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{ "allowed_amount": 1440.77, "providers": [{ "billed_charge": 4788.00, "npi": [1700906427] } ] } ] } ] }, { "name": "PET IMAGE W/CT SKULL-THIGH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "78815", "description": "POSITRON EMISSION TOMOGRAPHY (PET) W CONCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ATTENUATION", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582244832" }, "service_code": ["11", "22", "19", "21"], "billing_class": "professional", "payments": [{ "allowed_amount": 555.51, "providers": [{ "billed_charge": 10794.00, "npi": [1013545912] } ] }, { "allowed_amount": 465.05, "providers": [{ "billed_charge": 8995.00, "npi": [1013545912] } ] }, { "allowed_amount": 93.01, "providers": [{ "billed_charge": 1799.00, "npi": [1013545912] } ] } ] } ] }, { "name": "METABOLIC PANEL TOTAL CA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80048", "description": "BASIC METABOLIC PANEL (CALCIUM, TOTAL) THIS PANEL MUST INCLUDE THE FOLLOWING: CALCIUM, TOTAL (82310)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 223.57, "providers": [{ "billed_charge": 2673.36, "npi": [1234567893] } ] } ] } ] }, { "name": "GENERAL HEALTH PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80050", "description": "GENERAL HEALTH PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: COMPREHENSIVE METABOLIC PANEL (80053) BL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.98, "providers": [{ "billed_charge": 59.15, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.96, "providers": [{ "billed_charge": 554.40, "npi": [1234567893] } ] } ] } ] }, { "name": "COMPREHEN METABOLIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80053", "description": "COMPREHENSIVE METABOLIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "264810354" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 134.37, "providers": [{ "billed_charge": 245.00, "npi": [1942900394] } ] }, { "allowed_amount": 99.00, "providers": [{ "billed_charge": 210.00, "npi": [1831242544] } ] }, { "allowed_amount": 311.26, "providers": [{ "billed_charge": 665.00, "npi": [1194350546] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1124.69, "providers": [{ "billed_charge": 7866.92, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 129.42, "providers": [{ "billed_charge": 522.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 44.67, "providers": [{ "billed_charge": 60.00, "npi": [1234567893] } ] }, { "allowed_amount": 5040.58, "providers": [{ "billed_charge": 59522.22, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1467.84, "providers": [{ "billed_charge": 5838.00, "npi": [1225021678] } ] } ] } ] }, { "name": "LIPID PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80061", "description": "LIPID PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: CHOLESTEROL, SERUM, TOTAL (82465) LIPOPROTEIN, DI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 974.71, "providers": [{ "billed_charge": 10731.56, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.88, "providers": [{ "billed_charge": 294.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "17", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.05, "providers": [{ "billed_charge": 44.40, "npi": [1234567893] } ] }, { "allowed_amount": 18.88, "providers": [{ "billed_charge": 20.00, "npi": [1234567893] } ] }, { "allowed_amount": 5851.01, "providers": [{ "billed_charge": 67459.04, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1084.59, "providers": [{ "billed_charge": 4698.00, "npi": [1225021678] } ] } ] } ] }, { "name": "HEPATIC FUNCTION PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80076", "description": "HEPATIC FUNCTION PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: ALBUMIN (82040) BILIRUBIN, TOTAL (8224", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.12, "providers": [{ "billed_charge": 1437.92, "npi": [1234567893] } ] } ] } ] }, { "name": "OBSTETRIC PANEL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80081", "description": "OBSTETRIC PANEL (INCLUDES HIV TESTING)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 94.22, "providers": [{ "billed_charge": 205.40, "npi": [1962481820] } ] } ] } ] }, { "name": "DRUG TEST PRSMV DIR OPT OBS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80305", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; CAPABLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 220.50, "providers": [{ "billed_charge": 2100.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "844246379" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.36, "providers": [{ "billed_charge": 30.00, "npi": [1609451194] } ] } ] }, { "tin": { "type": "ein", "value": "274310706" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.40, "providers": [{ "billed_charge": 300.00, "npi": [1619003746] } ] } ] }, { "tin": { "type": "ein", "value": "582640568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 430.30, "providers": [{ "billed_charge": 4875.00, "npi": [1306860101] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1208.36, "providers": [{ "billed_charge": 2446.95, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 504.00, "providers": [{ "billed_charge": 2352.00, "npi": [1225021678] } ] } ] } ] }, { "name": "DRUG TEST PRSMV CHEM ANLYZR", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "80307", "description": "DRUG TEST(S), PRESUMPTIVE, ANY NUMBER OF DRUG CLASSES, ANY NUMBER OF DEVICES OR PROCEDURES; BY INSTR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "883706617" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1743.06, "providers": [{ "billed_charge": 6600.00, "npi": [1427398007] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 116.37, "providers": [{ "billed_charge": 671.30, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 38540.10, "providers": [{ "billed_charge": 335928.45, "npi": [1234567893] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81001", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "822647012" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.22, "providers": [{ "billed_charge": 140.00, "npi": [1649001058] } ] }, { "allowed_amount": 242.76, "providers": [{ "billed_charge": 510.00, "npi": [1275160210] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 179.14, "providers": [{ "billed_charge": 2142.92, "npi": [1234567893] } ] } ] } ] }, { "name": "URINALYSIS NONAUTO W/O SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81002", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "431967388" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.44, "providers": [{ "billed_charge": 30.00, "npi": [1275673105] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 41.10, "providers": [{ "billed_charge": 296.00, "npi": [1124064316] } ] } ] }, { "tin": { "type": "ein", "value": "581187683" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.60, "providers": [{ "billed_charge": 64.00, "npi": [1568481539] } ] } ] }, { "tin": { "type": "ein", "value": "760717890" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.88, "providers": [{ "billed_charge": 90.00, "npi": [1013094184] } ] } ] }, { "tin": { "type": "ein", "value": "582640568" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.96, "providers": [{ "billed_charge": 105.60, "npi": [1306860101] } ] } ] }, { "tin": { "type": "ein", "value": "205558808" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.18, "providers": [{ "billed_charge": 49.84, "npi": [1851406359] } ] } ] }, { "tin": { "type": "ein", "value": "800058224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 150.54, "providers": [{ "billed_charge": 672.00, "npi": [1861486094] } ] } ] }, { "tin": { "type": "ein", "value": "454102348" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 89.87, "providers": [{ "billed_charge": 210.00, "npi": [1699742320] } ] } ] }, { "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.94, "providers": [{ "billed_charge": 930.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "205870972" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 74.82, "providers": [{ "billed_charge": 860.00, "npi": [1285325282] } ] } ] }, { "tin": { "type": "ein", "value": "453766969" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 65.40, "providers": [{ "billed_charge": 458.32, "npi": [1053536177] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.84, "providers": [{ "billed_charge": 588.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "992816647" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.22, "providers": [{ "billed_charge": 30.00, "npi": [1144794504] } ] }, { "allowed_amount": 20.88, "providers": [{ "billed_charge": 120.00, "npi": [1982233623] } ] }, { "allowed_amount": 99.18, "providers": [{ "billed_charge": 570.00, "npi": [1821316571] } ] }, { "allowed_amount": 109.62, "providers": [{ "billed_charge": 630.00, "npi": [1255517595] } ] }, { "allowed_amount": 97.44, "providers": [{ "billed_charge": 560.00, "npi": [1568873214] } ] } ] }, { "tin": { "type": "ein", "value": "582610763" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 50.46, "providers": [{ "billed_charge": 290.00, "npi": [1306860044] } ] } ] } ] }, { "name": "URINALYSIS AUTO W/O SCOPE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81003", "description": "URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,", "allowed_amounts": [{ "tin": { "type": "ein", "value": "273818647" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.96, "providers": [{ "billed_charge": 96.00, "npi": [1881205169] } ] } ] }, { "tin": { "type": "ein", "value": "871253958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.93, "providers": [{ "billed_charge": 427.00, "npi": [1366651507] } ] } ] }, { "tin": { "type": "ein", "value": "581109444" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.85, "providers": [{ "billed_charge": 154.00, "npi": [1700632338] } ] } ] }, { "tin": { "type": "ein", "value": "264810354" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 52.45, "providers": [{ "billed_charge": 120.00, "npi": [1194350546] } ] }, { "allowed_amount": 8.24, "providers": [{ "billed_charge": 16.00, "npi": [1942900394] } ] }, { "allowed_amount": 38.25, "providers": [{ "billed_charge": 88.00, "npi": [1831242544] } ] } ] }, { "tin": { "type": "ein", "value": "924026234" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 14.20, "providers": [{ "billed_charge": 44.00, "npi": [1164006615] } ] } ] }, { "tin": { "type": "ein", "value": "581643029" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.36, "providers": [{ "billed_charge": 20.00, "npi": [1619039476] } ] } ] }, { "tin": { "type": "ein", "value": "990909070" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.30, "providers": [{ "billed_charge": 6.00, "npi": [1285971796] } ] } ] }, { "tin": { "type": "ein", "value": "331804183" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.93, "providers": [{ "billed_charge": 11.00, "npi": [1205878386] } ] } ] }, { "tin": { "type": "ein", "value": "992262156" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.47, "providers": [{ "billed_charge": 171.00, "npi": [1457400251] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 73.06, "providers": [{ "billed_charge": 234.00, "npi": [1295969228] } ] } ] }, { "tin": { "type": "ein", "value": "271738064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.85, "providers": [{ "billed_charge": 486.00, "npi": [1851750582] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.25, "providers": [{ "billed_charge": 20.00, "npi": [1225021678] } ] } ] } ] }, { "name": "MICROSCOPIC EXAM OF URINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81015", "description": "URINALYSIS; MICROSCOPIC ONLY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.25, "providers": [{ "billed_charge": 300.00, "npi": [1912167578] } ] } ] } ] }, { "name": "URINE PREGNANCY TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "81025", "description": "URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "431967388" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 25.83, "providers": [{ "billed_charge": 75.00, "npi": [1275673105] } ] } ] }, { "tin": { "type": "ein", "value": "822647012" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 38.76, "providers": [{ "billed_charge": 78.00, "npi": [1275160210] } ] } ] }, { "tin": { "type": "ein", "value": "992816647" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.31, "providers": [{ "billed_charge": 26.00, "npi": [1821316571] } ] }, { "allowed_amount": 12.93, "providers": [{ "billed_charge": 78.00, "npi": [1255517595] } ] } ] } ] }, { "name": "ANES LWR INTST NDSC NOS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "811", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; NOT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581400731" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 120.54, "providers": [{ "billed_charge": 1085.00, "npi": [1093192528] } ] } ] }, { "tin": { "type": "ein", "value": "461116325" }, "service_code": ["22", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 700.00, "providers": [{ "billed_charge": 1085.00, "npi": [1528010659] } ] }, { "allowed_amount": 1200.00, "providers": [{ "billed_charge": 1860.00, "npi": [1528010659] } ] } ] } ] }, { "name": "ANES LWR INTST SCR COLSC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "812", "description": "ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES, ENDOSCOPE INTRODUCED DISTAL TO DUODENUM; SCRE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "810769749" }, "service_code": ["24"], "billing_class": "professional", "payments": [{ "allowed_amount": 1701.11, "providers": [{ "billed_charge": 14924.00, "npi": [1487830618] } ] }, { "allowed_amount": 1653.73, "providers": [{ "billed_charge": 14536.00, "npi": [1952440919] } ] } ] }, { "tin": { "type": "ein", "value": "582207776" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.26, "providers": [{ "billed_charge": 992.25, "npi": [1558552257] } ] } ] }, { "tin": { "type": "ein", "value": "581400731" }, "service_code": ["22"], "billing_class": "professional", "payments": [{ "allowed_amount": 210.96, "providers": [{ "billed_charge": 1937.50, "npi": [1093192528] } ] } ] }, { "tin": { "type": "ein", "value": "461116325" }, "service_code": ["22", "24"], "billing_class": "professional", "payments": [{ "allowed_amount": 4200.00, "providers": [{ "billed_charge": 6510.00, "npi": [1083717029] } ] }, { "allowed_amount": 5100.00, "providers": [{ "billed_charge": 7905.00, "npi": [1528010659] } ] }, { "allowed_amount": 1500.00, "providers": [{ "billed_charge": 2325.00, "npi": [1831143932] } ] }, { "allowed_amount": 5900.00, "providers": [{ "billed_charge": 9145.00, "npi": [1528010659] } ] }, { "allowed_amount": 7000.00, "providers": [{ "billed_charge": 10850.00, "npi": [1831143932] } ] } ] } ] }, { "name": "ANES UPR LWR 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"type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 438.11, "providers": [{ "billed_charge": 5248.24, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 187.98, "providers": [{ "billed_charge": 624.00, "npi": [1295969228] } ] }, { "allowed_amount": 57.84, "providers": [{ "billed_charge": 192.00, "npi": [1912167578] } ] } ] } ] }, { "name": "HEMO/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "821", "description": "HEMODIALYSIS - OUTPT OR HOME - HEMODIALYSIS/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261305281" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4189.20, "providers": [{ "billed_charge": 77378.55, "npi": [1235317454] } ] } ] }, { "tin": { "type": "ein", "value": "352161251" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1517.82, "providers": [{ "billed_charge": 44160.00, "npi": [1497860241] } ] } ] }, { "tin": { "type": "ein", "value": "472418747" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 3442.96, "providers": [{ "billed_charge": 36265.52, "npi": [1104224054] } ] } ] }, { "tin": { "type": "ein", "value": "582350026" }, "service_code": ["12", "65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 52000.00, "providers": [{ "billed_charge": 459264.00, "npi": [1003928821] } ] }, { "allowed_amount": 9000.00, "providers": [{ "billed_charge": 79488.00, "npi": [1003928821] } ] } ] }, { "tin": { "type": "ein", "value": "852834926" }, "service_code": ["65"], "billing_class": "institutional", "payments": [{ "allowed_amount": 1352.67, "providers": [{ "billed_charge": 17500.00, "npi": [1972259737] } ] } ] } ] }, { "name": 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"value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.60, "providers": [{ "billed_charge": 401.60, "npi": [1234567893] } ] } ] } ] }, { "name": "VITAMIN D 25 HYDROXY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82306", "description": "VITAMIN D; 25 HYDROXY, INCLUDES FRACTION(S), IF PERFORMED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 693.50, "providers": [{ "billed_charge": 8451.76, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 240.37, "providers": [{ "billed_charge": 1056.25, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5002.87, "providers": [{ "billed_charge": 54316.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2368.00, "providers": [{ "billed_charge": 12000.00, "npi": [1225021678] } ] } ] } ] }, { "name": "TOTAL CORTISOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82533", "description": "CORTISOL; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.40, "providers": [{ "billed_charge": 652.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF URINE CREATININE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82570", "description": "CREATININE; OTHER SOURCE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 358.11, "providers": [{ "billed_charge": 4289.04, "npi": [1234567893] } ] } ] } ] }, { "name": "VITAMIN B-12", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82607", "description": "CYANOCOBALAMIN (VITAMIN B-12);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 140.70, "providers": [{ "billed_charge": 1473.65, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 112.86, "providers": [{ "billed_charge": 455.40, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2090.84, "providers": [{ "billed_charge": 22454.12, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1100.84, "providers": [{ "billed_charge": 5110.00, "npi": [1225021678] } ] } ] } ] }, { "name": "DEHYDROEPIANDROSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82627", "description": "DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 126.12, "providers": [{ "billed_charge": 1311.58, "npi": [1234567893] } ] } ] } ] }, { "name": "DIHYDROTESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82642", "description": "DIHYDROTESTOSTERONE (DHT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 78.24, "providers": [{ "billed_charge": 936.96, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF ESTRADIOL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82670", "description": "ESTRADIOL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 703.37, "providers": [{ "billed_charge": 2836.05, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 844.24, "providers": [{ "billed_charge": 9485.63, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FERRITIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82728", "description": "FERRITIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 470.91, "providers": [{ "billed_charge": 5458.83, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 218.08, "providers": [{ "billed_charge": 1088.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF FOLIC ACID SERUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82746", "description": "FOLIC ACID; SERUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.80, "providers": [{ "billed_charge": 100.57, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 716.80, "providers": [{ "billed_charge": 8320.20, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 220.50, "providers": [{ "billed_charge": 960.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF IGE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82785", "description": "GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 113.58, "providers": [{ "billed_charge": 1067.45, "npi": [1740262880] } ] } ] } ] }, { "name": "HEMO/HOME/OTHER", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "829", "description": "HEMODIALYSIS - OUTPT OR HOME - OTHER OUPT HEMODIALYSIS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581519911" }, "service_code": ["23"], "billing_class": "institutional", "payments": [{ "allowed_amount": 5355.58, "providers": [{ "billed_charge": 19881.00, "npi": [1528056066] } ] } ] } ] }, { "name": "ASSAY, GLUCOSE, BLOOD QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82947", "description": "GLUCOSE; QUANTITATIVE, BLOOD (EXCEPT REAGENT STRIP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.02, "providers": [{ "billed_charge": 175.24, "npi": [1234567893] } ] }, { "allowed_amount": 1.31, "providers": [{ "billed_charge": 15.72, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "582610763" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 76.83, "providers": [{ "billed_charge": 780.00, "npi": [1306860044] } ] } ] } ] }, { "name": "GLUCOSE BLOOD TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82962", "description": "GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY THE FDA SPECIFICALLY FOR HOME USE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "800058224" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.76, "providers": [{ "billed_charge": 900.00, "npi": [1861486094] } ] } ] }, { "tin": { "type": "ein", "value": "582545719" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 106.62, "providers": [{ "billed_charge": 435.00, "npi": [1063515815] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 26.92, "providers": [{ "billed_charge": 180.00, "npi": [1124064316] } ] } ] }, { "tin": { "type": "ein", "value": "311591242" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.00, "providers": [{ "billed_charge": 145.00, "npi": [1831318187] } ] } ] } ] }, { "name": "ASSAY OF GGT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "82977", "description": "GLUTAMYLTRANSFERASE, GAMMA (GGT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.60, "providers": [{ "billed_charge": 115.20, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (FSH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83001", "description": "GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 657.80, "providers": [{ "billed_charge": 2652.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 521.49, "providers": [{ "billed_charge": 5741.22, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF GONADOTROPIN (LH)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83002", "description": "GONADOTROPIN; LUTEINIZING HORMONE (LH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 264.60, "providers": [{ "billed_charge": 1066.80, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 501.24, "providers": [{ "billed_charge": 5500.44, "npi": [1234567893] } ] } ] } ] }, { "name": "GLYCOSYLATED HEMOGLOBIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83036", "description": "HEMOGLOBIN; GLYCOSYLATED (A1C)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "586004640" }, "service_code": ["11", "72"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.28, "providers": [{ "billed_charge": 100.00, "npi": [1346249109] } ] }, { "allowed_amount": 36.42, "providers": [{ "billed_charge": 150.00, "npi": [1346249109] } ] } ] }, { "tin": { "type": "ein", "value": "581233448" }, "service_code": ["50"], "billing_class": "professional", "payments": [{ "allowed_amount": 172.61, "providers": [{ "billed_charge": 1200.00, "npi": [1124064316] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 415.05, "providers": [{ "billed_charge": 4251.30, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 204.91, "providers": [{ "billed_charge": 826.15, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 492.18, "providers": [{ "billed_charge": 1404.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "331166863" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 933.88, "providers": [{ "billed_charge": 2368.00, "npi": [1790707925] } ] } ] }, { "tin": { "type": "ein", "value": "586002922" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.13, "providers": [{ "billed_charge": 45.00, "npi": [1851010466] } ] } ] }, { "tin": { "type": "ein", "value": "874714839" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.02, "providers": [{ "billed_charge": 308.00, "npi": [1518595339] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 18.55, "providers": [{ "billed_charge": 80.00, "npi": [1234567893] } ] }, { "allowed_amount": 2209.68, "providers": [{ "billed_charge": 24653.90, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.76, "providers": [{ "billed_charge": 2576.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF IRON", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83540", "description": "IRON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 344.52, "providers": [{ "billed_charge": 4040.53, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 245.86, "providers": [{ "billed_charge": 1216.00, "npi": [1225021678] } ] } ] } ] }, { "name": "IRON BINDING TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83550", "description": "IRON BINDING CAPACITY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.40, "providers": [{ "billed_charge": 4195.20, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 332.12, "providers": [{ "billed_charge": 1330.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF MAGNESIUM", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83735", "description": "MAGNESIUM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 172.44, "providers": [{ "billed_charge": 1943.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF NATRIURETIC PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "83880", "description": "NATRIURETIC PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 39.33, "providers": [{ "billed_charge": 471.12, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY ALKALINE PHOSPHATASE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84075", "description": "PHOSPHATASE, ALKALINE;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.57, "providers": [{ "billed_charge": 186.48, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PHOSPHORUS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84100", "description": "PHOSPHORUS INORGANIC (PHOSPHATE);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 6.32, "providers": [{ "billed_charge": 75.84, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROGESTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84144", "description": "PROGESTERONE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 42.60, "providers": [{ "billed_charge": 171.75, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.81, "providers": [{ "billed_charge": 1428.91, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PROLACTIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84146", "description": "PROLACTIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 118.71, "providers": [{ "billed_charge": 478.80, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 336.44, "providers": [{ "billed_charge": 4031.04, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PSA, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84153", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1185.02, "providers": [{ "billed_charge": 14197.08, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF PSA, FREE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84154", "description": "PROSTATE SPECIFIC ANTIGEN (PSA); FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.20, "providers": [{ "billed_charge": 5884.80, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF SEX HORMONE GLOBUL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84270", "description": "SEX HORMONE BINDING GLOBULIN (SHBG)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.58, "providers": [{ "billed_charge": 119.30, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 769.56, "providers": [{ "billed_charge": 9213.52, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF SOMATOMEDIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84305", "description": "SOMATOMEDIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.00, "providers": [{ "billed_charge": 637.80, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FREE TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84402", "description": "TESTOSTERONE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 970.14, "providers": [{ "billed_charge": 11614.32, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TOTAL TESTOSTERONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84403", "description": "TESTOSTERONE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.68, "providers": [{ "billed_charge": 1463.95, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 474.39, "providers": [{ "billed_charge": 1912.95, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1482.32, "providers": [{ "billed_charge": 15899.04, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TOTAL THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84436", "description": "THYROXINE; TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 251.93, "providers": [{ "billed_charge": 2837.34, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF FREE THYROXINE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84439", "description": "THYROXINE; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 169.18, "providers": [{ "billed_charge": 2244.98, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 24.56, "providers": [{ "billed_charge": 99.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1330.41, "providers": [{ "billed_charge": 15866.18, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY THYROID STIM HORMONE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84443", "description": "THYROID STIMULATING HORMONE (TSH)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1121.29, "providers": [{ "billed_charge": 10379.29, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 606.32, "providers": [{ "billed_charge": 2443.30, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 5388.18, "providers": [{ "billed_charge": 63411.60, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1646.40, "providers": [{ "billed_charge": 7056.00, "npi": [1225021678] } ] } ] } ] }, { "name": "TRANSFERASE (AST) (SGOT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84450", "description": "TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.30, "providers": [{ "billed_charge": 207.20, "npi": [1234567893] } ] } ] } ] }, { "name": "ALANINE AMINO (ALT) (SGPT)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84460", "description": "TRANSFERASE; ALANINE AMINO (ALT) (SGPT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.70, "providers": [{ "billed_charge": 212.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF TRANSFERRIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84466", "description": "TRANSFERRIN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.80, "providers": [{ "billed_charge": 242.44, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF THYROID (T3 OR T4)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84479", "description": "THYROID HORMONE (T3 OR T4) UPTAKE OR THYROID HORMONE BINDING RATIO (THBR)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.80, "providers": [{ "billed_charge": 1601.35, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY, TRIIODOTHYRONINE (T3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84480", "description": "TRIIODOTHYRONINE T3; TOTAL (TT-3)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 165.90, "providers": [{ "billed_charge": 1985.20, "npi": [1234567893] } ] } ] } ] }, { "name": "FREE ASSAY (FT-3)", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84481", "description": "TRIIODOTHYRONINE T3; FREE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 449.83, "providers": [{ "billed_charge": 4853.31, "npi": [1234567893] } ] } ] } ] }, { "name": "ASSAY OF BLOOD/URIC ACID", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84550", "description": "URIC ACID; BLOOD", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.88, "providers": [{ "billed_charge": 1127.74, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 284.76, "providers": [{ "billed_charge": 1008.00, "npi": [1225021678] } ] } ] } ] }, { "name": "ASSAY OF C-PEPTIDE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84681", "description": "C-PEPTIDE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.85, "providers": [{ "billed_charge": 249.72, "npi": [1234567893] } ] } ] } ] }, { "name": "CHORIONIC GONADOTROPIN TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "84702", "description": "GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 77.35, "providers": [{ "billed_charge": 536.90, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.63, "providers": [{ "billed_charge": 1264.20, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMATOCRIT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85014", "description": "BLOOD COUNT; HEMATOCRIT (HCT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.90, "providers": [{ "billed_charge": 94.80, "npi": [1234567893] } ] } ] } ] }, { "name": "HEMOGLOBIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85018", "description": "BLOOD COUNT; HEMOGLOBIN (HGB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.90, "providers": [{ "billed_charge": 94.80, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "992816647" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 23.80, "providers": [{ "billed_charge": 200.00, "npi": [1255517595] } ] }, { "allowed_amount": 5.95, "providers": [{ "billed_charge": 50.00, "npi": [1821316571, 1568873214] } ] } ] } ] }, { "name": "COMPLETE CBC W/AUTO DIFF WBC", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85025", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT) AND AUTOMATED DIFFERE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "264810354" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.74, "providers": [{ "billed_charge": 210.00, "npi": [1942900394] } ] }, { "allowed_amount": 59.86, "providers": [{ "billed_charge": 175.00, "npi": [1831242544] } ] }, { "allowed_amount": 278.02, "providers": [{ "billed_charge": 805.00, "npi": [1194350546] } ] } ] }, { "tin": { "type": "ein", "value": "621647259" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 368.14, "providers": [{ "billed_charge": 1106.00, "npi": [1861473472] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 543.90, "providers": [{ "billed_charge": 3409.24, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 37.03, "providers": [{ "billed_charge": 149.45, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 424.20, "providers": [{ "billed_charge": 1344.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "581761689" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 146.76, "providers": [{ "billed_charge": 324.00, "npi": [1154178150] } ] }, { "allowed_amount": 134.86, "providers": [{ "billed_charge": 297.00, "npi": [1841984598] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 13.56, "providers": [{ "billed_charge": 46.08, "npi": [1234567893] } ] }, { "allowed_amount": 3408.44, "providers": [{ "billed_charge": 40186.52, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "472221436" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 145.65, "providers": [{ "billed_charge": 480.00, "npi": [1912167578] } ] }, { "allowed_amount": 48.55, "providers": [{ "billed_charge": 160.00, "npi": [1295969228] } ] } ] }, { "tin": { "type": "ein", "value": "271738064" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 367.80, "providers": [{ "billed_charge": 1080.00, "npi": [1851750582] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1072.26, "providers": [{ "billed_charge": 5520.00, "npi": [1225021678] } ] } ] } ] }, { "name": "COMPLETE CBC, AUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85027", "description": "BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELET COUNT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 17.24, "providers": [{ "billed_charge": 128.92, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 66.15, "providers": [{ "billed_charge": 266.25, "npi": [1962481820] } ] } ] } ] }, { "name": "AUTOMATED RETICULOCYTE COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85045", "description": "BLOOD COUNT; RETICULOCYTE, AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 43.89, "providers": [{ "billed_charge": 526.68, "npi": [1234567893] } ] } ] } ] }, { "name": "CCPD/COMPOSITE", "billing_code_type": "RC", "billing_code_type_version": "2022", "billing_code": "851", "description": "CCPD - OUTPT OR HOME - CCPD/COMPOSITE RATE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844408280" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 20467.74, "providers": [{ "billed_charge": 290847.00, "npi": [1023774429] } ] } ] }, { "tin": { "type": "ein", "value": "273219587" }, "service_code": ["12"], "billing_class": "institutional", "payments": [{ "allowed_amount": 4762.25, "providers": [{ "billed_charge": 154182.00, "npi": [1508175464] } ] } ] } ] }, { "name": "PROTHROMBIN TIME", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85610", "description": "PROTHROMBIN TIME;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "30417049" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.77, "providers": [{ "billed_charge": 75.00, "npi": [1336132679] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "81"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.01, "providers": [{ "billed_charge": 120.12, "npi": [1234567893] } ] }, { "allowed_amount": 72.60, "providers": [{ "billed_charge": 101.64, "npi": [1234567893] } ] } ] } ] }, { "name": "RBC SED RATE, NONAUTOMATED", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "85651", "description": "SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 45.75, "providers": [{ "billed_charge": 508.14, "npi": [1234567893] } ] } ] } ] }, { "name": "ALLERGEN SPECIFIC IGE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86003", "description": "ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE, CRUDE ALLERGEN EXTRACT, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "840611484" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1127.00, "providers": [{ "billed_charge": 10680.80, "npi": [1740262880] } ] } ] } ] }, { "name": "ANTINUCLEAR ANTIBODIES", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86038", "description": "ANTINUCLEAR ANTIBODIES (ANA);", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 137.34, "providers": [{ "billed_charge": 1535.44, "npi": [1234567893] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86140", "description": "C-REACTIVE PROTEIN;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 30.27, "providers": [{ "billed_charge": 359.52, "npi": [1234567893] } ] } ] } ] }, { "name": "C-REACTIVE PROTEIN, HS", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86141", "description": "C-REACTIVE PROTEIN; HIGH SENSITIVITY (HSCRP)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.65, "providers": [{ "billed_charge": 259.00, "npi": [1234567893] } ] } ] } ] }, { "name": "CCP ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86200", "description": "CYCLIC CITRULLINATED PEPTIDE (CCP), ANTIBODY", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 4.33, "providers": [{ "billed_charge": 51.80, "npi": [1234567893] } ] } ] } ] }, { "name": "DNA ANTIBODY NATIVE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86225", "description": "DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE STRANDED", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 142.29, "providers": [{ "billed_charge": 1703.76, "npi": [1234567893] } ] } ] } ] }, { "name": "T CELL, ABSOLUTE COUNT/RATIO", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86360", "description": "T CELLS; ABSOLUTE CD4 AND CD8 COUNT, INCLUDING RATIO", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 125.52, "providers": [{ "billed_charge": 1503.36, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROSOMAL ANTIBODY EACH", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86376", "description": "MICROSOMAL ANTIBODIES (EG, THYROID OR LIVER-KIDNEY), EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 128.76, "providers": [{ "billed_charge": 1345.89, "npi": [1234567893] } ] } ] } ] }, { "name": "RHEUMATOID FACTOR, QUANT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86431", "description": "RHEUMATOID FACTOR; QUANTITATIVE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 54.82, "providers": [{ "billed_charge": 657.72, "npi": [1234567893] } ] } ] } ] }, { "name": "TB TEST CELL IMMUN MEASURE", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86480", "description": "TUBERCULOSIS TEST, CELL MEDIATED IMMUNITY ANTIGEN RESPONSE MEASUREMENT; GAMMA INTERFERON", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 703.80, "providers": [{ "billed_charge": 13600.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TB INTRADERMAL TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86580", "description": "SKIN TEST; TUBERCULOSIS, INTRADERMAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["17"], "billing_class": "professional", "payments": [{ "allowed_amount": 241.49, "providers": [{ "billed_charge": 1302.00, "npi": [1234567893] } ] } ] } ] }, { "name": "SYPHILIS TEST NON-TREP QUAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86592", "description": "SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 491.79, "providers": [{ "billed_charge": 1985.75, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 314.60, "providers": [{ "billed_charge": 3757.60, "npi": [1234567893] } ] } ] } ] }, { "name": "BARTONELLA ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86611", "description": "ANTIBODY; BARTONELLA", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 3.40, "providers": [{ "billed_charge": 70.00, "npi": [1234567893] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 1 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86695", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 1", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 71.84, "providers": [{ "billed_charge": 289.60, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 224.91, "providers": [{ "billed_charge": 3025.92, "npi": [1234567893] } ] } ] } ] }, { "name": "HERPES SIMPLEX TYPE 2 TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86696", "description": "ANTIBODY; HERPES SIMPLEX, TYPE 2", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 223.89, "providers": [{ "billed_charge": 902.70, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 361.76, "providers": [{ "billed_charge": 4447.80, "npi": [1234567893] } ] } ] } ] }, { "name": "HEP B CORE ANTIBODY, TOTAL", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86704", "description": "HEPATITIS B CORE ANTIBODY (HBCAB); TOTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 56.28, "providers": [{ "billed_charge": 674.80, "npi": [1234567893] } ] } ] } ] }, { "name": "HEP B SURFACE ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86706", "description": "HEPATITIS B SURFACE ANTIBODY (HBSAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.39, "providers": [{ "billed_charge": 902.16, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS A ANTIBODY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86708", "description": "HEPATITIS A ANTIBODY (HAAB)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 53.82, "providers": [{ "billed_charge": 644.28, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS C AB TEST", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "86803", "description": "HEPATITIS C ANTIBODY;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1573.02, "providers": [{ "billed_charge": 6342.30, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 372.06, "providers": [{ "billed_charge": 4452.24, "npi": [1234567893] } ] } ] } ] }, { "name": "CULTURE AEROBIC IDENTIFY", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87077", "description": "CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTIFICATION, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.50, "providers": [{ "billed_charge": 66.60, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 91.80, "providers": [{ "billed_charge": 1098.88, "npi": [1234567893] } ] } ] } ] }, { "name": "URINE CULTURE/COLONY COUNT", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87086", "description": "CULTURE, BACTERIAL; QUANTITATIVE COLONY COUNT, URINE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 352.00, "providers": [{ "billed_charge": 1417.60, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 369.88, "providers": [{ "billed_charge": 3473.07, "npi": [1234567893] } ] } ] } ] }, { "name": "MICROBE SUSCEPTIBLE, DISK", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87184", "description": "SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; DISK METHOD, PER PLATE (12 OR FEWER AGENTS)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 40.00, "providers": [{ "billed_charge": 478.72, "npi": [1234567893] } ] } ] } ] }, { "name": "HEPATITIS B SURFACE AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87340", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HEPATITIS B SURFACE ANTIGEN (HBSAG); (E", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 920.93, "providers": [{ "billed_charge": 3713.85, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 227.70, "providers": [{ "billed_charge": 2727.12, "npi": [1234567893] } ] } ] } ] }, { "name": "HIV-1 AG W/HIV-1 & HIV-2 AB", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87389", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, HIV-1 ANTIGEN(S), W HIV-1 AND HIV-2 ANT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "751093698" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2786.30, "providers": [{ "billed_charge": 11237.00, "npi": [1962481820] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 1495.44, "providers": [{ "billed_charge": 17915.52, "npi": [1234567893] } ] } ] } ] }, { "name": "INFLUENZA A/B AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87400", "description": "INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY TECHNIQUE, INFLUENZA, A OR B, EACH; (EG, ENZYME IM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "300780743" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 46.83, "providers": [{ "billed_charge": 87.00, "npi": [1780092684] } ] } ] } ] }, { "name": "CORONAVIRUS AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87426", "description": "IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871253958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1007.19, "providers": [{ "billed_charge": 6042.00, "npi": [1366651507] } ] } ] }, { "tin": { "type": "ein", "value": "263792403" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.00, "providers": [{ "billed_charge": 200.00, "npi": [1164278362] } ] } ] } ] }, { "name": "SARSCOV & INF VIR A&B AG IA", "billing_code_type": "CPT", "billing_code_type_version": "2022", "billing_code": "87428", "description": 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"description": "TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2415.04, "providers": [{ "billed_charge": 6037.91, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "581409990" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1703.14, "providers": [{ "billed_charge": 2476.40, "npi": [1679287445] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 350.46, "providers": [{ "billed_charge": 1372.76, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1744.68, "providers": [{ "billed_charge": 4200.00, "npi": [1225115686] } 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"billing_class": "professional", "payments": [{ "allowed_amount": 3519.00, "providers": [{ "billed_charge": 5550.00, "npi": [1225115686] } ] } ] } ] }, { "name": "FCE MASK INTERFCE REPL FULL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7031", "description": "FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581409990" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 871.24, "providers": [{ "billed_charge": 871.24, "npi": [1679287445] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4755.64, "providers": [{ "billed_charge": 21322.16, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2299.32, "providers": [{ 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1621.80, "npi": [1225115686] } ] } ] } ] }, { "name": "TUBING USED W/POS ARWAY PRES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7037", "description": "TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1230.90, "providers": [{ "billed_charge": 4895.70, "npi": [1234567893] } ] } ] } ] }, { "name": "FLTR DISPBL W/POS ARWAY PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A7038", "description": "FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 791.78, "providers": [{ "billed_charge": 1978.65, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "581409990" }, 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[{ "allowed_amount": 476.96, "providers": [{ "billed_charge": 1191.96, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 241.64, "providers": [{ "billed_charge": 2036.06, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 351.77, "providers": [{ "billed_charge": 678.89, "npi": [1225115686] } ] } ] } ] }, { "name": "HOT WATER BOTTLE, ICE CAP OR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9273", "description": "HOT WATER BOTTLE, ICE CAP OR COLLAR, HEAT AND/OR COLD WRAP, ANY TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 240.00, "providers": [{ "billed_charge": 400.00, "npi": [1234567893] } ] } ] } ] }, { "name": "SENSOR; INVSV INTRSTL GLU MO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9276", "description": "SENSOR; INVASIVE (E.G., SUBCUTANEOUS), DISPOSABLE, FOR USE WITH INTERSTITIAL CONTINUOUS GLUCOSE MONI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 990.00, "providers": [{ "billed_charge": 2250.00, "npi": [1234567893] } ] } ] } ] }, { "name": "TC-99M SESTAMIBI DX PER STUD", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "A9500", "description": "TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "994689720" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5590.20, "providers": [{ "billed_charge": 18656.00, "npi": [1780772731] } ] } ] } ] }, { "name": "TC-99M TETROFOSMIN DX - 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"professional", "payments": [{ "allowed_amount": 3714.00, "providers": [{ "billed_charge": 6190.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PRTBLE GASEOUS O2 SYS RENTAL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0431", "description": "PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; INCLUDES PORTABLE CONTAINER, REGULATOR, FLOWMETER, HUMIDIFIE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1408.61, "providers": [{ "billed_charge": 1820.00, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 237.60, "providers": [{ "billed_charge": 1313.83, "npi": [1234567893] } ] } ] } ] }, { "name": "RESP ASST DEVC BI-LEVL PRSS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0470", "description": "RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE FEATURE, USED WITH NONI", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2384.06, "providers": [{ "billed_charge": 3900.00, "npi": [1184673030] } ] } ] } ] }, { "name": "HUMDIFIR HEAT USED W/POS ARW", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0562", "description": "HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7518.56, "providers": [{ "billed_charge": 12150.00, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "581409990" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 4422.89, "providers": [{ "billed_charge": 4422.89, "npi": [1679287445] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2839.64, "providers": [{ "billed_charge": 12601.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2435.03, "providers": [{ "billed_charge": 3146.00, "npi": [1225115686] } ] } ] } ] }, { "name": "CONTINUOUS POS AIRWAY PRESSU", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0601", "description": "CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 22254.40, "providers": [{ "billed_charge": 41280.00, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "581409990" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 6192.19, "providers": [{ "billed_charge": 7630.75, "npi": [1679287445] } ] } ] }, { "tin": { "type": "ein", "value": "593154523" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2821.17, "providers": [{ "billed_charge": 6270.00, "npi": [1558341289] } ] } ] }, { "tin": { "type": "ein", "value": "203301086" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7994.84, "providers": [{ "billed_charge": 11773.48, "npi": [1245215797] } ] } ] }, { "tin": { "type": "ein", "value": "810691481" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2067.85, "providers": [{ "billed_charge": 7300.00, "npi": [1487104774] } ] } ] }, { "tin": { "type": "ein", "value": "800002984" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 902.98, "providers": [{ "billed_charge": 1263.72, "npi": [1427097328] } ] }, { "allowed_amount": 208.38, "providers": [{ "billed_charge": 270.93, "npi": [1326359985] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1871.25, "providers": [{ "billed_charge": 25735.30, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "522439178" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3382.84, "providers": [{ "billed_charge": 4980.00, "npi": [1225115686] } ] } ] } ] }, { "name": "BREAST PUMP ELECTRIC ANY TYP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0603", "description": "BREAST PUMP, ELECTRIC (AC AND/OR DC), ANY TYPE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "464408166" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 450.18, "providers": [{ "billed_charge": 2400.00, "npi": [1003462581] } ] } ] } ] }, { "name": "OSTOGNS STIM NONINVASV SP AP", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E0748", "description": "OSTEOGENESIS STIMULATOR, ELECTRICAL, NONINVASIVE, SPINAL APPLICATIONS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 39571.70, "providers": [{ "billed_charge": 61184.50, "npi": [1234567893] } ] } ] } ] }, { "name": "O2 CONC 85%/>02 CONC PRSC FL", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1390", "description": "OXYGEN CONCENTRATOR, SINGLE DELIVERY PORT, CAPABLE OF DELIVERING 85 PERCENT OR GREATER OXYGEN CONCEN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 11699.40, "providers": [{ "billed_charge": 17250.00, "npi": [1184673030] } ] } ] }, { "tin": { "type": "ein", "value": "593154523" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 7960.15, "providers": [{ "billed_charge": 22550.00, "npi": [1558341289] } ] } ] }, { "tin": { "type": "ein", "value": "800002984" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 235.20, "providers": [{ "billed_charge": 305.76, "npi": [1427097328] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8352.00, "providers": [{ "billed_charge": 61952.56, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "581815731" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3175.20, "providers": [{ "billed_charge": 4050.00, "npi": [1174523765] } ] } ] } ] }, { "name": "PORTABLE OXYGEN CONCENTRATOR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E1392", "description": "PORTABLE OXYGEN CONCENTRATOR, RENTAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 561.33, "providers": [{ "billed_charge": 2930.00, "npi": [1234567893] } ] } ] } ] }, { "name": "NEG PRSS WND TX PUMP STATN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "E2402", "description": "NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, STATIONARY OR PORTABLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "742152396" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 2697.00, "providers": [{ "billed_charge": 6348.10, "npi": [1780671529] } ] } ] } ] }, { "name": "PRVS TST MATL&EQUIP HM INR M", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0249", "description": "PROVISION OF TEST MATERIALS AND EQUIPMENT FOR HOME INR MONITORING OF PATIENT WITH EITHER MECHANICAL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12", "49"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.60, "providers": [{ "billed_charge": 280.00, "npi": [1234567893] } ] } ] } ] }, { "name": "PHYS REV INTEPR HOME INR MON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0250", "description": "PHYSICIAN REVIEW, INTERPRETATION, AND PATIENT MANAGEMENT OF HOME INR TESTING FOR PATIENT WITH EITHER", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 12.64, "providers": [{ "billed_charge": 20.00, "npi": [1234567893] } ] } ] } ] }, { "name": "ANL WELLNESS VST PPS SUB VST", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0439", "description": "ANNUAL WELLNESS VISIT, INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), SUBSEQUENT VISIT", "allowed_amounts": [{ "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 760.98, "providers": [{ "billed_charge": 1800.00, "npi": [1770655987] } ] } ] } ] }, { "name": "ANL ALCHL MISUSE SCREN 15MIM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0442", "description": "ANNUAL ALCOHOL MISUSE SCREENING, 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 248.70, "providers": [{ "billed_charge": 520.00, "npi": [1093391997] } ] } ] } ] }, { "name": "ANL DEPRSSION SCREENG 15 MIN", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0444", "description": "ANNUAL DEPRESSION SCREENING, 15 MINUTES", "allowed_amounts": [{ "tin": { "type": "ein", "value": "844955447" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.40, "providers": [{ "billed_charge": 300.00, "npi": [1033497318] } ] } ] }, { "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 373.05, "providers": [{ "billed_charge": 780.00, "npi": [1093391997] } ] } ] } ] }, { "name": "COLL V BLD VP/URN SMP CATH I", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0471", "description": "COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE OR URINE SAMPLE BY CATHETERIZATION FROM AN INDIVIDUAL IN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "651108312" }, "service_code": ["32"], "billing_class": "professional", "payments": [{ "allowed_amount": 10.57, "providers": [{ "billed_charge": 10.57, "npi": [1831228709] } ] } ] }, { "tin": { "type": "ein", "value": "582328865" }, "service_code": ["31"], "billing_class": "professional", "payments": [{ "allowed_amount": 243.98, "providers": [{ "billed_charge": 440.00, "npi": [1760579825] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 1-7", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0480", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "471359076" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2074.19, "providers": [{ "billed_charge": 11900.72, "npi": [1134538713] } ] } ] }, { "tin": { "type": "ein", "value": "133757370" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 68.66, "providers": [{ "billed_charge": 151.20, "npi": [1538144910] } ] } ] }, { "tin": { "type": "ein", "value": "464450977" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 2231.52, "providers": [{ "billed_charge": 15104.76, "npi": [1184041949] } ] } ] } ] }, { "name": "DR TST DEFIN DR ID M P D 22/", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G0483", "description": "DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "261565558" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 329.88, "providers": [{ "billed_charge": 1996.00, "npi": [1497933162] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["81"], "billing_class": "professional", "payments": [{ "allowed_amount": 82.47, "providers": [{ "billed_charge": 499.00, "npi": [1234567893] } ] } ] } ] }, { "name": "MED ASST TX METHADONE;WEEKLY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2067", "description": "MEDICATION ASSISSTED TX METHADONE; WEEKLY BUNDLE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582341219" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 8985.24, "providers": [{ "billed_charge": 22137.00, "npi": [1760419899] } ] } ] }, { "tin": { "type": "ein", "value": "582341216" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 31675.43, "providers": [{ "billed_charge": 119439.00, "npi": [1225447188] } ] } ] } ] }, { "name": "TH SUP METHADONE;TO 7 ADD D", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2078", "description": "TAKE HOME SUP METHADONE; UP TO 7 ADD DAY SUP;", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582341219" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 758.34, "providers": [{ "billed_charge": 2063.10, "npi": [1760419899] } ] } ] }, { "tin": { "type": "ein", "value": "582341216" }, "service_code": ["58"], "billing_class": "professional", "payments": [{ "allowed_amount": 189.60, "providers": [{ "billed_charge": 635.00, "npi": [1225447188] } ] } ] } ] }, { "name": "VISIT CPLX INHERENT E&M ASSO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G2211", "description": "VISIT CPLX INHERENT E&M ASSOC WITH MED CARE SRVC", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208583725" }, "service_code": ["11", "02"], "billing_class": "professional", "payments": [{ "allowed_amount": 31.20, "providers": [{ "billed_charge": 72.00, "npi": [1578690467] } ] }, { "allowed_amount": 1872.00, "providers": [{ "billed_charge": 4320.00, "npi": [1578690467] } ] } ] }, { "tin": { "type": "ein", "value": "383899808" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 95.25, "providers": [{ "billed_charge": 311.80, "npi": [1306293592] } ] } ] }, { "tin": { "type": "ein", "value": "510461094" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 85.12, "providers": [{ "billed_charge": 150.00, "npi": [1194930222] } ] } ] }, { "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 723.84, "providers": [{ "billed_charge": 1516.00, "npi": [1093391997] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9744.70, "providers": [{ "billed_charge": 13935.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "581443753" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 75.00, "providers": [{ "billed_charge": 75.00, "npi": [1114421682] } ] } ] } ] }, { "name": "INTENS MOD TX DEL 1/MX FLDS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "G6015", "description": "INTENSITY MODULATED TREATMENT DELIVERY, SINGLE OR MULTIPLE FIELDS/ARCS, VIA NARROW SPATIALLY AND TEM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208030976" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1646.86, "providers": [{ "billed_charge": 5164.00, "npi": [1710961750] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC;AC DTOX RES", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0011", "description": "ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION PROGRAM INPATIENT)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "262961334" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 221.25, "providers": [{ "billed_charge": 885.00, "npi": [1871943886] } ] } ] } ] }, { "name": "ALCOHL&/RX SRVC; INTENSV OP;", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0015", "description": "ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENT (TREATMENT PROGRAM THAT OPERATES AT LEAST 3 HOURS", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871411317" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 5382.00, "providers": [{ "billed_charge": 13455.00, "npi": [1760671655] } ] } ] }, { "tin": { "type": "ein", "value": "560950370" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1725.00, "providers": [{ "billed_charge": 6900.00, "npi": [1699471094] } ] } ] } ] }, { "name": "BHVAL HLTH; SHRTTRM RES DIEM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0018", "description": "BEHAVIORAL HEALTH; SHORT-TERM RESIDENTIAL (NONHOSPITAL RESIDENTIAL TREATMENT PROGRAM), WITHOUT ROOM", "allowed_amounts": [{ "tin": { "type": "ein", "value": "237433368" }, "service_code": ["55"], "billing_class": "professional", "payments": [{ "allowed_amount": 1853.28, "providers": [{ "billed_charge": 3150.00, "npi": [1053431676] } ] } ] } ] }, { "name": "MENTAL HEALTH ASSESS NON-PHY", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0031", "description": "MENTAL HEALTH ASSESSMENT, BY NONPHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "582103386" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 780.26, "providers": [{ "billed_charge": 1014.00, "npi": [1629131214] } ] } ] }, { "tin": { "type": "ein", "value": "200690840" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 963.84, "providers": [{ "billed_charge": 1177.08, "npi": [1174891774] } ] } ] }, { "tin": { "type": "ein", "value": "581973324" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 9.22, "providers": [{ "billed_charge": 400.00, "npi": [1871283630] } ] } ] } ] }, { "name": "MENTL HLTH SVC PLAN DVLP NON", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "H0032", "description": "MENTAL HEALTH SERVICE PLAN DEVELOPMENT BY NONPHYSICIAN", "allowed_amounts": [{ "tin": { "type": "ein", "value": "200690840" }, "service_code": ["53"], "billing_class": "professional", "payments": [{ "allowed_amount": 282.44, "providers": [{ "billed_charge": 349.84, "npi": [1174891774] } ] } ] }, { "tin": { "type": "ein", "value": "581973324" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.08, "providers": [{ "billed_charge": 800.00, "npi": [1871283630] } ] } ] } ] }, { "name": "INJECTION, BELIMUMAB, 10 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0490", "description": "INJECTION, BELIMUMAB, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "208583725" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 13190.40, "providers": [{ "billed_charge": 38880.00, "npi": [1578690467] } ] } ] } ] }, { "name": "INJ CEFEPIME HYDRCHLRID500MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0692", "description": "INJECTION, CEFEPIME HCL, 500 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 147.84, "providers": [{ "billed_charge": 4237.80, "npi": [1346329620] } ] } ] } ] }, { "name": "INJ CEFTRIAXONE SODM PER 250", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0696", "description": "INJECTION, CEFTRIAXONE SODIUM, PER 250 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871253958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 108.16, "providers": [{ "billed_charge": 2850.00, "npi": [1366651507] } ] } ] }, { "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 182.51, "providers": [{ "billed_charge": 13009.52, "npi": [1346329620] } ] } ] }, { "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 105.17, "providers": [{ "billed_charge": 34880.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 20.14, "providers": [{ "billed_charge": 480.00, "npi": [1902942220] } ] } ] } ] }, { "name": "njection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J0872", "description": "njection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 227.50, "providers": [{ "billed_charge": 17595.30, "npi": [1346329620] } ] } ] } ] }, { "name": "Injection, methylprednisolone acetate, 1 mg", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1010", "description": "Injection, methylprednisolone acetate, 1 mg ", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 33.64, "providers": [{ "billed_charge": 240.00, "npi": [1093391997] } ] } ] }, { "tin": { "type": "ein", "value": "202595343" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.44, "providers": [{ "billed_charge": 735.00, "npi": [1225021678] } ] } ] } ] }, { "name": "INJ DEXMETH SODM PHOSHA 1MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1100", "description": "INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871253958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 119.90, "providers": [{ "billed_charge": 6110.00, "npi": [1366651507] } ] } ] }, { "tin": { "type": "ein", "value": "264810354" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.96, "providers": [{ "billed_charge": 96.00, "npi": [1194350546] } ] } ] }, { "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 29.49, "providers": [{ "billed_charge": 7525.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "581973570" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 0.92, "providers": [{ "billed_charge": 8.00, "npi": [1669016747] } ] } ] }, { "tin": { "type": "ein", "value": "30417049" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 1.76, "providers": [{ "billed_charge": 13.00, "npi": [1861977381] } ] }, { "allowed_amount": 7.50, "providers": [{ "billed_charge": 52.00, "npi": [1336870765] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 72.46, "providers": [{ "billed_charge": 994.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "581590562" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2.32, "providers": [{ "billed_charge": 768.00, "npi": [1093391997] } ] } ] }, { "tin": { "type": "ein", "value": "465736753" }, "service_code": ["20"], "billing_class": "professional", "payments": [{ "allowed_amount": 15.23, "providers": [{ "billed_charge": 2670.00, "npi": [1538132857] } ] }, { "allowed_amount": 9.74, "providers": [{ "billed_charge": 1680.00, "npi": [1255381950] } ] }, { "allowed_amount": 42.73, "providers": [{ "billed_charge": 7350.00, "npi": [1144887472] } ] }, { "allowed_amount": 16.92, "providers": [{ "billed_charge": 2850.00, "npi": [1346064177] } ] }, { "allowed_amount": 16.41, "providers": [{ "billed_charge": 2865.00, "npi": [1548016645] } ] }, { "allowed_amount": 30.93, "providers": [{ "billed_charge": 5115.00, "npi": [1053860361] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 34.98, "providers": [{ "billed_charge": 314.65, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ DIPHNHYDRMN HCL TO 50 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1200", "description": "INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 8.76, "providers": [{ "billed_charge": 84.00, "npi": [1346329620] } ] } ] } ] }, { "name": "INJ KETOROLAC TROMETHAMINE", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J1885", "description": "INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "871253958" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 172.30, "providers": [{ "billed_charge": 3912.50, "npi": [1366651507] } ] } ] }, { "tin": { "type": "ein", "value": "264810354" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.11, "providers": [{ "billed_charge": 16.00, "npi": [1194350546] } ] } ] }, { "tin": { "type": "ein", "value": "453455306" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 16.40, "providers": [{ "billed_charge": 4060.00, "npi": [1770655987] } ] } ] }, { "tin": { "type": "ein", "value": "582076411" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 22.75, "providers": [{ "billed_charge": 540.00, "npi": [1902942220] } ] } ] }, { "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11", "20"], "billing_class": "professional", "payments": [{ "allowed_amount": 102.30, "providers": [{ "billed_charge": 407.00, "npi": [1234567893] } ] }, { "allowed_amount": 3.06, "providers": [{ "billed_charge": 40.00, "npi": [1234567893] } ] } ] }, { "tin": { "type": "ein", "value": "453072990" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 7.00, "providers": [{ "billed_charge": 16.47, "npi": [1255562567] } ] } ] } ] }, { "name": "INJ MILRINONE LACTATE 5 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2260", "description": "INJECTION, MILRINONE LACTATE, 5 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 163.28, "providers": [{ "billed_charge": 6333.32, "npi": [1346329620] } ] } ] } ] }, { "name": "INJ ONDANSETRON HCL PER 1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2405", "description": "INJECTION, ONDANSETRON HCL, PER 1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 5.04, "providers": [{ "billed_charge": 61.64, "npi": [1346329620] } ] } ] } ] }, { "name": "INJ PIP SOD/TZ SOD 1 G/0.125", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2543", "description": "INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 G/0.125 G (1.125 G)", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 287.28, "providers": [{ "billed_charge": 3987.10, "npi": [1346329620] } ] } ] } ] }, { "name": "INJ PROMETHAZINE HCL UPTO 50", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2550", "description": "INJECTION, PROMETHAZINE HCL, UP TO 50 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 21.42, "providers": [{ "billed_charge": 126.00, "npi": [1346329620] } ] } ] } ] }, { "name": "INJECTION REGADENOSON 0.1 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J2785", "description": "INJECTION, REGADENOSON, 0.1 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 133.92, "providers": [{ "billed_charge": 4000.00, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ TRIAMCINOLON ACETONID NO", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3301", "description": "INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 200.33, "providers": [{ "billed_charge": 1007.88, "npi": [1234567893] } ] } ] } ] }, { "name": "INJ VANCOMYCIN HCL 500 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J3370", "description": "INJECTION, VANCOMYCIN HCL, 500 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "541823804" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 79.95, "providers": [{ "billed_charge": 1822.96, "npi": [1346329620] } ] } ] } ] }, { "name": "HYALURONAN/DERIV EUFLEXXA IA", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J7323", "description": "HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2899.05, "providers": [{ "billed_charge": 9080.40, "npi": [1234567893] } ] } ] } ] }, { "name": "INJECTION BEVACIZUMAB 10 MG", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "J9035", "description": "INJECTION, BEVACIZUMAB, 10 MG", "allowed_amounts": [{ "tin": { "type": "ein", "value": "581519372" }, "service_code": ["11"], "billing_class": "professional", "payments": [{ "allowed_amount": 2115.47, "providers": [{ "billed_charge": 8700.00, "npi": [1245765601] } ] } ] } ] }, { "name": "STANDARD WHEELCHAIR", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "K0001", "description": "STANDARD WHEELCHAIR", "allowed_amounts": [{ "tin": { "type": "ein", "value": "580566121" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1637.46, "providers": [{ "billed_charge": 1951.00, "npi": [1184673030] } ] } ] } ] }, { "name": "PORT GASEOUS O2 SYS RNTL;HOM", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "K0738", "description": "PORTABLE GASEOUS OXYGEN SYSTEM, RENTAL; HOME COMPRESSOR USED TO FILL PORTABLE OXYGEN CYLINDERS; INCL", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1831.20, "providers": [{ "billed_charge": 15993.60, "npi": [1234567893] } ] } ] } ] }, { "name": "KNEE ORTHOSIS ELASTIC W/JNTS", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "L1812", "description": "KNEE ORTHOSIS, ELASTIC WITH JOINTS, PREFABRICATED, OFF-THE-SHELF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 1618.89, "providers": [{ "billed_charge": 2502.57, "npi": [1234567893] } ] } ] } ] }, { "name": "prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "L1821", "description": "prefabricated, off-the-shelf knee orthosis (braces) with elastic, condylar pads, joints, and optional patellar control", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": ["12"], "billing_class": "professional", "payments": [{ "allowed_amount": 3229.71, "providers": [{ "billed_charge": 5280.00, "npi": [1234567893] } ] } ] } ] }, { "name": "KNEE ORTHOSIS, IMMOBILIZER", "billing_code_type": "HCPCS", "billing_code_type_version": "2022", "billing_code": "L1830", "description": "KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, OFF-THE-SHELF", "allowed_amounts": [{ "tin": { "type": "ein", "value": "999999999" }, "service_code": 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