{"name":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","allowed_amounts":[{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.52,"providers":[{"billed_charge":263.00,"npi":[1508837394]}]}]}]},{"name":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":90.05,"providers":[{"billed_charge":177.81,"npi":[1023251386]}]},{"allowed_amount":90.53,"providers":[{"billed_charge":169.34,"npi":[1023251386]}]}]}]},{"name":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99213","description":"Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more","allowed_amounts":[{"tin":{"type":"ein","value":"994071536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.52,"providers":[{"billed_charge":150.00,"npi":[1083286306]}]}]}]},{"name":"Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","description":"Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":56.80,"providers":[{"billed_charge":105.22,"npi":[1023251386]}]}]}]},{"name":"Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99212","description":"Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more","allowed_amounts":[{"tin":{"type":"ein","value":"871240358"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":60.00,"providers":[{"billed_charge":75.00,"npi":[1083391890]}]}]}]},{"name":"Gonadotropin, chorionic (reproductive hormone) level","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84702","description":"Gonadotropin, chorionic (reproductive hormone) level","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":349.38,"providers":[{"billed_charge":411.04,"npi":[1477874337]}]}]}]},{"name":"Gonadotropin, chorionic (reproductive hormone) level","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"84702","description":"Gonadotropin, chorionic (reproductive hormone) level","allowed_amounts":[{"tin":{"type":"ein","value":"631154831"},"service_code":["22"],"billing_class":"professional","payments":[{"allowed_amount":21.20,"providers":[{"billed_charge":26.50,"npi":[1437125275]}]}]}]},{"name":"Injection of additional new drug or substance into vein","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96375","description":"Injection of additional new drug or substance into vein","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":61.02,"providers":[{"billed_charge":496.00,"npi":[1538163886]}]}]}]},{"name":"Medical\/Surgical Supplies and Devices - Sterile Supply","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0272","description":"Medical\/Surgical Supplies and Devices - Sterile Supply","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":45.70,"providers":[{"billed_charge":53.76,"npi":[1477874337]}]}]}]},{"name":"Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3074F","description":"Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1023251386]}]}]}]},{"name":"Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"3074F","description":"Most recent systolic blood pressure less than 130 mm Hg (DM) (HTN, CKD, CAD)","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1659769222,1770582371]}]}]}]},{"name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","allowed_amounts":[{"tin":{"type":"ein","value":"272026551"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":130.21,"providers":[{"billed_charge":164.00,"npi":[1407957129]}]}]}]},{"name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":127.04,"providers":[{"billed_charge":252.17,"npi":[1881675965]}]}]}]},{"name":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"99214","description":"Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and\/or examination and moderate le","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":51.00,"providers":[{"billed_charge":140.00,"npi":[1770582371]}]},{"allowed_amount":84.00,"providers":[{"billed_charge":140.00,"npi":[1659769222]}]}]}]},{"name":"Office\/Op Visit, Est Pt, 2 Key Components: Detailed Hx; Detailed Exam; Med Decision Mod Complexity","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921425","description":"Office\/Op Visit, Est Pt, 2 Key Components: Detailed Hx; Detailed Exam; Med Decision Mod Complexity","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":84.00,"providers":[{"billed_charge":140.00,"npi":[1659769222]}]}]}]},{"name":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921325","description":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","allowed_amounts":[{"tin":{"type":"ein","value":"391351587"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":69.52,"providers":[{"billed_charge":263.00,"npi":[1508837394]}]}]}]},{"name":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9921395","description":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","allowed_amounts":[{"tin":{"type":"ein","value":"862568333"},"service_code":["02"],"billing_class":"professional","payments":[{"allowed_amount":61.28,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]},{"allowed_amount":63.82,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]},{"allowed_amount":72.07,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]}]}]},{"name":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"99213GT","description":"Office\/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complex","allowed_amounts":[{"tin":{"type":"ein","value":"862568333"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":61.28,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]},{"allowed_amount":72.07,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]},{"allowed_amount":87.57,"providers":[{"billed_charge":200.00,"npi":[1053541581]}]}]}]},{"name":"Office\/Op Visit, New Pt, 3 Key Components: Detailed Hx; Detailed Exam; Med Decision Low Complexity","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"9920325","description":"Office\/Op Visit, New Pt, 3 Key Components: Detailed Hx; Detailed Exam; Med Decision Low Complexity","allowed_amounts":[{"tin":{"type":"ein","value":"994071536"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":86.00,"providers":[{"billed_charge":175.00,"npi":[1083286306]}]}]}]},{"name":"Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal he","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81528","description":"Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal he","allowed_amounts":[{"tin":{"type":"ein","value":"463095174"},"service_code":["81"],"billing_class":"professional","payments":[{"allowed_amount":508.87,"providers":[{"billed_charge":681.00,"npi":[1629407069]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":104.28,"providers":[{"billed_charge":122.68,"npi":[1477874337]}]}]}]},{"name":"Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0250","description":"Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":0.01,"providers":[{"billed_charge":0.05,"npi":[1538163886]}]}]}]},{"name":"Pharmacy - IV Solutions","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0258","description":"Pharmacy - IV Solutions","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":104.28,"providers":[{"billed_charge":122.68,"npi":[1477874337]}]}]}]},{"name":"Pharmacy - Other Pharmacy","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0259","description":"Pharmacy - Other Pharmacy","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":8.25,"providers":[{"billed_charge":9.71,"npi":[1477874337]}]}]}]},{"name":"Psychotherapy, 60 Minutes With Patient And\/Or Family Member","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"90837GT","description":"Psychotherapy, 60 Minutes With Patient And\/Or Family Member","allowed_amounts":[{"tin":{"type":"ein","value":"813627932"},"service_code":["10"],"billing_class":"professional","payments":[{"allowed_amount":250.00,"providers":[{"billed_charge":250.00,"npi":[1295265437]}]}]}]},{"name":"Recovery Room","billing_code_type":"RC","billing_code_type_version":"2026","billing_code":"0710","description":"Recovery Room","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":949.15,"providers":[{"billed_charge":1116.64,"npi":[1477874337]}]}]}]},{"name":"Screening 3D breast mammography","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"77063","description":"Screening 3D breast mammography","allowed_amounts":[{"tin":{"type":"ein","value":"272451336"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":63.78,"providers":[{"billed_charge":75.04,"npi":[1477874337]}]},{"allowed_amount":70.16,"providers":[{"billed_charge":82.54,"npi":[1477874337]}]}]}]},{"name":"Therapeutic, Prophylactic, or Diagnostic Injection; Intravenous Push, Single or Initial Substance\/Drug","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"96374","description":"Therapeutic, Prophylactic, or Diagnostic Injection; Intravenous Push, Single or Initial Substance\/Drug","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":72.22,"providers":[{"billed_charge":587.00,"npi":[1538163886]}]}]}]},{"name":"Tobacco Nonuser","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"1036F","description":"Tobacco Nonuser","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":0.00,"providers":[{"billed_charge":0.00,"npi":[1023251386]}]}]}]},{"name":"Ultrasound, Transvaginal","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"76830","description":"Ultrasound, Transvaginal","allowed_amounts":[{"tin":{"type":"ein","value":"611661796"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":111.84,"providers":[{"billed_charge":256.20,"npi":[1881675965]}]}]}]},{"name":"Urinalysis, Dip Stick\/Tablet Reagent; Automated W\/O Microscopy","billing_code_type":"CPT","billing_code_type_version":"2026","billing_code":"81001","description":"Urinalysis, Dip Stick\/Tablet Reagent; Automated W\/O Microscopy","allowed_amounts":[{"tin":{"type":"ein","value":"941201197"},"service_code":[],"billing_class":"institutional","payments":[{"allowed_amount":40.60,"providers":[{"billed_charge":330.00,"npi":[1538163886]}]}]}]},{"name":"Urinalysis, Dip Stick\/Tablet Reagent; Automated, W\/O Microscopy","billing_code_type":"HCPCS","billing_code_type_version":"2026","billing_code":"81003QW","description":"Urinalysis, Dip Stick\/Tablet Reagent; Automated, W\/O Microscopy","allowed_amounts":[{"tin":{"type":"ein","value":"630923366"},"service_code":["11"],"billing_class":"professional","payments":[{"allowed_amount":2.59,"providers":[{"billed_charge":10.00,"npi":[1659769222]}]},{"allowed_amount":5.25,"providers":[{"billed_charge":10.00,"npi":[1770582371]}]}]}]}]}
