{
	"reporting_entity_name": "QUEST BEHAVIORAL HEALTH",
	"reporting_entity_type": "TPA",
	"issuer_name": "Quest Behavioral Health",
	"plan_name": "646",
	"plan_id_type": "HIOS",
	"plan_id": "000000646",
	"plan_market_type": "group",
	"last_updated_on": "2026-03-20",
	"version": "2.0.1",
	"out_of_network":[{
		"name": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL - PSYCHIATRIC",
		"billing_code_type": "RC",
		"billing_code_type_version": "2025",
		"billing_code": "1001",
		"description": "Behavioral Health Accommodations",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "352250273"
			},
			"service_code": ["21"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 761.80,
				"providers":[{
					"billed_charge": 3600.00,
					"npi": [1124175021]
				}]
			}]
		}]
	},{
		"name": "BEHAVIORAL HEALTH ACCOMMODATIONS - RESIDENTIAL - CHEMICAL DEPENDENCY",
		"billing_code_type": "RC",
		"billing_code_type_version": "2025",
		"billing_code": "1002",
		"description": "Behavioral Health Accommodations",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "260792459"
			},
			"service_code": ["21"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 553.48,
				"providers":[{
					"billed_charge": 3500.00,
					"npi": [1508290636]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "844248322"
			},
			"service_code": ["21"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 633.02,
				"providers":[{
					"billed_charge": 5125.00,
					"npi": [1255113569]
				}]
			}]
		}]
	},{
		"name": "PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "99213",
		"description": "Established patient office or other outpatient visit",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "223693606"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1801400551]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "223756645"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 95.57,
				"providers":[{
					"billed_charge": 125.00,
					"npi": [1013002369]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232777286"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 184.00,
					"npi": [1073514535]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "272890294"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1083770507]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "308909548"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 99.26,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1780792929]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "383916265"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1396753182]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "452687705"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 195.00,
					"npi": [1578652814]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454928449"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1215172374]
				}]
			},{
				"allowed_amount": 92.85,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1215172374]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "465237445"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 95.57,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1184854259]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "472574911"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 99.26,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1851346399]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "710988764"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1386618742]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "852537346"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1225065006]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "862863447"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 92.85,
				"providers":[{
					"billed_charge": 115.00,
					"npi": [1114381266]
				},{
					"billed_charge": 130.00,
					"npi": [1114381266]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1114381266]
				}]
			}]
		}]
	},{
		"name": "PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "99214",
		"description": "Established patient office or other outpatient visit",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "201115136"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 188.00,
					"npi": [1386084713]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "223693606"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 312.00,
					"npi": [1285805200]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232777286"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25"],
				"providers":[{
					"billed_charge": 261.00,
					"npi": [1245056548]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 261.00,
					"npi": [1073514535,1245056548]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232930697"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 120.57,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 210.00,
					"npi": [1295718237]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "233027382"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 206.55,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1053669218]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "251686412"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 120.57,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1770545998]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "251838458"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 102.48,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 359.00,
					"npi": [1689292674]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "271115748"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 118.43,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1689389447]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "332158174"
			},
			"service_code": ["57"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 850.00,
					"npi": [1861557795]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "452687705"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 130.62,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1578652814]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1578652814]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "461384155"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 90.00,
				"providers":[{
					"billed_charge": 90.00,
					"npi": [1316960792]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462763974"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.36,
					"npi": [1285679092]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464528708"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 112.59,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1356024699]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "823126586"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 114.16,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1154196194]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "823742760"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 114.16,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1649963653]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "834189934"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 118.43,
				"billing_code_modifier": ["SA", "95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1679093827]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "861826692"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 243.04,
					"npi": [1790377489]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["93"],
				"providers":[{
					"billed_charge": 243.04,
					"npi": [1790377489]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "863799290"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1457937088]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872540072"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 221.85,
					"npi": [1669510319]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "873043249"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1235589664]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "931552733"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 111.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1881001550]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990998201"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1841400223]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["25", "95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1841400223]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "994123222"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 114.16,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1497513535]
				}]
			}]
		},{
			"tin": {
				"type": "npi",
				"value": "1467581892"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 134.30,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1467581892]
				}]
			}]
		}]
	},{
		"name": "PR PARTIAL HOSPITALIZATION SERV",
		"billing_code_type": "HCPCS",
		"billing_code_type_version": "2025",
		"billing_code": "S0201",
		"description": "Partial hospitalization serv",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "332158174"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 339.25,
				"providers":[{
					"billed_charge": 4600.00,
					"npi": [1669284972]
				}]
			},{
				"allowed_amount": 395.90,
				"providers":[{
					"billed_charge": 4600.00,
					"npi": [1669284972]
				}]
			}]
		}]
	},{
		"name": "PR PSYCHIATRIC DIAGNOSTIC EVALUATION",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "90791",
		"description": "Psychiatric Diagnostic Evaluation",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "193782765"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 142.77,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1972918761]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "236297362"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.41,
				"providers":[{
					"billed_charge": 160.00,
					"npi": [ ]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462687843"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 132.40,
				"providers":[{
					"billed_charge": 2399.70,
					"npi": [1700053840]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464760709"
			},
			"service_code": ["22"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.41,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1255954046]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814703232"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 163.78,
				"providers":[{
					"billed_charge": 750.00,
					"npi": [1194804153]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "821324687"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.84,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1679695670]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "821542923"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1821978586]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "824404501"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 275.00,
					"npi": [1457801185]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 275.00,
					"npi": [1457801185]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "854160637"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 138.83,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1366801912]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "861180757"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.41,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 185.00,
					"npi": [1386510790]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "862474324"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 135.98,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1376065805]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872675757"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.41,
				"providers":[{
					"billed_charge": 225.00,
					"npi": [1457639841]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 225.00,
					"npi": [1457639841]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "873860178"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 122.84,
				"providers":[{
					"billed_charge": 500.00,
					"npi": [1841070794]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "883365660"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 129.41,
				"providers":[{
					"billed_charge": 270.00,
					"npi": [1982240370]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "920548950"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 132.40,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1689911448]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "923816380"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.84,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 122.84,
					"npi": [1689120693]
				}]
			}]
		}]
	},{
		"name": "PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "90833",
		"description": "Psychotherapy with evaluation and management visit, 30 minutes",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "223693606"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 64.04,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 226.00,
					"npi": [1285805200]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "233027382"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 120.09,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1053669218]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "271115748"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 67.41,
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1689389447]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "308909548"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 79.30,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1780792929]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "454928449"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.34,
				"providers":[{
					"billed_charge": 135.00,
					"npi": [1215172374]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "461384155"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.00,
				"providers":[{
					"billed_charge": 75.00,
					"npi": [1316960792]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "465237445"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 77.03,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1184854259]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "823126586"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 65.48,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1154196194]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "834189934"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 67.41,
				"billing_code_modifier": ["SA", "95"],
				"providers":[{
					"billed_charge": 120.00,
					"npi": [1679093827]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "842292733"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 55.00,
					"npi": [1306569678]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "861826692"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["93"],
				"providers":[{
					"billed_charge": 133.12,
					"npi": [1790377489]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "863799290"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 64.04,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 85.00,
					"npi": [1457937088]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "873043249"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 64.04,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1235589664]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "922753418"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 65.48,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1225619414]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "931552733"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 50.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 50.00,
					"npi": [1881001550]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "990998201"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 125.00,
					"npi": [1841400223]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 125.00,
					"npi": [1841400223]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "994123222"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 65.48,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1497513535]
				}]
			}]
		}]
	},{
		"name": "PR PSYCHOTHERAPY W/PATIENT 45 MINUTES",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "90834",
		"description": "Psychotherapy, 45 minutes",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "061567385"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 82.55,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1275508426]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "139646610"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 82.55,
				"providers":[{
					"billed_charge": 116.61,
					"npi": [1225175698]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "199689437"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 80.69,
				"providers":[{
					"billed_charge": 90.00,
					"npi": [1194212415]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "203691272"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 155.00,
					"npi": [1538185921]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232809585"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 165.00,
					"npi": [1669498903]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "263572220 "
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1558302265]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1558302265]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "264544321"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 206.00,
					"npi": [1275774549]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "270348264"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1952537623]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "270594034"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1568540268]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "271115748"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 84.97,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1356149363]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "275033062"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 135.00,
					"npi": [1578843660]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "394022499"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.00,
				"providers":[{
					"billed_charge": 75.00,
					"npi": [1477328565]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "400018252"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 275.00,
					"npi": [1174153761]
				}]
			},{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 275.00,
					"npi": [1174153761]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462019440"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 110.06,
				"providers":[{
					"billed_charge": 550.00,
					"npi": [1154582500]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462687843"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 82.55,
				"providers":[{
					"billed_charge": 2494.80,
					"npi": [1154135101,1700053840]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "463948639"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 80.69,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1194607796]
				}]
			},{
				"allowed_amount": 80.69,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1194607796]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475226134"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 76.75,
				"providers":[{
					"billed_charge": 125.00,
					"npi": [1053593368]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "510097026"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 103.93,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 103.93,
					"npi": [1073035754]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "810940799"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 80.69,
				"providers":[{
					"billed_charge": 185.00,
					"npi": [1689280885]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 185.00,
					"npi": [1689280885]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814997625"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1649523085]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "822378598"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 80.69,
				"providers":[{
					"billed_charge": 165.00,
					"npi": [1205597358]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "842494027"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 89.99,
				"providers":[{
					"billed_charge": 99.66,
					"npi": [1356910285]
				},{
					"billed_charge": 99.67,
					"npi": [1356910285]
				},{
					"billed_charge": 149.50,
					"npi": [1356910285]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "843667601"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1659846475]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "843676786"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 82.55,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1437793114]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "845032501"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 70.00,
				"providers":[{
					"billed_charge": 70.00,
					"npi": [1053392001]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872513503"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 80.69,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1922776798]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "882206961"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 190.00,
					"npi": [1083088280]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "900889101"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 112.21,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1306105846]
				},{
					"billed_charge": 200.00,
					"npi": [1306105846]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "994777771"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 40.00,
				"providers":[{
					"billed_charge": 40.00,
					"npi": [1598487902]
				}]
			}]
		},{
			"tin": {
				"type": "npi",
				"value": "1427067461"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 107.58,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1427067461]
				}]
			},{
				"allowed_amount": 200.00,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1427067461]
				}]
			}]
		}]
	},{
		"name": "PR PSYCHOTHERAPY W/PATIENT 60 MINUTES",
		"billing_code_type": "CPT",
		"billing_code_type_version": "2025",
		"billing_code": "90837",
		"description": "Psychotherapy, 1 hour",
		"allowed_amounts":[{
			"tin": {
				"type": "ein",
				"value": "138568665"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1447315353]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "139646610"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 116.61,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 116.61,
					"npi": [1225175698]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "152406369"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 190.00,
					"npi": [1972709830]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "174447736"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 159.39,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1609099001]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "193782765"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 125.52,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1972918761]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "198663267"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1558379768]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "202349105"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1346507449]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1346507449]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "203691272"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 155.00,
				"providers":[{
					"billed_charge": 155.00,
					"npi": [1538185921]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "223310529"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 163.04,
				"providers":[{
					"billed_charge": 373.00,
					"npi": [1730743600]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "231744721"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 137.50,
				"providers":[{
					"billed_charge": 137.50,
					"npi": [1578860672]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232807445"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 225.00,
					"npi": [1881021194]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "232997714"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1497251938]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1497251938]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "233062537"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 159.39,
				"providers":[{
					"billed_charge": 225.00,
					"npi": [1649910951]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "236297362"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 160.00,
					"npi": [ ]
				}]
			},{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 160.00,
					"npi": [ ]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "263527045"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.17,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 190.00,
					"npi": [1396171476]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "263572220 "
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 159.39,
				"providers":[{
					"billed_charge": 480.00,
					"npi": [1558302265]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "271387771"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 159.39,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1801013206]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "273042701"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1710005012]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "275271213"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 116.21,
				"providers":[{
					"billed_charge": 118.89,
					"npi": [1053509737]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "332359570"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 120.00,
					"npi": [1205273190]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "372062042"
			},
			"service_code": ["10", "11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1568946135]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "394022499"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 75.00,
				"providers":[{
					"billed_charge": 75.00,
					"npi": [1477328565]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462141648"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 128.36,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1316266620]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "462763974"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 308.58,
					"npi": [1669002671]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464805462"
			},
			"service_code": ["22"],
			"billing_class": "institutional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 1775.00,
					"npi": [1366848582]
				}]
			},{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 1775.00,
					"npi": [1366848582]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "464955459"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1629714472]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "472954685"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1972208858]
				}]
			},{
				"allowed_amount": 159.39,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1447492715]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "474089159"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1164858874]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "474216519"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 159.39,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1427615822]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "474861603"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 135.00,
					"npi": [1265130900]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475226134"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 165.00,
					"npi": [1053593368,1326378944]
				}]
			},{
				"allowed_amount": 113.70,
				"providers":[{
					"billed_charge": 165.00,
					"npi": [1326378944]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475495265"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 150.00,
				"billing_code_modifier": ["HP"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1922472398]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "475584467"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["GT", "SA"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1710524863]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "521703880"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 168.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1386893238]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "522390812"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1780195057]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "811503771"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1093360190]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "814286094"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1144068370]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "821324687"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1265193452]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "821542923"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1821978586]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "822352646"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 163.04,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1598284770]
				}]
			},{
				"allowed_amount": 163.04,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1598284770,1619306669]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "822533204"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 157.85,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 170.00,
					"npi": [1285081091]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "822667464"
			},
			"service_code": ["53"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 975.00,
					"npi": [1922655315]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "823541467"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1972367571]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "824404501"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1457801185]
				}]
			},{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1457801185]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1457801185]
				}]
			},{
				"allowed_amount": 0.00,
				"providers":[{
					"billed_charge": 250.00,
					"npi": [1457801185]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "833011232"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"providers":[{
					"billed_charge": 190.00,
					"npi": [1891544854]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "833196063"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1508330218]
				}]
			},{
				"allowed_amount": 150.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1508330218]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "850518141"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1699381442]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "851154080"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 220.00,
					"npi": [1679628572]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "852632211"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1205478369]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "852643083"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1780457390]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "852908260"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 145.00,
					"npi": [1427552785]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "853611253"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 160.00,
					"npi": [1003582867]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "854341876"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1649603473]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "861180757"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 185.00,
					"npi": [1386510790]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "861826692"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 296.00,
					"npi": [1790377489]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "862474324"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 140.00,
					"npi": [1376065805]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "862525586"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 117.17,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 225.00,
					"npi": [1922630847]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "863510200"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 125.84,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1871728386]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "863594203"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 150.00,
					"npi": [1508552548]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872088742"
			},
			"service_code": ["10", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 120.09,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1437372547]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872675757"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 195.00,
					"npi": [1457639841]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "872835013"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1336759398]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "874588702"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1275330235,1457095291,1578444295]
				}]
			},{
				"allowed_amount": 159.39,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1841673001]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "882443032"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1619680162]
				}]
			},{
				"allowed_amount": 100.00,
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1619680162]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "883365660"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 229.00,
					"npi": [1982240370]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "900889101"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 165.40,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1306105846]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "920548950"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1689911448]
				}]
			},{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1376273300]
				}]
			},{
				"allowed_amount": 0.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1568248268]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "920683799"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1265944771]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "920805712"
			},
			"service_code": ["11", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 116.21,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 116.21,
					"npi": [1528521184]
				}]
			},{
				"allowed_amount": 116.21,
				"providers":[{
					"billed_charge": 116.21,
					"npi": [1528521184]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "920915208"
			},
			"service_code": ["10", "02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 175.00,
					"npi": [1366675274]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "922276465"
			},
			"service_code": ["10", "11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 122.28,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1518488691]
				}]
			},{
				"allowed_amount": 122.28,
				"providers":[{
					"billed_charge": 180.00,
					"npi": [1518488691]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "923816380"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 113.70,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 113.70,
					"npi": [1689120693]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "933758017"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 145.00,
					"npi": [1679928816]
				},{
					"billed_charge": 217.00,
					"npi": [1679928816]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "934039307"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1578827432]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "991082382"
			},
			"service_code": ["10"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 100.00,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 100.00,
					"npi": [1982865424]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "991285142"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 168.00,
				"billing_code_modifier": ["GT"],
				"providers":[{
					"billed_charge": 300.00,
					"npi": [1386893238]
				}]
			}]
		},{
			"tin": {
				"type": "ein",
				"value": "993872558"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1669943213]
				}]
			}]
		},{
			"tin": {
				"type": "npi",
				"value": "1366821654"
			},
			"service_code": ["02"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 119.54,
				"billing_code_modifier": ["95"],
				"providers":[{
					"billed_charge": 130.00,
					"npi": [1366821654]
				}]
			}]
		},{
			"tin": {
				"type": "npi",
				"value": "1639896772"
			},
			"service_code": ["11"],
			"billing_class": "professional",
			"payments":[{
				"allowed_amount": 118.39,
				"providers":[{
					"billed_charge": 200.00,
					"npi": [1639896772]
				}]
			}]
		}]
	}]
}
